Desafios no diagnóstico e manejo da neuroparacoccidioidomicose associada à tuberculose pulmonar / Challenges in the diagnosis and management of neuroparacoccidioidomycosis associated with pulmonary tuberculosis

A paracoccidioidomicose é uma das micoses sistêmicas mais relevantes da América Latina, principalmente no Brasil, onde há a maior prevalência. O acometimento do sistema nervoso central é uma complicação grave da doença e requer identificação e tratamento precoce, a fim de que se obtenha a cura clínica efetiva. Os tratamentos atuais são prolongados, com considerável toxicidade e, somados à gravidade dos casos, resultam em elevadas taxas de morbiletalidade. O presente relato refere-se a um paciente sem imunodepressão prévia conhecida com acometimento do sistema nervoso central pelo fungo Paracoccidioides spp. associado à tuberculose com acometimento exclusivamente pulmonar. Embora inicialmente equivocado, o diagnóstico se deu por meio de comprovação anatomopatológica e o tratamento inicial foi instituído com dose de ataque de anfotericina B lipossomal, seguida de consolidação com fluconazol em alta dose, com boa evolução clínica.

First case report of monkeypox in Brazil: clinical manifestations and differential diagnosis with sexually transmitted infections.

In 2022, an outbreak of monkeypox is being reported in non-endemic areas, with unusual clinical manifestations. The detailed clinical description of the first patient that received the diagnosis of monkeypox in Brazil is reported here, whose clinical manifestations can easily lead to misdiagnosis of sexually transmitted infections. A 41 years old male presented to an emergency room with a vesicular rash with eight days of evolution. He had traveled to Portugal and Spain and reported non-penetrative sexual involvement with three different male individuals. On the third day of symptoms, he sought medical care and received empirical treatment directed to sexually transmitted infections. As the symptoms did not improve, he sought medical attention at an infectious disease referral center presenting, on admission, an ulcerated penile lesion with central necrotic crusts, a disseminated pleomorphic skin rash and an oropharyngeal ulcer. The monkeypox diagnosis was suspected due to the characteristics of the lesions and the history of intimate contact with casual partners, and it was later confirmed by sequencing the almost complete monkeypox genome. The patient was hospitalized for pain control, which required opiate administration. He developed a secondary bacterial infection on the penile lesions, which were treated with oral antibiotics. He was discharged after 14 days, with lesions in process of re-epithelialization. Given the current outbreak, we must consider the possibility of monkeypox in patients with suggestive lesions, anywhere on the body (including the genitals), added to an epidemiological link or history of intimate contact with strangers or casual partners.

Shotgun metagenomic sequencing of the first case of monkeypox virus in Brazil, 2022.

Monkeypox virus (MPXV), a zoonotic virus endemic to the African continent, has been reported in 33 non-endemic countries since May 2022. We report an almost complete genome of the first confirmed case of MPXV in Brazil. Shotgun metagenomic sequencing was completed in 18 hours, from DNA extraction to consensus sequence generation.

Post COVID-19 Disseminated Mucormycosis in a 55-year-old patient in Western Amazon: Case report

A feared fungal disease surprised and became a warning to severe cases of COVID-19, especially to health professionals involved with the pandemic. Designated as black fungus for public health services in India, where reported data reflects an increase of more than eighty times the expected increase for Rhizopus among the communities. The disease has become even more worrisome due to the high mortality already established as an opportunistic infection, coupled with the reserved prognosis for all those infected and hospitalised by the SARS-CoV-2 severity criteria. This patient, who was submitted to corticosteroid therapy, in an excessive dose, therefore immunosuppressive, developed a severe, disseminated clinical form. It was verified the progression of the lesions and thus the high risk of trans- surgical lethality, or, also, by the insufficiency of conduct in removing the lesions to their satisfaction. Thus, the therapeutic option is the associated use of micafungin, liposomal amphotericin B and isavuconazole for the regressive phase. The patient remains hospitalised with progressive and discrete improvement. Until the opportunity of reevaluation of the surgery by the interspecialty collaboration.

Uma temida doença fúngica surpreendeu e se tornou um alerta para casos graves de COVID-19, principalmente aos profissionais de saúde envolvidos com a pandemia. Designado como fungo preto para serviços de saúde pública na Índia, onde os dados relatados refletem um aumento de mais de oitenta vezes o aumento esperado para Rhizopus entre as comunidades. A doença tornou-se ainda mais preocupante devido à alta mortalidade já estabelecida como infecção oportunista, aliada ao prognóstico reservado para todos os infectados e internados pelos critérios de gravidade do SARS-CoV-2. Esse paciente, que foi submetido à corticoterapia, em dose excessiva, portanto imunossupressora, desenvolveu uma forma clínica grave e disseminada. Verificou-se a progressão das lesões e, portanto, o alto risco de letalidade transcirúrgica, ou, ainda, pela insuficiência de conduta na remoção das lesões a contento. Assim, a opção terapêutica é o uso associado de micafungina, anfotericina B lipossomal e isavuconazol para a fase regressiva. O paciente permanece internado com melhora progressiva e discreta. Até a oportunidade de reavaliação da cirurgia pela colaboração interespecialista.

Shotgun metagenomic sequencing of the first case of monkeypox virus in Brazil, 2022

ABSTRACT Monkeypox virus (MPXV), a zoonotic virus endemic to the African continent, has been reported in 33 non-endemic countries since May 2022. We report an almost complete genome of the first confirmed case of MPXV in Brazil. Shotgun metagenomic sequencing was completed in 18 hours, from DNA extraction to consensus sequence generation.

First case report of monkeypox in Brazil: clinical manifestations and differential diagnosis with sexually transmitted infections

ABSTRACT In 2022, an outbreak of monkeypox is being reported in non-endemic areas, with unusual clinical manifestations. The detailed clinical description of the first patient that received the diagnosis of monkeypox in Brazil is reported here, whose clinical manifestations can easily lead to misdiagnosis of sexually transmitted infections. A 41 years old male presented to an emergency room with a vesicular rash with eight days of evolution. He had traveled to Portugal and Spain and reported non-penetrative sexual involvement with three different male individuals. On the third day of symptoms, he sought medical care and received empirical treatment directed to sexually transmitted infections. As the symptoms did not improve, he sought medical attention at an infectious disease referral center presenting, on admission, an ulcerated penile lesion with central necrotic crusts, a disseminated pleomorphic skin rash and an oropharyngeal ulcer. The monkeypox diagnosis was suspected due to the characteristics of the lesions and the history of intimate contact with casual partners, and it was later confirmed by sequencing the almost complete monkeypox genome. The patient was hospitalized for pain control, which required opiate administration. He developed a secondary bacterial infection on the penile lesions, which were treated with oral antibiotics. He was discharged after 14 days, with lesions in process of re-epithelialization. Given the current outbreak, we must consider the possibility of monkeypox in patients with suggestive lesions, anywhere on the body (including the genitals), added to an epidemiological link or history of intimate contact with strangers or casual partners.