Viruela símica grave en un paciente con infección por VIH, Ecuador / Severe mpox in a HIV patient, Ecuador. A case report

En mayo de 2022 se reportó un aumento de casos de viruela símica (mpox en inglés) en el mundo, cuyo comportamiento epidemiológico y clínico, particularmente en pacientes con infección por VIH, condujo a la declaración del brote de mpox 2022 como emergencia de salud pública internacional. Se presenta el caso de un paciente con infección por VIH que cursó con mpox grave y fulminante, con placas necróticas en párpado y membrana inflamatoria sobre la superficie ocular; mucosa oral con lesiones blanquecinas y úlceras en lengua; induración de tejidos blandos y lesiones necróticas en los pies. Tras múltiples complicaciones, se convirtió en la primera víctima fatal reportada en Ecuador en 2022. En pacientes con infección por VIH, mpox puede presentarse como un agente oportunista, causando lesiones cutáneas graves, con o sin manifestaciones sistémicas.

In May 2022 several cases of mpox were reported worldwide, whose epidemiological and clinical outcome, particularly in patients seropositive for HIV, led to declaring the 2022 mpox outbreak as a public health emergency. We describe a case of a patient with HIV infection and severe and fulminant mpox, with necrotic plaques on the eyelid and an inflammatory membrane on the ocular surface; oral mucosa with whitish lesions and ulcers on the tongue; soft tissues induration, and necrotic lesions on the feet. After multiple complications, he became the first fatality reported in Ecuador in 2022. In HIV-infected patients mpox can be considered an opportunistic agent, with severe skin lesions with or without systemic manifestations.

Indirect evidence of following association between golden dorados (Salminus brasiliensis) and green anacondas (Eunectes murinus) in a Clearwater river of Midwest Brazil / Evidência indireta de associação de seguidor entre dourado (Salminus brasiliensis) e sucuri-verde (Eunectes murinus) em um rio de águas claras do Centro-Oeste do Brasil

Abstract On four occasions, the golden dorado (Salminus brasiliensis) was recorded following the green anaconda (Eunectes murinus) in a clearwater river of Midwest Brazil. These observations were considered as an indirect evidence of a following association known as "nuclear-follower feeding association", a condition in which the follower approach the nuclear when it somehow disturbs the substrate and form sediment clouds while foraging, taking the opportunity to feed during this situation. However, no direct observations of golden dorados getting some benefit from the activity of the green anacondas to feed were made. Nevertheless, as there is a varied list of vertebrates considered as nuclear species in the clearwater rivers of Midwest Brazil, it is to be expected that future observations may provide unusual information about nuclear-follower feeding association between fish and snakes in the Neotropics.

Resumo Em quatro ocasiões, o dourado (Salminus brasiliensis) foi registrado seguindo a sucuri-verde (Eunectes murinus) em um rio de águas claras do Centro-Oeste do Brasil. Essas interações foram consideradas como uma evidência indireta de uma associação de seguidor conhecida como "associação de alimentação nuclear-seguidor", uma condição na qual o seguidor se aproxima da espécie nuclear quando esta de alguma forma perturba o substrato e/ou forma nuvens de sedimentos enquanto forrageia, aproveitando a oportunidade para se alimentar durante essa situação. No entanto, observações diretas de dourados obtendo algum benefício da atividade das sucuris para se alimentar não foram feitas. No entanto, como há uma lista variada de vertebrados considerados como espécies nucleares nos rios de águas claras do Centro-Oeste do Brasil, é de se esperar que observações futuras possam fornecer informações incomuns sobre associações do tipo "nuclear-seguidor" entre peixes e serpentes na região Neotropical.

Notificações de tuberculose no período pré- pandêmico e pandêmico da Covid-19 no Estado do Paraná / Tuberculosis notifications in the pre-pandemic and pandemic period of Covid-19 in Paraná state / Notificaciones de tuberculosis en el período prepandémico y pandémico de la Covid-19 en el estado de Paraná

Introdução: A tuberculose (TB) é considerada uma doença bem desafiadora para o sistema de saúde no Brasil, devido ao número elevado de casos nas últimas décadas. Contudo, com a pandemia da COVID-19, foi observada uma redução significativa de casos de TB. Objetivo: O objetivo desse trabalho foi avaliar o comportamento da TB nas macrorregionais de saúde do estado do Paraná, bem como nas populações vulneráveis nos anos de 2011 a 2021, e sua associação com a ocorrências de casos de COVID-19 a partir de 2020. Metodologia: Trata-se de um estudo ecológico, com dados secundários de TB do Sistema de Informação de Agravos de Notificação (SINAN) e de COVID-19 no banco de dados público oficial da Secretaria de Estado da Saúde do Paraná (SESA) para o coronavírus. Principais resultados: Foi observada diferenças significativas de ocorrência de casos de TB entre as macrorregionais relacionadas à faixa etária da população e entre os períodos pré-pandêmico e pandêmico no Paraná. Os dados obtidos apontam também para uma associação significativa de casos de TB em populações em situação de rua, privadas de liberdade e portadores do vírus da imunodeficiência humana (HIV) no estado ao longo dos anos observados. Conclusão: As notificações de TB no estado do Paraná foram afetadas pela pandemia da COVID-19.

Introduction: Tuberculosis (TB) is considered a very challenging disease for the health system in Brazil, due to the high number of cases in recent decades. However, with the COVID-19 pandemic, a significant reduction in TB cases was observed. Objective: The objective of this study was to evaluate the behavior of TB in the macro-regional health regions of the state of Paraná, as well as in vulnerable populations in the years 2011 to 2021 and the association with the occurrence of COVID-19 cases from 2020. Methodology: Its an ecological study with secondary tuberculosis data from SINAN and data COVID-19 in the official public database of the Paraná State Health Department (SESA). Results: Results show significant differences of TB cases among the macro-regions related to the age group of the population and between the pre-pandemic and pandemic periods. A significant association of TB cases was also observed for the homeless, deprived of liberty and HIV-positive populations in the state over the years observed. Conclusion: TB notifications in the state of Paraná were affected by the COVID-19 pandemic.

