RESUMEN
Paracoccidioidomycosis (PCM) is a life-threatening systemic mycosis widely reported in the Gran Chaco ecosystem. The disease is caused by different species from the genus Paracoccidioides, which are all endemic to South and Central America. Here, we sequenced and analyzed 31 isolates of Paracoccidioides across South America, with particular focus on isolates from Argentina and Paraguay. The de novo sequenced isolates were compared with publicly available genomes. Phylogenetics and population genomics revealed that PCM in Argentina and Paraguay is caused by three distinct Paracoccidioides genotypes, P. brasiliensis (S1a and S1b) and P. restrepiensis (PS3). P. brasiliensis S1a isolates from Argentina are frequently associated with chronic forms of the disease. Our results suggest the existence of extensive molecular polymorphism among Paracoccidioides species, and provide a framework to begin to dissect the connection between genotypic differences in the pathogen and the clinical outcomes of the disease.
Asunto(s)
Variación Genética/genética , Genómica , Paracoccidioides/genética , Paracoccidioidomicosis/genética , Argentina/epidemiología , Ecosistema , Genética de Población , Genoma Fúngico/genética , Genotipo , Humanos , Paracoccidioides/clasificación , Paracoccidioides/patogenicidad , Paracoccidioidomicosis/clasificación , Paracoccidioidomicosis/epidemiología , Paracoccidioidomicosis/microbiología , Paraguay/epidemiología , FilogeniaRESUMEN
Cytomegalovirus infection is a frequent complication after transplantation. This infection occurs due to transmission from the transplanted organ, due to reactivation of latent infection, or after a primary infection in seronegative patients and can be defined as follows: latent infection, active infection, viral syndrome or invasive disease. This condition occurs mainly between 30 and 90 days after transplantation. In hematopoietic stem cell transplantation in particular, infection usually occurs within the first 30 days after transplantation and in the presence of graft-versus-host disease. The major risk factors are when the recipient is cytomegalovirus seronegative and the donor is seropositive as well as when lymphocyte-depleting antibodies are used. There are two methods for the diagnosis of cytomegalovirus infection: the pp65 antigenemia assay and polymerase chain reaction. Serology has no value for the diagnosis of active disease, whereas histology of the affected tissue and bronchoalveolar lavage analysis are useful in the diagnosis of invasive disease. Cytomegalovirus disease can be prevented by prophylaxis (the administration of antiviral drugs to all or to a subgroup of patients who are at higher risk of viral replication) or by preemptive therapy (the early diagnosis of viral replication before development of the disease and prescription of antiviral treatment to prevent the appearance of clinical disease). The drug used is intravenous or oral ganciclovir; oral valganciclovir; or, less frequently, valacyclovir. Prophylaxis should continue for 90 to 180 days. Treatment is always indicated in cytomegalovirus disease, and the gold-standard drug is intravenous ganciclovir. Treatment should be given for 2 to 3 weeks and should be continued for an additional 7 days after the first negative result for viremia.
