As condições clínicas de mulheres com diabetes tipo 2: avaliando para prevenir agravos / The clinical conditions of women with type 2 Diabetes: evaluating to prevent worsening / Lascondiciones clínicas de las mujeres con Diabetes Tipo 2: evaluación para prevenir empeoramientos

Introdução:O diabetes mellitus é uma doença metabólica caracterizada pelo controle inadequado dos níveis de glicose no sangue, principalmente um estado crônico de hiperglicemia, causado por diferentes processos patogênicos, levando a complicaçõesdosistema nervoso do diabético queincluem axonopatias, doenças neurodegenerativas, doenças neurovasculares e comprometimento cognitivo geral.Objetivo:Avaliar as complicações clínicas da diabetes tipo 2 em mulheres. Metodologia:Tratou-se de um transversal, do tipo prevalência. Foram usados dois grupos de mulheres, onde todas as mulheres estavam com diagnóstico de diabetes Tipo 2 e idade de 40 e 60 anos, comotratamentooral -G1e com tratamentocominsulinoterapia ­G2,ambosfornecidospelarede pública Para comparação das variáveis estudadas foi utilizado o método de Mann-Whitney, adotando-se o nível de significância menor que 5% (p, valor ,0,05). Resultados:Aproporçãode pessoas com diabetes no Piauí, com consulta e hemoglobina glicada solicitada no primeiro quadrimestre de 2021, 2022, 2023, foi de18, 16 e 34 percentuais,respectivamenteeem Boa Hora nos mesmos quadrimestres foi 36, 39, 56 percentuais, respectivamente.Osprocedimentoshospitalares-por local de residência -Piauí foi de um total de 1.193e em Boa Hora 24. O grupo de mulheres estudadas mostrou uma diferença significativa para a glicemia em jejum e a Hemoglobina glicada quando comparados os grupos G1 e G2. Quase 100% da amostra estava obesa (IMC > 25), não fumava e não praticava atividade física.Conclusões:Concluiu-se que a as pacientes tiveram um agravamento do adoecimento ao longo dos anos com aumento de medicação. A ausência das boas práticas de promoção de saúde, atividade física e alimentação, podem ter contribuídocom o agravamento. Outrossim há necessidade urgente de uma intervenção para mudança de hábitos na população para que a medicalização seja diminuída para a promoção da saúde (AU).

Introduction: Diabetes mellitus is a metabolic disease characterized by inadequate control of blood glucose levels, mainly a chronic state of hyperglycemia, caused by different pathogenic processes, leading to complications of the nervous system including axonopathies, neurodegenerative diseases,neurovascular diseases and general cognitive impairment.Objective: To evaluate the clinical complications of type 2 diabetes in women.Methodology: This was a cross-sectional, prevalence study.Two groupsof women were used, where all women were diagnosed with Type 2 diabetes and aged between 40 and 60 years, with oral treatment -G1 and treatment with insulin therapy -G2, both provided by the public network .To compare the variables studied, the Mann-Whitney method was used, adopting a significance level of less than 5% (p, value 0.05).Results:The proportion of people with diabetes in Piauí, with consultation and glycated hemoglobin requested in the first four months of 2021, 2022, 2023, was 18, 16 and34 percentages, respectively and in Boa Hora in the same four months it was 36, 39, 56percentages, respectively.SUS hospital procedures -by place of residence -Piauí was a total of 1,193 and in Boa Hora 24. The group of women studied showed a significant difference in fasting blood glucose and glycated hemoglobin when comparing groups G1 and G2.Almost 100% of the sample was obese (BMI > 25), did not smoke and did not practice physical activity.Conclusions: It was concluded that the patients' illness worsened over the years with increased medication.The absence of good health promotion practices, physical activity and nutrition may have contributed to the worsening.Furthermore, there is an urgent need for intervention to change habits in the population so that medicalization is reduced to promote health (AU).