Introducción: La tuberculosis (TB) es considerada una enfermedad muy desafiadora para el sistema de salud en Brasil, debido al elevado número de casos en las últimas décadas. Sin embargo, con la pandemia de COVID-19, se observó una reducción significativa de los casos de TB. Objetivo: El objetivo de este estudio fue evaluar el comportamiento de la TB en las macro regiones sanitarias del estado de Paraná, así como en poblaciones vulnerables en los años 2011 a 2021 y la asociación con la ocurrencia de casos de COVID-19 a partir de 2020. Metodología: Es un estudio ecológico con datos secundarios de tuberculosis del SINAN y datos COVID-19 en la base de datos pública oficial de la Secretaría de Salud del Estado de Paraná (SESA). Resultados: Los resultados muestran diferencias significativas de casos de TB entre las macrorregiones relacionadas con el grupo de edad de la población y entre los períodos prepandémico y pandémico. También se observó una asociación significativa de casos de TB para la población sin hogar, privada de libertad y seropositiva al VIH en el estado a lo largo de los años observados. Conclusiones: Las notificaciones de TB en el estado de Paraná fueron afectadas por la pandemia de COVID-19.

Tuberculosis y otras causas de morbilidad y mortalidad hospitalaria en pacientes con VIH/sida / Tuberculosis and other causes of morbidity and mortality in hospitalized patients with HIV/AIDS

Introducción: A diferencia de lo descrito en países desarrollados, en los que se informan las enfermedades crónicas no transmisibles como causa de hospitalización en pacientes con VIH, en este estudio las principales causas de admisión hospitalaria y muerte fueron las infecciones oportunistas, particularmente la tuberculosis, algo similar a lo reportado en otros países de ingresos bajos en América y África Occidental, aun con la disponibilidad de la terapia antirretroviral. Objetivos: Se determinaron las causas más frecuentes de morbilidad y mortalidad hospitalaria en pacientes con VIH. Material y métodos: Se analizaron los datos demográficos, clínicos y de laboratorio de pacientes ingresados con diagnóstico de VIH durante un año, en un hospital de Guayaquil, Ecuador. Resultados: De 151 pacientes, el 76% era del sexo masculino, con 37 años en promedio. El 56.3% conocía el diagnóstico de infección por VIH. Las principales causas de hospitalización y muerte fueron las enfermedades definitorias de sida, entre las que las formas meníngeas, como criptococosis, toxoplasmosis, sífilis y leucoencefalopatía en conjunto, siguen a la tuberculosis; el 93.5% de los fallecidos tenía recuento de CD4 menor de 200 células/mm3 (p = 0.007). Conclusión: De manera similar a lo informado en pacientes adultos jóvenes con VIH en países de bajos ingresos económicos, las infecciones oportunistas fueron la principal causa de hospitalización y muerte, relacionada con inmunosupresión intensa, estadios avanzados de la enfermedad y falta de terapia antirretroviral. Los resultados refuerzan la importancia del diagnóstico precoz y el tratamiento de la infección por VIH, así como la profilaxis de las infecciones oportunistas prevenibles.

Introduction: Unlike what has been described in developed countries where chronic non-communicable diseases are reported as the cause of hospitalization in patients with HIV, in this study the main cause of hospital admission and death were opportunistic infections, particularly tuberculosis similar to what was reported in other low-income countries in the Americas and West Africa even with the availability of antiretroviral therapy. Aim: The most frequent causes of hospital morbidity and mortality in patients with HIV were determined. Material and methods: The demographic, clinical, and laboratory data of patients admitted with a diagnosis of HIV for one year in a Guayaquil General Hospital were analyzed. Results: Of 151 patients, 76% were male with an average age of 37 years old. 56.3% knew the diagnosis of HIV infection. The main cause of hospitalization and death were AIDS-defining diseases where the meningeal forms: cryptococcosis, toxoplasmosis, syphilis and leukoencephalopathy together follow tuberculosis, and 93.5% of the deceased had a CD4 count of fewer than 200 cells/ mm3 (p = 0.007). Conclusion: Similar to what was reported in young adult patients with HIV in low-income countries, opportunistic infections were the main cause of hospitalization and death, related to severe immunosuppression, advanced stages of the disease, and without antiretroviral therapy. The results reinforce the importance of early diagnosis and treatment of HIV infection and the prophylaxis of preventable opportunistic infections.

Caracterização das infecções que acometem o usuário no momento do diagnóstico para o Hiv/Aids / Characterization of infections that affect the user at the moment of diagnosis for Hiv/Aids / Caracterización de las infecciones que afectan a los usuarios en el momento del diagnóstico del Vih/Sida

: O estado do Pará, de 2009 a 2019, apresentou um aumento de 46,5% na taxa de detecção de aids. O que destaca a importância de estudos para a avaliação e acompanhamento deste público. Objetivo: Analisar as infecções que acometem os usuários de um centro de referência no momento de seu diagnóstico para a infecção pelo HIV. Métodos: Estudo descritivo, realizado em um centro de referência da cidade de Santarém, Pará. A amostra foi de 332 prontuários de pacientes diagnosticados para o HIV nos anos de 2016 e 2017. A coleta de dados buscou informações sociodemográficas, clínicas e imunológicas dos pacientes no momento do diagnóstico para a infecção pelo HIV. Os dados foram organizados e analisados por estatística descritiva e inferencial, adotando- se p<0,05. Resultados: Observou-se prevalência do sexo masculino (67%), faixa etária de 15-24 anos (32,2%), solteiros (59%), com vínculo empregatício (64,5%), contagem de linfócitos T CD4+ ≥200 céls/mm3 (54,8%) e carga viral detectável (75,3%). A Candidíase (25%) e a Tuberculose (25%) predominaram como infecções oportunistas (IO), e a Sífilis (67,5%) como outras infecções. Conclusão: Conforme método proposto e os dados já informados, conclui-se que o diagnóstico para a Sífilis se associou ao sexo masculino, bem como a situação de contagem de linfócitos T CD4+ <200 céls/mm3 se associou com a presença de alguma infecção oportunista, da instalação da Candidíase e da Tuberculose.

