ABSTRACT
We report a case of fungal and mycobacterial co-infection in an immunosuppressed patient from Southern Brazil. Histoplasmosis was diagnosed in an AIDS patient admitted to the hospital with nonspecific respiratory signs. However, 4 months post hospital discharge, the patient worsened and a co-infection with Mycobacterium avium was detected. Physicians must consider and investigate a broad spectrum of diseases which can occur as co-infections and which share the same clinical symptoms and signs in immunosuppressed patients.
ABSTRACT
Introduction. Nosocomial transmission of Mycobacterium tuberculosis is an important health issue and the detection of tuberculosis (TB) cases is the main tool for controlling this disease.Aim. We aimed to assess the possible occurrence of nosocomial transmission of M. tuberculosis in a reference hospital for HIV/AIDS patients and evaluate both the performance of the Xpert MTB/RIF (Xpert) platform and drug resistance profiles.Methodology. We evaluated the performance of the Xpert platform. Samples that tested positive on the BACTEC MGIT 320 (MGIT320) platform were submitted for genotyping and drug susceptibility testing.Results. In this study, pulmonary and extrapulmonary samples from 407 patients were evaluated, and among these, 15.5â% were diagnosed with TB by the MGIT320 platform, with a TB/HIV coinfection rate of 52.4â%. The Xpert platform gave positive results for TB for 11 samples with negative results on the MGIT320 platform. In the genotyping results, 53.3â% of the strains clustered; of these strains, half were in two of the four clusters formed, and the patients had visited the hospital on the same day. Drug resistance was observed in 11.7â% of the strains.Conclusion. Putative nosocomial transmission of M. tuberculosis was detected, showing that genotyping is a powerful approach for understanding the dynamics of M. tuberculosis transmission, especially in a high-burden TB and HIV landscape.
Subject(s)
HIV Infections/complications , Molecular Diagnostic Techniques/methods , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Pulmonary/microbiology , Acquired Immunodeficiency Syndrome/complications , Antibiotics, Antitubercular/pharmacology , Clinical Laboratory Techniques , Cross Infection/diagnosis , Cross Infection/microbiology , Cross-Sectional Studies , Drug Resistance, Bacterial , Humans , Microbial Sensitivity Tests , Mycobacterium tuberculosis/classification , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/genetics , Phylogeny , Tuberculosis , Tuberculosis, Pulmonary/diagnosisABSTRACT
The objective of this study was to evaluate the frequency of different extended-spectrum ß-lactamases (ESBL) as well as to associate these ESBL with antimicrobial (ATM) resistance in Escherichia coli and Klebsiella spp. isolates from outpatients and inpatients with urinary tract infections. The study included 435 consecutive nonduplicate clinical isolates, including 362 E. coli isolates, 62 Klebsiella pneumoniae isolates, and 11 K. oxytoca isolates. Isolates were obtained from patients who were treated in a University Hospital between August 2012 and July 2013. Three multiplex PCR were performed to identify the ESBL groups. A total of 48 (11%) ESBL-producing isolates were found. The risk for the ESBL presence was significantly higher in males (26.4%) than females (8%), from hospital-acquired infections (29.1%) than community-acquired infections (7.0%) and in Klebsiella spp. (27.4%) than in E. coli (7.7%). ESBL-producing isolates presented a significantly higher percentage of resistance in 21 of the 23 ATMs analyzed. The CTX-M-1 group was the most predominant ESBL identified. The blaCTX-M-1-group gene was found in 56% of the total ESBL producers from community and in 42.4% from hospital origins; it was followed in frequency by the blaCTX-M-8/25-group, also found in both environments. Klebsiella spp. presented the largest variety of ß-lactamase enzyme combinations and a higher level of resistance to cefotaxime. These findings contribute to better knowledge of the epidemiology of ESBL enzymes and are alarming for the reduced therapeutic options available for the risk groups identified in the studied populations.
Subject(s)
Anti-Bacterial Agents/pharmacology , Escherichia coli/drug effects , Escherichia coli/genetics , Klebsiella/drug effects , Klebsiella/genetics , Urinary Tract Infections/epidemiology , Urinary Tract Infections/microbiology , beta-Lactamases/genetics , Adult , Aged , Brazil/epidemiology , Community-Acquired Infections/microbiology , Cross Infection/microbiology , Drug Resistance, Bacterial/drug effects , Escherichia coli Infections , Female , Humans , Klebsiella Infections , Male , Microbial Sensitivity Tests , Middle Aged , Polymerase Chain Reaction , Retrospective Studies , Sex Characteristics , Young AdultABSTRACT
A Política Nacional de Saúde da Pessoa Idosa (PNSPI) foi formulada pelo Ministério da Saúde por meio da Portaria n. 2.528/2006, em consonância com a Constituição de 1988. O estudo investigou se os municípios de uma região do Sul do Estado de Santa Catarina conhecem e aplicam a PNSPI durante as ações realizadas na atenção básica à saúde, em especial nas Unidades de Estratégia de Saúde da Família, à luz do que dispõem a Constituição e o Estatuto do Idoso. Na pesquisa, utilizou-se o método dedutivo, com abordagem qualitativa e pesquisa descritiva. Como resultados, destacam-se as dificuldades apresentadas pelos sujeitos da pesquisa acerca de dois pontos importantes das diretrizes e estratégias da PNSPI: a falta de uma política planejada e contínua de educação em saúde para os idosos; e a inexistência de estímulo ao exercício do controle social, no âmbito seja da saúde, seja do Conselho Municipal da Pessoa Idosa...