Asunto(s)
Infecciones por Citomegalovirus/etiología , Complicaciones Posoperatorias , Receptores de Trasplantes , Citomegalovirus , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/terapia , Rechazo de Injerto/etiología , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapiaRESUMEN
Migrações acarretam mudanças nos perfis epidemiológicos, impactando sistemas de saúde dos países receptores. O Brasil atrai imigrantes que se inserem precariamente nas metrópoles. Na Bolívia, a doença de Chagas é endêmica, fato relevante para o SUS brasileiro.O texto analisa a atuação e os limites dos profissionais de saúde no atendimento aos bolivianos no SUS, enfocando a doença de Chagas, por meio de entrevistas aplicadas nos serviços primário, secundário e terciário na região central da cidade de São Paulo, principal destino dos imigrantes bolivianos. As precárias condições de vida dos bolivianos caracterizam iniquidades em saúde. Idioma e cultura limitam a compreensão sobre o cuidado. Constata-se desconhecimento da clínica e epidemiologia da doença de Chagas entre os profissionais que atendem esses imigrantes. Faz-se necessária a revisão de estratégias assistenciais e de controle da doença de Chagas.(AU)
Las migraciones traen consigo cambios en los perfiles epidemiológicos, impactando los sistemas de salud de los países receptores. Brasil atrae a inmigrantes que se insieren de forma precaria en las metrópolis. En Bolivia, la enfermedad de Chagas es endémica, hecho relevante para el SUS. El texto analiza la actuación y los límites de los profesionales de salud en la atención a los bolivianos en el SUS, enfocando la enfermedad de Chagas, por medio de entrevistas realizadas en los servicios primario, secundario y terciario en la región central de la ciudad de São Paulo, principal destino de los inmigrantes bolivianos. Las precarias condiciones de vida de los bolivianos caracterizan iniquidades en salud. El idioma y la cultura limitan la comprensión sobre el cuidado. Se constata el desconocimiento de la clínica y de la epidemiología de la enfermedad de Chagas entre los profesionales que atienden a esos inmigrantes. Es necesaria la revisión de estrategias asistenciales y de control de la enfermedad de Chagas.(AU)
Migration provoke changes in epidemiological profiles impinging on the health care systems of reception countries. Immigrants come to Brazil from neighbor countries usually having precarious insertion in metropolitan areas. Chagas disease is endemic in Bolivia, something that has to be taken into account by the SUS. This paper analyzes both action and limits regarding health professionals who provide services to Bolivians in SUS with a focus on Chagas disease. Interviews were applied to primary, secondary and tertiary health services in the central region of São Paulo, the main destination of Bolivian immigrants. The precarious living conditions of Bolivians are the cause of health inequities. Language and culture also hamper their understanding about care. There is a lack of knowledge about clinic and epidemiology aspects of Chagas disease among the professionals who attend these immigrants. It is necessary to rethink strategies of health care and control of Chagas disease.(AU)
Asunto(s)
Humanos , Sistema Único de Salud , Bolivia/etnología , Enfermedad de Chagas/epidemiología , Atención a la Salud/etnología , Emigración e Inmigración , BrasilRESUMEN
Candida infections account for 80% of all fungal infections in the hospital environment, including bloodstream, urinary tract and surgical site infections. Bloodstream infections are now a major challenge for tertiary hospitals worldwide due to their high prevalence and mortality rates. The incidence of candidemia in tertiary public hospitals in Brazil is approximately 2.5 cases per 1000 hospital admissions. Due to the importance of this infection, the authors provide a review of the diversity of the genus Candida and its clinical relevance, the therapeutic options and discuss the treatment of major infections caused by Candida. Each topography is discussed with regard to epidemiological, clinical and laboratory diagnostic and therapeutic recommendations based on levels of evidence.
Asunto(s)
Antifúngicos/uso terapéutico , Candidiasis , Sociedades Médicas , Brasil , Candida/clasificación , Candidiasis/diagnóstico , Candidiasis/tratamiento farmacológico , Candidiasis/microbiología , HumanosRESUMEN