Introducción: La diabetes mellitus ecaracterizada por un control inadecuado de los niveles de glucosa en sangre, principalmente un estado crónico de hiperglucemia, causado por diferentes procesos patogénicos, derivando en complicaciones del sistema nervioso incluyendo axonopatías, enfermedades neurodegenerativas, enfermedades neurovasculares y deterioro cognitivo general.Objetivo: Evaluar las complicaciones clínicas de la diabetes tipo 2 en mujeres.Metodología: Se trata de un estudio transversal de prevalencia.Se utilizaron dos grupos de mujeres, donde todas fueron diagnosticadas con diabetes tipo 2 y con edades entre 40 y 60 años, con tratamiento oral -G1 y tratamiento con insulinoterapia -G2, ambos prestados por la red pública.Para comparar las variables estudiadas se utilizó el método de Mann-Whitney, adoptando un nivel de significancia inferior al 5% (p, valor 0,05).Resultados:La proporción de personas con diabetes en Piauí, con consulta y hemoglobina glucosilada solicitada en los primeros cuatro meses de 2021, 2022, 2023, fuede 18, 16 y 34 porcentajes, respectivamente y en Boa Hora en los mismos cuatro meses fue de 36 , 39, 56 porcentajes, respectivamente.Los procedimientos hospitalarios del SUS -por lugar de residencia -en Piauí fueron en total 1.193 y en Boa Hora 24. El grupo de mujeres estudiado presentó diferencia significativa en la glucemia en ayunas y en la hemoglobina glucosilada al comparar los grupos G1 y G2.Casi el 100% de la muestra era obesa (IMC > 25), no fumaba y no practicaba actividad física.Conclusiones:Se concluyó que la enfermedad de los pacientes empeoró con el paso de los años con el aumento de la medicación.La ausencia de buenas prácticas de promoción de la salud, actividad física y nutrición puede haber contribuido al empeoramiento.Además, es urgente intervenir para cambiar los hábitos de la población para promover la salud (AU).

Epidemiological, clinical, and genomic landscape of coccidioidomycosis in northeastern Brazil.

Coccidioidomycosis, listed as a priority mycosis by the WHO, is endemic in the United States but often overlooked in Central and South America. Employing a multi-institutional approach, we investigate how disease characteristics, pathogen genetic variation, and environmental factors impact coccidioidomycosis epidemiology and outcomes in South America. We identified 292 cases (1978-2021) and 42 outbreaks in Piauí and Maranhão states, Brazil, the largest series outside the US/Mexico epidemic zone. The male-to-female ratio was 57.4:1 and the most common activity was armadillo hunting (91.1%) 4 to 30 days before symptom onset. Most patients (92.8%) exhibited typical acute pulmonary disease, with cough (93%), fever (90%), and chest pain (77%) as predominant symptoms. The case fatality rate was 8%. Our negative binomial regression model indicates that reduced precipitation levels in the current (p = 0.015) and preceding year (p = 0.001) predict heightened incidence. Unlike other hotspots, acidic soil characterizes this region. Brazilian strains differ genomically from other C. posadasii lineages. Northeastern Brazil presents a distinctive coccidioidomycosis profile, with armadillo hunters facing elevated risks. Low annual rainfall emerges as a key factor in increasing cases. A unique C. posadasii lineage in Brazil suggests potential differences in environmental, virulence, and/or pathogenesis traits compared to other Coccidioides genotypes.

The spleen is the graveyard of CD4+ cells in patients with immunological failure of visceral leishmaniasis and AIDS.

BACKGROUND: Visceral leishmaniasis (VL), or kala-azar, is a common comorbidity in patients with AIDS in endemic areas. Many patients continue to experiences relapses of VL despite virological control, but with immunological failure. These patients remain chronically symptomatic with hypersplenism, for example with anemia, leukopenia, and thrombocytopenia, and are at risk of severe co-infection due to low CD4+ count. Therefore, in this study, splenectomized patients with VL and HIV infection were investigated to understand why the CD4+ count fails to recover in these patients, evaluating the importance of spleen mass for hypersplenism and immunological failure. METHODS: From a retrospective open cohort of 13 patients who had previously undergone splenectomy as salvage therapy for relapsing VL, 11 patients with HIV infection were investigated. This study compared the patients' complete blood cell count (CBC) and CD4+ and CD8+ cell counts before and after splenectomy with respect to spleen weight. RESULTS: CBC was substantially improved after splenectomy, indicating hypersplenism. However, to the best of our knowledge, this is the first study to show that spleen mass is strongly and negatively correlated with CD4+ cell count (ρ = -0.71, P = 0.015). CONCLUSIONS: This finding was unexpected, as the spleen is the most extensive lymphoid tissue and T-lymphocyte source. After reviewing the literature and reasoning, we hypothesized that the immunological failure was secondary to CD4+ loss initially by apoptosis in the spleen induced by productive HIV infection and, subsequently, by pyroptosis sustained by parasitic infection in spleen macrophages.

Primary Health Care professionals' knowledge about initial care for burn victims.

