Disseminated cutaneous Actinomyces bovis infection in an immunocompromised host: case report and review of the literature.

BACKGROUND: Actinomycosis is an uncommon endogenous bacterial infection caused by Actinomyces species, characterized by the development of abscesses, tissue fibrosis, and fistulisation. It remains a diagnostic challenge, due to its similarities with diverse aetiologies' presentation, such as neoplasms, tuberculosis, or fungal infections. Actinomyces bovis is a microorganism rarely reported as a cause of human disease. Cutaneous involvement is sporadic. In this case, Actinomyces bovis was responsible for disseminated cutaneous disease in an immunosuppressed patient. CASE PRESENTATION: We report the case of a 69-year-old female with multiple skin masses, under immunosuppressive therapy due to ulcerative colitis. Imaging exams were compatible with multiple cutaneous abscesses in the cervicofacial region and limbs. Actinomyces bovis was isolated in culture after abscess drainage. Antimicrobial therapy with parenteral penicillin G and oral amoxicillin was administered for 6 months, with complete resolution of cutaneous lesions and no relapse of the infection. CONCLUSIONS: Considering actinomycosis as a possible diagnosis in the presence of subacute/chronic recurrent mass-like cutaneous lesions, especially in the setting of immunosuppression, may reduce the burden associated with delayed diagnosis and incorrect treatment and provide better outcomes and improvement of patient's quality of life.

Acute disseminated encephalomyelitis after mumps infection in a vaccinated patient.

Mumps is an infectious disease caused by a paramyxovirus. It can involve several organs in the acute stage of the infection, including central nervous system. (Rubin et al., 2015) [1] Neurological complications in the post-infectious period are also described, one of which is acute disseminated encephalomyelitis (ADEM). (Jonhson et al., 2004) [2] We present the case of an healthy young man previously vaccinated, who contracted ADEM after mumps.

Herpes simplex virus 1 rhombencephalitis in a patient with chromosomally integrated human herpesvirus-6A.

Central nervous system infection caused by Herpes simplex virus 1 remains a significant cause of morbidity and mortality in transplant patients. Additionally, the clinical implications of the recently discovered Human herpesvirus 6A are still under investigation. Hereby, we report a clinical case of an immunosuppressed patient following kidney transplantation and with chromosomally integrated human herpesvirus-6A (CIHHV-6A) that developed rhombencephalitis due to herpes virus simplex 1. This case highlights the importance of investigating the CIHHV-6 status in the differential diagnosis whenever a human herpesvirus is detected in the cerebrospinal fluid.

Pais: literacia em saúde para a prevenção da obesidade infantil dos 0 aos 5 anos / Parents: health literacy for childhood obesity prevention from 0 to 5 years

A obesidade infantil é um problema à escala mundial, por isso torna-se emergente a capacitação dos pais em literacia em saúde de modo a promover a prevenção deste problema. Evidencia-se a necessidade de intervenções de enfermagem para capacitar os pais das crianças com ou sem obesidade infantil, sendo as educativas as mais adequadas na persecução desse objetivo. Evocando à metodologia de trabalho de projeto, foi traçado como objetivo geral capacitar os pais em literacia em saúde na prevenção da obesidade infantil, inserido na linha de investigação de segurança e qualidade de vida. Como resultado final construímos um manual educativo/informativo para os pais no âmbito da prevenção da obesidade infantil. A redação do Relatório de Estágio possibilitou registar a trajetória formativa determinante na aquisição e desenvolvimento das competências de Mestre, comuns e específicas do Enfermeiro Especialista em Enfermagem de Saúde Infantil e Pediátrica.

Childhood obesity is a worldwide problem, which is why the training of parents in health literacy is emerging in order to promote the prevention of this problem. The need for nursing interventions to empower parents of children with or without childhood obesity is evident, with educational ones being the most appropriate in pursuing this objective. Based on the project work methodology, the general objective was to train parents in health literacy in the prevention of childhood obesity, inserted in the line of investigation of safety and quality of life. As a final result, we built an educational / informative manual for parents in the context of preventing childhood obesity. The execution of the Internship Report made it possible to record the decisive training path in the acquisition and development of the Master's competences, common and specific to the Specialist Nurse in Child and Pediatric Health Nursing.

