Nocardiosis: a single-center experience and literature review.

INTRODUCTION: Nocardiosis is a rare bacterial infection caused by Nocardia spp. However, an increasing incidence has been described whereby data about epidemiology and prognosis are essential. METHODS: A retrospective descriptive study was conducted among patients with positive Nocardia spp. culture, from January 2019 to January 2023, at a Terciary Hospital in Portugal. RESULTS: Nocardiosis was considered in 18 cases with a median age of 63.8-years-old. At least one immunosuppressive cause was identified in 70% of patients. Five patients had Disseminated Nocardiosis (DN). The lung was the most common site of clinical disease (77.8%) and Nocardia was most commonly identified in respiratory tract samples. The most frequently isolated species were Nocardia nova/africana (n = 7) followed by Nocardia cyriacigeorgica (n = 3) and Nocardia pseudobrasiliensis (n = 3). The majority of the patients (94.4%) received antibiotic therapy, of whom as many as 55.6% were treated with monotherapy. The most frequently prescribed antibiotic was trimethoprim-sulfamethoxazole. Selected antimicrobial agents were generally effective, with linezolid and cotrimoxazole (100% Susceptibility [S]) and amikacin (94% S) having the most activity against Nocardia species. The median (IQR) duration of treatment was 24.2 (1‒51.4) weeks for DN; The overall one-year case fatality was 33.3% (n = 6) and was higher in the DN (66.7%). No recurrence was observed. CONCLUSION: Nocardiosis is an emerging infectious disease with a poor prognosis, particularly in DN. This review offers essential epidemiological insights and underscores the importance of gaining a better understanding of the microbiology of nocardiosis. Such knowledge can lead to the optimization of antimicrobial therapy and, when necessary, guide appropriate surgical interventions to prevent unfavorable outcomes.

Adverse Events of Latent Tuberculosis Treatment With Isoniazid in People Living With HIV: A Case-Control Study in a Resource-Rich Setting.

Introduction Multiple risk factors, such as human immunodeficiency virus (HIV) infection and immunosuppressive therapies, increase the odds of latent tuberculosis infection (LTBI) reactivation and progression to active tuberculosis. A six-to-nine-month preventive treatment with isoniazid (INH) decreases the risk of LTBI reactivation, but its effectiveness can be limited by its long duration and adverse events (AEs), including liver toxicity. Due to comorbidities and polypharmacy, people living with HIV (PLHIV) may be at increased risk of INH-associated AEs. Our study aimed to assess the prevalence of AEs among patients receiving INH treatment for LTBI, to identify risk factors for their occurrence, and to evaluate whether PLHIV have higher odds of developing INH-associated AEs. Methods We conducted a single-center retrospective case-control study, including 130 outpatients with LTBI treated with INH between July 2019 and March 2022. Participants who developed AE (cases) were compared to controls, and a subgroup of PLHIV was compared to HIV-negative participants. Demographics, socioeconomic variables, comorbidities, and clinical variables were compared between study groups. Patient data were obtained from institutional electronic medical records, and outcomes were measured at regularly scheduled appointments. Results We included 130 participants, of which 54 were PLHIV. The PLHIV subgroup was significantly younger (p = 0.01) and demonstrated significantly higher prevalences of chronic liver disease, previous viral hepatitis, daily alcohol consumption, and intravenous drug use (IDU). One-third of the participants had an AE (45 cases, 34.6%), with liver toxicity being the most common (22.3%). Participants who developed AEs were significantly older (p = 0.030) and had a higher prevalence of economic hardship (p = 0.037), as well as higher scores of the Charlson comorbidity index (p = 0.002) than the controls. INH withdrawal occurred in 17 participants (13.1%) and was mainly associated with liver toxicity (p < 0.01) and gastrointestinal symptoms (p = 0.022). In the adjusted effect model, an age ≥ 65 years, economic hardship, and excessive alcohol consumption were significantly associated with higher odds of AEs, while HIV infection decreased the odds by 68.4% (p = 0.033). Conclusions In our study, INH-associated AEs were common, with liver toxicity being the most frequent. Older age, economic hardship, and excessive alcohol consumption increased the odds of INH-associated AEs, while PLHIV had lower odds of developing INH-associated AEs, even when adjusting for other variables in the multivariate analysis. Further studies should be conducted to assess if these results are replicable in a larger population and in different settings.

Not all Nodules Are Cancer and not all Fungal Infections Are Aspergillus.