OBJECTIVES: to assess Primary Health Care physicians and nurses' knowledge about initial care for burn patients. METHODS: a descriptive cross-sectional survey of 71 professionals between February 19 and March 30, 2018. A validated questionnaire was used to assess knowledge through the correct answers obtained in the tool; Mann-Whitney test to compare professionals' level of knowledge; and logistic regression to investigate the association with other variables. RESULTS: there was an overall wrong answer rate of 40.27% in a tool applied to the subject in relation to physicians and 45.59% of nurses, with no statistically significant difference among them (p=0.27). There was a positive association between level of knowledge and length of practice in Primary Health Care (p=0.043). 29.19% of physicians and 14.89% of nurses knew the Ministry of Health's flowchart for initial care for burn victims. CONCLUSIONS: professionals had a low level of knowledge associated with their time in Primary Health Care.

Recurrent kala-azar: report of two cured cases after total splenectomy.

In Latin America, the causative agent of kala-azar is the intracellular protozoan Leishmania infantum. Most cases in South America are reported in Brazil. Worldwide, it mainly affects Bangladesh, Ethiopia, India, South Sudan and Sudan. Despite the high morbidity and lethality of kala-azar, most infections are asymptomatic. However, a small portion of patients evolves with recurrence of kala-azar becoming symptomatic even after all available drug treatments. Kala-azar is not a formal indication for splenectomy in adults. Splenectomy is recommended as a saving measure, when kala-azar is associated with symptomatic hypersplenism and for drug-resistant cases. In the study, we report two cases of kala-azar with splenomegaly that presented several hospitalizations due to the recurrence of the kala-azar, in addition to hospitalizations for normalizing the blood count. After splenectomy, kala-azar cases and the effects of hypersplenism are cured. Thus, splenectomy should be seen as a surgical treatment option with a curative purpose in patients with recurrent kala-azar, in whom the possibilities of drug therapy have been exhausted and even so they progressed with hypersplenism and clinical repercussions.

Primary Health Care professionals' knowledge about initial care for burn victims / Conocimiento de los profesionales de la Atención Primaria de Salud sobre la atención inicial al quemado / Conhecimento dos profissionais da Atenção Primária à Saúde sobre o atendimento inicial ao queimado

ABSTRACT Objectives: to assess Primary Health Care physicians and nurses' knowledge about initial care for burn patients. Methods: a descriptive cross-sectional survey of 71 professionals between February 19 and March 30, 2018. A validated questionnaire was used to assess knowledge through the correct answers obtained in the tool; Mann-Whitney test to compare professionals' level of knowledge; and logistic regression to investigate the association with other variables. Results: there was an overall wrong answer rate of 40.27% in a tool applied to the subject in relation to physicians and 45.59% of nurses, with no statistically significant difference among them (p=0.27). There was a positive association between level of knowledge and length of practice in Primary Health Care (p=0.043). 29.19% of physicians and 14.89% of nurses knew the Ministry of Health's flowchart for initial care for burn victims. Conclusions: professionals had a low level of knowledge associated with their time in Primary Health Care.

RESUMEN Objetivos: evaluar el conocimiento de médicos y enfermeros de la Atención Primaria de Salud sobre atención inicial al paciente quemado. Métodos: investigación descriptiva, transversal con 71 profesionales en el período entre 19 de febrero y 30 de marzo de 2018. Se utilizó un cuestionario validado para evaluar el conocimiento por medio de los aciertos obtenidos en el instrumento y la prueba de Mann-Whitney para comparar el nivel de conocimiento de los profesionales y regresión logística para investigar la asociación con las demás variables. Resultados: se observó índice general de errores en el instrumento aplicado sobre el tema del 40,27% en relación a los médicos y el 45,59% de los enfermeros, sin haber diferencia estadísticamente significativa entre ellos (p=0,27). Se verificó asociación positiva entre nivel de conocimiento y tiempo de actuación en la Atención Primaria de Salud (p=0,043). El 29,19% de los médicos y el 14,89% de los enfermeros conocían el diagrama de flujo para atención inicial al quemado del Ministerio de Salud. Conclusiones: Los profesionales presentaron bajo nivel de conocimiento y éste se mostró asociado al tiempo de actuación en la Atención Primaria de Salud.

