Re-evaluation of antibiotic and mercury resistance in Escherichia coli populations isolated in 1978 from Amazonian rubber tree tappers and Indians.

A study was carried out to assess the stability of antimicrobial susceptibility of wild isolates upon long-term storage using fifty-three Escherichia coli strains isolated in 1978 from feces of healthy children from the Amazon region in Brazil, exposed to low levels of antimicrobial agents, and examined for resistance to mercury and four antibiotics. All of the strains were kept in Lignières medium at room temperature and were transferred to fresh media four times during this period. Thirty-five out of the 53 strains analyzed in 1978 were viable. Upon recovery, antibiotic and mercury resistance was estimated. All of the 35 strains maintained their original phenotype in a stable fashion, except for one multiresistant strain which became susceptible to kanamycin. Fifty-four percent of the strains exhibited a resistance phenotype, among which 47% had conjugative plasmids.

Listerial meningoencephalitis: AIDS and non AIDS patients

A total of 11 patients with listeriosis wereadmited to the Hospital Emilio Ribas - Säo Paulo, Brasil. The etiology Listeria monocytogenes in 2 Aids and Listeria spp in underlying conditions was established in the other patients. The age ranged from 20 to 60 years old and white: black; male:famele ratio was 3:1 for all them. Acute meningoencephalitis in 11; renal failure in 2; acute respiratory failure, septicemia and AIDS with drug multiform exantema, respectively in 1 were observed. Leukocytosis > 500 cells/mm elevado ao cubo; glucose < 45 mg/dl; protein > 90 mg/dl and Gram-positive rod strains with positive culture to Listeria spp were revealed in the cerebrospinal fluid study. These strains were resistant to betalactamin; colistin; streptomycin and amikacin and sensitive to kanamicin; gentamicin; tetracicline; erytromicin and chloramphenicol. Monotherapy (ampicillin) or associate (ampicillin/chloramphenicol) had not influence on death or improvement during the follow-up of patients. Listeral meningoencephalitis is similar to tuberculosis or other bacterial meningitis include in cerebrospinal fluid chemistries data

Immunodiffusion exo-antigen and elisa serologies evaluation in twenty paracoccidioidomycosis (PBM) patients

Serological evaluation was performed in 20 active chronic pulmonary PBM patients males with age ranging from 20 to 60 years. Farmaer workers, heavy smokers, alcoholic and long duration of disease (5 to 25 years) were observed in these patients. Tegumentary lesions were found in 18 of them, cough in 18, dyspnea in 17, COPD in 6 and hoarseness in 2. The initial mild bilateral interstitial fibromodular infiltrate (15 por cento); moderate (40 por cento) and severe (45 por cento) canged to mild (15 por cento), moderate (20 por cento) and severe (65 por cento) during the follow-up of the lung X-ray study. Immunodiffusion (ID) exo-antigen in 3 patients and positive Elisa polyclonal (polyglobulins) 1/800 reactions in 2 were related to mild or without lesions, mean while ID > 1/4 and Elisa (1/1600 to 1/52000) seric levels were associated with maintenance or worsening of the pulmonary lesion types

[The cerebrospinal fluid in bacterial meningitis]. / Aspectos dos líquidos cefalorraquidianos nas meningites bacterianas.

Samples of 1815 cerebrospinal fluid (CSF) were studied in a meningitis outbreak during 1989 in São Paulo, Brazil. Neisseria meningitis 56% with 44% type B, Haemophilus influenzae 17%, from which 72% in children (days to 3-year-old) and Streptococcus pneumoniae 14% from which 60% in children (day to 1-year-old) of 443 (24%) of all strains. Cytochemistry study showed: purulent or turbidity aspects in 70 to 79% positive bacterioscopy or culture of CSF; white cells count > 500/mm3; glucose < 45 mg/dl; protein > 90 mg/dl in 90% of all patients. We concluded that: CSF prognostic factors: (aspect and cytochemistry) were correlated with bacterial meningitis. Bacterioscopy and positive cultures were correlated to NM, SP and HI isolation from these patients (Goodman Test).

[A retrospective therapeutic study of neurocryptococcosis in 112 AIDS and non-AIDS patients]. / Estudo retrospectivo terapêutico da neurocriptococose em 112 aidéticos ou não.

