Paracoccidioidomycosis due to Paracoccidioides brasiliensis S1 associated with acquired immunodeficiency syndrome: A case report / Paracoccidioidomicosis por Paracoccidioides brasiliensis S1 asociado al síndrome de inmunodeficiencia adquirida: A propósito de un caso

BACKGROUND: Paracoccidioidomycosis (PCM) is an endemic disease in Latin America. In immunocompetent hosts, PCM occurs in two main clinical forms: acute and chronic. However, in HIV-infected patients PCM may show up simultaneous manifestations of acute and chronic forms. CASE REPORT: We present the case of a patient diagnosed with HIV who had disseminated skin lesions and generalized lymphadenopathy, as well as respiratory and central nervous system involvement. The PCM diagnosis was confirmed by direct KOH examination, double immunodiffusion and the isolation of the fungus in samples of an abscess in the subcostal region. The isolate was identified as Paracoccidioides brasiliensis S1 by species-specific PCR using primers for protein-coding gene GP43 (exon 2) followed by PCR-RFLP of the alpha-tubulin gene. CONCLUSIONS: There are few data in literature reporting species-specific molecular identification of Paracoccidioides in HIV/PCM patients. Therefore, this case report may contribute to improve the knowledge about this severe disease, its causative cryptic species, and its consequences to patients

ANTECEDENTES: La paracoccidioidomicosis (PCM) es una enfermedad endémica en Latinoamérica. En los pacientes inmunocompetentes, la PCM cursa con dos principales formas: aguda y crónica. Sin embargo, los pacientes infectados por el VIH pueden presentar manifestaciones simultáneas de las dos formas clínicas. CASO CLÍNICO: Se presenta el caso de un paciente VIH-positivo, con lesiones cutáneas diseminadas, linfadenopatía generalizada y afectación del sistema nervioso central y respiratorio. El diagnóstico de PCM se confirmó mediante un examen directo con KOH, doble inmunodifusión y el aislamiento del hongo en cultivo, a partir de muestras de un absceso en la región subcostal. La cepa aislada se identificó como Paracoccidioides brasiliensis S1 mediante PCR especie-específica del gen codificador de la proteína GP43 (exón 2), seguida de PCR-RFLP del gen de la alfa-tubulina. CONCLUSIONES: Existen pocos datos en la literatura que describan la identificación molecular especie-específica de Paracoccidioides en pacientes con VIH/PCM. Por lo tanto, la presentación de este caso clínico puede contribuir a mejorar el conocimiento sobre esta enfermedad grave, la especie críptica implicada y sus consecuencias para los pacientes

[First description of human bronchial syngamosis in the State of Espírito Santo]. / Primeira descrição de singamose brônquica ocorrida no Estado do Espírito Santo.

We report the case of a 48-year-old man who presented progressive dry cough associated with chest pain over a four-month period. After ruling out the most probable etiologies, bronchofibroscopy was performed and showed a pair of Syngamus laringeus inside the left upper lobe bronchus. The patient became asymptomatic after the nematodes had been removed.

Primeira descrição de singamose brônquica ocorrida no Estado do Espírito Santo / First description of human bronchial syngamosis in the State of Espírito Santo

Relatamos o caso de um homem de 48 anos, que evoluiu durante 4 meses com quadro de tosse seca associada à dor torácica. Após serem descartadas as etiologias mais prováveis, realizou-se uma broncofibroscopia que revelou a presença de um casal de Syngamus laringeus no brônquio do lobo superior esquerdo. O paciente tornou-se assintomático após a retirada do nematóide.

We report the case of a 48-year-old man who presented progressive dry cough associated with chest pain over a four-month period. After ruling out the most probable etiologies, bronchofibroscopy was performed and showed a pair of Syngamus laringeus inside the left upper lobe bronchus. The patient became asymptomatic after the nematodes had been removed.

Disseminated histoplasmosis in HIV positive patients in Espírito Santo state, Brazil: a clinical-laboratory study of 12 cases (1999-2001)

Twelve cases of histoplasmosis in HIV-infected patients were found in a retrospective analysis at the Hospital Universitário Cassiano Antônio de Moraes of the Universidade Federal do Espírito Santo (HUCAM), Vitória (ES), from June 1999 to May 2001. The frequency of histoplasmosis among HIV-positive patients was 2.1 percent in the infectious diseases division of the hospital during this period. Histoplasmosis compromised mainly males (11/12), 27 to 44 years old, and residents of the metropolitan urban area (10/12). Alcohol abuse and tobacco smoking were described in 10 of the 12 patients. For all patients, this was the first opportunistic infection. Two of the 12 patients died; 10 patients had disseminated disease, one patient had an intestinal presentation and one had disease restricted to the lungs. The most frequent clinical manifestations were weight loss, fever, hepatomegaly and splenomegaly, coughing, abdominal pain, and diarrhea. Six of the 12 patients had skin lesions. Time of symptoms preceding the diagnosis varied from two months to one year. CD4 counts were below 200 cells/mm³ in 9 of 10 patients. Diagnosis was made by histology in two thirds of the patients. The typical adult patient with HIV infection and histoplasmosis in our series was male, had a CD4 count below 200 cells/mm³, had fever, weight loss, cough, abdominal pain and hepatomegaly in the last two months or more, had a high probability of alcohol and tobacco addiction, was having his first opportunistic infection, and had no identifiable environmental exposure risk.