Serum markers as an aid in the diagnosis of pulmonary fungal infections in AIDS patients

ABSTRACT Introduction: The etiology of pulmonary infections in HIV patients is determined by several variables including geographic region and availability of antiretroviral therapy. Materials and methods: A cross-sectional prospective study was conducted from 2012 to 2016 to evaluate the occurrence of pulmonary fungal infection in HIV-patients hospitalized due to pulmonary infections. Patients' serums were tested for (1-3)-β-D-Glugan, galactomannan, and lactate dehydrogenase. The association among the variables was analyzed by univariate and multivariate regression analysis. Results: 60 patients were included in the study. The patients were classified in three groups: Pneumocystis jirovecii pneumonia (19 patients), community-acquired pneumonia (18 patients), and other infections (23 patients). The overall mortality was 13.3%. The time since diagnosis of HIV infection was shorter in the pneumocystosis group (4.94 years; p = 0.001) than for the other two groups of patients. The multivariate analysis showed that higher (1-3)-β-D-Glucan level (mean: 241 pg/mL) and lactate dehydrogenase (mean: 762 U/L) were associated with the diagnosis of pneumocystosis. Pneumocystosis was the aids-defining illness in 11 out of 16 newly diagnosed HIV-infected patients. Conclusion: In the era of antiretroviral therapy, PJP was still the most prevalent pulmonary infection and (1-3)-β-D-Glucan and lactate dehydrogenase may be suitable markers to help diagnosing pneumocystosis in our HIV population.

Incidence of tuberculous and non-tuberculous mycobacteria, differentiated by multiplex PCR, in clinical specimens of a large general hospital

OBJECTIVE: To determine the incidence of Mycobacterium tuberculosis complex and non-tuberculous mycobacterial isolates in the routine setting of a large general hospital using an "in-house" multiplex polymerase chain reaction method and to establish a paradigm for the definitive identification of mycobacteria isolated using semi-automated equipment. METHODS: Established tests, including polymerase chain reaction restriction enzyme analysis, PNB, and NAP inhibition tests as the gold standard, showed 100% agreement with an IS6110/hsp65 multiplex polymerase chain reaction when used to identify stock strains (n = 117). RESULTS: In a subsequent study, 8,790 clinical specimens producing 476 isolates were evaluated with multiplex PCR and also showed 100% agreement in identification using PRA-polymerase chain reaction as the gold standard. The application of this technique to routine analysis was demonstrated in this study. A method was established with the initial application of multiplex PCR for all positive liquid cultures and the subsequent identification of non-tuberculous mycobacteria by polymerase chain reaction restriction enzyme analysis. In total, 77% of isolates belonged to the Mycobacterium tuberculosis complex, and 23% were non-tuberculous mycobacteria. CONCLUSIONS: Several non-tuberculous mycobacterial species were identified, primarily M. avium, but other potentially pathogenic species were also frequently observed, including M. fortuitum, M. abscessus, and M. kansasii. The expeditious communication of these data to the clinical staff was fundamental for the diagnosis of clinical cases. Even in settings where tuberculosis is of major importance, the incidence of non-tuberculous mycobacteria infection is substantial.

Simultaneous monitoring of CMV and human herpesvirus 6 infections and diseases in liver transplant patients: one-year follow-up

