Trends in AIDS incidence in individuals aged 50 years or older in the city of Rio de Janeiro, Brazil, 1982-2011: an age-period-cohort analysis.

OBJECTIVE: The aim of this study was to investigate the effects of three temporal components of AIDS incidence (i.e., age, period and cohort) on individuals aged 50 or older living in Niteroi, Rio de Janeiro (Brazil). METHODS: Age-specific incidence rates were calculated from 1982-2011. Negative binomial and Poisson models were used to analyze the risk of AIDS by age, period and cohort. RESULTS: The risk of AIDS in men was 2.45 times higher than in women, regardless of age and period (p-value < 0.001). The incidence of AIDS in individuals older than 69 years was 7-fold lower than in those aged 50-59 years (p-value < 0.001). A decreasing trend in AIDS risk was observed from the youngest cohort (≥ 1940) to the oldest (1910-1919). From 1982 to 2006, we could detect an increasing trend in AIDS risk in the population aged 50 years or older. A peak in rates was detected in the period from 2002-2006. The incidence rates in 2002-2006 were six times higher than those in 1987-1991 (p-value < 0.001), independent of age and sex (p-value < 0.001). CONCLUSIONS: An increase of AIDS risk in older people was detected. This group should not be neglected by public health programs.

Treatment of cutaneous sporotrichosis with itraconazole--study of 645 patients.

BACKGROUND: Itraconazole has become the first choice for treatment of cutaneous sporotrichosis. However, this recommendation is based on case reports and small series. The safety and efficacy of itraconazole were evaluated in 645 patients who received a diagnosis on the basis of isolation of Sporothrix schenckii in Rio de Janeiro, Brazil. METHODS: A standard regimen of itraconazole (100 mg/day orally) was used. Clinical and laboratory adverse events were assessed a grades 1-4. A multivariate Cox model was used to analyze the response to treatment. RESULTS: The median age was 43 years. Lymphocutaneous form occurred in 68.1% and fixed form in 23.1%. Six hundred ten patients (94.6%) were cured with itraconazole (50-400 mg/day): 547 with 100 mg/day, 59 with 200-400 mg/day, and 4 children with 50 mg/day. Three patients switched to potassium iodide, 2 to terbinafine, and 4 to thermotherapy. Twenty-six were lost to follow-up. Clinical adverse events occurred in 18.1% of patients using 100 mg/day and 21.9% of those using 200-400 mg/day. The most frequent clinical adverse events were nausea and epigastric pain. Laboratory adverse events occurred in 24.1%; the most common was hypercholesterolemia, followed by hypertriglyceridemia. Four hundred sixty-two patients (71.6%) completed clinical follow-up, and all remained cured. Only 2 variables were significant in explaining the cure: patients with erythema nodosum healed faster, and lymphocutaneous form took longer to cure. CONCLUSIONS: In the current series, the therapeutic response was excellent with the minimum dose of itraconazole, and there was a low incidence of adverse events and treatment failure.

Comparative study of 250 mg/day terbinafine and 100 mg/day itraconazole for the treatment of cutaneous sporotrichosis.

UNLABELLED: Itraconazole is currently used for the treatment of cutaneous sporotrichosis. Terbinafine at a daily dose of 250 mg has been successfully applied to the treatment of cutaneous sporotrichosis. OBJECTIVE: To compare the efficacy of 250 mg/day terbinafine and 100 mg/day itraconazole for the treatment of cutaneous sporotrichosis. MATERIALS AND METHODS: A bidirectional cohort study was conducted on 55 patients receiving 250 mg/day terbinafine and 249 patients receiving 100 mg/day itraconazole. The latter patients were matched for age and clinical form to the terbinafine group at a ratio of 5:1. Sporothrix schenckii was isolated by culture from all patients (age range: 18-70 years), who were submitted to the standard care protocol consisting of clinical and laboratory evaluation and periodic visits. RESULTS: Cure was observed in 51 (92.7%) patients of the terbinafine group and 229 (92%) of the itraconazole group within a similar mean period of time (11.5 and 11.8 weeks, respectively). An increase in the terbinafine dose to 500 mg was necessary in two patients due to the lack of a response, and one patient presented recurrence. In the itraconazole group, two patients required a dose increase and three presented recurrence. Adverse events were equally frequent among patients receiving terbinafine (n = 4, 7.3%) and itraconazole (n = 19, 7.6%) and were generally mild without the need for drug discontinuation, except for two patients of the itraconazole group. CONCLUSION: Terbinafine administered at a daily dose of 250 mg is an effective and well-tolerated option for the treatment of cutaneous sporotrichosis.