UNLABELLED: A total of 112 AIDS and no AIDS cryptococcosis patients admitted at Emílio Ribas Hospital--São Paulo, Brazil, were treated with amphotericin B (AMB) or amphotericin B and 5 fluorocytosine (5FC). Age, race, predisposing and epidemiological factors, respiratory symptoms were evaluated. Goodman tests applied in three patients groups (I, II and III) with associate or unique therapy revealed: 1. prognostic factors: leukocytes ang glucose showed similar response in groups I, II and III and protein spinal fluid after 1.5g/AMB; 2. India ink tests and Cryptococcus culture were often positive until 1.0g/AMB; 3. significant hypokalemia during monotherapy. Hypo and hyperkalemia had similar data in associate therapy; 4. significant difference in adverse reactions often appeared above 0.7g AMB/250g 5FC; 5. early and late death were common in group III (unique) and group I (no AIDS) and III (2.5 to 4.0g) respectively; 6. similar remission and deaths were verified in AIDS/cryptococcosis. CONCLUSIONS: adverse reactions were observed above 0.75g/AMB plus 250g 5FC. Association was important in initial therapy and AMB maintenance permitted late relapses.

Candidíase em pacientes aidéticos / Candidiasis in AIDS patients

Trinta e cinco aidéticos entre 19 e 55 anos admitidos e tratados de candidíase no Hospital Emílio Ribas, SP, com ELISA positivo para HIV e confirmado pelo Western Blot. Tuberculose em 9 sendo 2 com pericardite; neurotoxoplasmose em 6; neurocriptococose em 5; herpes labial em 4; pneumocistose em 3 e sarcoma de kaposi em 2, achavam-se associadas. A concentraçäo inibitória mínima 50 por cento (MIC 50 por cento) para os azoles foi: ketoconazol = 2,2 µg/ml; itraconazol = 21,0 µg/ml; fluconazol = 19,0 ég/ml. O MIC 50 por cento para os polienos: nistatina = 50,0 µg/ml; anfotericina B = 0,12 µg/ml e para 5 fluorcitosina = 1,6 µg/ml nas 35 amostras de Candida isoladas. Testes näo paramétricos de Siegel revelaram significante identificaçäo (80 por cento) das Candida albicans na candidíase, e que a dose de AMB näo modificou o número de óbitos, precoce e tardio, ocorridos nesses aidéticos. O uso prévio de azoles e da nistatina explicaria, talves, o elevado MIC 50 por cento observado nas amostras de Candida isoladas

[Candidiasis in AIDS patients]. / Candidíase em pacientes aidéticos.

UNLABELLED: A total of 35 in patients admitted at Emilio Ribas Hospital--São Paulo, Brazil, with digestive candidiasis and AIDS clinical diagnostic were evaluated 10 month later, being 29 male and 6 female; white outnumbering black with age ranged from 30 to 50 years old. Agar Sabouraud culture and tube germinative tests identified 28 (80%) Candida albicans out 35 strains. Minimum inhibitory concentration (MIC) 50% was against azoles (ketoconazole = 2.2 micrograms/ml; itraconazole = 21.0 micrograms/ml and fluconazole = 19.0 micrograms/ml); polyenes (nystatin = 50.0 micrograms/ml and amphotericin B = 0.12 micrograms/ml) and 5 fluorocytosine = 1.6 micrograms/ml. Siegel tests showed significant Candida albicans proportions in strains isolated from 35 AIDS patients. There was no significant relation between AMB doses and early or late death. CONCLUSIONS: candidiasis in AIDS patients showed high MIC 50% to azoles and nystatin and significant Candida albicans proportion in all strains isolated from AIDS patients. Previous amphotericin B therapy had no influence in early or late death in 30 patients. Previous therapy possibly explained MIC 50% increases in Candida strains.

[Pulmonary lymph node in acute juvenile paracoccidioidomycosis (a case report)]. / Linfonodo pulmonar na paracoccidioidomicose aguda infantil (relato de um caso).

The primary complex like Ghon was observed in a child's clinical roentgenographic study. C.S., white, male, 6 years old, was born in Curitiba (PR), Brazil and living in Guaratingueta (SP), Brazil, developed "common cold", bimodal diary fever, chills, shake and sweats. Dyspnea, cough with general lymphadenopathy. Foot and right shoulder arthralgias. Six months ago visited a cave, equitation practice, dog and cat contacts and no transfusion, frontal sweats, fever (38.4 degrees C). T.A. was 8/6, tachycardia in generalized lymphadenopathy. Cardiopulmonary system was normal, mesogastric tumoral mass, hepatosplenomegaly and no ascites. Bone marrow with eosinophilia; nodule demonstrated presence of P. brasiliensis, hypoalbuminemia; hyperglobulinemia; anemia; leukocytosis with eosinophilia. Immunodiffusion with exoantigen 43 kd of P. brasiliensis was 1/32. Primary complex like Ghon was observed in interstitial pneumonia followed by mediastinal and mesogastric mass (35 to 40 days). Clavicular osteolytic lesions (45 to 60 days) appeared during paracoccidioidomycosis therapy. Recovery was observed 2 months after treatment of acute infantile paracoccidioidomycosis.

