Guillain-Barré syndrome as the first presentation of human immunodeficiency virus infection.

AIM: Antiretroviral therapy (ART) development has reduced the severity of neurological complications of the human immunodeficiency virus (HIV), but they remain prevalent and need prompt recognition. Acute inflammatory demyelinating polyneuropathy (AIDP) is a rare complication of human immunodeficiency virus (HIV) infection that may appear at any stage of the disease. In this case, AIDP represents a late presentation of HIV infection. METHODS: Descriptive study. Patient data were collected from their medical records and by health assessment interviews. RESULTS: We report a case of a 52-year-old male with acute lower limb weakness. Given the suggestive clinical presentation of AIDP and a positive HIV test, intravenous immunoglobulin (IVIG) was administered along with antiretroviral therapy. Progressive weakness to the upper limbs, autonomic dysfunction, and pain was observed. The second regimen of IVIG plus corticosteroids was administered. Muscle strength improved after three weeks. CONCLUSIONS: Screening for HIV in a patient with AIDP may provide a better outcome because of the early start of ART with good central nervous system penetration in HIV-infected patients.

Mortality predictive factors of people living with human immunodeficiency virus and bloodstream infection.

INTRODUCTION: Portugal has one of the highest mortality rates for people living with HIV (PLWHIV) in Europe. After antiretroviral therapy introduction, HIV-associated mortality declined, included the one associated with bloodstream infection (BSI). However it is still high, and European data are scarce . Therefore, characterizing BSI and defining prognostic factors may improve our approach. METHODS: This was a 10-year retrospective study of predictive factors for 30-day and 3-year mortality in PLWHIV with BSI in a tertiary infectious diseases ward. RESULTS: Of 2134 PLWHIV admissions, 145 (6.8%) had a BSI, mostly respiratory and catheter-related bacteremia and globally community-acquired. Nosocomial infections occurred in 42 (36%) cases, mostly caused by Enterococcus spp, Staphylococcus aureus, and Candida spp. PLWHIV with a BSI had higher 30-day mortality (27%) compared to those without a BSI (14%). APACHE II score, corticotherapy, and current intravenous drug use (IDU) had a prognostic impact on 30-day mortality. Three-year survival was 54% in PLWHIV with a BSI; a CD4 <200 cells, vascular or chronic pulmonary disease, and lymphoma were prognostic factors. CONCLUSIONS: Patients with a BSI were more likely to present advanced HIV disease, have more comorbidities, a longer length of stay, and higher 30-day mortality. IDU and severity of infection determined the short-term prognosis. Three-year mortality was primarily influenced by lower CD4 cell counts, hematological tumor, and cardiopulmonary comorbidities. Systemic corticotherapy may influence nosocomial BSI and short-term prognosis.

[Acute bacterial meningitis as an occupational disease]. / Meningite bacteriana aguda como doença ocupacional.

Streptococcus suis is a zoonotic pathogen with worldwide distribution, responsible for more than 700 human cases globally reported. This infection affects mostly men, exposed to pig or pork, which leads to its usual classification as an occupational disease. We report a case of acute bacterial meningitis in a 44 years old male. According to his past medical history, the patient had chronic alcoholism and worked in a restaurant as a piglet roaster. Microbiological examination of blood and CSF revealed S. suis. After 14 days of ceftriaxone the patient fully recovered. The authors review the clinical reports previously described in Portugal. In all of them was possible to identify risk exposition to pork. We alert to this microorganism's importance in Portugal where it is probably underdiagnosed.

Streptococcus suis é um agente zoonótico com distribuição mundial, atualmente responsável por mais de 700 casos reportados em humanos. Atinge quase em exclusivo indivíduos do sexo masculino com exposição a suínos ou à sua carne, classificando-se neste contexto como uma doença ocupacional. Os autores apresentam um caso de meningite bacteriana aguda por este agente infeccioso, num homem de 44 anos com antecedentes de etilismo crónico cuja atividade profissional consistia em assar leitões num restaurante. A análise microbiológica do sangue e do LCR revelou S. suis, agente etiológico desta infecção. Foi tratado empiricamente com ceftriaxona, completando 14 dias de antibioterapia com resolução total do quadro. Reveem-se os casos previamente descritos em Portugal. Em todos foi possível identificar exposição a carne de porco crua. Alerta-se para a importância deste agente infeccioso em Portugal, onde possivelmente se encontrará sub-diagnosticado.