Intramedullary histoplasmosis lesion in children: A case report.

Background: Histoplasmosis is a fungal disease endemic in some regions of the United States of America, Canada, and Latin America. The geographic characteristics, humidity, soil, and climate are responsible for such distribution. In Brazil, there are case reports of histoplasmosis throughout its territory, being considered an endemic region. It is considered an opportunistic disease, affecting mostly immunocompromised patients. To the present date, scientific publications dealing with pediatric cases of histoplasmosis are restricted to case series. Spinal cord injuries caused by histoplasmosis are rare, even in the adult population, being described in few studies. Case Description: The present report deals with a 4-year-old patient, from the southeast region of Brazil, who started a condition of fever, weight loss, cervicobrachialgia, and symmetrical tetraparesis, with evolution over 2 months. In the diagnostic investigation, she was found to have primary immunodeficiency and neuroimaging examinations showed a cervical spinal cord lesion at the level of C4-C6. The anatomopathological diagnosis of histoplasmosis was possible after surgery for decompression and biopsy of the lesion. Conclusion: According to our research, there are no reports in the literature that address the situation of spinal cord compression syndrome due to histoplasmosis in the pediatric population.

Unusual manifestations of visceral leishmaniasis in children: a case series and its spatial dispersion in the western region of São Paulo state, Brazil.

BACKGROUND: Visceral leishmaniasis (VL) is becoming endemic in São Paulo state, in the southeastern region of Brazil. Unusual manifestations with non-specific signs and symptoms may make diagnosis difficult and delay treatment, increasing the risk of severity and death, particularly in new endemic areas. There are few studies on patients with these characteristics in Brazil. We describe a case series of unusual manifestations of VL in children and its spatial dispersion in the western region of São Paulo state. CASES PRESENTATION: From 2009 to 2014, five clinical cases involving children treated in the Regional Hospital of Presidente Prudente (RH) were selected. Two patients had multiple relapses requiring liposomal amphotericin B; one patient had VL-cytomegalovirus-dengue co-infection and liver injury; one patient was diagnosed with X-linked agammaglobulinemia, a primary immunodeficiency; and one patient was diagnosed with VL-human immunodeficiency virus/acquired immunodeficiency syndrome (VL-HIV/AIDS) co-infection. Primary or secondary immunodeficiencies were found in four children, and associated viral infections were found in three children. Three patients were referred from other hospitals to RH. With regard to the geographic spread of VL, more cases were found in the northern area, in the epicenter of the infection where the first cases were registered, flowing south; a spatial-temporal occurrence was found. CONCLUSIONS: Primary and secondary immunodeficiencies and viral co-infectious should be considered among unusual manifestations of VL, especially in those with multiple relapses. Spatial-temporal occurrence was found. Thus, integrated actions and effective monitoring of the disease are needed to complement curative practices to stem the tide of the epidemic.

HIV-1-mother-to-child transmission and associated characteristics in a public maternity unit in Presidente Prudente, Brazil.

In children, vertical transmission is the main form of HIV infection. Our aim was to determine the prevalence of HIV-1 vertical transmission in mother-infant pairs in a public maternity ward in Presidente Prudente, SP. Additionally; we sought to identify characteristics associated with this form of transmission. The files of 86 HIV-1-infected mothers and their newborns referred to a Public Hospital from March 2002 to March 2007 were analyzed. The HIV-1-RNA viral load of the newborns was determined by bDNA. The HIV-1 vertical-transmission rate was 4.6%. Children that were born in the pre-term period and breastfed were at a higher risk of HIV-1 infection (p = 0.005 and p = 0.017 respectively) than children born at term and not breastfed. Prophylactic therapy with zidovudine after birth for newborns was associated with a lower risk of infection (p = 0.003). The number of newborns weighing < 2,500 g was significantly higher for infected children (p = 0.008) than for non-infected newborns. About 22.9% of mothers did not know the HIV-1 status of their newborns eight months after delivery. The study suggests that it is necessary to increase the identification of HIV-1 infection in pregnant women and their newborns as well as to offer and explain the benefits of ARV prophylaxis.