RESUMO Objetivos: avaliar o conhecimento de médicos e enfermeiros da Atenção Primária à Saúde sobre atendimento inicial ao paciente queimado. Métodos: pesquisa descritiva, transversal com 71 profissionais, entre 19 de fevereiro e 30 de março de 2018. Utilizou-se questionário validado para avaliar o conhecimento por meio dos acertos obtidos no instrumento; teste de Mann-Whitney para comparar o nível de conhecimento dos profissionais; regressão logística para investigar a associação com as demais variáveis. Resultados: observou-se índice geral de erros no instrumento aplicado sobre o tema de 40,27% em relação aos médicos e 45,59% dos enfermeiros, sem haver diferença estatisticamente significante entre eles (p=0,27). Verificou-se associação positiva entre nível de conhecimento e tempo de atuação na Atenção Primária à Saúde (p=0,043). 29,19% dos médicos e 14,89% dos enfermeiros conheciam o fluxograma para atendimento inicial ao queimado do Ministério da Saúde. Conclusões: os profissionais apresentaram baixo nível de conhecimento associado ao tempo de atuação na Atenção Primária à Saúde.

Proposal for a simplified approach to suspected meningitis case diagnosis: experience report of a reference service in the state of Piauí, Brazil, 2007-2016. / Proposta de abordagem simplificada para suspeitas de meningites: relato de experiência de serviço de referência no estado do Piauí, 2007-2016.

OBJECTIVE: to describe a simplified protocol to diagnose suspected cases of meningitis. METHODS: this is an experience report on the approach to diagnosing meningitis at the Tropical Diseases Reference Service in the state of Piauí, Brazil, between 2007 and 2016; information was extracted from the Notifiable Diseases Information System (SINAN) and the laboratory record book; the chi-square test was used to compare epidemiological surveillance indicators based on final meningitis case classification; the Phi coefficient was used to verify the correlation between presumed diagnosis and laboratory-confirmed diagnosis. RESULTS: considering the 4,096 cases of meningitis investigated, there was a reduction in the generic classification of meningitis cases from 72% to 47% (p<0.001); indicated laboratory investigation profile showed agreement with final meningitis case diagnosis. (rf=0.66; p<0.001). CONCLUSION: a greater proportion of specific etiologic diagnosis of meningitis was achieved while the protocol was in use.

Proposta de abordagem simplificada para suspeitas de meningites: relato de experiência de serviço de referência no estado do Piauí, 2007-2016 / Propuesta para el enfoque inicial simplificado de las sospechas de meningitis: relato de experiencia de servicio de referencia en el estado de Piauí, Brasil, 2007-2016 / Proposal for a simplified approach to suspected meningitis case diagnosis: experience report of a reference service in the state of Piauí, Brazil, 2007-2016

Objetivo: descrever um protocolo simplificado para abordagem de casos suspeitos de meningite. Métodos: relato de experiência na abordagem diagnóstica das meningites no serviço de referência em doenças tropicais do estado do Piauí, Brasil, no período de 2007-2016; extraíram-se informações do Sistema de Informação de Agravos de Notificação (Sinan) e do livro de registro do laboratório; utilizou-se o teste do qui-quadrado para comparar os indicadores da vigilância epidemiológica baseados na classificação final dos casos de meningite; utilizou-se o teste de concordância Phi para verificar a correlação entre os diagnósticos etiológicos presumidos pelo protocolo e aqueles confirmados laboratorialmente. Resultados: considerando-se 4.096 casos de meningite estudados, houve redução na classificação genérica desses casos, de 72 para 47% (p<0,001); a indicação do perfil de investigação laboratorial mostrou concordância com o diagnóstico final dos casos de meningite (rf=0,66; p<0,001). Conclusão: o diagnóstico etiológico específico das meningites foi alcançado em maior proporção durante a utilização do protocolo.

Objetivo: describir un protocolo para el abordaje de casos sospechosos de meningitis. Métodos: se relata la experiencia del diagnóstico de meningitis en el servicio de referencia para enfermedades tropicales del estado de Piauí, Brasil, entre 2007 y 2016; extrajimos informaciones del Sistema de Información de Notificación (Sinan) y del libro de laboratorio; la prueba de chi-cuadrado verificó la alteración de los indicadores de la vigilancia epidemiológica basados en la clasificación de los casos de meningitis; usamos la prueba de concordancia Phi para correlacionar los diagnósticos etiológicos presumidos por el protocolo y aquellos confirmados laboratorialmente. Resultados: considerando los 4.096 casos de meningitis investigados, se observó reducción en la clasificación genérica de casos del 72 al 47% (p<0,001); la selección del perfil de investigación mostró concordancia con la clasificación final de los casos de meningitis (rf=0,66; p<0,001). Conclusión: el diagnóstico etiológico de las meningitis se alcanzó en mayor proporción durante la utilización del protocolo.