Cerebral Venous Thrombosis as Rare Presentation of Herpes Simplex Virus Encephalitis.

Herpes simplex virus 1 is a prevalent neurotropic pathogen that infects and establishes latency in peripheral sensory neurons. It can migrate into the central nervous system and cause encephalitis. The association between herpes simplex virus encephalitis and cerebral venous thrombosis is rare, with a very limited number of case reports described in the literature, despite the recognized thrombogenic effects of the virus. A 44-year-old man was brought to the emergency department with generalized tonic-clonic seizures requiring sedation and ventilation to control it. Initial brain computed tomography revealed cortical and subcortical edema on the left frontal lobe, and a subsequent contrast-enhanced exam showed absence of venous flow over the anterior half of the superior sagittal sinus. Cerebrospinal fluid polymerase chain reaction was positive for herpes simplex virus type 1, and the patient was started on acyclovir and anticoagulation, with clinical improvement. Acyclovir administration was maintained for 14 days and oral anticoagulation for one year, with no recurrence of thrombotic events or other complications. A well-timed treatment has a validated prognostic impact on herpes simplex encephalitis, making early recognition of its clinical aspects of main importance.

Prevalence of Hepatitis A Virus Antibody in Portuguese Travelers: A New Paradigm.

INTRODUCTION: In Portugal, the prevalence of hepatitis A virus infection has decreased in the past decades, especially in young adults. The aim of this study was to detect the prevalence of antibody to hepatitis A virus in a population observed in our Travel Clinic. MATERIAL AND METHODS: Antibodies against hepatitis A, hepatitis B, hepatitis C and human immunodeficiency virus were tested using standard enzyme immunoassay in patients older than 18. The exclusion criteria were: prior vaccination for hepatitis A virus, previous diagnosis of infection with hepatitis B virus, hepatitis C virus and/or human immunodeficiency virus, foreign travelers and long-term expatriates. We applied an epidemiological survey and data was statistically analyzed with SPSS® 18.0. RESULTS: In the 665 travelers studied, natural immunity to hepatitis A virus was present in 57.6% (n = 383). They were stratified into 8 age groups and for each one hepatitis A immunity was clarified: 5.0% (n = 1) in 18 - 25 years, 32.3% (n = 21) in 26 - 30 years, 40.9% (n = 47) in 31 - 35 years, 45.8% (n = 54) in 36 - 40 years, 68.7% (n = 79) in 41 - 45 years, 70.1% (n = 68) in 46 - 50 years, 80.8% (n = 63) in 51 - 55 years and 87.7% (n = 50) over 56 years old. In those who accepted further screening, positivity for hepatitis B core antibody was found in 0.6% (n = 3) travelers, hepatitis C virus infection in 1.1% (n = 6) and human immunodeficiency virus infection in 0.5% (n = 3) whose previous status was unknown. The most frequent travel destination was sub-Saharan Africa (72.6%; n = 483). DISCUSSION: We found 49.1% (n = 260) travelers under 50 years old susceptible to hepatitis A virus infection and for those between 40 and 50 years, 30.7% (n = 65) still need vaccine protection. CONCLUSION: Across age groups there is a trend towards lower prevalence of hepatitis A virus antibody, in particular among youngsters, when compared with older Portuguese studies.