Pithomyces, a dematiaceous fungus, is a common colonizer of dead leaves and stems of many different plants and is associated with facial eczema in some animals. We report a case of invasive fungal pulmonary disease by Pithomyces chartarum in a healthy, nonimmunocompromised patient. We aim to demonstrate our diagnostic and therapeutic approach and focus on the major challenges arising from the lack of scientific evidence regarding infection by this fungus in humans.

Pithomyces, um fungo demáceo, é um colonizador comum de folhas e caules de diferentes plantas e está associado a eczema facial em alguns animais. Neste trabalho, descrevemos um caso de infeção fúngica invasiva pelo fungo Pithomyces chartarum, numa mulher não imunocomprometida. O nosso objetivo é descrever a abordagem diagnóstica e terapêutica deste caso, realçando os principais desafios que surgem devido à falta de evidência científica relativamente à infeção deste fungo em humanos.

Nocardiosis: a single-center experience and literature review

ABSTRACT Introduction: Nocardiosis is a rare bacterial infection caused by Nocardia spp. However, an increasing incidence has been described whereby data about epidemiology and prognosis are essential. Methods: A retrospective descriptive study was conducted among patients with positive Nocardia spp. culture, from January 2019 to January 2023, at a Terciary Hospital in Portugal. Results: Nocardiosis was considered in 18 cases with a median age of 63.8-years-old. At least one immunosuppressive cause was identified in 70% of patients. Five patients had Disseminated Nocardiosis (DN). The lung was the most common site of clinical disease (77.8%) and Nocardia was most commonly identified in respiratory tract samples. The most frequently isolated species were Nocardia nova/africana (n = 7) followed by Nocardia cyriacigeorgica (n = 3) and Nocardia pseudobrasiliensis (n = 3). The majority of the patients (94.4%) received antibiotic therapy, of whom as many as 55.6% were treated with monotherapy. The most frequently prescribed antibiotic was trimethoprim-sulfamethoxazole. Selected antimicrobial agents were generally effective, with linezolid and cotrimoxazole (100% Susceptibility [S]) and amikacin (94% S) having the most activity against Nocardia species. The median (IQR) duration of treatment was 24.2 (1-51.4) weeks for DN; The overall one-year case fatality was 33.3% (n = 6) and was higher in the DN (66.7%). No recurrence was observed. Conclusion: Nocardiosis is an emerging infectious disease with a poor prognosis, particularly in DN. This review offers essential epidemiological insights and underscores the importance of gaining a better understanding of the microbiology of nocardiosis. Such knowledge can lead to the optimization of antimicrobial therapy and, when necessary, guide appropriate surgical interventions to prevent unfavorable outcomes.

State estimation of the time-space propagation of COVID-19 using a distributed parameter observer based on a SEIR-type model.

The real-time prediction and estimation of the spread of diseases, such as COVID-19 is of paramount importance as evidenced by the recent pandemic. This work is concerned with the distributed parameter estimation of the time-space propagation of such diseases using a diffusion-reaction epidemiological model of the susceptible-exposed-infected-recovered (SEIR) type. State estimation is based on continuous measurements of the number of infections and deaths per unit of time and of the host spatial domain. The observer design method is based on positive definite matrices to parameterize a class of Lyapunov functionals, in order to stabilize the estimation error dynamics. Thus, the stability conditions can be expressed as a set of matrix inequality constraints which can be solved numerically using sum of squares (SOS) and standard semi-definite programming (SDP) tools. The observer performance is analyzed based on a simplified case study corresponding to the situation in France in March 2020 and shows promising results.

Secondary Organising Pneumonia Among COVID-19 Patients: A Retrospective Case-Control Study.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Secondary organising pneumonia (OP) induced by SARS-CoV-2 infection is a recently recognised complication of COVID-19. We aimed to evaluate the prevalence of OP among hospitalised patients with COVID-19 pneumonia and to assess whether disease severity and other clinical factors and comorbidities are correlated with OP development. We conducted a retrospective case-control study including hospitalised patients due to COVID-19 who performed a chest CT scan during hospitalisation and compared patients with clinical and radiological evidence of OP to patients without evidence of OP. Demographics, comorbidities, disease severity, dexamethasone/remdesivir treatment, laboratory results, and outcomes were compared between groups. One hundred fifteen patients were included, of whom 48 (41.7%) fulfilled clinical and imaging criteria for OP. Among OP patients, the most common chest CT-scan findings were consolidations, arciform condensations, and subpleural bands. OP patients had longer hospitalisation (19.5 vs 10 days, p=0.002) and more frequent ICU admission, but no significant differences in readmittance or mortality rates within 180 days compared to controls. In the adjusted effects model, the need for supplementary oxygen on the 21st day after symptom onset, the presence of Ordinal Scale for Clinical Improvement (OSCI) = 4, when compared to OSCI ≤ 3, and higher C-reactive protein on admission, were significantly associated with higher odds for OP. No other differences were identified between OP and controls after adjusting for other factors. The use of remdesivir or dexamethasone did not impact the diagnosis of OP. Only 38% of OP patients required treatment with high-dose corticosteroids. In conclusion, SARS-CoV-2-induced OP may be more frequent than previously thought, especially among hospitalised patients and patients with a more severe disease, particularly those who fail to improve after the second week of disease or who present higher inflammatory markers on admission. It increases the length of stay, but not all patients require specific treatment and OP may improve despite the absence of high-dose corticosteroid treatment.

