Detection of immunoglobulin G antibodies to Neospora caninum in humans: high seropositivity rates in patients who are infected by human immunodeficiency virus or have neurological disorders.

Considering that little is known about the epidemiology of Neospora caninum infection in humans, particularly in populations with high Toxoplasma gondii infection rates, the present study aimed to investigate the presence of antibodies to N. caninum in T. gondii-seropositive and -seronegative individuals. A total of 256 serum samples divided into four groups (61 samples from human immunodeficiency virus [HIV]-positive patients, 50 samples from patients with neurological disorders, 91 samples from newborns, and 54 samples from healthy subjects) were assessed for N. caninum and T. gondii serologies by indirect fluorescent-antibody test, enzyme-linked immunosorbent assay, and immunoblotting (IB). Immunoglobulin G antibodies to N. caninum were predominantly detected in HIV-infected patients (38%) and patients with neurological disorders (18%), while newborns and healthy subjects showed lower seropositivity rates (5% and 6%, respectively). Seropositivity to N. caninum was significantly associated with seropositivity to T. gondii in both HIV-infected patients and patients with neurological disorders. Seroreactivity to N. caninum was confirmed by IB, with positive sera predominantly recognizing the 29-kDa antigen of N. caninum. The results of this study indicate the presence of N. caninum infection or exposure in humans, particularly in HIV-infected patients or patients with neurological disorders, who could have opportunistic and concurrent infections with T. gondii. These findings may bring a new concern for the unstable clinical health of HIV-infected patients and the actual role of N. caninum infection in immunocompromised patients.

Intestinal parasitic infections in HIV/AIDS patients: experience at a teaching hospital in central Brazil.

In order to verify the occurrence of intestinal parasitic infections in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients, 100 HIV/AIDS patients (Group 1) and 85 clinically healthy individuals (Group 2) were submitted to coproparasitological examination. Intestinal parasites were detected in 27% of patients from Group 1 and in 17.6% from Group 2. In Group 1 the most frequent parasites were Strongyloides stercoralis (12%), with 2 cases of hyperinfection; Isospora belli, 7%; Cryptosporidium sp., 4%; with 1 asymptomatic case and hookworm, 4%. Of the infected patients from Group 1 who reported to be chronic alcoholics, 64.3% had strongyloidiasis. Only 6 of the 27 infected patients from Group 1 were on highly antiretroviral therapy (HAART). In Group 2 the most frequent parasites were S. stercoralis, 7.1%; hookworm, 7.1% and Giardia lamblia, 3.5%. In conclusion, diagnosing intestinal parasites in HIV/AIDS patients is necessary especially in those who report to be chronic alcoholics or are not on antiretroviral treatment.

[Skin diseases in patients with AIDS: study in 55 cases in Uberlândia, MG, Brazil]. / Dermatoses em pacientes com AIDS: estudo de 55 casos. Uberlândia, MG, Brasil.

UNLABELLED: Fifty-five patients with acquired immunodeficiency syndrome (AIDS) seen at the Dermatology outpatient clinic and who had mucocutaneous diseases were studied. These diseases, some of them opportunistic, are common but difficult to diagnose given the atypical features of the lesions. OBJECTIVES: The aim of this study was to analyse the frequency and clinical presentation of dermatoses related to Aids seen at the Dermatology outpatient clinic. METHODS: Fifty-five patients with Aids and mucocutaneous lesions were examined from 1995 to 1997 in a cross-sectional study carried out at the Dermatology outpatient clinic of the Universidade Federal de Uberlândia (Minas Gerais, Brazil). Biopsies and cultures were undertaken for laboratory diagnosis. RESULTS: One hundred sixteen dermatoses were diagnosed. Fungal infections (78%) were the commonest among them, followed by viral infections (40%), papulosquamous disorders (27%), papular eruptions (18%), adverse drug reactions (10%), tumors (9%) and a variety of others (7%). The majority of the patients (67%) had more than one type of skin disorder. CONCLUSIONS: In agreement with previous literature data fungal and viral infections were confirmed as the most frequent skin disorders in HIV-positive patients. Dermatological examination, laboratory tests and skin biopsy for histopathological study are necessary for appropriate diagnostic investigation of HIV-related mucocutaneous diseases considering that atypical presentation occurs in a large proportion of the patients.

Oral histoplasmosis in Brazil.

OBJECTIVE: We report 10 cases of histoplasmosis with oral manifestations seen in a teaching hospital in Brazil. STUDY DESIGN: This is a retrospective study of the sociodemographic, clinicopathologic, and treatment data of these cases. RESULTS: Overall, 8 of 10 cases were seropositive for human immunodeficiency virus (HIV), whereas 2 were negative. The predominant oral manifestations found in HIV-seropositive patients were ulcers, oral pain, and odynophagia; both of the HIV-seronegative patients were symptom-free. HIV infection was suspected in 7 cases because of the presence of oral lesions of histoplasmosis. Asthenia, fever, weight loss, lymphadenopathy, and hepatosplenomegaly were found only in HIV-seropositive patients. Radiographs in 3 out of 10 patients suggested pulmonary involvement. Amphotericin B was the antifungal therapy chosen, and clinical remission of oral lesions occurred in an average of 30 days (accumulated doses: 500-1500 mg). Itraconazole was very effective as a follow-up treatment in terms of prevention of recurrence. CONCLUSION: Histoplasmosis only rarely affects HIV-seronegative patients; however, the possibility of hidden immunodepression should be considered when oral manifestations of histoplasmosis are present.

