Doenças que mudaram a história

Doenças têm o poder de alterar o andamento do processo histórico? A resposta é positiva para o autor deste livro, um médico infectologista. Uma vez por mês, oito médicos se reúnem para jantar e conversar. Além da profissão, eles compartilham a paixão pela História, em particular pelo estudo de doenças que influenciaram no desencadeamento e na evolução de acontecimentos históricos. O tema dos encontros: de que modo doenças como varíola, tifo, escorbuto, cólera alteraram o destino de povos e nações?

Herpes zoster ophthalmicus and varicella zoster virus vasculopathy.

Herpes zoster (HZ) corresponds to the reactivation of varicella zoster virus (VZV). Among adults, the ophthalmic division of the trigeminal nerve is one of the most common sites of involvement. Vasculopathy caused by HZ is associated with significant morbidity and mortality, affecting structures such as the brain, which can lead to stroke. In this review, we analyzed the epidemiological and clinical aspects of the vascular involvement of VZV, focusing on the peculiarities of its association with ocular HZ. A review of the available literature indicated that ocular involvement of HZ was a risk factor for vasculopathy after adjusting for age, sex, body mass index, smoking, indicators of metabolic syndrome, and vascular and heart diseases. Considering the severity of this complication, vascular disease mediated by VZV requires early diagnosis and aggressive treatment. Finally, the anti-HZ vaccine has been recommended as a prophylactic measure in the elderly, but it should be used with caution in immunocompromised individuals.

Herpes zoster ophthalmicus and varicella zoster virus vasculopathy / Herpes zoster ophthalmicus e vasculopatia por vírus varicella zoster

ABSTRACT Herpes zoster (HZ) corresponds to the reactivation of varicella zoster virus (VZV). Among adults, the ophthalmic division of the trigeminal nerve is one of the most common sites of involvement. Vasculopathy caused by HZ is associated with significant morbidity and mortality, affecting structures such as the brain, which can lead to stroke. In this review, we analyzed the epidemiological and clinical aspects of the vascular involvement of VZV, focusing on the peculiarities of its association with ocular HZ. A review of the available literature indicated that ocular involvement of HZ was a risk factor for vasculopathy after adjusting for age, sex, body mass index, smoking, indicators of metabolic syndrome, and vascular and heart diseases. Considering the severity of this complication, vascular disease mediated by VZV requires early diagnosis and aggressive treatment. Finally, the anti-HZ vaccine has been recommended as a prophylactic measure in the elderly, but it should be used with caution in immunocompromised individuals.

RESUMO Herpes zoster (HZ) corresponde à reativação do vírus varicela zoster (VVZ) e, entre os adultos, o envolvimento da divisão oftálmica do nervo trigêmeo é um dos locais mais comuns A vasculopatia associada ao HZ é uma complicação dotada de grande morbimortalidade e afeta diferentes estruturas, favorecendo, inclusive o acidente vascular cerebral. Nesta revisão analisamos aspectos epidemiológicos e clínicos da vasculopatia mediada pelo VZV, bem como as peculiaridades relacionadas com o HZ ocular. De acordo com dados disponíveis na literatura, o acometimento ocular pelo HZ mostrou ser um fator de risco para vasculopatia após se ajustar para idade, sexo, índice de massa corporal, tabagismo, indicadores da síndrome metabólica, doença vascular e cardiopatias. Em face da gravidade dessa complicação, a doença vascular mediada pelo VZV requer diagnóstico precoce e tratamento agressivo. A vacina anti-HZ tem sido recomendada profilaticamente em idosos, mas deve ser usada com cautela em indivíduos imunocomprometidos.

Varíola, sua prevenção vacinal e ameaça como agente de bioterrorismo / Smallpox, vaccine prevention and the bioterrorism threat

Com a ameaça internacional do bioterrorismo, a varíola voltou a ganhar destaque mundial. Os autores revisam aspectos da varíola e trazem consideraçöes atuais da utilizaçäo do agente como arma biológica. Também apresentam dados dos esforços atuais na produçäo e desenvolvimento de vacinas contra a doença

[Smallpox, vaccine prevention and the bioterrorism threat]. / Varíola, sua prevenção vacinal e ameaça como agente de bioterrorismo.