HIV-1-mother-to-child transmission and associated characteristics in a public maternity unit in Presidente Prudente, Brazil / Transmissão vertical do HIV e características associadas em maternidade pública em Presidente Prudente, Brasil

In children, vertical transmission is the main form of HIV infection. Our aim was to determine the prevalence of HIV-1 vertical transmission in mother-infant pairs in a public maternity ward in Presidente Prudente, SP. Additionally; we sought to identify characteristics associated with this form of transmission. The files of 86 HIV-1-infected mothers and their newborns referred to a Public Hospital from March 2002 to March 2007 were analyzed. The HIV-1-RNA viral load of the newborns was determined by bDNA. The HIV-1 vertical-transmission rate was 4.6 percent. Children that were born in the pre-term period and breastfed were at a higher risk of HIV-1 infection (p = 0.005 and p = 0.017 respectively) than children born at term and not breastfed. Prophylactic therapy with zidovudine after birth for newborns was associated with a lower risk of infection (p = 0.003). The number of newborns weighing < 2,500 g was significantly higher for infected children (p = 0.008) than for non-infected newborns. About 22.9 percent of mothers did not know the HIV-1 status of their newborns eight months after delivery. The study suggests that it is necessary to increase the identification of HIV-1 infection in pregnant women and their newborns as well as to offer and explain the benefits of ARV prophylaxis.

A transmissão vertical é a principal forma de infecção pelo HIV em crianças. Nosso objetivo foi determinar a prevalência da transmissão vertical do HIV em maternidade pública em Presidente Prudente, SP. Além disso, procuramos identificar características associadas a essa forma de transmissão. De março de 2002 a março de 2007, os prontuários de 86 mães HIV-1 positivo e seus bebês, nascidos na maternidade de Hospital Público foram analisadas. A carga viral do HIV-1-RNA dos recém-nascidos foi determinada por bDNA. A prevalência da transmissão vertical pelo HIV-1 foi de 4,6 por cento. Crianças nascidas a pré-termo e amamentadas tiveram um risco maior de infecção (p = 0,005 e p = 0,017, respectivamente), comparado com crianças nascidas a termo e não amamentadas. A profilaxia com zidovudina depois do nascimento para os recém-nascidos foi associada ao menor risco de infecção (p = 0,003). O número de recém-nascidos com peso < 2.500 g foi maior entre as crianças infectadas (p = 0,008), comparado com crianças não infectadas. Oito meses depois do parto 22,9 por cento das mães não tinham conhecimento da infecção de seus bebês pelo HIV. O presente estudo sugere a necessidade em aumentar a identificação do HIV em gestantes e seus bebês e explicar e oferecer os benefícios da profilaxia antiretroviral.

Vertical transmission of HIV-1 in the western region of the State of São Paulo.

INTRODUCTION: This study aimed to determine the prevalence of vertical HIV-1 transmission in the western region of the State of São Paulo, Brazil. METHODS: The study analyzed the medical records of HIV-1-infected mothers and infant pairs living in the municipalities of São Paulo Regional Health Departments DRS II (Araçatuba) and DRS XI (Presidente Prudente). From March 2001 to March 2006, blood samples were collected and referred to the Molecular Biology Unit of the Adolfo Lutz Institute (ALI), Presidente Prudente. HIV-1-RNA viral load was determined by bDNA assay. RESULTS: The number of births (109/217, 50.2%) and vertical HIV-1 transmissions (6/109, 5.5%) that occurred in DRS II was similar to births (108/217, 49.8%) and vertical transmissions (7/108, 6.5%) in DRS XI (p > 0.05). Although 80% (4/5) of the infected children were male in DRS II, while in DRS XI, 75% (6/8) were female, no differences between sex regarding infected and noninfected children in the regions of Araçatuba and Presidente Prudente were verified. The overall vertical HIV-1 transmission rate was 6%. No consistent reduction in the prevalence of vertical HIV-1 transmission occurred over the years. About 20% of mothers did not know the HIV-1 status of their newborns eight months after delivery. CONCLUSIONS: In the present study, MTCT prevalence rates were about 70% higher than those previously determined in the State of São Paulo, with noreduction throughout the period.Furthermore, a significant number of mothers did not know the HIV-status of their newborns eight months after delivery.