The literature describing tuberculosis (TB) in hematopoietic stem cell transplant (HSCT) recipients is scant, even in countries where TB is common. We describe a case of pulmonary TB in a patient who underwent HSCT and review the English language literature on this subject. An extensive PubMed and Ovid search was undertaken for the period January 1980 to March 2009; the search terms used were 'Mycobacterium tuberculosis' or 'tuberculosis', in combination with 'hematopoietic stem cell transplantation' or 'bone marrow transplantation'. The patient in the present case report underwent allogeneic transplantation and developed TB 8 days after his HSCT. The patient had received vaccination against TB in childhood. During the year prior to the HSCT he had had contact with a relative who had pulmonary TB. On day 3 of anti-TB treatment he developed pericarditis. The patient received anti-TB treatment for 6 months without major problems. From the literature review, we found 34 related studies, 25 on the clinical manifestations of TB. Most of the reports were from Asia (48%), and the incidence of TB varied from 0.0014% in the USA to 16% in Pakistan. TB occurred at between +21 and +1410 days post-HSCT (257.2 days the median), and the lung was the organ most frequently involved. Mortality varied from 0% to 50% and was higher in allogeneic HSCT. There is no consensus regarding screening with the tuberculin skin test or primary prophylaxis for latent TB, and further research into this is necessary in developing countries with a high prevalence of TB.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas/efectos adversos , Tuberculosis Pulmonar/etiología , Antituberculosos/uso terapéutico , Brasil , Humanos , Masculino , Pericarditis Tuberculosa/diagnóstico por imagen , Pericarditis Tuberculosa/tratamiento farmacológico , Pericarditis Tuberculosa/etiología , Factores de Tiempo , Tomografía Computarizada por Rayos X , Trasplante Homólogo , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/tratamiento farmacológico , Adulto JovenRESUMEN
Cytomegalovirus infection is a frequent complication after transplantation. This infection occurs due to transmission from the transplanted organ, due to reactivation of latent infection, or after a primary infection in seronegative patients and can be defined as follows: latent infection, active infection, viral syndrome or invasive disease. This condition occurs mainly between 30 and 90 days after transplantation. In hematopoietic stem cell transplantation in particular, infection usually occurs within the first 30 days after transplantation and in the presence of graft-versus-host disease. The major risk factors are when the recipient is cytomegalovirus seronegative and the donor is seropositive as well as when lymphocyte-depleting antibodies are used. There are two methods for the diagnosis of cytomegalovirus infection: the pp65 antigenemia assay and polymerase chain reaction. Serology has no value for the diagnosis of active disease, whereas histology of the affected tissue and bronchoalveolar lavage analysis are useful in the diagnosis of invasive disease. Cytomegalovirus disease can be prevented by prophylaxis (the administration of antiviral drugs to all or to a subgroup of patients who are at higher risk of viral replication) or by preemptive therapy (the early diagnosis of viral replication before development of the disease and prescription of antiviral treatment to prevent the appearance of clinical disease). The drug used is intravenous or oral ganciclovir; oral valganciclovir; or, less frequently, valacyclovir. Prophylaxis should continue for 90 to 180 days. Treatment is always indicated in cytomegalovirus disease, and the gold-standard drug is intravenous ganciclovir. Treatment should be given for 2 to 3 weeks and should be continued for an additional 7 days after the first negative result for viremia. .
Asunto(s)
Humanos , Infecciones por Citomegalovirus/etiología , Complicaciones Posoperatorias , Receptores de Trasplantes , Citomegalovirus , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/terapia , Rechazo de Injerto/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapiaAsunto(s)
Enfermedad de Chagas/tratamiento farmacológico , Nifurtimox/administración & dosificación , Nitroimidazoles/administración & dosificación , Tripanocidas/administración & dosificación , Combinación de Medicamentos , Diseño de Fármacos , Humanos , Nitroimidazoles/economía , Tripanocidas/economía , Organización Mundial de la SaludRESUMEN
Candida infections account for 80% of all fungal infections in the hospital environment, including bloodstream, urinary tract and surgical site infections. Bloodstream infections are now a major challenge for tertiary hospitals worldwide due to their high prevalence and mortality rates. The incidence of candidemia in tertiary public hospitals in Brazil is approximately 2.5 cases per 1000 hospital admissions. Due to the importance of this infection, the authors provide a review of the diversity of the genus Candida and its clinical relevance, the therapeutic options and discuss the treatment of major infections caused by Candida. Each topography is discussed with regard to epidemiological, clinical and laboratory diagnostic and therapeutic recommendations based on levels of evidence.