Objective: to describe a simplified protocol to diagnose suspected cases of meningitis. Methods: this is an experience report on the approach to diagnosing meningitis at the Tropical Diseases Reference Service in the state of Piauí, Brazil, between 2007 and 2016; information was extracted from the Notifiable Diseases Information System (SINAN) and the laboratory record book; the chi-square test was used to compare epidemiological surveillance indicators based on final meningitis case classification; the Phi coefficient was used to verify the correlation between presumed diagnosis and laboratory-confirmed diagnosis. Results: considering the 4,096 cases of meningitis investigated, there was a reduction in the generic classification of meningitis cases from 72% to 47% (p<0.001); indicated laboratory investigation profile showed agreement with final meningitis case diagnosis. (rf=0.66; p<0.001). Conclusion: a greater proportion of specific etiologic diagnosis of meningitis was achieved while the protocol was in use.

Visual evoked potentials show strong positive association with intracranial pressure in patients with cryptococcal meningitis.

OBJECTIVE: To verify the relationship between intracranial pressure and flash visual evoked potentials (F-VEP) in patients with cryptococcal meningitis. Method The sample included adults diagnosed with cryptococcal meningitis admitted at a reference hospital for infectious diseases. The patients were subjected to F-VEP tests shortly before lumbar puncture. The Pearson’s linear correlation coefficient was calculated and the linear regression analysis was performed. RESULTS: Eighteen individuals were subjected to a total of 69 lumbar punctures preceded by F-VEP tests. At the first lumbar puncture performed in each patient, N2 latency exhibited a strong positive correlation with intracranial pressure (r = 0.83; CI = 0.60 - 0.94; p < 0.0001). The direction of this relationship was maintained in subsequent punctures. CONCLUSION: The intracranial pressure measured by spinal tap manometry showed strong positive association with the N2 latency F-VEP in patients with cryptococcal meningitis.

Visual evoked potentials show strong positive association with intracranial pressure in patients with cryptococcal meningitis / Potenciais evocados visuais mostram correlação positiva forte com a pressão intracraniana em pacientes com meningite criptocócica

Objective : To verify the relationship between intracranial pressure and flash visual evoked potentials (F-VEP) in patients with cryptococcal meningitis. Method The sample included adults diagnosed with cryptococcal meningitis admitted at a reference hospital for infectious diseases. The patients were subjected to F-VEP tests shortly before lumbar puncture. The Pearson’s linear correlation coefficient was calculated and the linear regression analysis was performed. Results : Eighteen individuals were subjected to a total of 69 lumbar punctures preceded by F-VEP tests. At the first lumbar puncture performed in each patient, N2 latency exhibited a strong positive correlation with intracranial pressure (r = 0.83; CI = 0.60 - 0.94; p < 0.0001). The direction of this relationship was maintained in subsequent punctures. Conclusion : The intracranial pressure measured by spinal tap manometry showed strong positive association with the N2 latency F-VEP in patients with cryptococcal meningitis. .

Objetivo : Verificar a relação entre pressão intracraniana e potencial evocado visual por flash (PEV-F) em pacientes com meningite criptocócica. Método A amostra incluiu pacientes admitidos em um hospital de referência para doenças infecciosas. Realizou-se PEV-F antes de cada punção lombar. Calculou-se o coeficiente de correlação de Pearson e a equação de regressão linear entre as variáveis latência N2 e pressão intracraniana inferida através de raquimanometria. Resultados Dezoito pacientes foram submetidos a um total de 69 punções lombares. A latência N2 mostrou correlação positiva forte com a pressão de abertura verificada na primeira punção lombar a que cada paciente foi submetido (r = 0,83; IC = 0,60 – 0,94; p < 0,0001). A positividade da correlação foi mantida nas aferições subsequentes. Conclusão Houve associação positiva forte entre a latência N2 do PEV-F e pressão intracraniana em pacientes com meningite criptocócica. .

HIV-1 transmitted drug resistance and genetic diversity among patients from Piauí State, Northeast Brazil.