Clinical Characteristics, Management, and Outcomes of 19 Nonpediatric Patients with Desmoplastic Small Round Cell Tumor: A Cohort of Brazilian Patients.

Desmoplastic small round cell tumor (DSRCT) is a rare and aggressive mesenchymal malignancy, usually affecting young males. There is no consensus on the best therapeutic approach. We seek to characterize a cohort of nonpediatric patients with DSRCT treated at a large Brazilian cancer center. We performed a retrospective analysis of patients with histologically confirmed DSRCT referred to our institution (2007-2020). Clinical and imaging data were extracted and summarized with descriptive statistics. Survival analyses were conducted by the Kaplan-Meier method and compared with the log-rank test. We included 19 patients with DSRCT, the median age at diagnosis was 26 years (range: 15-41 years), and 68% were male. Ninety percent presented with abdominopelvic masses, and 32% had extra-abdominal metastasis at diagnosis. Eleven patients (58%) underwent surgery, four patients (21%) received whole abdominal adjuvant radiotherapy, and five patients (26%) had hyperthermic intraperitoneal chemotherapy. Median OS was 27 months (interquartile range: 18-51 m). The five-year OS rate was 12%. Our data confirm the aggressiveness of DSRCT despite intense multimodality treatment. Outcomes of patients treated in a reference cancer center in a developing country are similar to cancer centers in developed nations. Multicenter cooperation is urgent to the development of clinical trials and to improve diagnosis and treatment efficacy.

Refractory tracheoesophageal fistula management with Amplatzer Occluder® placement.

Tracheoesophageal fistulas (TEF) in adults can be managed either surgically or endoscopically, depending on their etiology, size, anatomy and patient comorbidities. A 68-year-old female was admitted to the ER due to dysphagia and a cough. The patient had a medical history of TEF resulting from a tracheostomy and prolonged mechanical ventilation. Previous endoscopic treatment had failed, namely 3-attempts of closure with an over-the-scope clip (OTSC®). The patient refused surgery. After a multidisciplinary discussion (Gastroenterology, Pneumology, Surgery and Interventional-Cardiology), we decided to attempt Amplatzer-Occluder® placement. An 8mm Amplatzer-Occluder® was placed from the tracheal side, with sequential opening of the esophageal and tracheal strands (under endoscopic, bronchofibroscopic and fluoroscopic visualization). Nevertheless, migration of the device occurred 8-weeks later. Percutaneous endoscopic gastrostomy (PEG) was placed and the patient was referred to surgery. When there is extensive fibrosis that is not amendable to the application of clips, atrial septal defect occluder devices can be considered to manage TEF. Nevertheless, there is a need to develop strategies to minimize migration risk.

Refractory tracheoesophageal fistula management with Amplatzer Occluder® placement

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Phylogenetic relationships of the species of Plagioscion Gill, 1861 (Eupercaria, Sciaenidae).

The genus PlagioscionGill, 1861 (Sciaenidae; Eupercaria) is currently composed of five valid species (P. squamosissimus, P. auratus, P. magdalenae, P. ternetzi and P. montei) widely distributed in South America. This study seeks to test the monophyly of Plagioscion and develope an hypothesis of phylogenetic relationships among the species of the genus, based on the analysis of 28 characters of external and internal morphology and behavior. The ingroup consists of the five species of Plagioscion. The outgroup was composed of eight species of the genera Ctenosciaena, Cynoscion, Isopisthus, Larimus, Macrodon and Pachyurus. Cladistic analysis yielded a single most parsimonious cladogram (L = 50, CI = 0.60 and RI = 0.72). The monophyly of genus Plagioscion was supported by the presence of five synapomorphies, corroborating previous studies. The single most parsimonious cladogram recovered the following hypothesis of relationships among the species of the genus: ((P. squamosissimus + P. ternetzi) (P. magdalenae (P. montei + P. magdalenae))). Comments about all characters are presented.

Non-AIDS-related comorbidities in people living with HIV-1 aged 50 years and older: The AGING POSITIVE study.