Sporotrichosis caused by Sporothrix globosa in Rio De Janeiro, brazil: case report.

This report describes the first isolation of Sporothrix globosa from a Brazilian patient. A 77-year-old woman was examined for sporotrichosis infection. Histopathological examination of skin biopsy revealed chronic granulomatous infiltrate with microabcess. Furthermore, S. schenckii-like yeasts were evident as demonstrated by PAS and Grocott stains. The fungus was identified based on colony morphology on Sabouraud Dextrose Agar slants, Potato Dextrose Agar, and Corn Meal Agar, microscopic morphology on slides cultures, and assimilation of different carbon sources. The species confirmation was made by molecular methodology.

Primary conjunctival sporotrichosis: two cases from a zoonotic epidemic in Rio de Janeiro, Brazil.

PURPOSE: To describe Sporothrix schenckii conjunctivitis in 2 owners of cats with sporotrichosis. METHODS: Small case series and literature review. RESULTS: Two women had been caring for their pet cats with sporotrichosis for 2 months but did not recall any traumatic injury such as scratches or bites. Each presented a conjunctival granulomatous lesion measuring 4 to 5 mm accompanied by local hyperemia, secretion, and edema, in addition to painful facial subcutaneous nodes and regional lymph node enlargement. Pyogenic material was collected from the conjunctival sac and from cutaneous lesions on the cats. In both the patients and their respective cats, fungal colonies were isolated and identified as S. schenckii. Treatment with oral itraconazole 100 mg/d for 3 months resulted in complete healing of lesions in both patients. Patients remained clinically cured 15 months after end of treatment. CONCLUSION: Sporotrichosis is presently occurring as an emerging zoonosis in Rio de Janeiro, and some unusual clinical forms have been diagnosed in humans. The cases reported here suggest atraumatic exposure to cats infected by S. schenckii.

Positive Montenegro skin test among patients with sporotrichosis in Rio De Janeiro.

We studied 52 patients with sporotrichosis confirmed by isolation of Sporothrix schenckii and reactivity to the Montenegro skin test (MST) during an ongoing outbreak of this mycosis in Rio de Janeiro. The objective was to emphasize the importance of parasitological confirmation and the possibility of incorrect diagnosis based on the lesion's appearance, epidemiological information, and immunological tests. The antigen used for the MST was conserved in either thimerosal 1:10,000 (group 1) or 0.4% phenol (group 2). Nineteen patients (39%) in group 1 and seven (12%) in group 2 presented an induration>or=10 mm (p<0.001). Sera from three patients (6.7%) reacted to indirect immunofluorescence (IIF) for leishmaniasis, while sera from 10 patients (22.2%) reacted to enzyme-linked immunosorbent assay (ELISA). Fifteen patients (28.8%) presented up to two lesions, with a predominance of ulcers. Forty-four patients (84.6%) were treated with itraconazole. In the differential diagnosis between sporotrichosis and cutaneous leishmaniasis, the possibility of co-infection, allergy to the reagent diluent, and cross-reactions should be further investigated, especially in regions with limited laboratory facilities.

Sporotrichosis with widespread cutaneous lesions: report of 24 cases related to transmission by domestic cats in Rio de Janeiro, Brazil.

BACKGROUND: Sporotrichosis most commonly presents as a localized lymphocutaneous infection following traumatic inoculation of soil, vegetables or organic substrates contaminated with the dimorphic fungus Sporothrix schenckii. Cases of widespread cutaneous lesions are rare. There have been isolated reports of household outbreaks of sporotrichosis involving cats and humans. METHODS: We report 24 cases of culture-proven sporotrichosis presenting with widespread cutaneous lesions. RESULTS: These 24 cases are part of an epidemic currently occurring in Rio de Janeiro. All patients reported contact with cats with sporotrichosis and 17 reported a history of a scratch or bite. Clinical manifestations included fixed lesions at multiple anatomical sites, and fixed lesions associated with the lymphocutaneous, bilateral lymphocutaneous and mucosal forms of the disease. Two patients were alcoholics and one patient was diabetic, while the remaining patients did not present any immunosuppressing condition. All patients responded to treatment with itraconazole. CONCLUSIONS: The domestic cat has played an important role in the transmission of sporotrichosis in Rio de Janeiro and seems to have contributed to this unusual clinical manifestation.