HIV-1 transmitted-drug-resistance and genetic diversity are dynamic and may differ in distinct locations/risk groups. In Brazil, increased AIDS incidence and related mortality have been detected in the Northeast region, differently from the epicenter in the Southeast. This cross-sectional study describes transmitted-dru- resistance and HIV-1 subtypes in protease/PR and reverse transcriptase/RT regions among antiretroviral naïve patients from Piauí State, Northeast Brazil. Among 96 patients recruited 89 (92.7%) had HIV-1 PR/RT regions sequenced: 44 females and 45 males, 22 self-declared as men who have sex with men. Transmitted-drug-resistance was investigated by CPR tool (Stanford HIV-1 Drug Resistance/SDRM). HIV-1 subtypes were assigned by REGA and phylogenetic inference. Overall, transmitted-drug-resistance rate was 11.2% (10/89; CI 95%: 5.8-19.1%); 22.7% among men who have sex with men (5/22; CI 95%: 8.8-43.4%), 10% in heterosexual men (2/20; CI 95%: 1.7-29.3%) and 6.8% in women (3/44; CI 95%: 1.8-17.4%). Singleton mutations to protease-inhibitor/PI, nucleoside-reverse-transcriptase-inhibitor/NRTI or non-nucleoside-reverse-transcriptase-inhibitor/NNRTI predominated (8/10): PI mutations (M46L, V82F, L90M); NRTI mutations (M41L, D67N) and NNRTI mutations (K103N/S). Dual class resistance mutations to NRTI and NNRTI were observed: T215L (NRTI), Y188L (NNRTI) and T215N (NRTI), F227L (NNRTI). Subtype B prevailed (86.6%; 77/89), followed by subtype F1 (1.1%, 1/89) and subtype C (1.1%, 1/89). B/F1 and B/C intersubtype recombinants represented 11.2% (10/89). In Piauí State extensive testing of incidence and transmitted-drug-resistance in all populations with risk behaviors may help control AIDS epidemic locally.

Low rate of transmitted drug resistance may indicate low access to antiretroviral treatment in Maranhão State, northeast Brazil.

The Brazilian AIDS epidemic is characterized by significant geographic contrasts: a reduction in incidence and mortality in the epicenter (southeast) and an increase in the northeast. HIV-1-transmitted drug resistance (TDR) and genetic diversity were investigated among 106 antiretroviral (ARV)-naive patients from Maranhão State, northeast. The HIV-1 protease (PR) and reverse transcriptase (RT) regions were sequenced; subtypes were assigned by REGA/phylogenetic analysis. TDR to the nucleoside/nonnucleoside reverse transcriptase inhibitor (NRTI/NNRTI) and protease inhibitor (PI) was identified by the Calibrated Population Resistance tool (Stanford). The median age was 31 years (range 18-72), with 54.7% women, 78.3% heterosexual transmission, and 17.9% men who have sex with men (MSM). Around 30% had <350 CD4(+) T cells/µl and 47.2% had plasma viral loads ≤10,000 copies/ml. The TDR rate was 3.8% (4/106; CI 95%, 1.2-8.9%) (three males, two of them MSM). Only single class mutations to NRTI (M184V; T215S) or NNRTI (K103S/N) were detected. Subtype B represented 81.1% (86/106), F1 1.9% (2/106), and C 2.8% (3/106); 14.2% were mosaics: 13 BF1 and 2 BC. Surveillance of TDR and HIV-1 genetic diversity is important to improve control strategies regionally.

Antigens of Coccidioides posadasii as an important tool for the immunodiagnosis of coccidioidomycosis.

Serologic diagnosis has been presented as a safe alternative for coccidioidomycosis. However, commercial kits based on coccidioidal antibodies available in the USA are considered too expensive for laboratories outside that country. In this study, we describe the preparation of antigens for detection of human coccidioidal antibodies by the immunodiffusion test (ID) and enzyme immunoassay (EIA). Antigens were tested against serum samples from patients with coccidioidomycosis, histoplasmosis and paracoccidioidomycosis, as well as healthy individuals. The highest reactivity in the ID tests was seen in the F0-90 antigen. In the EIAs, the best results were obtained with the F60-90 antigen. None of the serum samples from healthy individuals were recognized by any of the antigen extracts tested by ID or EIA. In conclusion, the F0-90 and F60-90 antigens have the potential to be commercially employed in presumptive diagnosis of coccidioidomycosis by ID or EIA, respectively. The tests could improve serological diagnosis of coccidioidomycosis in South America.

Genotypes of Cryptococcus neoformans and Cryptococcus gattii as agents of endemic cryptococcosis in Teresina, Piauí (northeastern Brazil).