The Brazilian National Health Policy for Elderly Persons (PNSPI in Portuguese) was formulated by the Ministry of Health through Ordinance No. 2.528/2006 in line with the 1988Brazilian Constitution. The study investigated whether municipalities from the South regionof the State of Santa Catarina had knowledge and applied the PNSPI, on the performed actionsin basic healthcare, especially on the Units of Family Healthcare Services based on what theConstitution and the Statute of the Elderly comprise. A deductive method with a qualitativeapproach and a descriptive research were used. As a result, some difficulties experienced by the research subjects related to two important points of policies and strategies of PNSPI wereidentified: the lack of a planned policy and of a continuous health education for the elderly; and the lack of a stimulating exercise of social control, whether in the health sector, or in theMunicipal Council of Elderly People...
Subject(s)
Humans , Male , Female , Aged , Population Dynamics , Health of the Elderly , Health Personnel , Health Policy , Human Rights , Primary Health Care , Public Policy , Constitution and Bylaws , National Health Strategies , Qualitative Research , Quality-Adjusted Life Expectancy , Unified Health SystemABSTRACT
Sporotrichosis occurs after fungal implantation of Sporothrix spp. in the skin, and is the main subcutaneous mycosis in Latin America. Here we describe three atypical cases of the disease. The first case report an extra-cutaneous occurrence of the disease with joint infection; the second one describes a patient with bilateral lymphocutaneous form of sporotrichosis; and the third shows a zoonotic cutaneous case with the development of an erythema nodosum as a hypersensitivity reaction. These cases show the disease importance on the region and the necessity of fungal culture to the diagnosis confirmation.
Subject(s)
Sporotrichosis/diagnosis , Adult , Antifungal Agents/therapeutic use , Female , Humans , Itraconazole/therapeutic use , Male , Middle Aged , Sporotrichosis/drug therapyABSTRACT
Sporotrichosis occurs after fungal implantation of Sporothrix spp. in the skin, and is the main subcutaneous mycosis in Latin America. Here we describe three atypical cases of the disease. The first case report an extra-cutaneous occurrence of the disease with joint infection; the second one describes a patient with bilateral lymphocutaneous form of sporotrichosis; and the third shows a zoonotic cutaneous case with the development of an erythema nodosum as a hypersensitivity reaction. These cases show the disease importance on the region and the necessity of fungal culture to the diagnosis confirmation.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Sporotrichosis/diagnosis , Antifungal Agents/therapeutic use , Itraconazole/therapeutic use , Sporotrichosis/drug therapyABSTRACT
O presente estudo analisou o conhecimento e a atuação do enfermeiro da Unidade Estratégia da Saúde da Família (UESF), do município de Criciúma/SC, nas notificações compulsórias de trabalho precoce, conforme previsto na Lei Municipal n° 4.797/05. No desenvolvimento da pesquisa, utilizou-se o método dedutivo e com abordagem qualitativa e pesquisa descritiva. Nesse sentido os procedimentos metodológicos contemplaram os aspectos éticos, tipo de pesquisa, local de estudo, levantamento de dados através da aplicação de entrevista semiestruturada com as 29 enfermeiras que atuam na EUSF do município estudado e procedimento para análise e interpretação dos dados. O resultado e discussão da análise dos dados foram categorizados e classificados em sete temas principais. Os objetivos do estudo foram atingidos e a hipótese foi comprovada: os profissionais enfermeiros desconhecem e não realizam as notificações compulsórias do trabalho precoce, de acordo com a Lei n°4.797/05. Das 29 enfermeiras entrevistadas, 28 afirmaram a necessidade da realização de capacitação sobre os direitos e deveres das crianças e adolescentes, referente à erradicação do trabalho precoce.
Subject(s)
Male , Female , Child , Adolescent , Humans , Child Advocacy , Child Labor , Dentist-Patient Relations , Family Health , Human Rights , Nursing Services , Nursing Staff , Policy Making , Right to Health , Health Promotion , Qualitative ResearchABSTRACT
O quadro clínico da toxoplasmose adquirida em pacientes imunocompetentes habitualmente não inclui manifestações neurológicas focais, o que é freqüente em pacientes imunodeprimidos, como aqueles com síndrome da imunodeficiência adquirida. este trabalho tem como objetivo relatar o caso de uma paciente adulta que apresentou abscessos cerebrais por Toxoplasma gondii, sem evidência de qualquer fator causador de imunossupressão