Introduction: The state of Pará, from 2009 to 2019, showed a 46.5% increase in the AIDS detection rate. What stands out the importance of studies for the evaluation and monitoring of this public. Objective: Analyze the infections that affect the users of a reference center at the moment of diagnosis for HIV infection. Methods: Descriptive study, carried out in a reference center in the city of Santarém, Pará. The sample consisted of 332 records of patients diagnosed with HIV in the years 2016 and 2017. The data collection sought sociodemographic, clinical and immunological information of the patients at the moment diagnosis for HIV infection. The data were organized and analyzed using descriptive and inferential statistics, adopting p <0.05. Results: There was a prevalence of males (67%), aged 15-24 years (32.2%), single (59%), with employment (64.5%), CD4 + T lymphocyte count ≥200 cells/mm3 (54.8%) and detectable viral load (75.3%). Candidiasis (25%) and Tuberculosis (25%) predominated as opportunistic infections (IO), and Syphilis (67.5%) as other infections. Conclusion: According to the proposed method and the data already reported, it is concluded that the diagnosis for Syphilis was associated with the male gender, as well as the situation of CD4 + T lymphocyte count <200 cells/mm3 was associated with the presence of some opportunistic infection, of the installation of Candidiasis and Tuberculosis.

Introducción: El estado de Pará, de 2009 a 2019, presentó un aumento del 46,5% en la tasa de detección del SIDA. Lo que pone de manifiesto la importancia de los estudios para la evaluación y el seguimiento de este público. Objetivo: Analizar las infecciones que sufren los usuarios de un centro de referencia en el momento de su diagnóstico de infección por VIH. Métodos: Estudo descritivo, realizado em um centro de referência da cidade de Santarém, Pará. La muestra fue de 332 historias clínicas de pacientes diagnosticados de VIH en los años 2016 y 2017. La recogida de datos buscaba información sociodemográfica, clínica e inmunológica de los pacientes en el momento del diagnóstico de la infección por VIH. Los datos se organizaron y analizaron mediante estadísticas descriptivas e inferenciales, adoptando p<0,05. Resultados: Se observó la prevalencia del sexo masculino (67%), el grupo de edad de 15 a 24 años (32,2%), la soltería (59%), el empleo (64,5%), el recuento de linfocitos T CD4+ ≥200 células/mm3 (54,8%) y la carga viral detectable (75,3%). La candidiasis (25%) y la tuberculosis (25%) predominaron como infecciones oportunistas (IO), y la sífilis (67,5%) como otras infecciones. Conclusión: De acuerdo con el método propuesto y los datos ya informados, se concluye que el diagnóstico de Sífilis se asocia al sexo masculino, así como la situación de contagio de linfocitos T CD4+ <200 células/mm3 se asocia a la presencia de alguna infección oportunista, a la instauración de la Candidiasis y a la Tuberculosis.

Diet of Psalidodon aff. fasciatus (Cuvier, 1819) (Teleostei: Characidae) in a neotropical river before reservoir formation / Dieta de Psalidodon aff. fasciatus (Cuvier, 1819) (Teleostei: Characidae) antes da formação de reservatório na região neotropical

The main objective of this study was to identify spatial and seasonal variations on the diet of Psalido-don aff. fasciatus from the Tibagi River (South Brazil) before the construction of the Tibagi Montante hydropower plant. Fish were collected quarterly between October 2017 and July 2019. 536 stomachs containing feeding items and identified to the lowest taxonomic level as possible have been analyzed. Results showed that plants, Hymenoptera, and insect parts in general were the most consumed items. The analysis of feeding strategy showed a diet based on rare items but with individuals varying among specialist, generalist, and opportunistic trends depending on the season. The non-metric multidimen-sional scaling (NMDS) revealed diet overlap in both spatial and seasonal terms, which was confir-med by the permutational analysis of variance (PERMANOVA). The indicator value analysis (IndVal) identified 15 items as the most important components of this species' diet such as superior plants, Hymenoptera and insect parts. Therefore, before the formation of the reservoir, P. aff. fasiatus could be characterized as predominantly herbivore with a strong trend for insectivory. Across seasons, this species had a specialized diet all year, although with more specialized preferences in the spring when the consumption of plants was increased.(AU)

O objetivo deste trabalho foi identificar variações espaciais e sazonais da dieta do Psalidodon aff. fas-ciatus do rio Tibagi (Sul do Brasil) antes da construção da usina hidrelétrica Tibagi Montante. Os peixes foram amostrados trimestralmente entre outubro de 2017 e julho de 2019. Foram analisados 536 estômagos contendo itens alimentares e identificados até o menor nível taxonômico possível. Os resultados indicaram que vegetais, Hymenoptera e restos de insetos em geral foram os itens mais con-sumidos. A análise da estratégia alimentar mostrou uma dieta baseada em itens raros, mas com indi-víduos variando entre tendências especialistas, generalistas e oportunistas, dependendo da estação. O escalonamento multidimensional não-métrico (NMDS) mostrou sobreposição da composição da dieta tanto em escala espacial quanto sazonal, o que foi confirmado pela análise de variância permutacional (PERMANOVA). A análise do valor indicador (Indval) identificou 15 itens como os componentes mais importantes na dieta desta espécie, como plantas superiores, Hymenoptera e resto de insetos. Por-tanto, antes da formação do reservatório, P.aff. fasciatus, pode ser caracterizada como predominante-mente herbívora com forte tendência insetívora. Ao longo das estações, esta espécie apresentou dieta especializada durante todo o ano, embora com especialização na primavera, quando houve aumento do consumo de vegetais. (AU)

