ABSTRACT
ABSTRACT Herpes zoster (HZ) corresponds to the reactivation of varicella zoster virus (VZV). Among adults, the ophthalmic division of the trigeminal nerve is one of the most common sites of involvement. Vasculopathy caused by HZ is associated with significant morbidity and mortality, affecting structures such as the brain, which can lead to stroke. In this review, we analyzed the epidemiological and clinical aspects of the vascular involvement of VZV, focusing on the peculiarities of its association with ocular HZ. A review of the available literature indicated that ocular involvement of HZ was a risk factor for vasculopathy after adjusting for age, sex, body mass index, smoking, indicators of metabolic syndrome, and vascular and heart diseases. Considering the severity of this complication, vascular disease mediated by VZV requires early diagnosis and aggressive treatment. Finally, the anti-HZ vaccine has been recommended as a prophylactic measure in the elderly, but it should be used with caution in immunocompromised individuals.
RESUMO Herpes zoster (HZ) corresponde à reativação do vírus varicela zoster (VVZ) e, entre os adultos, o envolvimento da divisão oftálmica do nervo trigêmeo é um dos locais mais comuns A vasculopatia associada ao HZ é uma complicação dotada de grande morbimortalidade e afeta diferentes estruturas, favorecendo, inclusive o acidente vascular cerebral. Nesta revisão analisamos aspectos epidemiológicos e clínicos da vasculopatia mediada pelo VZV, bem como as peculiaridades relacionadas com o HZ ocular. De acordo com dados disponíveis na literatura, o acometimento ocular pelo HZ mostrou ser um fator de risco para vasculopatia após se ajustar para idade, sexo, índice de massa corporal, tabagismo, indicadores da síndrome metabólica, doença vascular e cardiopatias. Em face da gravidade dessa complicação, a doença vascular mediada pelo VZV requer diagnóstico precoce e tratamento agressivo. A vacina anti-HZ tem sido recomendada profilaticamente em idosos, mas deve ser usada com cautela em indivíduos imunocomprometidos.
Subject(s)
Humans , Vascular Diseases/virology , Herpes Zoster Ophthalmicus/physiopathology , Herpesvirus 3, Human/physiology , Vascular Diseases/complications , Herpes Zoster Ophthalmicus/complications , Herpes Zoster Ophthalmicus/therapy , Risk Factors , Stroke/complications , Stroke/virologySubject(s)
Humans , Toxoplasmosis , Clinical Laboratory Techniques , Diagnosis, Differential , Parasitic DiseasesABSTRACT
Com a ameaça internacional do bioterrorismo, a varíola voltou a ganhar destaque mundial. Os autores revisam aspectos da varíola e trazem consideraçöes atuais da utilizaçäo do agente como arma biológica. Também apresentam dados dos esforços atuais na produçäo e desenvolvimento de vacinas contra a doença
Subject(s)
Humans , Biological Warfare , Smallpox , Bioterrorism , Smallpox , Smallpox VaccineABSTRACT
Usando sangue e soro efetuamos prova imunocromatográfica qualificada como rápida para diagnosticar a infecçäo causada pelo vírus da imunodeficiência humana (HIV). Näo encontramos resultados falso-positivos, mas ocorreram 1,7 por cento e 5 por cento de falso-negativos quando empregamos sangue ou soro, respectivamente, de pessoas sem dúvida infectadas pelo HIV. Com esta análise procuramos cooperar no sentido de que testes de tal natureza, singelos e prontamente executáveis, fiquem suficientemente avaliados.
Subject(s)
Humans , Evaluation Study , False Negative Reactions , HIV Antibodies/analysis , HIV Infections/diagnosis , Predictive Value of Tests , AIDS Serodiagnosis , HIV Seropositivity , Acquired Immunodeficiency Syndrome/diagnosis , Serologic Tests/methodsSubject(s)
Humans , Pregnancy , Anti-Bacterial Agents , Microbial Sensitivity Tests , Cholestasis , Antibiotic Prophylaxis , Postpartum Period , Renal Insufficiency , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents , Anti-Bacterial Agents/therapeutic use , Communicable Diseases , Hepatic Insufficiency/therapy , Drug Resistance, MicrobialABSTRACT
The author discuses the management of some opportunistic diseases more commonly observed in South American AIDS patients than in European ones. Characteristics of coinfection with HIV and leprosy, paracoccidioidomycosis, Chagas's disease, mucocutaneous leishmaniasis, malaria, disseminated BCG and strongyloidiasis are reviewed, with special emphasis on preferred therapeutic schedules for these conditions.