OBJECTIVE: The aim of this study was to simultaneously monitoring cytomegalovirus and human herpesvirus 6 active infections using nested-polymerase chain reaction and, together with clinical findings, follow the clinical status of patients undergoing liver transplant. INTRODUCTION: The human β-herpesviruses, including cytomegalovirus and human herpesvirus 6, are ubiquitous among human populations. Active infections of human herpesvirus 6 and cytomegalovirus are common after liver transplantation, possibly induced and facilitated by allograft rejection and immunosuppressive therapy. Both viruses affect the success of the transplant procedure. METHODS: Thirty patients submitted to liver transplant at the Liver Transplant Unit, at the Gastro Center, State University of Campinas, SP, Brazil, were studied prospectively from six months to one year, nested-polymerase chain reaction for cytomegalovirus and human herpesvirus 6 DNA detections. Two or more consecutive positive nested-polymerase chain reaction were considered indicative of active infection. RESULTS: Active infection by cytomegalovirus was detected in 13/30 (43.3 percent) patients, median time to first cytomegalovirus detection was 29 days after transplantation (range: 0-99 days). Active infection by human herpesvirus 6 was detected in 12/30 (40 percent) patients, median time to first human herpesvirus 6 detection was 23.5 days after transplantation (range: 0-273 days). The time-related appearance of each virus was not statistically different (p = 0.49). Rejection of the transplanted liver was observed in 16.7 percent (5/30) of the patients. The present analysis showed that human herpesvirus 6 and/or cytomegalovirus active infections were frequent in liver transplant recipients at our center. CONCLUSIONS: Few patients remain free of betaherpesviruses after liver transplantation. Most patients presenting active infection with more than one virus were infected sequentially and not concurrently. Nested-polymerase chain reaction can be considered of limited value for clinically monitoring cytomegalovirus and human herpesvirus 6.

Molecular typing of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated in two metropolitan areas of São Paulo State, southeast Brazil

One hundred and fifty-one methicillin-resistant z (MRSA) strains have been isolated from patients admitted in tertiary care hospitals in two metropolitan areas (Campinas City and Ribeirão Preto City) in the southeast region of Brazil and analyzed through PCR-based techniques [(PCR amplification of spa, coa, and housekeeping genes (arcC, aroE, gmk, pta, tpi, yqiL)] and further restriction fragment typing of coa and of housekeeping genes. The heterogeneity of spa gene was determined directly by agarose gel electrophoresis migration. The results obtained indicate the existence of three (A, B, C) main clusters. Since the strain distribution in these three clusters is much characteristic, it denotes the existence of three main clones. All strains isolated in Campinas were grouped in clusters A and B, while most of the strains isolated in Ribeirão Preto were grouped in cluster C. This distribution denotes the existence of different founder strains that undergo independent genetic variability. The strains considered representative of the Brazilian Epidemic Clone (BEC) were categorized as cluster A. These results indicate a possible higher variability among Brazilian MRSA strains than currently described and indicate that the techniques herein used can be used as an alternative to Pulsed Field Gel Electrophoresis (PFGE).

Doença pulmonar por Mycobacterium tuberculosis e micobactérias não-tuberculosas entre pacientes recém-diagnosticados como HIV positivos em Moçambique, África / Mycobacterium tuberculosis and nontuberculous mycobacterial isolates among patients with recent HIV infection in Mozambique

OBJECTIVE: Mycobacteriosis is frequently diagnosed among HIV-infected patients. In Mozambique, where few patients are under antiretroviral therapy and the prevalence of tuberculosis is high, there is need for better characterization of mycobacteria at the species level, as well as for the identification of patterns of resistance to antituberculous drugs. METHODS: We studied a sample of 503 HIV-infected individuals suspected of having pulmonary tuberculosis. Of those 503, 320 tested positive for mycobacteria through sputum smear microscopy or culture of bronchoalveolar lavage fluid. RESULTS: Acid-fast bacilli were observed in the sputum of 73 percent of the individuals presenting positive cultures. Of 277 isolates tested, only 3 were nontuberculous mycobacteria: 2 were identified as Mycobacterium avium and one was identified as M. simiae. Strains initially characterized as M. tuberculosis complex through polymerase chain reaction restriction analysis (PRA) of the hsp65 gene were later confirmed as such through PRA of the gyrB gene. Among the M. tuberculosis isolates, resistance patterns were as follows: to isoniazid, 14 percent; to rifampin, 6 percent; and multidrug resistance, 5 percent. Previously treated cases showed significantly higher rates of resistance to first-line antituberculous drugs. The most common radiological pattern was interstitial infiltrate (in 67 percent), followed by mediastinal lymph node enlargement (in 30 percent), bronchiectasis (in 28 percent), miliary nodules (in 18 percent) and cavitation (in 12 percent). Patients infected with nontuberculous mycobacteria presented clinical profiles indistinguishable from those of other patients. The median CD4 lymphocyte count in this group was 134 cells/mm³. CONCLUSIONS: There is a strong association between tuberculosis and AIDS in Mozambique, as expected in a country with a high prevalence of tuberculosis. Although drug resistance rates are high, the isoniazid-rifampin...