Importancia diagnóstica de leucoencefalopatía multifocal progresiva cerebelosa

RESUMEN Introducción: La leucoencefalopatía multifocal progresiva es una enfermedad desmielinizante del sistema nervioso central, de etiología viral. Se presenta en pacientes con enfermedades inmunosupresoras y la localización en fosa posterior es rara. Debido a sus formas clínicas inespecíficas se hace infrecuente su diagnóstico lo que conlleva a daño irreversible y/o a la muerte del paciente. Objetivo: Orientar sobre la posibilidad de leucoencefalopatía multifocal progresiva cerebelosa en pacientes inmunodeprimidos con manifestaciones neurológicas de daño en fosa posterior. Caso clínico: Paciente masculino, de 25 años de edad, sin antecedentes de enfermedades aparentes, que comienza con lenguaje escandido, temblor mixto dismetría y ataxia. Se diagnostica leucoencefalopatía multifocal progresiva cerebelosa por cuadro clínico, neuroimagen y presencia de virus JC en líquido cefalorraquídeo, además de una inmunosupresión severa causada por virus de inmunodeficiencia humana diagnosticado por pruebas serológicas. Conclusiones: Considerar leucoencefalopatía multifocal progresiva cerebelosa en todo paciente con manifestaciones neurológicas de afectación en fosa posterior y estudiar causas de inmunosupresión subyacente.

ABSTRACT Introduction: Progressive multifocal leukoencephalopathy is a demyelinating disease of viral etiology that affects the central nervous system. It presents in patients with immunosuppressive conditions and location in the posterior fossa is rare. Due to its unspecific clinical forms, its diagnosis is infrequent, leading to irreversible damage and/or the patient's death. Objective: Instruct about the possibility of cerebellar progressive multifocal leukoencephalopathy in immunocompromised patients with neurological manifestations of posterior fossa damage. Clinical case: A case is presented of a male 25-year-old patient without apparent pathological antecedents who started out with slurred speech, mixed tremor, dysmetria and ataxia. Cerebellar progressive multifocal leukoencephalopathy was diagnosed by clinical picture, neuroimaging and the presence of JC virus in the cerebrospinal fluid, alongside severe immunosuppression caused by human immunodeficiency virus diagnosed by serological testing.

Infecciones oportunistas en el paciente adulto con infección por VIH/Sida

RESUMEN Esta revisión tiene un enfoque práctico y conciso, con el fin de que sea un apoyo rápido y eficiente, para la prevención de las Infecciones Oportunistas (IO) en pacientes que viven con VIH, proporciona al médico que atiende a este tipo de pacientes, un conjunto de herramientas y metodologías para que tengan un criterio uniforme al momento de la identificación, y garantizar un tratamiento oportuno de estas infecciones. Los objetivos principales de esta revisión son: a) Conocer las pautas para la prevención de IO, b) Conocer el inicio de la profilaxis primaria y secundaria, c) Determinar el momento de la suspensión de la profilaxis. La calidad de la evidencia científica para el tratamiento se califica según el sistema estándar que utiliza la Sociedad de Enfermedades Infecciosas en otras guías

This review has a practical and concise approach, in order to be a quick and efficient support, for the prevention of Opportunistic Infections (OI) in patients living with HIV, it provides the doctor who cares for this type of patients, a set of tools and methodologies so that they have a uniform criterion at the time of identification, and guarantee a timely treatment of these infections. The main objectives of this review are: a) know the guidelines for the prevention of OI, b) know the start of primary and secondary prophylaxis, c) determine the moment of suspension of prophylaxis. The quality of the scientific evidence for treatment is rated according to the standard system used by the Infectious Diseases Society in other guidelines.

Candidose sistêmica em cães associada à cinomose / Systemic candidosis in dogs associated with canine distemper virus

Background: Candidosis is an opportunistic fungal infection caused by yeasts of the genus Candida, which normally reside on the surfaces of the mucous membranes and in the skin of several animal species and healthy humans; however the fungi can convert into pathogenic microorganisms and result in invasive infections with systemic involvement due to the impairment of the immune system. Systemic candidosis is rare in dogs and few reports of this mycosis are available in literature. Therefore, the objective of this study was to describe three cases of systemic candidosis associated to canine distemper virus in dogs, highlighting the main epidemiological, clinical and pathological aspects. Cases: Three cases of systemic infection by Candida sp. were diagnosed in dogs. The animals predominantly presented neurological clinical manifestations, followed by unspecific alterations with an evolution of 5 to 30 days. Macroscopically, the lesions were characterized by white-yellowish multifocal to coalescent areas surrounded by reddish borders in the kidneys and heart (cases 1, 2 and 3); liver and submandibular lymph node (case 1); and lung (case 2). In the brains of the three dogs were observed multifocal, blackened and/or reddish and friable areas. In case 1, was observed an increased volume of the right carpometacarpal joint, that when cut, released a reddish and turbid content. In case 2, there was deposition of a whitish lumpy material on the epicardial surface, aorta artery, pericardial sac and spleen; infarction on the right testicle, hydroureter, pyelonephritis and hydronephrosis. Microscopically, the lesions consisted of necrossupurative inflammation associated to hemorrhage, vasculitis, congestion, thrombosis, infarction and fungal structures with distinct morphological patterns which included blastoconidia, pseudohyphae and hyphae. The fungal structures were...(AU)

NATURAL HISTORY OF THE BLACK IGUANA Ctenosaura similis (SQUAMATA: IGUANIDAE) IN ISLA CONTOY, QUINTANA ROO, MEXICO / Historia natural de la iguana negra Ctenosaura similis (Squamata: Iguanidae) en isla Contoy, Quintana Roo, México

ABSTRACT The genera Iguana and Ctenosaura belong to the Iguanidae family, and populations of most species of these genera have decreased due to anthropogenic effects. The natural history of most species of this family is poorly known, including Ctenosaura similis. Therefore, this study documents some ecological aspects of the species, such as its feeding habits, and habitat and microhabitat use in a population of Isla Contoy in Quintana Roo, Mexico. The data showed that even though C. similis is distributed throughout the island, individuals more commonly use human construction (buildings) of Parque Nacional Isla Contoy (PNIC) and mangrove areas. Microhabitats most used by all age classes and sexes were rocks and trees. The diet of the species is omnivorous; however, the frequency of prey type consumed changes with the age of the individuals (hatchlings, juveniles, and adults), as well as with the season of the year. The practice of cannibalism by some individuals is also reported, as well as coprophagy and scavenging. This work provides general information on the life history of C. similis, complementing the scarce information that is currently available.