OBJECTIVE: To characterize the profile of non-AIDS-related comorbidities (NARC) in the older HIV-1-infected population and to explore the factors associated with multiple NARC. METHODS: This was a multicentre, cross-sectional study including HIV-1-infected patients aged ≥50 years, who were virologically suppressed and had been on a stable antiretroviral therapy (ART) regimen for at least 6 months. A multiple regression model explored the association between demographic and clinical variables and the number of NARC. RESULTS: Overall, 401 patients were enrolled. The mean age of the patients was 59.3 years and 72.6% were male. The mean duration of HIV-1 infection was 12.0 years and the median exposure to ART was 10.0 years. The mean number of NARC was 2.1, and 34.7% of patients had three or more NARC. Hypercholesterolemia was the most frequent NARC (60.8%), followed by arterial hypertension (39.7%) and chronic depression/anxiety (23.9%). Arterial hypertension and diabetes mellitus were the most frequently treated NARC (95.6% and 92.6% of cases, respectively). The linear regression analysis showed a positive relationship between age and NARC (B=0.032, 95% confidence interval 0.015-0.049; p=0.0003) and between the duration of HIV-1 infection and NARC (B=0.039, 95% confidence interval 0.017-0.059; p=0.0005). CONCLUSIONS: A high prevalence of NARC was found, the most common being metabolic, cardiovascular, and psychological conditions. NARC rates were similar to those reported for the general population, suggesting a larger societal problem beyond HIV infection. A multidisciplinary approach is essential to reduce the burden of complex multi-morbid conditions in the HIV-1-infected population.

Cross-sectional study of Treponema pallidum PCR in diagnosis of primary and secondary syphilis.

BACKGROUND: Syphilis remains a major challenge and a complex diagnosis. We aim to evaluate the role of polymerase chain reaction (PCR) in Treponema pallidum (Tp) detection in various types of biological samples in the diagnosis of early syphilis. METHODS: We conducted a cross-sectional study including all attendees of the STI clinic with clinical suspicion of early syphilis. One or more specimens for the detection of Tp by PCR testing were collected. RESULTS: The overall sensitivity of Tp PCR test was 82.61% (95% CI: 68.6-92.2%). Tp PCR test had sensitivity of 84.6% (95% CI: 54.6-98.1%) in primary syphilis cases and 81.8% (95% CI: 64.5-93%) in secondary syphilis cases. PCR test performance was independent of HIV status. CONCLUSION: Tp PCR test is a fast and reliable method for the detection of Tp in skin lesions of early syphilis, and it is a powerful tool in clinical settings.

Uso de la ecografía torácica en la comprobación de la resolución del neumotórax tras drenaje / Use of Thoracic Ultrasound in the Detection of Pneumothorax Resolution after Drainage

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Single symptomatic colonic metastasis as first presentation of a pulmonary mucoepidermoid carcinoma.

Metastatic lesions in the large bowel are rare. A case of single symptomatic colonic metastasis as first presentation of pulmonary mucoepidermoid carcinoma (MEC) is described. A 62-year-old male was admitted with constipation and rectal bleeding. Colonoscopy revealed extrinsic compression at sigmoid colon, and microscopy suggested a secondary origin. Subsequent chest computed tomography confirmed a right perihilar mass invading posterior mediastinum, carina and esophagus, and also a second consolidation on right lower lobe and ipsilateral mediastinal and subcarinal lymph nodes. After pathologic evaluation of a transthoracic biopsy specimen, the diagnosis of pulmonary high-grade MEC, stage IV (T4, N3, M1b - 7th ed. TNM), was established. Chemotherapy with carboplatin and paclitaxel was initiated, and disease progression occurred after two cycles with increasing colonic mass. Palliative surgery was rejected because of advanced stage, and the patient was submitted to palliative pelvic radiotherapy. Second-line chemotherapy with gemcitabine was initiated, but clinical status worsened and the patient died because of severe lung failure. Clinical, pathological and therapeutic aspects of this uncommon site of extrathoracic metastatic disease are discussed, emphasizing the important contribution of special stains and immunohistochemistry to the diagnosis.

[Bronchopleurocutaneous Fistula: A Rare Complication of Pulmonary Tuberculosis]. / Fístula Bronco-Pleuro-Cutânea: Uma Manifestação Rara de Tuberculose Pulmonar.