Vertical transmission of HIV-1 in the western region of the State of São Paulo / Transmissão vertical do HIV-1 na região oeste do Estado de São Paulo

INTRODUCTION: This study aimed to determine the prevalence of vertical HIV-1 transmission in the western region of the State of São Paulo, Brazil. METHODS: The study analyzed the medical records of HIV-1-infected mothers and infant pairs living in the municipalities of São Paulo Regional Health Departments DRS II (Araçatuba) and DRS XI (Presidente Prudente). From March 2001 to March 2006, blood samples were collected and referred to the Molecular Biology Unit of the Adolfo Lutz Institute (ALI), Presidente Prudente. HIV-1-RNA viral load was determined by bDNA assay. RESULTS: The number of births (109/217, 50.2 percent) and vertical HIV-1 transmissions (6/109, 5.5 percent) that occurred in DRS II was similar to births (108/217, 49.8 percent) and vertical transmissions (7/108, 6.5 percent) in DRS XI (p > 0.05). Although 80 percent (4/5) of the infected children were male in DRS II, while in DRS XI, 75 percent (6/8) were female, no differences between sex regarding infected and noninfected children in the regions of Araçatuba and Presidente Prudente were verified. The overall vertical HIV-1 transmission rate was 6 percent. No consistent reduction in the prevalence of vertical HIV-1 transmission occurred over the years. About 20 percent of mothers did not know the HIV-1 status of their newborns eight months after delivery. CONCLUSIONS: In the present study, MTCT prevalence rates were about 70 percent higher than those previously determined in the State of São Paulo, with noreduction throughout the period.Furthermore, a significant number of mothers did not know the HIV-status of their newborns eight months after delivery.

INTRODUÇÃO: O objetivo desse estudo foi determinar a prevalência da transmissão vertical do HIV-1 na região oeste do Estado de São Paulo, Brasil. MÉTODOS: Foram analisadas as fichas de mães infectadas pelo HIV-1 e recém-nascidos, residindo em municípios das Delegacias Regionais de Saúde (DRS II, Araçatuba) e (DRS XI, Presidente Prudente). Entre março de 2001 e março de 2006 as amostras foram colhidas e enviadas ao Instituto Adolfo Lutz, Presidente Prudente. A carga viral do RNA-HIV-1 foi determinada por bDNA. RESULTADOS: O número de nascimentos, 50,2 por cento (109/217) e a transmissão vertical do HIV-1, 5,5 por cento (6/109) ocorrido na DRS II foi semelhante aos nascimentos, 49,8 por cento (108/217) e a transmissão vertical, 6,5 por cento (7/108) ocorrido na DRS XI, respectivamente. Embora na DRS II, 80 por cento (4/5) das crianças infectadas fossem meninos e na DRS XI, 75 por cento (6/8) meninas, não houve diferença entre sexo em crianças infectadas ou não nas regiões de Presidente Prudente e Araçatuba. A taxa de transmissão vertical para o HIV-1 foi de 6 por cento.Não houve diminuição da taxa de infecção ao longo dos anos. Cerca de 20 por cento das mães não haviam feito exame para HIV-1 de seus filhos oito meses após o nascimento. CONCLUSÕES: A transmissão vertical para HIV-1 foi cerca de 70 por cento maior que a encontrada anteriormente no Estado de São Paulo, sem diminuição ao longo do período. Além disso, um número expressivo de mães não realizou exame de seus filhos oito meses após o nascimento.