RESUMEN Las iguanas de los géneros Iguana y Ctenosaura son algunas de las especies de escamados que han tenido una importante disminución en sus poblaciones naturales, principalmente por factores antropogénicos. No obstante, a pesar de esto existen especies de las que el conocimiento sobre su historia natural es escaso, como es el caso de la iguana negra Ctenosaura similis. Por lo que, en este trabajo se documentan algunos aspectos de la ecología, tal como los hábitos alimentarios y uso del hábitat y del microhábitat de la población de la iguana negra (C. similis) en Isla Contoy, en el estado de Quintana Roo, México. Los análisis de este estudio revelaron que a pesar de que C. similis se distribuye en toda la isla, utiliza con mayor frecuencia las instalaciones del Parque Nacional Isla Contoy (PNIC) y la zona de manglar; los microhábitats más usados por las diferentes clases de edad y los diferentes sexos, fueron las rocas y los árboles. En general, la dieta de esta especie es omnívora, pero la frecuencia con la que consumen ciertas categorías de presa cambia con la edad del individuo (cría, juvenil y adulto), así como a través de las estaciones del año. Además, se observó que algunos individuos practicaron el canibalismo, la coprofagia y la carroñeria. Este trabajo aporta datos generales de la historia natural de C. similis, lo que complementa la escasa información que hasta ahora se tiene disponible.

Rhodococcus equi, primer reporte de un caso de enfermedad diseminada en el Perú / Rhodococcus equi, first case report of disseminated disease in Peru

Resumen Presentamos el caso de un paciente con infección por virus de inmunodeficiencia humana (VIH) con recuento de LTCD4+ 49 céls/mm3, que consultó por un cuadro de siete meses de baja de peso, dolor abdominal, diarrea crónica y lesiones cutáneas gomosas. El mielocultivo y hemocultivos fueron positivos para Rhodococcus equi. Además, se observaron lesiones histológicas en piel e intestino compatibles con este agente como malacoplaquia, reacción granulomatosa y cuerpos de Michaelis-Gutmann. Se descartó compromiso pulmonar mediante tomografía de tórax. Recibió terapia antibacteriana combinada con claritromicina, imipenem y vancomicina. A pesar del tratamiento, el paciente evolucionó desfavorablemente y falleció.

Abstract We present the case of a patient with human immunodeficiency virus (HIV) with a LTCD4 + 49 cells/mm3, who was admitted due to a seven-month period of weight loss, abdominal pain, chronic diarrhea and rubbery skin lesions. Myeloculture and blood cultures were positive for Rhodococcus equi. In addition, histological lesions in the skin and intestine compatible with this agent were observed, such as malacoplachy, granulomatous reaction and Michaelis-Gutmann bodies. Pulmonary involvement was ruled out by chest tomography. The patient received antibacterial therapy combined with clarithromycin, imipenem, and vancomycin. Despite the treatment, the patient evolved unfavorably and died.

Candidose sistêmica em cães associada à cinomose / Systemic candidosis in dogs associated with canine distemper virus

Background: Candidosis is an opportunistic fungal infection caused by yeasts of the genus Candida, which normally reside on the surfaces of the mucous membranes and in the skin of several animal species and healthy humans; however the fungi can convert into pathogenic microorganisms and result in invasive infections with systemic involvement due to the impairment of the immune system. Systemic candidosis is rare in dogs and few reports of this mycosis are available in literature. Therefore, the objective of this study was to describe three cases of systemic candidosis associated to canine distemper virus in dogs, highlighting the main epidemiological, clinical and pathological aspects. Cases: Three cases of systemic infection by Candida sp. were diagnosed in dogs. The animals predominantly presented neurological clinical manifestations, followed by unspecific alterations with an evolution of 5 to 30 days. Macroscopically, the lesions were characterized by white-yellowish multifocal to coalescent areas surrounded by reddish borders in the kidneys and heart (cases 1, 2 and 3); liver and submandibular lymph node (case 1); and lung (case 2). In the brains of the three dogs were observed multifocal, blackened and/or reddish and friable areas. In case 1, was observed an increased volume of the right carpometacarpal joint, that when cut, released a reddish and turbid content. In case 2, there was deposition of a whitish lumpy material on the epicardial surface, aorta artery, pericardial sac and spleen; infarction on the right testicle, hydroureter, pyelonephritis and hydronephrosis. Microscopically, the lesions consisted of necrossupurative inflammation associated to hemorrhage, vasculitis, congestion, thrombosis, infarction and fungal structures with distinct morphological patterns which included blastoconidia, pseudohyphae and hyphae. The fungal structures were...

Detection of Pseudomonas sp. in pirarucu (Arapaima gigas): a case report in the Western Amazon / Detecção dePseudomonas sp.em pirarucu (Arapaima gigas): um relato de caso na Amazônia Ocidental

Pirarucu (Arapaima gigas) is one of the most important fish in Amazonian fish farming. However, information about its nutritional, zootechnical and microbiological aspects is still scarce. This is especially true for the juvenile phase due to high mortality rates caused by malnutrition, difficulties in food training, endo and ectoparasite infestations, which in turn lead to immunosuppression, favoring secondary bacterial infections that may be present due to various environmental factors (e.g., sudden temperature variations, water acidity and pollution of the aquatic environment) and the status of fish. The Pseudomonas sp. species studied in this work is part of the aquatic ecosystem and is considered a contaminant or invader because it infects a wide variety of aquatic species, including pirarucu. Given this assumption, the objective of the study was to report a case of Pseudomonas sp. in the viscera and dorsum of a juvenile pirarucu Arapaima gigas (SCHINZ, 1822) detected through bacteriological analysis. In the fish production chain in the Western Amazon, pirarucu is one of the most prominent fish species because of its high zootechnical performance in terms of weight gain and commercial value. However, one of the biggest obstacles in its production chain occurs during the juvenile phase, with high mortality rates caused by mainly bacterial infections, leading to economic