OBJETIVO: A micobacteriose é frequentemente diagnosticada entre pacientes infectados pelo HIV. Em Moçambique, onde apenas um pequeno número de pacientes encontra-se sob tratamento anti-retroviral, e a tuberculose tem alta prevalência, existe a necessidade de melhor caracterização destes agentes bacterianos, em nível de espécie, bem como de se caracterizar os padrões de resistência às drogas antituberculosas. MÉTODOS: Em uma coorte de 503 indivíduos HIV positivos suspeitos de tuberculose pulmonar, 320 apresentaram positividade para baciloscopia ou cultura no escarro e no lavado brônquico. RESULTADOS: Bacilos álcool-ácido resistentes foram detectados no escarro em 73 por cento dos casos com cultura positiva. De 277 isolados em cultura, apenas 3 mostraram-se tratar de micobactérias não-tuberculosas: 2 Mycobacterium avium e uma M. simiae. Todos os isolados de M. tuberculosis inicialmente caracterizados através de reação em cadeia de polimerase (RCP) do gene hsp65 foram posteriormente caracterizados como tal através de RCP do gene gyrB. Resistência à isoniazida foi encontrada em 14 por cento dos casos; à rifampicina em 6 por cento; e multirresistência em 5 por cento. Pacientes previamente tratados para tuberculose mostraram tendência a taxas maiores de resistência às drogas de primeira linha. O padrão radiológico mais freqüente encontrado foi o infiltrado intersticial (67 por cento), seguido da presença de linfonodos mediastinais (30 por cento), bronquiectasias (28 por cento), padrão miliar (18 por cento) e cavidades (12 por cento). Os pacientes infectados por micobactérias não-tuberculosas não apresentaram manifestações clínicas distintas das apresentadas pelos outros pacientes. A mediana de linfócitos CD4 entre todos os pacientes foi de 134 células/mm³. CONCLUSÕES: Tuberculose e AIDS em Moçambique estão fortemente associadas, como é de se esperar em países com alta prevalência de tuberculose. Embora as taxas de resistência a drogas sejam...

IS6110 restriction fragment length polymorphism of Mycobacterium tuberculosis isolated from patients with pulmonary tuberculosis in Campinas, Brazil: evidence of intercontinental distribution of strains

Tuberculosis (TB) is a major concern in developing countries. In Brazil, few genotyping studies have been conducted to verify the number of IS6110 copies present in local prevalent strains of Mycobacterium tuberculosis, the distribution and clustering of strains. IS6110 DNA fingerprinting was performed on a sample of M. tuberculosis isolates from patients with AFB smear-positive pulmonary TB, at a hospital in Brazil. The IS6110 profiles were analyzed and compared to a M. tuberculosis database of the Houston Tuberculosis Initiative, Houston, US. Seventy-six fingerprints were obtained from 98 patients. All M. tuberculosis strains had an IS6110 copy number between 5-21 allowing for differentiation of the isolates. Human immunodeficiency virus infection was confirmed in nearly half the patients of whom data was available. Fifty-eight strains had unique patterns, while 17 strains were grouped in 7 clusters (2 to 6 strains). When compared to the HTI database, 6 strains matched isolates from El Paso, Ciudad de Juarez, Houston, and New York. Recently acquired infections were documented in 19 percent of cases. The community transmission of infection is intense, since some clustered strains were recovered during the four-year study period. The intercontinental dissemination of M. tuberculosis strains is suspected by demonstration of identical fingerprints in a distant country

Doença de Chagas e hipertensäo arterial primária / Chagas disease and primary arterial hypertension

