Non-lactational Infectious Mastitis in the Americas: A Systematic Review.

Background: Non-lactational infectious mastitis (NLIM) is an inflammatory breast disease with broad clinical presentation. Inadequate treatment can lead to chronic infections that cause breast deformities. NLIM information is limited, especially in the Americas. A systematic review and meta-analysis have been conducted here. Methods: Literature search was conducted in three databases (Lilacs, PubMed, and Scielo) on NLIM cases in the Americas. Demographic, epidemiological, clinical, radiological, and laboratory data were extracted. The main characteristics and results were also compared according to the country's gross national income. Results: A total of 47 articles were included, resulting in 93 cases. The etiological agent was described in 86 (92.5%) patients. Bacteria were the most prevalent etiology (73; 84.8%). Amongst bacterial diagnoses, more frequent cases were Mycobacterium tuberculosis (28; 38.4%); Corynebacterium spp. (15; 20.5%); non-tuberculous mycobacteria (13; 17.8%). The cases were reported in eight different countries, with the USA being the country with the highest number of cases (35; 37.6%). Patients from high-income countries group presented a shorter diagnostic time when compared to low, low-middle, and upper-middle-income countries. A greater number of radiographic studies with pathological findings were described in high-income countries. Conclusion: Non-lactational infectious mastitis is a complex public health problem with diagnostic and treatment challenges. Hence, multi-professional approach-based additional studies are recommended on its epidemiology, diagnosis, treatment, and control.

Methylprednisolone as Adjunctive Therapy for Patients Hospitalized With Coronavirus Disease 2019 (COVID-19; Metcovid): A Randomized, Double-blind, Phase IIb, Placebo-controlled Trial.

BACKGROUND: Steroid use for coronavirus disease 2019 (COVID-19) is based on the possible role of these drugs in mitigating the inflammatory response, mainly in the lungs, triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to evaluate the efficacy of methylprednisolone (MP) among hospitalized patients with suspected COVID-19. METHODS: A parallel, double-blind, placebo-controlled, randomized, Phase IIb clinical trial was performed with hospitalized patients aged ≥18 years with clinical, epidemiological, and/or radiological suspected COVID-19 at a tertiary care facility in Manaus, Brazil. Patients were randomly allocated (1:1 ratio) to receive either intravenous MP (0.5 mg/kg) or placebo (saline solution) twice daily for 5 days. A modified intention-to-treat (mITT) analysis was conducted. The primary outcome was 28-day mortality. RESULTS: From 18 April to 16 June 2020, 647 patients were screened, 416 were randomized, and 393 were analyzed as mITT, with 194 individuals assigned to MP and 199 to placebo. SARS-CoV-2 infection was confirmed by reverse transcriptase polymerase chain reaction in 81.3%. The mortality rates at Day 28 were not different between groups. A subgroup analysis showed that patients over 60 years old in the MP group had a lower mortality rate at Day 28. Patients in the MP arm tended to need more insulin therapy, and no difference was seen in virus clearance in respiratory secretion until Day 7. CONCLUSIONS: The findings of this study suggest that a short course of MP in hospitalized patients with COVID-19 did not reduce mortality in the overall population. CLINICAL TRIALS REGISTRATION: NCT04343729.

Safety and efficacy of N-acetylcysteine in hospitalized patients with HIV-associated tuberculosis: An open-label, randomized, phase II trial (RIPENACTB Study).

Despite the availability of effective antimicrobials, tuberculosis (TB) is still a serious health threat. Mortality is even higher in people living with HIV who are diagnosed with TB. New therapies are needed to shorten the time required to cure TB and decrease fatality rates in this population. N-acetylcysteine (NAC) is a glutathione precursor and has shown recently in experimental setting to present in vitro and in vivo anti-mycobacterial activity. We test the hypothesis that NAC is safe, well tolerated and secondarily efficacious as adjunctive anti-TB therapy in hospitalized individuals with HIV-associated TB. Patients were enrolled sequentially in a tertiary care center, in the Brazilian Amazon. We performed a randomized, parallel group, single-center, open study trial of two arms, in hospitalized patients over 18 years of age, with microbiologically confirmed pulmonary TB in HIV: one with rifampicin, isoniazid, pyrazinamide and ethambutol at standard doses (Control Group), and a second in which NAC 600 mg bid for eight weeks was added (NAC Group). A total of 21 and 18 patients were enrolled to the Control Group and NAC Group, respectively. Adverse event rates were similar in the two arms. Our findings suggest that in the more critical population of hospitalized patients with HIV-associated TB, the use of NAC was not unsafe, despite the low sample size, and a potential impact on faster negative cultures needs to be further explored in larger studies.

Clinical relevance of gallbladder wall thickening for dengue severity: A cross-sectional study.

