[Leukemoid reaction and fever after polyvalent polysaccharide pneumococcal vaccination]. / Reacção leucemóide e febre após vacinação anti-pneumocócica polissacarídica 23-valente.

Streptococcus pneumoniae is one of the leading causes of pneumonia and several other invasive diseases as well as upper respiratory tract infections. They are more prevalent and serious in elderly and in those with chronic diseases and with high morbidity and mortality. Invasive pneumococcal diseases can most effectively be prevented by vaccination. The vaccine is effective and safe, even after revaccination. Nevertheless, some adverse events can occur, the most frequent being local, mild and self-limited. Although unusual, serious systemic reactions can eventually have a great impact in the individual health. The authors report a clinical case of a 66 years old man who was vaccinated with polyvalent polysaccharide pneumococcal vaccine and who developed a serious local and systemic reaction, including leukemoid reaction and respiratory insufficiency. In this respect they make some comments regarding the value of this vaccine.

Ophthalmic manifestations in 18 patients with botulism diagnosed in Porto, Portugal between 1998 and 2003.

BACKGROUND: Botulism is a rare but potentially lethal disease in which ophthalmic signs and symptoms are among the very earliest manifestations. The aim of this study was to investigate the epidemiological and clinical features of botulism-infected patients admitted to a general hospital in Porto, Portugal. METHODS: We performed a retrospective chart review of all botulism patients admitted to São João Hospital between January 1998 and January 2003. We excerpted data on epidemiology, ophthalmic and non-ophthalmic manifestations, and treatment. RESULTS: We identified 18 patients in nine registered outbreaks. In two patients (11%), ophthalmic manifestations preceded systemic manifestations; in six patients (33%), ophthalmic and systemic manifestations occurred simultaneously; in ten patients (56%), systemic manifestations occurred first. Ophthalmologists had examined only seven patients and made the correct diagnosis in five. The most common ocular symptoms were blurred near vision (100%), blurred distant vision (94%), and diplopia (44%). Accommodation impairment was documented in all seven patients examined by ophthalmologists. CONCLUSIONS: Ophthalmic manifestations were among the earliest and most prominent manifestations of botulism in this series, as in earlier reports. The diagnosis should be suspected when impaired accommodation and gastrointestinal symptoms occur together.

Intrathecal baclofen for the treatment of tetanus.

Tetanus remains a serious problem in public health, particularly in developing countries, despite efficient prevention programs. A retrospective study was conducted at an infectious diseases intensive care unit during 1998-2003 involving patients admitted with grade III tetanus. The aim of the study was to evaluate the efficacy and safety of intrathecal baclofen for the treatment of tetanus. Lumbar puncture was performed, and a subarachnoid catheter was inserted for drug administration. An intrathecal bolus of baclofen was followed by a continuous infusion of 20 microg/h, until a maximum daily dose of 2 mg was provided. Twenty-two patients were treated overall. Control of the symptoms was achieved in all patients but one. Seven patients had colonization of the catheter, and 1 patient developed meningitis. All patients except one recovered. In our study, this means of treatment was efficacious and well tolerated.

[Cervical smear, viral load and t cell counting in seropositive HIV women]. / Alterações citológicas em mulheres seropositivas para o VIH. Relação com Carga Vírica e Linfócitos T CD4+

The aim of this study was to compare the T cell counting and viral load in seropositive women for HIV with normal cervical smear and intraepithelial lesions. 87 women were studied, 26 with normal smear, 46 with low grade intraepithelial lesions and 15 with high grade intraepithelial lesions. Women with normal smears showed the lowest viral load and high grade lesions the highest. There were no differences between cervical smear result and T cell counting.

Phylogenetic demonstration of two cases of perinatal human immunodeficiency virus type 2 infection diagnosed in adulthood.

HIV-2 infection was diagnosed in two patients 15 and 24 years of age and, thereafter, in their mothers. Epidemiological data suggested that vertical transmission was the most probable mode of infection in both patients (Mota-Miranda A, et al.: AIDS 2001;15:2460-2461). Phylogenetic analysis of env C2-C3 sequences from the patients and their mothers was used in an attempt to confirm or exclude the events of perinatal HIV-2 transmission. Sequences from each putative transmission pair formed monophyletic clusters in phylogenetic analysis, a clear indication of common ancestry. Interpatient nucleotide distances increased with the period of infection being consistent with long-term infection. In conclusion, the results are consistent with an epidemiological linkage between the viruses infecting each mother-child pair and support the occurrence of perinatal HIV-2 infection in both cases. Application of similar phylogeny methods to other suspected transmission cases may permit a better understanding of the epidemiology and molecular evolution of HIV-2.