With the international threat of bioterrorism, smallpox is again a matter of intense debate. The authors review this disease and raise considerations on the exploitation of the etiologic agent as a biological weapon. Also bring to discussion the available efforts to produce and develop vaccines against the disease.

Apreciaçäo sobre prova rápida imunocromatográfica para diagnóstico da infecçäo pelo vírus da imunodeficiência humana (HIV) / Appreciation on a rapid immunochromatographic test for human immunodeficiency virus (HIV) infection

Usando sangue e soro efetuamos prova imunocromatográfica qualificada como rápida para diagnosticar a infecçäo causada pelo vírus da imunodeficiência humana (HIV). Näo encontramos resultados falso-positivos, mas ocorreram 1,7 por cento e 5 por cento de falso-negativos quando empregamos sangue ou soro, respectivamente, de pessoas sem dúvida infectadas pelo HIV. Com esta análise procuramos cooperar no sentido de que testes de tal natureza, singelos e prontamente executáveis, fiquem suficientemente avaliados.

Manegement of opportunistic infections in HIV + patients: contrasts between Europe and South America

The author discuses the management of some opportunistic diseases more commonly observed in South American AIDS patients than in European ones. Characteristics of coinfection with HIV and leprosy, paracoccidioidomycosis, Chagas's disease, mucocutaneous leishmaniasis, malaria, disseminated BCG and strongyloidiasis are reviewed, with special emphasis on preferred therapeutic schedules for these conditions.

Disseminated Strongyloides stercoralis infection in an AIDS patient: The role of suppressive therapy

Patients with AIDS are prome to develop infections caused by opportunistic pathogens. Unusual agents, such as Stongyloides stercoralis, are being described in this syndrome, resulting in disseminated disease which is always severe and, in some cases, fatal. We describe a case of patient with AIDS and Strongyloides stercoralis infection involving the gastrointestinal tract and lungs. Therapy with thiabendazole for ten days led to resolution of the acute episode. Preventive therapy with 3g of thiabendazole once a week was then prescribed, and repeated fecal examinations were negative for larvae. Following discontinuation of treatment, however, the patient again had a positive fecal examination for Strongyloides stercoralis larvae, even though reinfection was considered to be very unlikely. The patient was retreated with a shorter course of therapy and once per week preventive therapy was reintroduced. After four months of follow-up, repeated fecal examinations were negative. When the treatment was changed to thiabendazole given once every two weeks, however, pulmonary Strongyloides stercoralis recurred. Subsequently, because of intolerance to thiabendazole, the patient was treated with cambendazole. The patient died three months later due to Pseudomonas aeruginosa pneumonia. Prolonged therapy for Strongyloides stercoralis infection may be necessary. Although further evaluation is needed, 3g of thiabendazole once a week may be adequate for this purpose. Cambendazole may be a useful alternative for disseminated Strongyloides stercoralis.

Tuberculose mamária: relato de caso e revisäo de literatura / Tuberculosis of the breast: case report and literature review

Os autores apresentam um caso de tuberculose mamária em homem adulto como primeira manifestaçäo clinica da Sindrome da Imunodeficiencia Adquirida (SIDA). A doença surgiu quando as contagens de CD4 ainda apresentavam queda moderada (475 celulas/mm 3), e näo foi acompanhada por evidências de tuberculose em qualquer outro local do organismo. Revendo a literatura médica chama a atençäo a raridade do acometimento tuberculoso isolado da glandula mamária, em especial no sexo masculino, näo havendo aumento no numero de casos relatados desta localizaçäo mesmo em pacientes com SIDA

Tratamento da criptosporidíase em pacientes com AIDS, por meio da paromomicina / Treatment of cryptosporidiasis with paramomycin in AIDS patients

The authors treated with paromomycin 25 patients, with AIDS and cryptosporidiosis. The drug was given orally in a doses of 500 mg qid, for a period of 14 days. Tolerance was good, with just two cases of mild side-effects. Clinical improvement was obtained in 19 (76 per cent) patients. Parasitological cure, however, occurred only in a low percentage (25 per cent). In some cases where initial success was observed, recrudescence occurred after some weeks or few months, but with retreatment again clinical improvement was obtained. Even if it does not lead to frequent parasite eradication, the good clinical results and tolerance permit us to consider paromomycin one of the few drugs effective for the treatment of cryptosporidial diarrhea in AIDS patients. Studies with maintainance therapy are indicated.