Subject(s)
Humans , Child , Adult , Chagas Disease/epidemiology , Leprosy/epidemiology , HIV , HIV-1 , AIDS-Related Opportunistic Infections/epidemiology , Leishmaniasis, Mucocutaneous/physiopathology , Malaria/physiopathology , Paracoccidioidomycosis/epidemiology , Rifampin/administration & dosage , Acquired Immunodeficiency Syndrome/epidemiology , South America/epidemiology , BCG Vaccine/therapeutic use , Drug Administration Schedule , Jupiter/epidemiology , Acquired Immunodeficiency Syndrome/therapyABSTRACT
Patients with AIDS are prome to develop infections caused by opportunistic pathogens. Unusual agents, such as Stongyloides stercoralis, are being described in this syndrome, resulting in disseminated disease which is always severe and, in some cases, fatal. We describe a case of patient with AIDS and Strongyloides stercoralis infection involving the gastrointestinal tract and lungs. Therapy with thiabendazole for ten days led to resolution of the acute episode. Preventive therapy with 3g of thiabendazole once a week was then prescribed, and repeated fecal examinations were negative for larvae. Following discontinuation of treatment, however, the patient again had a positive fecal examination for Strongyloides stercoralis larvae, even though reinfection was considered to be very unlikely. The patient was retreated with a shorter course of therapy and once per week preventive therapy was reintroduced. After four months of follow-up, repeated fecal examinations were negative. When the treatment was changed to thiabendazole given once every two weeks, however, pulmonary Strongyloides stercoralis recurred. Subsequently, because of intolerance to thiabendazole, the patient was treated with cambendazole. The patient died three months later due to Pseudomonas aeruginosa pneumonia. Prolonged therapy for Strongyloides stercoralis infection may be necessary. Although further evaluation is needed, 3g of thiabendazole once a week may be adequate for this purpose. Cambendazole may be a useful alternative for disseminated Strongyloides stercoralis.
Subject(s)
Humans , Male , Adult , Cambendazole/therapeutic use , Strongyloidiasis/complications , Strongyloidiasis/drug therapy , Immunocompromised Host , Acquired Immunodeficiency Syndrome/immunology , Strongyloides stercoralis/drug effects , Thiabendazole/therapeutic use , AIDS-Related Opportunistic Infections , Digestive System/pathology , Feces/parasitology , Pneumonia, Bacterial/mortality , Lung/pathologyABSTRACT
Os autores apresentam um caso de tuberculose mamária em homem adulto como primeira manifestaçäo clinica da Sindrome da Imunodeficiencia Adquirida (SIDA). A doença surgiu quando as contagens de CD4 ainda apresentavam queda moderada (475 celulas/mm 3), e näo foi acompanhada por evidências de tuberculose em qualquer outro local do organismo. Revendo a literatura médica chama a atençäo a raridade do acometimento tuberculoso isolado da glandula mamária, em especial no sexo masculino, näo havendo aumento no numero de casos relatados desta localizaçäo mesmo em pacientes com SIDA
Subject(s)
Humans , Male , Adult , Mastitis/diagnosis , Acquired Immunodeficiency Syndrome/etiology , Tuberculosis/diagnosis , AIDS-Related Opportunistic Infections , Culture Media , Mycobacterium tuberculosis/isolation & purificationABSTRACT
The authors treated with paromomycin 25 patients, with AIDS and cryptosporidiosis. The drug was given orally in a doses of 500 mg qid, for a period of 14 days. Tolerance was good, with just two cases of mild side-effects. Clinical improvement was obtained in 19 (76 per cent) patients. Parasitological cure, however, occurred only in a low percentage (25 per cent). In some cases where initial success was observed, recrudescence occurred after some weeks or few months, but with retreatment again clinical improvement was obtained. Even if it does not lead to frequent parasite eradication, the good clinical results and tolerance permit us to consider paromomycin one of the few drugs effective for the treatment of cryptosporidial diarrhea in AIDS patients. Studies with maintainance therapy are indicated.