Objetivo - Avaliar o comportamento pressórico em chagásicos crônicos com distintos graus de comprometimento miocárdico, buscando correlacionar fisiopatlógicamente essas doenças. Métodos - Foram estudados 644 pacientes chagásicos, acompanhados ambulatoriamente no HCUNICAMP, divididos pela condiçäo de serem ou näo portadores de hipertensäo arterial primária, associada ao grau de comprometimento funcional miocárdico. Essa amostra foi confrontada com 370 pacientes hipertensos primarios näo-chagásicos. Ambos os grupos foram distribuídos segundo sexo e faixa etária. Os resultados foram avaliados pela análise de covariância multivariada de perfis, considerando-se significantes aqueles com p < 0,05. Resultados - Foi observada uma elevada prevalência de hipertensäo arterial na amostra de chagásicos, sendo 16,8% na forma I, 27.8% na forma II e 34% na forma III. Constatou-se uma acentuada e significativa queda na apresentaçäo da forma clinical I, a partir dos 30 anos, nos chagásicos hipertensos e näo-hipertensos. Entre as idades de 30-50 anos evidenciou-se uma grande concentraçäo de chagásicos na forma II, independentemente do sexo e dos níveis pressóricos. A disfunçäo miocárdica sintomática (forma III) foi rara antes dos 40 anos em indivíduos portadores ou näo de hipertensäo arterial, predominando essa apresentaçäo clínica a partir dos 50 anos entre os pacientes chagásicos hipertensos e do sexo masculino. Conclusäo - A concomitância de doença de Chagas e hipertensäo arterial incide com freqüência mais elevada entre os cardiopatas descompensados e a partir da 4ª década de vida, o que evidencia um caráter somatório e progressivo destas doenças. Aventa-se a possibilidade de que fatores etiopatogênicos da doença de Chagas contribuam para a elevaçäo dos níveis pressóricos

Purpose - To evaluate the pressoric behaviour in chagasic patients in different stages of myocardial damage and to correlate Chagus' disease with arterial hypertension. Methods - The arterial blood pressure of 644 chagasic patients surveyed in the HC-UNICAMP, with arterial hypertension or not, associated with the stage of myocardial dysfunction was evaluated. This group was compared with 370 hypertensive patients without Chagas' disease. Both were divided by sex and age. The results were evaluated by covariance analysis and the significance was pointed at p < 0,05. Results - The chagasic group presented a high prevalence of arterial hypertension with 16,8% in the clinical phase I, 27.8% in the phase II and 34% in the III. Both hypertensive and nonhypertensive chagasic patients had a significant drop in clinical phase I after the age of 30 years. The chagasic patients classified in phase II presented a high prevalence between 30-50 years, not associated with the pressoric behaviour and/ or sex. The symptomatic myocardial dysfunction (phase III) was uncommon bellow 40 years old in chagasic group with hypertension or not, but presented a highost prevalence in male hypertensive chagasic patients above 50 years old. Conclusion - The study demonstrated a more usual association of Chagas' disease and hypertension in patients with symptomatic myocardial dysfunction, above 50 years old. This find evidenciates the somatory and progressive effect of both diseases. It is possible that the pathogenic mechanisms of Chagas' disease contributed to the increment of the arterial blood pressure

Exame citopatológico realizado durante colonoscopia no diagnóstico das estenoses colorretais / Cytopathological test performed during colonoscopy in diagnosis of colorectal stenosis