O pirarucu (Arapaima gigas)é um dos peixes de maior interesse para piscicultura amazônica. No entanto, os conhecimentos sob os aspectos nutricional, zootécnico e microbiológico desse peixe ainda são escassos. Sobretudo, na fase juvenil, porque nessa fase ocorrem altas taxas de mortalidade porque são mais susceptíveis à desnutrição, dificuldades no treinamento alimentar, infestações por endo e ectoparasitas, que por sua vez, ocasionam imunossupressão, favorecendo infecções bacterianas secundárias que podem estar presentes em virtude de diversos fatores ambientais e estado imunológico dos peixes. São exemplos, variações bruscas de temperatura, acidez da água e poluição do ambiente aquático. A espécie Pseudomonas sp. estudada nesse trabalho faz parte do ecossistema aquático, sendo considerada como contaminante ou um invasor, porque infecta grande variedade de espécies aquáticas, inclusive o pirarucu. Diante do pressuposto, o objetivo do trabalho foi relatar o caso de detecção de Pseudomonas sp.em vísceras e dorso do pirarucu Arapaima gigas(SCHINZ, 1822) juvenil por meio de análise bacteriológica. Na cadeia produtiva do pescado na Amazônia Ocidental, o pirarucu é um dos peixes de destaque por ser uma espécie com alto desempenho zootécnico em ganho de peso e valor comercial. Porém, um dosmaiores empecilhos da cadeia produtiva se encontra na fase juvenil da espécie havendo altos índices de mortalidade ocasionados por infecções principalmente de origem bacteriana levando a percas econômicas a piscicultura. Neste estudo detectou-se Pseudomonas sp.em amostra de dorso e vísceras de pirarucu em uma piscicultura no município de Ouro Preto do Oeste, Rondônia, Brasil.

Detection of Pseudomonas sp. in pirarucu (Arapaima gigas): a case report in the Western Amazon / Detecção dePseudomonas sp.em pirarucu (Arapaima gigas): um relato de caso na Amazônia Ocidental

Pirarucu (Arapaima gigas) is one of the most important fish in Amazonian fish farming. However, information about its nutritional, zootechnical and microbiological aspects is still scarce. This is especially true for the juvenile phase due to high mortality rates caused by malnutrition, difficulties in food training, endo and ectoparasite infestations, which in turn lead to immunosuppression, favoring secondary bacterial infections that may be present due to various environmental factors (e.g., sudden temperature variations, water acidity and pollution of the aquatic environment) and the status of fish. The Pseudomonas sp. species studied in this work is part of the aquatic ecosystem and is considered a contaminant or invader because it infects a wide variety of aquatic species, including pirarucu. Given this assumption, the objective of the study was to report a case of Pseudomonas sp. in the viscera and dorsum of a juvenile pirarucu Arapaima gigas (SCHINZ, 1822) detected through bacteriological analysis. In the fish production chain in the Western Amazon, pirarucu is one of the most prominent fish species because of its high zootechnical performance in terms of weight gain and commercial value. However, one of the biggest obstacles in its production chain occurs during the juvenile phase, with high mortality rates caused by mainly bacterial infections, leading to economic

O pirarucu (Arapaima gigas)é um dos peixes de maior interesse para piscicultura amazônica. No entanto, os conhecimentos sob os aspectos nutricional, zootécnico e microbiológico desse peixe ainda são escassos. Sobretudo, na fase juvenil, porque nessa fase ocorrem altas taxas de mortalidade porque são mais susceptíveis à desnutrição, dificuldades no treinamento alimentar, infestações por endo e ectoparasitas, que por sua vez, ocasionam imunossupressão, favorecendo infecções bacterianas secundárias que podem estar presentes em virtude de diversos fatores ambientais e estado imunológico dos peixes. São exemplos, variações bruscas de temperatura, acidez da água e poluição do ambiente aquático. A espécie Pseudomonas sp. estudada nesse trabalho faz parte do ecossistema aquático, sendo considerada como contaminante ou um invasor, porque infecta grande variedade de espécies aquáticas, inclusive o pirarucu. Diante do pressuposto, o objetivo do trabalho foi relatar o caso de detecção de Pseudomonas sp.em vísceras e dorso do pirarucu Arapaima gigas(SCHINZ, 1822) juvenil por meio de análise bacteriológica. Na cadeia produtiva do pescado na Amazônia Ocidental, o pirarucu é um dos peixes de destaque por ser uma espécie com alto desempenho zootécnico em ganho de peso e valor comercial. Porém, um dosmaiores empecilhos da cadeia produtiva se encontra na fase juvenil da espécie havendo altos índices de mortalidade ocasionados por infecções principalmente de origem bacteriana levando a percas econômicas a piscicultura. Neste estudo detectou-se Pseudomonas sp.em amostra de dorso e vísceras de pirarucu em uma piscicultura no município de Ouro Preto do Oeste, Rondônia, Brasil.(AU)

Toxoplasmosis hemorrágica en paciente VIH / Hemorrhagic toxoplasmosis in hiv patient

La Toxoplasmosis Cerebral es una neuroinfección oportunista frecuente en el paciente VIH, sin embargo, hay escasos reportes en el mundo en relación con la presentación hemorrágica de esta entidad por lo que se presenta el caso de un paciente varón de 44 años, cuya evolución clínica llevó a sospechar Toxoplasmosis Cerebral Hemorrágica precozmente, pero, pese al tratamiento oportuno finalmente fallece.

