Cellulitis in a Liver Transplant Patient as an Initial Manifestation of Disseminated Cryptococcal Disease.

A 50-year-old male underwent liver transplantation due to cryptogenic cirrhosis and was admitted with severe pain in the left leg as well as phlogosis. Amoxicillin/clavulanic acid was prescribed, assuming bullous erysipelas. Among the tests performed, the latex agglutination test for the Cryptococcus sp. antigen was positive, and in both the blood culture and blister culture Cryptococcus sp. was isolated. Daily fluconazole was started. Even though liposomal amphotericin B has been started on the fifth day of hospitalization, the patient progressed to death.

Low rates of sustained virologic response with peginterferon plus ribavirin for chronic hepatitis C virus infection in HIV infected patients in Rio de Janeiro, Brazil.

BACKGROUND: The standard treatment for chronic hepatitis C virus (HCV) infection in HIV-infected subjects is the combination of alfapeginterferon (PEG-IFN) plus ribavirin. We designed this study to evaluate the rate of SVR and predictors of SVR in a public health setting in Rio de Janeiro, Brazil. METHODS: Retrospective cohort study of HCV/HIV co-infected patients treated with PEG-IFN plus ribavirin from 2004 to 2011 in 3 outpatient units in Rio de Janeiro. Exposure variables included age, sex, CD4+ cell count, HCV genotype, HCV and HIV viral loads, liver histology (METAVIR fibrosis scoring system) and previous treatment. The main outcome measurement was SVR. RESULTS: 100 patients were included in this analysis. Median age was 47 years and 68% were male. 80%, 4%, 14% and 2% were infected with HCV genotypes 1, 2, 3 and 4, respectively. At baseline, 77% had HCV viral load greater than 800,000 IU/ml, 99% had CD4+ greater than 200 cells/mm(3) and 10% had a diagnosis of cirrhosis. The treatment was withdrawn in 9% of the subjects (5% with adverse effects and 4% dropped out). SVR was observed in 27 (27%) of the 100 patients included. 13 (13%) subjects were classified as null-responders, 33(33%) as non-responders, 9 (9%) as breakthrough and 9(9%) as relapsers. In the multivariate model only being infected with genotype 2 or 3 (p<0.01) and having low levels of gamma glutamyl transferase (GGT) at baseline (p = 0.04), were predictive of SVR. CONCLUSION: SVR in HCV/HIV co-infected subjects in a public health setting is similar to that observed in clinical trials, albeit very low. A delay in therapy initiation should be considered until new therapies as direct acting antiviral drugs (DAA) become widely available and tested in coinfected subjects.

Fatal spotted fever group rickettsiosis due to Rickettsia conorii conorii mimicking a hemorrhagic viral fever in a South African traveler in Brazil.

The authors present a fatal case of spotted fever group rickettsiosis (SFGR) caused by Rickettsia conorii conorii mimicking a hemorrhagic viral fever in a South African male on a business trip in Brazil. SFGR was confirmed by molecular and immunohistochemical analyses.