As estenoses colorretais podem apresentar dificuldades para um diagnóstico etiológico. Com a colonoscopia e a coleta de material diretamente da lesäo, a citopatologia passou a revelar uma eficácia diagnóstica semelhante à histopatologia. Neste estudo (107 pacientes), empregou-se citopatologia durante colonoscopia, de material de estenose, esfregado em lâmina, fixado em álcool etílico a 95% e corado pela HE, com conclusöes obtidas durante a endoscopia. Os resultados foram comparados com a histopatologia e ambos cotejados com o anatomopatológico do espécime cirúrgico. Nos näo operados, comparou-se com a evoluçäo tardia. Observaçäo elevado grau de correlaçäo entre os exames. O citopatológico näo apresentou resultado inconclusivo, falso-negativos foram menos freqüentes do que com a histopatologia e falso-positivo foi observado em apenas um paciente (adenoma viloso do reto). Correlacionados quanto ao tipo, localizaçäo e permeabilidade da lesäo, conclusöes semelhantes puderam ser tiradas e estas condiçöes näo afetaram a efetividade dos exames, exceto que existiram mais resultados falso-negativos para o cito e histopatologia, quando as lesöes eram impérvias. Tanto a cito como a histopatologia se mostraram sensíveis e específicos para o diagnóstico do carcinoma colorretal. Como conclusäo, pode-se afirmar ser a citopatologia realizada durante a colonoscopia, um exame seguro e eficiente para o estudo de lesöes com estenose em cólon e reto, contribuindo na orientaçäo desses pacientes

Paracoccidioidomicose e infecçäo pelo vírus da imunodeficiência humana / Paracoccidioidomycosis and infection by the human immunodeficiency virus

Säo apresentados dois casos de paracoccidioidomicose, um em paciente com a síndrome da imunodeficiência adquirida e o outro em paciente com infecçäo pelo HIV. Trata-se dos primeiros relatos em que esta associaçäo é descrita na lieteratura. No primeiro, a micose se evidenciou durante o acompanhamento de paciente com AIDS, que passou a apresentar hépato-esplenomegalia e febre elevada. A ecografia, radiografia simples e tomografia computadorizada do abdomen, demonstraram nódulos sólidos, alguns calcificados, no parênquima esplênico. A punçäo aspirativa da medula óssea confirmou o diagnóstico; o conjunto dos achados caracterizou a forma aguda disseminada da paracoccidioidomicose, a qual levou o paciente ao óbito. No segundo relato, em paciente com infecçäo pelo HIV, a propósito de investigaçäo de tumoraçäo na regiäo inguinal e fossa ilíaca à direita, constatou-se a associaçäo de doença de Hodgkin, tipo celularidade mista e paracoccidioidomicose. Avalia-se a importância destes relatos frente a expansäo da infecçäo pelo HIV e estima-se que mais casos venham a ser relatados em pacientes com AIDS, procedentes de áreas endêmicas desta micose. Propöe-se a inclusäo da paracoccidioídomicose como infecçäo oportunista potencial em pacientes HIV positivos nestas áreas

Efeito adverso no uso intermitente de rifampicina para tratamento de hanseníase / Adverse effect of the intermittent use of rifampicin for leprosy treatment

Os autores apresentam um caso de insuficiência renal aguda, hemólise aguda e trombocitopenia relacionada ao uso intermitente de Rifampicina para tratamento da Hanseníase. Estas reaçöes adversas säo observadas com extrema raridade na literatura mundial. A evoluçäo da paciente foi benina havendo recuperaçäo total da funçäo renal e regressäo completa das alteraçöes hematológicas. Este foi o primeiro registro no Brasil dos efeitos adversos da Rifampicina no tratamento de Hanseníase. Säo discutidos os principais aspectos patogênicos das alteraçöes apresentadas e fe-se revisäo da literatura existente sobre o assunto

Ciclo menstrual e crises epilépticas / Menstrual cycle and epileptic crisis

Mostra-se a pouca confiabilidade que merece a informaçäo fornecida pelas pacientes de relaçäo entre crises epilépticas e ciclo menstrual. Avaliam-se ainda a ocorrência de ciclos irregulares e síndrome pré-menstrual nas pacientes que referiam (grupo I) e nas que negavam (grupo II) a relaçäo das crises epilépticas com as menstruaçöes, näo tendo havido diferença estatisticamente significante entre os dois grupos. Ressaltam-se que há piora menstrual mesmo em 37% dos ciclos de pacientes que negavam tal relaçäo