Dermatoses em pacientes com AIDS: estudo de 55 casos. Uberlândia, MG, Brasil / Skin diseases in acquired immunodeficiency syndrome (AIDS): analysis of 55 Brazilian cases from Uberlândia - MG, Brazil

Foram estudados 55 pacientes com a síndrome da imunodeficiência adquirida (Aids), triados ao serviço de Dermatologia, apresentando doenças cutâneo-mucosas, algumas de caráter oportunista. As dermatoses säo freqüentes nestes doentes e, às vezes, de difícil diagnóstico pelo caráter atípico das lesöes. OBJETIVOS: Analisar a freqüência e apresentaçäo clínica das dermatoses relacionadas à Aids. MÉTODOS: Cinqüenta e cinco pacientes com Aids e lesöes tegumentares foram estudados, de modo transversal, no Serviço de Dermatologia da Universidade Federal de Uberlândia, de 1995 a 1997. Foram realizadas biopsias e culturas diversas para elucidaçäo diagnóstica. RESULTADOS: Foram encontradas 116 dermatoses, com predomínio das fúngicas (78 por cento), seguidas pelas virais (40 por cento), eritêmato-escamosas (27 por cento), pápulo-pruríticas (18 por cento), causadas por drogas (10 por cento), neoplásicas (9 por cento) e outras afecçöes cutâneo-mucosas (7 por cento). A maioria dos pacientes apresentou mais de uma dermatose (67 por cento). CONCLUSÖES: Confirmou-se a maior freqüência de dermatoses fúngicas, seguidas pelas virais, na Aids. Observou-se a necessidade de propedêutica bem elaborada para o diagnóstico preciso das dermatoses, devido à sua apresentaçäo atípica em grande número de doentes. O exame dermatológico e a biopsia das lesöes tiveram grande relevância na suspeita do diagnóstico de Aids

Histoplasmose em pacientes imunodeprimidos: estudo de 18 casos observados em Uberlândia, MG / Histoplasmosis in immunodepressed patients: a study of eighteen cases observed in Uberlândia, Minas Gerais State, Brazil

Os autores descrevem dezoito casos de histoplasmose observados em pacientes imunodeprimidos, sendo 17 com SIDA e um associado à cirrose hepática alcoólica. O diagnóstico de histoplasmose foi obtido através do isolamento do fungo em cultura de LCR, sangue e medula óssea ou por exame histopatológico obtido por biópsia ou necrópsia. A idade média dos pacientes foi de 35,8 anos, sendo 13 (72,2 por cento) do sexo masculino. Em geral a doença mostrou-se disseminada com acometimento por ordem de freqüência de: pele (38,8 por cento), medula óssea (27,7 por cento), mucosa nasofaringeana (22,2 por cento), pulmäo (22,2 por cento), cólon (11,1 por cento), SNC (5,5 por cento) e esôfago (5,5 por cento). Adenomegalia (50 por cento), hepatomegalia (77,7 por cento) e esplenomegalia (61,1 por cento) também foram observados com muita freqüência. Hematologicamente observou-se mais comumente pancitopenia (33,3 por cento). Onze dos 18 pacientes receberam tratamento, sendo 9 com anfotericina B e 2 com itraconazol; 8 obtiveram boa resposta clínica e todos receberam terapia de manutençäo com anfotericina B ou derivado triazólico. Este trabalho enfatiza a importância desta micose em pacientes imunodeprimidos, particularmente em pacientes com SIDA onde a infecçäo tende a acometer o sistema macrofágico-linfóide e o tegumento cutâneo.

Mielite transversa como manifestaçäo clínica inicial de linfoma näo Hodgkin disseminado e mielopatia vacuolar associada ao HIV: relato de caso / Transverse myelitis as initial symptom of disseminated non-Hodgkin lymphoma and HIV-associated vacuolar myelopathy: case report

Linfomas näo Hodgkin de alto grau sao comumente relatados em pacientes com a síndrome da imunodeficiência adquirida (AIDS). Comprometendo com grande frequência o sistema nervoso central, particularmente as leptomeninges e os hemisférios cerebrais. O acometimento epidural é pouco frequente, variando de 3,5 por cento a 8,3 por cento de acordo com os registros da literatura. Os autores relatam o caso de um paciente de 27 anos de idade com AIDS, cuja manifestaçao clínica inicial da doença linfomatosa disseminada foi a mielite transversa associada à mielopatia vacuolar. Destaca-se a importância do diagnóstico diferencial precoce das mielopatias na AIDS, em virtude da alta malignidade da neoplasia e da evoluçao extremamente rápida nesses pacientes.