Throughout Brazil, Cryptococcus neoformans is the cause of cryptococcosis, whereas Cryptococcus gattii is endemic to the northern and northeastern states. In this study, the molecular types of 63 cryptococcal isolates recovered from the cerebrospinal fluid of meningitis patients diagnosed between 2008-2010 in Teresina, Piauí, Brazil, were analysed. Out of the 63 patients, 37 (58.7%) were human immunodeficiency virus (HIV)-positive and 26 (41.3%) were HIV-negative. URA5-restriction fragment length polymorphism analysis identified 37/63 (58.7%) isolates as the C. neoformans VNI genotype, predominantly in HIV-positive patients (32/37, 86.5%), and 24/63 (38.1%) as the C. gattii VGII genotype, mostly in HIV-negative patients (21/26, 80.8%). The occurrence of C. gattii VGII in six apparently healthy children and in seven adolescents/young adults in this region reaffirms the endemic occurrence of C. gattii VGII-induced primary cryptococcosis and early cryptococcal infection. Lethality occurred in 18/37 (48.6%) of the HIV-positive subjects and in 13/26 (50%) of the HIV-negative patients. Our results provide new information on the molecular epidemiology of C. neoformans and C. gattii in Brazilian endemic areas.

Genotypes of Cryptococcus neoformans and Cryptococcus gattii as agents of endemic cryptococcosis in Teresina, Piauí (northeastern Brazil)

Throughout Brazil, Cryptococcus neoformans is the cause of cryptococcosis, whereas Cryptococcus gattii is endemic to the northern and northeastern states. In this study, the molecular types of 63 cryptococcal isolates recovered from the cerebrospinal fluid of meningitis patients diagnosed between 2008-2010 in Teresina, Piauí, Brazil, were analysed. Out of the 63 patients, 37 (58.7 percent) were human immunodeficiency virus (HIV)-positive and 26 (41.3 percent) were HIV-negative. URA5-restriction fragment length polymorphism analysis identified 37/63 (58.7 percent) isolates as the C. neoformans VNI genotype, predominantly in HIV-positive patients (32/37, 86.5 percent), and 24/63 (38.1 percent) as the C. gattii VGII genotype, mostly in HIV-negative patients (21/26, 80.8 percent). The occurrence of C. gattii VGII in six apparently healthy children and in seven adolescents/young adults in this region reaffirms the endemic occurrence of C. gattii VGII-induced primary cryptococcosis and early cryptococcal infection. Lethality occurred in 18/37 (48.6 percent) of the HIV-positive subjects and in 13/26 (50 percent) of the HIV-negative patients. Our results provide new information on the molecular epidemiology of C. neoformans and C. gattii in Brazilian endemic areas.

Clinical and epidemiological analysis of patients with HIV/AIDS admitted to a reference hospital in the northeast region of Brazil.

The AIDS epidemic has become a worldwide phenomenon of enormous magnitude and extension, deeply transforming medical practices and public health initiatives. This retrospective survey aimed to analyze clinical and epidemiological characteristics of patients with HIV/AIDS admitted to the Institute of Tropical Diseases Natan Portella, Teresina, Piauí, Brazil, from January, 2001 through December, 2004. Of the 828 patients, 43% were from other states and 71.3% were men. Average patient age was 35.4 +/- 11.5 years-old and 85.5% were illiterate or had primary education. The main form of exposure to HIV was heterosexual behavior (54.1%), while injectable drug use was confirmed by only 2.7% of registered cases. The most frequent infectious complications were candidiasis (42.4%) and pneumocystosis (22.2%). Sixty-eight cases (8.2%) of visceral leishmaniasis were registered. Using multivariate analysis, individuals aged over 40 years-old, patients with active tuberculosis, Pneumocystis carinii pneumonia and central nervous system cryptococcosis showed increased risk of death. In this study, young male adults with low educational levels predominated and the most frequent opportunistic infections were candidiasis and pneumocystosis.