Introdução: A prevalência da hepatite A em Portugal tem diminuído nas últimas décadas, sobretudo nos jovens adultos. O objetivo deste estudo foi avaliar a prevalência do anticorpo contra o vírus da hepatite A numa população que recorreu à consulta de Medicina do Viajante. Material e Métodos: Avaliamos a serologia de hepatite A, hepatite B, hepatite C e do vírus da imunodeficiência humana, através de imunoensaio enzimático padrão, de viajantes com idade igual ou superior a 18 anos. Excluímos aqueles previamente vacinados contra o vírus da hepatite A, com diagnóstico prévio de infeção pelos vírus da hepatite B, hepatite C e/ou vírus da imunodeficiência humana, estrangeiros e emigrantes. Aplicamos um inquérito epidemiológico prospetivo e analisamos os dados estatisticamente com o SPSS® versão 18. Resultados: Participaram no estudo 665 viajantes, dos quais 57,6% (n = 383) eram imunes para o vírus da hepatite A. Foram estratificados por oito grupos etários e, para cada um, foi avaliada a presença de imunidade: 5,0% (n = 1) nos 18 - 25 anos, 32,3% (n = 21) nos 26 - 30 anos, 40,9% (n = 47) nos 31 - 35 anos, 45,8% (n = 54) nos 36 - 40 anos, 68,7% (n = 79) nos 41 - 45 anos, 70,1% (n = 68) nos 46 - 50 anos, 80,8% (n = 63) nos 51 - 55 anos e 87,7% (n = 50) com idade igual ou superior a 56 anos. Dos que aceitaram realizar rastreio, detetou-se o anticorpo hepatitis B core em 0,6% (n = 3) viajantes, infeção pelo vírus da hepatite C em 1,1% (n = 6) e pelo vírus da imunodeficiência humana em 0,5% (n = 3), cujos estados serológicos eram desconhecidos. O destino mais frequente foi a África Subsariana (72,6%; n = 483). Discussão: Detetamos 49,1% (n = 260) viajantes suscetíveis a infeção pelo vírus da hepatite A e o grupo dos 40 aos 50 anos de idade, 30,7% (n = 65) ainda necessita de proteção vacinal. Conclusão: A prevalência do anticorpo contra o vírus da hepatite A tem diminuindo na população Portuguesa, aumentando a suscetibilidade a esta infeção nas deslocações a áreas endémicas.

Candida albicans osteomyelitis as a cause of chest pain and visual loss.

Candida albicans osteomyelitis is a rare disease that occurs in immunocompromised individuals, sometimes with a late diagnosis related to the mismatch between symptoms and candidemia. This case refers to a 36-year-old male patient with a history of oesophageal surgery for achalasia with multiple subsequent surgeries and hospitalisation in the intensive care unit for oesophageal fistula complication. Four months after discharge, the patient was admitted to the infectious diseases department with pain in the 10th-12th left ribs, swelling of the 4th-6th costal cartilage and decreased visual acuity. An MRI study showed thickening and diffuse enhancement, with no defined borders in the cartilage and ribs, compatible with infection. After performing a CT-guided bone biopsy, isolated C. albicans sensitive to antifungal agents was detected. The patient started therapy with liposomal amphotericin B and maintenance fluconazole for 6 months and showed clinical and radiological improvement within this time.

Detection of the protease codon 35 amino acid insertion in sequences from treatment-naïve HIV-1 subtype C infected individuals in the Central Region of Portugal.

BACKGROUND: Amino acids insertions in the protease (PR) coding region have been reported in protease inhibitors (PIs) treatment-naïve and experienced HIV-1 infected individuals ranging from 0.1% to 4.55% and have been rarely found in non-B HIV-1 subtype strains. OBJECTIVES: To investigate the presence of amino acid insertions in the PR coding region in sequences from treatment-naïve HIV-1 infected individuals in the Central Region of Portugal. STUDY DESIGN: Sequences of the pol gene from 260 treatment-naïve HIV-1 infected individuals between 2000 and 2008 were analyzed and phylogenetic analysis was performed. RESULTS: A threonine insertion (E35E_T) was detected in 2.69% (n=7) of the sequences analyzed and all the sequences that possessed this insertion were identified as subtype C. All the seven inserted sequences clustered in the same lineage of the phylogenetic tree. Heterosexual and intravenous drug use were found to be the routes of infection. No major mutations in the PR coding region associated with resistance to PIs were detected. CONCLUSIONS: It was found the highest prevalence of PR codon 35 insertion among treatment-naïve HIV-1 infected individuals ever reported in the western countries. Epidemiological data and Phylogenetic analysis indicated the possibility of transmission of this insertion. The results suggested that these inserted strains have normal susceptibility to PIs containing regimens. This study demonstrated the spreading epidemic of PR codon 35 inserted strains from subtype C in the Central Region of Portugal, during the past eight years.