Cerebral toxoplasmosis is a frequent opportunistic neuro-infection in HIV patients. However, there are few reports worldwide of its hemorrhagic presentation, so we present the case of a 44 year old male patient whose clinical progress led to early suspicion of cerebral hemorrhagic toxoplasmosis. Despite timely treatment the case resulted in death.

Características sociodemográficas y clínicas de pacientes con diagnóstico nuevo de VIH / Sociodemographic and clinical characteristics of patients with new HIV diagnosis

Objetivo: Caracterizar de forma sociodemográfica y clínica pacientes con diagnóstico nuevo de VIH, que fueron hospitalizados en una Clínica Universitaria de alta complejidad entre el año 2010 - 2016. Materiales y métodos: Se realizó un estudio observacional, descriptico, de corte transversal por medio de revisión de historias clínicas, que incluyo pacientes ≥14 años, a quienes se les diagnosticó VIH durante la hospitalización y tuvieran al menos un conteo de linfocitos CD4. Resultados: La mediana para la edad fue 41 años (RIC 31 - 51), el 85,1% eran hombres. Los principales síntomas al ingreso fueron generales/sistémicos (70,2%). 99 pacientes (61,5%) tenían infecciones oportunistas siendo tuberculosis la más frecuente (34,3%). La mediana para el conteo de CD4 fue 88 células/mm3 RIC (27 - 327) y el 77% se clasificó como SIDA. 29 pacientes murieron (18%) encontrando como posible factor de riesgo tener conteo de CD4 fue 88 células/mm3 RIC (27 - 327) y el 77% se clasificó como SIDA. 29 pacientes murieron (18%) encontrando como posible factor de riesgo tener conteo de CD4<200 células/mm3 , no pertenecer al régimen contributivo, ingresar con síntomas respiratorios, tener diagnóstico de neumonía, criterios de falla multiorgánica o necesidad de UCI/UCE. Conclusión: Para nuestro caso la mayoría de pacientes con diagnóstico nuevo de VIH se encontraban en estados avanzados de inmunosupresión con alta carga de enfermedades definitorias de SIDA. Es importante fortalecer las políticas de salud pública para diagnosticar más temprano la infección por VIH.

Purposes: To characterize sociodemographic and clinical aspects in newly diagnosed HIV patients that were hospitalized at a university health center between 2010 - 2016. Methods: We made an observational descriptive cross - sectional study reviewing clinical records, including patients older than 14 years old, who were diagnosed with HIV infection during hospitalization and at least a CD4 count. Results: Median age at diagnosis was 41 years old (IQR 31 - 51), 85% were men. The main symptoms were general/systemic (70.2%). 99 patients (61.5%) had opportunist infections, being tuberculosis the most frequent (34.3%). The median CD4 were 88 cells/mm3 (IQR 27 - 327) and 77% were classified as AIDS. 29 patients died (18%), finding as a risk factor for mortality don't having a good health care insurance, low CD4 count, having respiratory symptoms, pneumonia diagnosis, multiple organic failure's criteria and ICU admission. Conclusion: In our case, the majority of patients with a new diagnosis of HIV were in advanced stages of immunosuppression with a high burden of AIDS defining diseases. It is important to strengthen public health policies to diagnose HIV infection earlier.

Aspectos clínicos e epidemiológicos da tuberculose em pacientes com HIV/aids / Clinical and epidemiological aspects of tuberculosis in patients with HIV/aids

RESUMO Objetivo: Avaliar aspectos clínicos e epidemiológicos da tuberculose em indivíduos HIV+ no estado de Alagoas. Métodos: Trata-se de estudo transversal e retrospectivo que analisou as notificações de coinfecção TB-HIV no período de 2001 a 2016 no estado de Alagoas, Brasil. Para elaboração de perfil da coinfecção foram empregadas variáveis clínicas e epidemiológicas dos casos novos de TB-HIV obtidas junto à Superintendência de Vigilância em Saúde do Estado de Alagoas. Resultados: Houve ascensão do número de coinfectados no período de 2001 a 2016. Os pacientes soropositivos residentes no Estado apresentaram-se como sendo a maioria do sexo masculino (74,2%), em idade economicamente produtiva (93,7%), com baixa escolaridade e de cor negra (92,5%). A tuberculose pulmonar foi a forma clínica mais presente (77,3%), seguida do subtipo extrapulmonar ganglionar periférico (7,5%). A estratégia diagnóstica mais elucidativa para o raciocínio clínico foi o exame radiográfico do tórax (72,5%). Houve óbito por tuberculose em 9,5% das investigações. O percentual de cura de casos novos de tuberculose em indivíduos HIV+ no estado de Alagoas ficou abaixo da meta de 85% pactuada pela OMS. Conclusão: Os resultados evidenciam a relevância epidemiológica da tuberculose como uma comorbidade de grande impacto na saúde dos indivíduos soropositivos para o HIV+ no âmbito estadual (AU)

ABSTRACT Objective: In this study, the objective was to evaluate the clinical and epidemiological aspects of tuberculosis in HIV+ individuals in the State of Alagoas. Methods: This was a cross-sectional and retrospective study that analyz-ed the reports of TB-HIV co-infection between 2001 and 2016 in the state of Alagoas, Brazil. To develop a profile of co-infection, clinical and epidemiological variables were used for new cases of HIV-TB obtained together with the Superintendence of Health Surveillance of the State of Alagoas. Results: There was a rise in the number of co-infected patients from 2001 to 2016. Seropositive patients living in the State were the majority male (74.2%), of economically productive age (93.7%), with low educational level and black (92.5%). Pulmonary tuberculosis was the most common clinical form (77.3%), followed by the peripheral ganglion extrapulmonary subtype (7.5%). The most diagnostic strategy for clinical reasoning was the radiographic examination of the thorax (72.5%). There was a TB death in 9.5% of the investigations. The percentage of cure of new cases of tuberculosis in HIV+ individuals in the state of Alagoas was below the 85% goal agreed by the WHO. Conclusion: The results evidenced the epide-miological relevance of tuberculosis as a comorbidity with a great impact on the health of seropositive individuals at the state level. (AU)