Clinical and epidemiological analysis of patients with HIV/AIDS admitted to a reference hospital in the northeast region of Brazil / Análise clínica e epidemiológica dos pacientes com HIV/AIDS internados em um Hospital de Referência na Região Nordeste do Brasil

The AIDS epidemic has become a worldwide phenomenon of enormous magnitude and extension, deeply transforming medical practices and public health initiatives. This retrospective survey aimed to analyze clinical and epidemiological characteristics of patients with HIV/AIDS admitted to the Institute of Tropical Diseases Natan Portella, Teresina, Piauí, Brazil, from January, 2001 through December, 2004. Of the 828 patients, 43 percent were from other states and 71.3 percent were men. Average patient age was 35.4 ± 11.5 years-old and 85.5 percent were illiterate or had primary education. The main form of exposure to HIV was heterosexual behavior (54.1 percent), while injectable drug use was confirmed by only 2.7 percent of registered cases. The most frequent infectious complications were candidiasis (42.4 percent) and pneumocystosis (22.2 percent). Sixty-eight cases (8.2 percent) of visceral leishmaniasis were registered. Using multivariate analysis, individuals aged over 40 years-old, patients with active tuberculosis, Pneumocystis carinii pneumonia and central nervous system cryptococcosis showed increased risk of death. In this study, young male adults with low educational levels predominated and the most frequent opportunistic infections were candidiasis and pneumocystosis.

A epidemia de AIDS tornou-se um fenômeno mundial de grande magnitude e extensão, transformando profundamente a prática médica e as iniciativas em saúde pública. O estudo retrospectivo analisou as características clínicas e epidemiológicas dos pacientes com HIV/AIDS internados no Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brasil, de janeiro de 2001 a dezembro de 2004 . Dos 828 pacientes, 43 por cento eram provenientes de outros estados e 71,3 por cento eram do sexo masculino. A idade média foi 35,4 ± 11,5 anos. Eram analfabetos ou cursaram até o ensino fundamental 85,5 por cento. A principal via de exposição ao HIV foi o comportamento heterossexual (54,1 por cento), enquanto o uso de drogas injetáveis foi observado em apenas 2,7 por cento dos casos registrados. As complicações infecciosas mais freqüentes foram candidíase (42,4 por cento) e pneumocistose (22,2 por cento). Foram computados 68 casos de leishmaniose visceral. Em análise multivariada, idade acima de 40 anos, portadores de tuberculose, pneumonia por Pneumocystis carinii, neurocriptococcose associaram-se a maior risco de evolução para o óbito. Predominaram, neste estudo, adultos jovens do sexo masculino, com baixa escolaridade, tendo como infecções oportunistas mais freqüentes candidíase e pneumocistose.

Eco-epidemiologia e manifestações clínicas da coccidioidomicose nos Estados do Piauí e do Maranhão / Echo-epidemiological and clinical manifestations of coccidioidomycosis in the States of the Piauí and the Maranhão

Foi realizado estudo retrospectivo e prospectivo sobre aspectos clínicos e epidemiológicos de todos os pacientes com diagnóstico laboratorial de coccidioidomicose procedentes dos Estados do Piauí e do Maranhão no período de 1978 a 2007. Foram estudados cem casos da doença, procedentes de 43 municípios piauienses (94 casos) e cinco municípios maranhenses (seis casos). A maioria dos casos ocorreu em homens (97 por cento), de etnia parda ou negra (78 por cento), com mediana de idade de 30 anos, lavradores (58 por cento) e com escolaridade média de 3,2 anos. A micose ocorreu na forma de 51 casos isolados e de 15 microepidemias envolvendo 49 pacientes. A principal atividade de risco identificada foi exposição à poeira de habitat de tatus (Dasypus spp.) durante caçada a esses animais (87 por cento). A maioria dos pacientes foi diagnosticada através de exame micológico direto (KOH 10 por cento) e de cultivo de escarro, positivos em 86,8 por cento e 88,9 por cento, respectivamente, dos indivíduos testados. Todos os pacientes apresentaram comprometimento pulmonar, a maioria na forma pulmonar aguda (81 por cento). Tosse (93 por cento), febre (90 por cento) e dor torácica (72 por cento) foram os sintomas predominantes. Padrão nodular múltiplo foi a alteração mais frequente, tanto no radiograma simples (86,3 por cento) quanto na tomografia computadorizada de tórax (91,3 por cento). Manifestações de hipersensibilidade cutânea ocorreram em 19 por cento dos pacientes, sendo eritema nodoso a mais frequente. Sete pacientes (7 por cento) apresentaram disseminação extrapulmonar, acometendo pele e TCS (3 por cento), SNC (2 por cento), glânglios linfáticos periféricos (2 por cento) e sistema ósteo-articular (1 por cento). Os fatores de risco identificados para disseminação foram etnia indígena e sexo feminino. Evolução para cura foi observada em 91 por cento dos casos. A letalidade foi de 8 por cento, sendo etnia indígena, disseminação para SNC e pneumonia grave os fatores de risco para óbito...Piauí.