Asunto(s)
Humanos , Antifúngicos/uso terapéutico , Candidiasis , Sociedades Médicas , Brasil , Candida/clasificación , Candidiasis/diagnóstico , Candidiasis/tratamiento farmacológico , Candidiasis/microbiologíaRESUMEN
A systemic and endemic emerging mycosis in Latin America, paracoccidioidomycosis, is characterised by its chronicity and by the severity of the disseminated form in healthy individuals, as well as in immunocompromised individuals co-infected with HIV, resulting, in the latter, in a mortality rate in the range of 30 - 45%. The long (several years) duration of treatment results from the immunosuppression induced by the disease or from the survival capacity of the fungus in tissue. A few controlled studies and case reports have shown that fast-acting azolic and sulfa derivatives are useful treatment alternatives for patients presenting milder forms of the disease. However, when using such drugs, treatment regimens of longer duration are required for the maintenance of patients with more severe forms. The search for new alternatives for treating the most severe forms is an ongoing challenge. Novel treatments may be found among new classes of drugs, drug combinations, or agents capable of modulating the immune response, such as a peptide derived from the 43-kDa Paracoccidioides brasiliensis glycoprotein.
Asunto(s)
Paracoccidioidomicosis/tratamiento farmacológico , Anfotericina B/uso terapéutico , Infecciones Fúngicas del Sistema Nervioso Central/tratamiento farmacológico , Resistencia a Medicamentos , Fluconazol/uso terapéutico , Estudios de Seguimiento , Humanos , Huésped Inmunocomprometido , Itraconazol/uso terapéutico , Cetoconazol/uso terapéutico , Paracoccidioidomicosis/epidemiología , Paracoccidioidomicosis/inmunología , Pirimidinas/uso terapéutico , Sulfonamidas/uso terapéutico , Triazoles/uso terapéutico , VoriconazolRESUMEN
The care and follow-up provided to healthcare workers (HCWs) from a large teaching hospital who were exposed to biological material between 1 August 1998 and 31 January 2002 is described here. After exposure, the HCW is evaluated by a nurse and doctor in an emergency consultation and receives follow-up counselling. The collection of 10 ml of blood sample from each HCW and its source patient, when known, is made for immunoenzymatic testing for HIV, HBV and HCV. Evaluation and follow-up of 404 cases revealed that the exposures were concentrated in only a few areas of the hospital; 83% of the HCWs exposed were seen by a doctor responsible for the prophylaxis up to 3 h after exposure. Blood was involved in 76.7% (309) of the exposures. The patient source of the biological material was known in 80.7% (326) of the exposed individuals studied; 80 (24.5%) sources had serological evidence of infection with 1 or more agents: 16.2% were anti-HCV positive, 3.8% were HAgBs positive and 10.9% were anti-HIV positive. 67% (273) of the study population completed the proposed follow-up. No confirmed seroconversion occurred. In conclusion, the observed adherence to the follow-up was quite low, and measures to improve it must be taken. Surprisingly, no difference in adherence to the follow-up was observed among those exposed HCW at risk, i.e. those with an infected or unknown source patient. Analysis of post-exposure management revealed excess prescription of antiretroviral drugs, vaccine and immunoglobulin. Infection by HCV is the most important risk of concern, in our hospital, in accidents with biological material.