El controvertido complejo Burkholderia cepacia, un grupo de especies promotoras del crecimiento vegetal y patógenas de plantas, animales y humanos / The controversial Burkholderia cepacia complex, a group of plant growth promoting species and plant, animals and human pathogens

El complejo Burkholderia cepacia está formado por 22 especies conocidas como patógenos oportunistas en personas inmunocomprometidas, especialmente en aquellas con fibrosis quística. También se aíslan de infecciones nosocomiales y son difíciles de erradicar debido a su capacidad intrínseca para resistir una gran variedad de antibióticos. En general, estas especies presentan genomas de gran tamaño (hasta 9 Mpb) divididos en 2-5 replicones. Esta característica aporta una gran versatilidad metabólica, que se considera importante para habitar el suelo, el agua, las plantas, incluso los nódulos en leguminosas. Algunas especies del complejo B. cepacia exhiben actividades benéficas, como biorremediación, biocontrol y promoción del crecimiento vegetal. No obstante, debido a su papel en infecciones de humanos, su uso en la agricultura está restringido. El complejo B. cepacia es un tema constante de estudio debido a su impacto en el sector salud y su potencial en la agricultura. En este trabajo se examina la historia del complejo B. cepacia y se revisa la información reciente relacionada con este grupo de bacterias.

The Burkholderia cepacia complex is a group of 22 species, which are known as opportunistic pathogens in immunocompromised people, especially those suffering from cystic fibrosis. It is also found in nosocomial infections and is difficult to eradicate due to intrinsic resistance to several antibiotics. The species have large genomes (up to 9 Mbp), distributed into 2-5 replicons. These features significantly contribute to genome plasticity, which makes them thrive in different environments like soil, water, plants or even producing nodules in legume plants. Some B. cepacia complex species are beneficial in bioremediation, biocontrol and plant-growth promotion. However, because the B. cepacia complex is involved in human infection, its use in agriculture is restricted. B. cepacia complex is being constantly studied due to the health problems that it causes and because of its agricultural potential. In this review, the history of B. cepacia complex and the most recently published information related to this complex are revised.

[The controversial Burkholderia cepacia complex, a group of plant growth promoting species and plant, animals and human pathogens]. / El controvertido complejo Burkholderia cepacia, un grupo de especies promotoras del crecimiento vegetal y patógenas de plantas, animales y humanos.

The Burkholderia cepacia complex is a group of 22 species, which are known as opportunistic pathogens in immunocompromised people, especially those suffering from cystic fibrosis. It is also found in nosocomial infections and is difficult to eradicate due to intrinsic resistance to several antibiotics. The species have large genomes (up to 9 Mbp), distributed into 2-5 replicons. These features significantly contribute to genome plasticity, which makes them thrive in different environments like soil, water, plants or even producing nodules in legume plants. Some B. cepacia complex species are beneficial in bioremediation, biocontrol and plant-growth promotion. However, because the B. cepacia complex is involved in human infection, its use in agriculture is restricted. B. cepacia complex is being constantly studied due to the health problems that it causes and because of its agricultural potential. In this review, the history of B. cepacia complex and the most recently published information related to this complex are revised.

Estudio clínico y micológico de otomicosis en diabéticos: una serie de 17 casos / Clinical and mycological study of otomycosis in diabetics: series of 17 cases

RESUMEN Introducción: La otomicosis en pacientes inmunosuprimidos esta caracterizada por ser bilateral y ser causada por candida. Pocos estudios comparan las características micológicas encontradas en la microscopía directa y el cultivo. Objetivo: Identificar las características clínicas y micológicas de la otomicosis en pacientes diabéticos. Material y método: Estudio transversal en centro hospitalario de segundo nivel. Criterios de inclusión: pacientes diabéticos con diagnóstico clínico de otomicosis. Intervención: la muestra se examinó directamente bajo el microscopio y se cultivó. Resultados: Se incluyeron 17 pacientes, 10 mujeres y 7 hombres con una edad media de 47,5 años. Los síntomas predominantes fueron hipoacusia en 91,4% (n =16), prurito en 82,4% (n =14), otorrea en 76,5% (n=13)y otalgia en 70,6% (n =12). Afección bilateral se encontró en 47,1% (n =8). Estudio directo al microscopio mostró levaduras en 94,1% (n =16) y 5,9% mostró aspergillus (n =1). Cándida fue el género más comúnmente encontrado en los cultivos y en el examen directo microscópico con 94,1% (n =16) y Candida albicans la especie más común con 88,2% (n =15). Conclusión: Candida albicans es el agente etiológico más común en pacientes diabéticos con otomicosis. Su presentación clínica más frecuente es hipoacusia, prurito y otorrea. El examen directo identificó adecuadamente a los géneros fúngicos.

ABSTRACT Introduction: Otomycosis in immunocompromised patients is characterize by its bilateral course and the predominant etiologic agent is Candida. Few studies compare the mycological features between microscopic direct exam and culture. Aim: To identify the clinical and mycological characteristics of otomycosis in diabetic patients. Material and method: Transversal study. Secondary care center. Inclusion criteria: diabetic patients with clinical diagnosis of otomycosis. Intervention: Direct examination under a microscope of the ear sample and culture. Results: We included 17 patients, 10 women, 7 men with a mean age of 47.5 years. Symptoms were hearing loss 94.1% (n = 16), pruritus 82.4% (n =14) otorrhoea 76.5% (n =13) and otalgia 70.6% (n =12). Bilateral involvement was found in 47.1% (n =8). Direct microscopic study found 94.1% of yeast (n =16) and 5.9% of Aspergillus (n =1). Candida was the most common fungal genus in culture and microscopic exam with 94.1% (n =16) of cases and Candida albicans was the most common species in 88.2% (n =15) cases. Conclusion: Candida albicans is the most common etiologic agent in diabetic patients with otomycosis. Main symptoms were hearing loss, itching and otorrhea. Direct exam correctly identified the fungal genus.