Subject(s)
Humans , Male , Female , Adult , Anti-Bacterial Agents/therapeutic use , Cryptosporidiosis/drug therapy , HIV-1 , AIDS-Related Opportunistic Infections/drug therapy , Paromomycin/therapeutic use , Anti-Bacterial Agents/adverse effects , Diarrhea/drug therapy , Drug Evaluation , Paromomycin/adverse effects , RecurrenceABSTRACT
Por meio do benznidazol e do nifurtimox foram tratados 49 pacientes acometidos de doenca de Chagas. Xenodiagnostico previo tinha sempre resultado positivo, evidenciando parasitemia pelo Trypanosoma cruzi e sendo as seguintes formas clinicas: indeterminada-19; cardiaca-28; digestiva-4 (dois pacientes apresentavam formas mistas). Quanto ao benznidazol, houve administracao de 5 a 8 mg/kg/dia, durante dois meses, e a proposito do nifurtimox o esquema terapeutico comecou com a dose de 5 a 7 mg/kg/dia, sucedendo aumento progressivo ate 15 a 17 mg/kg/dia, no decurso de quatro meses. O benznidazol, usado por 41 doentes, propiciou negativacao em 26 (63,4 por cento) a avaliacao realizada por meio de xenodiagnostico, em etapas de um a 20 anos e, em media, de 6 a 7 anos. Por seu turno, com o nifurtimox verificou-se uma negativacao relativamente a somente um individuo, tendo o seguimento sido efetuado em etapas de um a 18 anos
Subject(s)
Humans , Male , Female , Adolescent , Adult , Benzimidazoles/therapeutic use , Chagas Disease/therapy , Nifurtimox/therapeutic use , Benzimidazoles/administration & dosage , Nifurtimox/administration & dosageSubject(s)
Humans , Female , Adult , Chagas Disease/diagnosis , Chagas Disease/parasitology , Chagas Disease/drug therapy , Parasitology , Recurrence , Time FactorsABSTRACT
Há raras descriçöes da AIDS associadas a manifestaçöes sugestivas de síndrome de Behçet. Apresentamos o caso de uma jovem senhora que apresentou progressivamente no período de sete anos, critérios clínicos para o diagnóstico de síndrome de Behçet e que ao desenvolver meningoencefalite linfomonocitária recidivante, obserou-se estar infectada com o virus HIV-1. A terapêutica imunodepressora com glicocorticóides em altas doses näo foi satisfatória e a paciente veio a falecer por toxoplasmose cerebral, suspeita por ressonância magnética e confirmada por necrópsia, após sua terceira internaçäo. Níveis baixos de CD4 e da relaçäo CD4/CD8, algumas vezes observadas na síndrome de Behçet ativa, no entanto, mais altos do que comumente se observa na presença desta complicaçäo oportuísta grave, foram elementos que nos levaram a dificuldades diagnósticas, alertando o clínico para a necessidade de interpretar com restriçöes os achados laboratoriais. A falta de conhecimento definitivo do período no qual se infectou pelo HIV-1 possibilita as seguintes consideraçöes: ou estamos diante de síndrome de superposiçäo de distintas enfermidades; ou, entäo, de uma forma inusitada de apresentaçäo evolutiva, mimetizando a síndrome de Behçet, numa enferma infectada por este vírus, que posteriormente, desenvolveu AIDS
Subject(s)
Adult , Humans , Female , Toxoplasmosis, Cerebral/etiology , Behcet Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/complications , HIV-1 , Toxoplasmosis, Cerebral/diagnosis , /analysis , Diagnosis, Differential , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/etiology , Acquired Immunodeficiency Syndrome/diagnosisSubject(s)
Humans , Male , Female , Child , Amebiasis/drug therapy , Anthelmintics/therapeutic use , Giardiasis/drug therapy , Helminthiasis/drug therapy , Amebicides/therapeutic use , Cryptosporidiosis/complications , Hycanthone/adverse effects , Schistosomiasis mansoni/drug therapy , Acquired Immunodeficiency Syndrome/complicationsABSTRACT
O autor apresenta as perspectivas de progressos, no campo da terapêutica antimicrobiana, representadas pelo aparecimento de novos antibióticos macrolídicos com propriedades que os diferenciam, e muitas vezes os tornam mais atraentes, relativamente aos membros mais antigos da família. Compara esses novos antibióticos com a eritromicina, destacando as diferenças de propriedades farmacocinéticas e de espectro antimicrobiano. Por fim, apresenta as indicaçöes terapêuticas especiais que esses medicamentos poderäo vir a ter
Subject(s)
Humans , Anti-Bacterial Agents/pharmacokinetics , Anti-Bacterial Agents/chemistry , Anti-Bacterial Agents/therapeutic use , Bacteria/metabolism , Erythromycin/analogs & derivatives , Erythromycin/chemistry , Erythromycin/pharmacokinetics , Erythromycin/therapeutic use , Miocamycin/chemistry , Miocamycin/pharmacokinetics , Miocamycin/therapeutic use , Roxithromycin/chemistry , Roxithromycin/pharmacokinetics , Roxithromycin/therapeutic useABSTRACT
O autor analisa o papel das novas quinolonas na terapêutica antimicrobiana. Ressalta, em particular, as semelhanças e, principalmente, as diferenças entre elas, visando facilitar ao näo-especialista escolha adequada e uso apropriado dos membros dessa família de crescente importância na terapêutica antiinfecciosa