Asunto(s)
Infecciones por VIH/prevención & control , Hepatitis B/prevención & control , Hepatitis C/prevención & control , Exposición Profesional , Personal de Hospital , Adulto , Fármacos Anti-VIH/uso terapéutico , Antivirales/uso terapéutico , Patógenos Transmitidos por la Sangre , Brasil , Femenino , Estudios de Seguimiento , Vacunas contra Hepatitis B , Humanos , Inmunoglobulinas/uso terapéutico , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Masculino , Persona de Mediana EdadAsunto(s)
Humanos , Enfermedad de Chagas/tratamiento farmacológico , Nifurtimox/administración & dosificación , Nitroimidazoles/administración & dosificación , Tripanocidas/administración & dosificación , Combinación de Medicamentos , Diseño de Fármacos , Nitroimidazoles/economía , Tripanocidas/economía , Organización Mundial de la SaludRESUMEN
Padronizou-se método de fluorescência (soluçäo de diacetato de fluoresccína DF e brometo de etídio BE) para análise de viabilidade de células fúngicas, em 40 amostras de líquor, provenientes de casos comprovados de neurocriptococose. A utilizaçäo de soluçäo aquosa de saponina a 0,3% eliminou fluorescências interferentes emitidas por hemácias e leucócitos. Após o processamento dos materiais biológicos, foram retiradas alíquotas de 0,1ml das supensöes obtidas e misturadas a volumes iguais da soluçäo DF-BE preparada pouco antes do uso. O tempo de coloraçäo ideal foi de 30 minutos, resultando perfeita direnciaçäo entre microrganismos viáveis (fluorescência verde) e näo viáveis (fluorescência vermelha)
Asunto(s)
Humanos , Líquido Cefalorraquídeo/microbiología , Cryptococcus neoformans/crecimiento & desarrollo , Criptococosis/líquido cefalorraquídeo , Etidio , Fluoresceínas , Microscopía Fluorescente/métodosRESUMEN
Relata-se o quadro clínico de 27 pacientes com doença de Chagas aguda, acompanhados no ambulatório da Clínica de Doenças Infecciosas e Parasitárias do Hospital das Clínicas da FM-USP no período de 1974 a 1987. As vias de transmissäo envolvidas foram: vetorial em 7 casos, transfusional em 9, transplante de rim e/ou transfusional em 4, acidental em 1, via oral em 3, provável alcitamento materno em 1, congênita ou aleitamento materno em 1, congênita ou transfusional em 1. Pacientes com infecçäo por via vetorial eram procedentes da Bahia e Minas Gerais, infectados por via transfusional adquiriram a doença na Grande Säo Paulo, 7 deles após 1983. O quadro clínico foi oligossintomático ou assintomático em 4 pacientes, sendo 3 deles imunodeprimidos por doença de base ou por medicamentos. Em outros 2 pacientes imunodeprimidos ocorreu miocardite grave com insuficiência cardíaca congetiva. O quadro clínico foi também mais grave em 5 de 6 crianças menores de dois anos de idade, qualquer dque fosse a via de transmissäo
Asunto(s)
Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Bencimidazoles/uso terapéutico , Enfermedad de Chagas/transmisión , Tripanocidas/uso terapéutico , Transfusión Sanguínea/efectos adversos , Enfermedad de Chagas/sangre , Enfermedad de Chagas/tratamiento farmacológico , Pronóstico , Salud UrbanaRESUMEN
Os autores, mediante revissäo da literatura, estudam as infecçöes virais passíveis de ocasionar complicaçöes à profissional de saúde gestante e propöem precauçöes a serem obedecidas, especialmente em relaçäo à síndrome da imunodeficiência adquirida e citomegalovirose
Asunto(s)
Humanos , Femenino , Embarazo , Técnicos Medios en Salud , Complicaciones Infecciosas del Embarazo , Infecciones por Citomegalovirus/prevención & control , Infecciones por Citomegalovirus/transmisión , Enfermedades Profesionales/prevención & control , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Factores de RiesgoRESUMEN
Foram tratados com oxamniquine (dose oral única de 12,5 a 15 mg e 15 a 20 mg/kg de peso, para maiores e menores de 15 anos respectivamente) 180 indivíduos com esquistossomose mansoni, matriculados na Clínica de Doenças Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo. As idades variam de 5 a 65 anos e as formas clínico-evolutivas prevalentes foram a intestinal e hepatointestinal. Os principais efeitos colaterais neuropsiquiátricos foram:sonolência (50,6%), tontura (41,1%), cefaléia (16,1%), amnésia transitória (2,2%), alteraçöes de comportamento (1,7%), tremores (1,1%) e convulsäo (1,1%). Em 20 indivíduos foi avaliada a neurotoxicidade da froga através de eletroencefalografia, antes e após o tratamento. Em 3 (15%), foram detectados alteraçöes no traçado, sem contudo apresentarem manifestaçöes clínicas neuropsiquiátricas. Os resultados demonstraram ser o oxamniquine determinante de efeitos tóxico-colaterais na esfera neuropsiquiátrica