Dengue fever is the most important arthropod-borne viral infection worldwide. Secondary prevention to reduce mortality through improved clinical case management has substantially lowered the mortality rate for severe dengue during the past two decades. Gallbladder wall thickening (GBWT) is a nonspecific finding often associated with more severe cases of dengue infection. This study had the aim to describe the ultrasonographic findings in hospitalized patients with dengue infection from Manaus (in the Western Brazilian Amazon) and to correlate the GBWT with dengue severity, symptoms and laboratorial analysis. Patients from 13-84 years admitted to the emergency department at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) were enrolled in this study. Patients' selection occurred during the most recent and huge dengue outbreak within the first semester of 2011. All enrolled subjects were systematically tested in order to rule out other possible etiologies for gallbladder inflammation. Abdominal ultrasound was performed by a single physician through bedside portable equipment and all other clinical and laboratorial information were retrieved from patients' electronic files. 54 subjects were considered for analysis, with confirmed dengue infection by NS1 and/or RT-PCR positivity. From all enrolled patients, 50 (42.4%) presented GBWT. GBWT was significantly and independently related to: age under 31 years, pregnancy, presence of bleeding, presence of any cavitary effusion, DHF classification and severe dengue classifications. During dengue outbreaks, the GBWT identification through a non-invasive and bedside procedure is a confident marker for prompt recognition of potential severe cases.

Cerebelite aguda por Cryptococcus em paciente imunocompetente. Relato de caso / Acute cerebellitis caused by Cryptococcus in an immunocompetent patient. Case report

A cerebelite aguda é uma condição neurológica que pode ocorrer principalmente em associação à infecção viral, bem como a outros agentes infecciosos. A criptococose cerebral é a infecção que ocorre mais comumente em pacientes imunossuprimidos, principalmente na forma de meningoencefalite. O objetivo deste estudo foi relatar um caso de cerebelite fúngica em paciente imunocompetente, condição não relatada na literatura até omomento. Paciente do gênero masculino, 30 anos, foi encaminhado para investigação de quadro agudo de náuseas, vômitos, cefaleia intensa, vertigem e ataxia da marcha. A ressonância nuclear magnética de encéfalo demonstrou imagem hipodensaisolada em cerebelo. A análise liquórica evidenciou Criptococcus em fase de gemulação. Houve melhora completa do quadro após tratamento com anfotericina B e fluconazol. A infecção fúngica por Criptococcus é condição incomum em pacientes imunocompetentes. Casos previamente relatados de criptococose não seapresentaram de forma isolada em cerebelo. De acordo com o presente estudo, quando o quadro clínico do paciente for compatível com cerebelite, é importante atentar para outras possibilidades etiológicas, que não apenas vírus ou bactérias...

Acute cerebellitis is a neurological condition that can occur especially in association with viral infection, as well as other infectious agents. Cerebral criptococcose infection most commonly occurs in immunosuppressed patients, mainly in the form of meningoencephalitis. The objective of this study was to report a case of fungal cerebellitis in an immunocompetentpatient, a condition not reported in the literature. Male patient, 30 years old, was referred for investigation of acutenausea, vomiting, severe headache, vertigo and gait ataxia. The magnetic resonance of the brain showed an isolated hypodense image in cerebellum. The analysis of the cerebral spinal fluidrevealed cryptococcus in the process of budding. There was complete improvement after treatment with anphotericin B and fluconazole. The fungal infection cryptococcus is an uncommon condition in immunocompetent patients. Previously reported cases of criptococcose were not presented in isolation in thecerebellum. According to this study, when the patient’s condition is compatible with cerebellitis, it is important to pay attention to other etiological possibilities, not just viruses or bacteria...

Clinical profile of concurrent dengue fever and Plasmodium vivax malaria in the Brazilian Amazon: case series of 11 hospitalized patients.

Malaria and dengue fever are the most prevalent vector-borne diseases worldwide. This study aims to describe the clinical profile of patients with molecular diagnosis of concurrent malaria and dengue fever in a tropical-endemic area. Eleven patients with concurrent dengue virus (DENV) and Plasmodium vivax infection are reported. Similar frequencies of DENV-2, DENV-3, and DENV-4 were found, including DENV-3/DENV-4 co-infection. In eight patients, the World Health Organization (WHO) criteria for severe malaria could be fulfilled (jaundice being the most common). Only one patient met severe dengue criteria, but warning signs were present in 10. Syndromic surveillance systems must be ready to identify this condition to avoid misinterpretation of severity attributed to a single disease.

Evaluation of new strategies for the diagnosis of tuberculosis among pediatric contacts of tuberculosis patients.