Paracoccidioidomicose: estudo radiologico e pulmonar de 58 casos / Paracoccidioidomycosis: radiologic and pulmonary study of 58 cases

Provas funcionais respiratorias foram realizadas em 58 pacientes com Paracoccidioidomicose (Pbmicose) pulmonar uni e multifocal em 52; tumoral em 5 e genital feminino interno em 01. A idade oscilou de 20 a 74 anos e a duracao da doenca variou de 3 a 25 anos. Manifestacoes respiratorias, tegumentares e linfaticas foram predominantes. Catorze deles desenvolveram Cor pulmonale, funcao renal alterada em 19, modificacoes eletrocardiograficas em 8 e atividade hiporeatora adrenal em 13 dos 20 casos estudados. A analise radiologica revelou lesoes designadas: leve em 16; moderada em 24 e grave em 18 que a evolucao evidenciaram: manutencao e piora, respectivamente, em 35 e em 23 deles. As provas funcionais respiratorias mostraram: espirografia normal em 17; obstrutivo em 32 e misto em 9 doentes. O espaco morto foi superior a 35 por cento em 25 e a ventilacao alveolar minuto estava elevada em 54. A diferenca alveolo-arterial de Oxigenio estava aumentada em todos. A analise estatistica revelou associacao significativa entre radiologia: evolucao radiologica e a funcao pulmonar. A Pbmicose em doentes tabagistas inveterados conduziu ao enfisema, enquanto que as modificacoes alveolo-arteriais anoxemicas propiciaram a disseminacao da Doenca de Lutz.

[Paracoccidioidomycosis: radiologic and pulmonary study in 58 cases]. / Paracoccidioidomicose: estudo radiológico e pulmonar de 58 casos.

Spirometric and haemogasimetric tests were performed in 52 patients with unifocal and multifocal progressive Paracoccidioidomycosis pulmonary diseases, in 5 patients with juvenile and 1 female internal genital forms. The age ranged from 20 to 74 years old and the duration of disease from 3 to 25 years. Dyspnea, cough, tegumentary and lymphatic manifestations were the most predominant signs observed. Fourteen of them was developed Cor pulmonale. Impaired renal function was recorded in 19 patients, cardiac symptoms were described in 7 and hyporeactor adrenal activity was showed in 13 patients. Radiological studies demonstrated mild in 16, moderate in 24 and severe pulmonary lesions types in 18 patients. The pulmonary function revealed: normal spyrographic findings in 17, pure obstructive type in 32 and mixed form in 9 of them. Hyperventilation was described in 54 individuals and all of them showed an increasing of the alveolo-arterial difference. PaO2 less than 80 mm/Hg observed in 36 of them. Statistical analysis demonstrated significative association between clinical evolution and radiological interpretation. Similar data were obtained in radiology evaluations, clinical evolutive studies and pulmonary functions described in these patients. The granulomatous reaction due to Paracoccidioidomycosis, in heavy smokers patients, gave origin to the alterations in small airways predisposing the interalveolar dissemination an impaired alveolo-arterial diffusion.

Serological evaluation in follow up of the paracoccidioidomycasis patients

Compararam-se (4) quatro diferentes reaçöes de sorodiagnóstico evolutivo da Paracoccidioidomicose (Pbmicose). Foram utilizados a I.D. (Imunodifusäo), CIE (Contraimunoeletroforese), Fixaçäo do Complemento (F.C.) e a Enzima Magnética ligada por imuno absorçäo (Melisa), na avaliaçäo clínica semestral de 2 formas juvenil e de 18 formas pulmonares progressivas da Pbmicose. O padräo leve, moderado e grave foi assinalado, respectivamente, em 2, 6 e 10 doentes, que mostraram na evoluçäo: melhora em 2, piora em 6 e manutençäo em 10 das lesöes radiológicas avaliadas. A sorologia semestral aplicada na avaliaçäo de 20 doentes com Pbmicose revelou que: as reaçöes CIE e FC positivas foram mais relacionadas com a manutençäo, enquanto que as de I.D. e Melisa negativas estiveram diretamente relacionadas com a remissäo clínica na Paracoccidioidomicose. Além disso, a reaçäo de Melisa utilizada semestralmente nos doentes, mostrou que a remissäo e a recaída corresponderam, respectivament, a títulos inferiores ou iguis a 1.90 e superiores ou iguais a 2.00 densidade ópticas

