RESUMO
Fever and a petechial rash are strongly associated with meningococcal disease in the city of Rio de Janeiro. Early antibiotic therapy is indicated and, consequently, a reduction of confirmed cases by culture, Gram stain, and latex agglutination test is expected. We evaluated a multiplex PCR assay to identify Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae in biological samples from cases of non-culture proven meningitis with a petechial rash at presentation. To detect DNA in cerebrospinal fluid (n = 71) or blood (n = 5), a PCR screen was performed, based on the crgA, ply and bexA targets, respectively. Of the total, 70 CSF and 3 blood samples (96%) were positive by PCR for the presence of N. meningitidis DNA. Another PCR assay predicted in 82% of these samples N. meningitidis serogroups A (2%), B (60%), C (7%), X (3%), Y (2%), 29E (2%) or W135 (24%). In non-culture proven meningitis, PCR was found to be a valuable adjunct for the demonstration of meningococcal aetiology.
Assuntos
DNA Bacteriano/análise , Meningite Meningocócica/líquido cefalorraquidiano , Meningite Meningocócica/epidemiologia , Reação em Cadeia da Polimerase/métodos , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Haemophilus influenzae/genética , Humanos , Lactente , Masculino , Meningite Meningocócica/microbiologia , Pessoa de Meia-Idade , Neisseria meningitidis/genética , Sorotipagem/métodos , Streptococcus pneumoniae/genéticaRESUMO
This report describes a case of Toxoplasma encephalitis during pregnancy of an HIV infected woman who was severely immunosuppressed (CD(4): 17 cells/mm3), had a high viral load (RNA PCR:230,000 copies/ml), was treated with sulfadiazine, pyrimethamine and folinic acid for toxoplasmosis and was being treated with highly potent antiretroviral drugs (AZT, 3TC and nelfinavir) for HIV infection. The newborn was born through an elective C-section, received six weeks of AZT according to the 076 protocol and was clinically normal at birth. Subsequently he had two RNA PCR negatives for HIV, seroreverted and had no clinical or laboratory evidence of congenital toxoplasmosis. Despite the concerns of the use of these combined therapies on the foetus during pregnancy, their efficacy illustrates that keeping the mother alive and in good health is an important strategy to protect the unborn child from acquiring these two infections.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Infecções por HIV/complicações , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas , Toxoplasmose Cerebral/complicações , Toxoplasmose Cerebral/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/transmissão , Adulto , Animais , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Feminino , HIV/isolamento & purificação , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/tratamento farmacológico , Doenças do Recém-Nascido/parasitologia , Doenças do Recém-Nascido/virologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/parasitologia , Complicações Infecciosas na Gravidez/virologia , Toxoplasma/isolamento & purificação , Toxoplasmose Cerebral/transmissão , Resultado do Tratamento , Carga ViralRESUMO
This report describes a case of Toxoplasma encephalitis during pregnancy of an HIV infected woman who was severely immunosuppressed (CD(4): 17 cells/mm3), had a high viral load (RNA PCR:230,000 copies/ml), was treated with sulfadiazine, pyrimethamine and folinic acid for toxoplasmosis and was being treated with highly potent antiretroviral drugs (AZT, 3TC and nelfinavir) for HIV infection. The newborn was born through an elective C-section, received six weeks of AZT according to the 076 protocol and was clinically normal at birth. Subsequently he had two RNA PCR negatives for HIV, seroreverted and had no clinical or laboratory evidence of congenital toxoplasmosis. Despite the concerns of the use of these combined therapies on the foetus during pregnancy, their efficacy illustrates that keeping the mother alive and in good health is an important strategy to protect the unborn child from acquiring these two infections.