INTRODUCTION: Multiple complications can occur in tuberculosis. Bronchopleurocutaneous fistula is a pathological communication between bronchus, pleural space and skin. CLINICAL CASE: We present a 47 year-old male patient, schizophrenic, who presented with complaints of pleuritic chest pain, cough and weight loss. The patient was cachectic with purulent drainage from an orifice in the antero-lateral left chest wall. In this drainage acid-fast bacilli were identified and chest radiograph showed bilateral infiltrates. He was admitted to the Infectious Diseases Department with the diagnosis of fistulized pulmonary tuberculosis, confirmed by visualization of acid-fast bacilli, positive polymerase chain reaction and cultures for Mycobacterium tuberculosis in the sputum. The patient was started on quadruple antituberculosis therapy and had a favorable outcome. CONCLUSIONS: Bronchopleurocutaneous fistula is a rare complication of pulmonary tuberculosis. Despite pulmonary tuberculosis being a common condition in our country, the rarity of this complication prompted the authors to present it.

Introdução: A tuberculose pulmonar pode cursar com diversas complicações. As fístulas bronco-pleuro-cutâneas consistem em comunicações anormais entre o brônquio, o espaço pleural e a pele.Caso Clínico: Apresentamos o caso de um homem, 47 anos, esquizofrénico, enviado ao Serviço de Urgência por toracalgia esquerda, tosse produtiva e emagrecimento. Apresentava-se caquético, sendo evidente um orifício cutâneo torácico latero-anterior esquerdo com drenagem purulenta, na qual o exame direto revelou bacilos ácido-álcool resistentes. A radiografia torácica evidenciava infiltrado heterogéneo bilateral. Foi internado com o diagnóstico de tuberculose pulmonar fistulizada. Na expetoração, a pesquisa de bacilos ácido-álcool resistentes foi igualmente positiva, sendo evidenciado Mycobacterium tuberculosis por reação de polimerase em cadeia e exame cultural. Iniciou terapêutica antituberculosa quádrupla apresentando evolução clínica favorável.Conclusões: A formação de fístulas bronco-pleuro-cutâneas é atualmente e em países desenvolvidos, uma complicação rara de tuberculose pulmonar. Assim, apesar da tuberculose ser frequente em Portugal, a raridade deste tipo de complicações torna pertinente a apresentação deste caso clínico.

A new Hyphessobrycon (Ostariophysi: Characiformes: Characidae) from the middle Amazon basin, Brazil.

Hyphessobrycon montagi, new species, is described from tributaries of the Rio Arapiuns, a left margin affluent of the lower Rio Tapajós, Amazon basin, Pará, Brazil. The new species can be diagnosed from all its congeners by the possession of a combination of two well-defined humeral blotches, connected by a narrow stripe, and a caudal peduncle blotch. A putatively monophyletic Hyphessobrycon heterorhabdus species-group, restricted to H. heterorhabdus, H. amapaensis, and H. eschwartzae, is herein proposed based on shared derived features of color pattern. Alternative proposals of a "Hyphessobrycon heterorhabdus group" presented in the recent literature are evaluated and criticized.

A new species of leaffish Polycentrus Müller & Troschel, 1849 (Percomorpha: Polycentridae) from the rio Negro, Brazil

A new species of Polycentrus is described from the rio Negro, in Brazil. It is distinguished from P. schomburgkii by the presence of two dark postocular and one subocular band, all smaller than orbital diameter, blunt snout, isognathous mouth, reduction of the serrations on the lower edge of the lacrimal-spines ranging from zero to two tiny spines at the posterior end, intensely serrated edge of the interopercle, fully serrated posterior edge of the vertical arm of the preopercle, presence of five pungent opercular spines, subopercle broadly serrated along most of its posterior ventral edge, presence of serrations dorsally on the posterior margin of the cleithrum, fourth ray of pectoral fin reaching the vertical through the anal-fin origin, 19-21 predorsal scales, 19-20 scales on dorsal-fin base, 12-14 scales on anal-fin base, and absence of a median opercular blotch.

Uma nova espécie de Polycentrus é descrita do rio Negro, Brasil. Distingue-se de P. schomburgkii por duas bandas postoculares escuras e uma banda subocular menores do que o diâmetro do olho, focinho pontudo, boca isognata, cinco espinhos operculares pungentes, borda posterior do braço vertical do pré-opérculo totalmente serrilhada, serrilhas ausente na borda inferior do lacrimal ou duas pequenas serrilhas na margem posterior, subopercular amplamente serrilhada ao longo da borda, cleitro com serrilhas na margem posterior do processo dorsal, interopercular com borda amplamente serrilhada, quarto raio da nadadeira peitoral atingindo a vertical de origem da nadadeira anal, 19-20 escamas na base da nadadeira dorsal, 12-14 escamas na base de nadadeira anal, 19-21 escamas pré-dorsais e ausência de mancha opercular.