Funçäo pulmonar na evoluçäo de 35 doentes com paracoccidioidomicose / Pulmonary function in the course of 35 patients with paracoccidioidomycosis

Lesöes pulmonares observadas na paracoccidioidomicose (pbmicose) pela radiologia foram designadas: leve, moderada e grave de acordo com critério estabelecido pelos autores. Lesöes infiltrativas intersticiais bilaterais núdulo fibrolineares e cotonosas foram identificadas respectivamente em 34 e em 23 doentes. Formas leve, moderada e grave assinaladas respectivamente em 6, 10 e 19 mostraram à análise radiológica evolutiva melhora em 2, piora em 15 e manutençäo do padräo da lesäo em 18 doentes. Testes de funçäo pulmonar realizados nos doentes durante o retorno ambulatorial evidenciaram: 12 com padräo espirográfico normal, 20 obstrutivos e 3 mistos; 34 doentes estavam hiperventilando e todos apresentaram aumento da diferença alveólo arterial. Os resultados obtidos permitiram supor que a fibrose residual descrita nos padröes radiológicos; manutençäo e piora de 33 deles aliada à doença obstrutiva crônica verificada pelas provas de funçäo pulmonar constituíram subsídios para o desenvolvimento do Cor pulmonale assinalado

Paracoccidioidomicose pulmonar agressiva, endotraqueíte estenosante e cor-pulmonale subagudo: descriçäo de um caso / Aggressive pulmonary paracoccidioidomycosis, stenosing endotracheitis and cor pulmonale: report of a case

A paracoccidioidomicose (Pbmicose) atinge os pulmöes pela via inalatória, onde se estabelece o complexo primário semelhante ao da tuberculose. A traquéia comprometida pela via tubohemolinfática desenvolveria reaçäo inflamatória em processo granulomatoso levando à obstruçäo estenosante com asfixia. Acompanhou-se um doente, masculino, 32 anos, branco, natural de Sarutaiá (SP), lavrador, que há 8 meses desenvolveu tosse expectorativa branco-amarelada, diária, sem fatores de melhora ou piora e dispnéia inicial discreta. Há 4 meses, anorexia, fraqueza e astenia. Há 1 mês a dispneia se agravou. Perdeu 15 kg. Tabagista e etilista há 16 anos. Exame físico revelou: PA - 10/7 mmHg, FR = 28 bpm, peso 31 kg, hipocratismo digital e hipotrofia muscular Tórax enfisematoso e síndrome obstrutivo aos testes de funçäo pulmonar. Coraçäo: P2 desdobrada e hiperfonética. Hepatesplenomegalia. Desenvolveu cor-pulmonale e insuficiência adrenal à internaçäo, evoluindo após 45 dias para óbito em insuficiência respiratória aguda asfixiante, apesar da terapia antifúngica ter sido completa. A literatura médica revista näo mostrou registro de caso semelhante de cor-pulmonale e insuficiência adrenal de evoluçäo subaguda

Paracoccidioidomicose genital feminina: descriçäo de um caso clínico / Female genital paracoccidioidomycosis: report of a clinical case

A paracoccidioidomicose é doença sistêmica que atinge mais o sexo masculino do que o feminino. Modelos experimentais mostram maior sensibilidade dos machos do que as fêmeas à disseminaçäo da doença. A literatura médica é rica em relatos de casos de Pbmicose do trato genital masculino. A raridade da Pbmicose sistêmica na mulher à açäo hormoral tornou inusitada a descriçäo de um caso com envolvimento genital. Paciente de 57 anos, branca, procedente de Conchas (SP), queixando-se de dor abnominal há 10 anos, difusa, seguida de cólica periumbelical periódica, com diarréia e obstipaçäo alternadas. Piorou desse quadro e evoluiu para abdomem agudo cirúrgico. O anátomo patológico revelou Pbmicose no epiplon e ovário direito. A biópsia do endométrio mostrou endometrite crônica granulomatosa. A radiologia e a planigrafia revelaram nódulo parahilar direito. Os achados clínicos e laboratoriais permitiram explicar a provável origem do envolvimento genital