BACKGROUND: In young children, underdiagnosis and diagnostic delay have an adverse effect on morbidity and mortality of tuberculosis (TB). This study evaluated new strategies for early TB diagnosis using an outpatient protocol in children between 0 and 5 years of age, with a recent household TB contact. METHODS: Case recruitment was performed in Manaus, Amazonas, Brazil, from 2008 to 2009. Epidemiologic and clinical data, tuberculin test, chest radiograph and 2 induced sputum respiratory samples from each participant were obtained. Laboratory diagnosis was based on Lowenstein-Jensen (LJ) culture, mycobacteria growth indicator tube (MGIT) and polymerase chain reaction. We conducted a study of comparison of diagnostic tests and a study of cases and controls to identify the clinical characteristics of the population with positive culture and polymerase chain reaction results. RESULTS: A total of 102 children were evaluated. Thirty-two fulfilled criteria of suspicion of TB. MGIT was more sensitive (P = 0.035) and faster (P < 0.001) than LJ. Clinical score, MGIT, LJ and polymerase chain reaction presented no concordance or slight concordance. A positive MGIT culture was only associated with a strong tuberculin test reaction (P = 0.026). The combination of MGIT with the clinical score allowed the diagnosis of 33% more cases with little or no symptomatology compared with the exclusive use of the clinical classification. CONCLUSIONS: The sensitivity and speed of MGIT demonstrate the utility of liquid cultures for the diagnosis in children. Furthermore, these results suggest that the use of MGIT in children presenting recent household TB contact and a strong tuberculin test reaction may be a strategy to improve early TB diagnosis.

Urgências e emergências em neurorradiologia. / Neuroradiology urgencies and emergencies.

Objetivo: analisar os pacientes submetidos à TC (tomografia computadorizada) em uma clínicaparticular em Manaus AM. Método: abordar pacientes atendidos na urgência que realizaram TCde crânio no horário de sobreaviso, período de outubro/2007 a setembro/2008. Resultados:foram 144 pacientes, 60 do sexo masculino e 84 feminino; 66 não apresentaram achados de TCEou AVC; os traumatizados foram 20. Em relação aos acidentes vasculares, 22 recentes, 15isquêmicos, 02 hemorrágicos e 56 tardios. Discussão: em função da TC de crânio estar disponívele relativa boa sensibilidade, tem se tornado a técnica de escolha para rastreamento de AVCs etraumatismos. Conclusão: os exames de imagem, incluindo a TC são de extrema importânciapara o auxílio na conduta.

Objective: neuroradiology urgencies and emergencies in a private clinic at Manaus, state ofAmazonas are common and include strokes, head trauma, infecctions diseases and less commontumoral processes. This study has the objective of analyse the patients that were submitted tocomputed tomography scan (CT) at Sensumed Clinic. Methods: there were realizedretrospectively every patient that made CT scan during extra time from October 2007 untilSeptember 2008. Results: there were 144 patients, 60 male and 84 female. 66 patients did nothave any radiologic finding for head trauma or stroke. The trauma patients were 20. The strokeswere 22 recent events, including 15 ischemic, 02 hemorragic and 56 late findings. Discussion: asCT scan is a disponible and with relatively good sensibility exam comparing to other exams, thisis the choice for screening at urgencies. Conclusion: we conclude that imaging findings areextremely important for medical conduct.

[Radiological aspects of primary tuberculosis in the breast: a case report and review of the literature]. / Aspectos radiológicos da tuberculose primária da mama: relato de caso e revisão de literatura.

Mammary tuberculosis is an illness accounting for less than 0.1% of breast lesions. We present a case from our service and discuss the radiological findings from mammography, ultrasound scan and magnetic resonance, including kinetic curves. Mammary tuberculosis is an unusual condition and such reports are important in relation to the differential diagnoses versus breast cancer and pyogenic abscess.

Aspectos radiológicos da tuberculose primária da mama: relato de caso e revisão de literatura / Radiological aspects of primary tuberculosis in the breast: a case report and review of the literature

A tuberculose mamária é uma enfermidade equivalente a menos que 0,1 por cento das lesões deste órgão. Apresentamos a seguir um caso de nosso serviço discutindo os achados radiológicos da mamografia, ultrassonografia e ressonância magnética, incluindo curvas cinéticas. A tuberculose mamária é uma condição ímpar, sendo importante o relato pelos diagnósticos diferenciais com carcinoma mamário e o abscesso piogênico.

Mammary tuberculosis is an illness accounting for less than 0.1 percent of breast lesions. We present a case from our service and discuss the radiological findings from mammography, ultrasound scan and magnetic resonance, including kinetic curves. Mammary tuberculosis is an unusual condition and such reports are important in relation to the differential diagnoses versus breast cancer and pyogenic abscess.