Prevalence and lethality among patients with histoplasmosis and AIDS in the Midwest Region of Brazil.

Histoplasmosis is a systemic mycosis that is considered an important public health problem. In this work, we performed a descriptive, observational, cross-sectional and retrospective study with a secondary data analysis of medical records from 2000 to 2012 at a tertiary hospital. The study sample consisted of 275 patients with laboratory-confirmed Disseminated Histoplasmosis (DH)/AIDS. The results showed that the prevalence of DH associated with AIDS was 4.4%. The majority of patients were young adult men with fever in 84.2%, cough in 63.4%, weight loss in 63.1%, diarrhoea in 44.8% and skin manifestations in 27.6% of patients. In the overall cohort, the CD4 counts were low, but not significantly different in survivors and non-survivors. Higher levels of urea and lower levels of haemoglobin and platelets were observed in non-survivor patients (<.05). The global lethality was 71.3% (196/275). The results with high prevalence and lethality highlight the need to adopt measures to facilitate early diagnosis, proper treatment and improved prognosis.

Morbi-mortalidad en pacientes con infección por Mycobacterium tuberculosis comprobada, y co-infección VIH-Tuberculosis en Hospital Roosevelt en Guatemala / Morbi-mortality in patients with proved Mycobacterium tuberculosis infections, co-infected and no co-infected with HIV, at Roosevelt Hospital in Guatemala

Tuberculosis (TB) es la enfermedad oportunista más importante relacionada con VIH, provocando manifestaciones clínicas graves y con frecuencia diseminadas, y afección extrapulmonar. En Guatemala es la principal causa de muerte en pacientes con Sida. OBJETIVO: Determinar la morbi-mortalidad en pacientes hospitalizados con Tuberculosis en Hospital Roosevelt. MÉTODOS: Se incluyeron pacientes con diagnóstico comprobado por tests microbiológicos positivos para Mycobacterium tuberculosis, mayores de 12 años de edad, ingresados en los servicios de Medicina interna durante el año 2013. Se consideraron positivos los pacientes con frotes de ZN, prueba de PCR-RT (GeneXpert de Cepheid). Se colectaron los datos clínicos y epidemiológicos de los pacientes con un instrumento estandarizado de manera prospectiva, generándose una base de datos en Excel 2010 y realizando el análisis estadístico con: SPSS21...(AU)

Introduction: Tuberculosis (TB) is the main opportunistic infection related to HIV, causing complex and serious disease, frequently, extra-pulmonary in HIV patients. In Guatemala it represents the main cause of death in AIDS patients and with an increased incidence in patients with other co-morbidities. OBJECTIVE: To determine the morbi-mortalily in admitted patients in internal medicine wards with tuberculosis at Roosevelt Hospital in Guatemala City. METHODOLOGY: Patients with proved infection by clinical and/or culture/PCR-RT positive to Mycobacterium tuberculosis were included, older than 12 years old, admitted to the internal medicine guards, which presented positive culture and/or ZN smears and/or PCR-RT (GeneXpert, Cepheid) positive tests in 2013. Clinical and epidemiological data were collected in a prospective manner, with a standardized instrument, generating an Excel 2010 data base that was analyzed by SPSS21. RESULTS: 200 patients were included, 61% males with man: woman ratio of 1.5:1. 48% presented HIV coinfection. 54% of the patients aged: 25 to 44 years old. 43% residents outside Guatemala City. The extra pulmonary TB was present in 65%. The highest mortality was observed in TB-HIV co-infected patients: 30.2% versus 10. % in lung cases (p=0.001). 2.1% died in the first 24 hours after admission, 13.5% between 1-7 days; 14.6% after 7 days of hospital stay, (p=0.002). Regarding the CD4 count, the higher mortality index was shown in the cases <100cel/mL 28.12%, versus 2.08% in > 100 (p=0.0001). CONCLUSSIONS: In a reference center like Roosevelt Hospital, the coinfection HIV-TB represents 48% of the TB cases. Mortality was higher in extrapulmonary TB and HIV patients with <100 CD4 counts

Morbimortality of pandemic influenza A H1N1 infection in kidney transplant recipients requiring hospitalization: a comparative analysis with nonimmunocompromised patients.

BACKGROUND: Clinical and epidemiological data of pandemic influenza A H1N1 infection in solid-organ transplant recipients have been described, but scarce data compare these outcomes with nonimmunocompromised patients. METHODS: We retrospectively reviewed and compared the clinical presentation, morbidity, and mortality of all kidney transplant (KT) and nonimmunocompromised (non-KT) patients admitted for at least 12 hr with a diagnosis of pandemic influenza A H1N1 infection in a single hospital complex during the 2009 pandemic. RESULTS: There were 22 patients in the KT group (29.3%) and 53 in the non-KT group (70.7%). The prevalence of diabetes was higher in KT group (27.3% vs. 5.7%) while chronic pulmonary disease was more frequent in non-KT group (34% vs. 9.1%). Clinical and radiological presentations and duration of disease were similar between the two groups. The incidence of acute renal failure was higher among KT patients (40.9% vs. 17%). No differences in the rate of intensive care unit admission (22.7% vs. 22.6%) or hospital mortality (9.1% vs. 7.5%) were observed. For the overall population, poor outcome, defined as intensive care unit admission or death, was associated with in-hospital acquisition (relative risk [RR]=42.6 [95% confidence interval {95% CI } 2.2-831.9], P=0.003), symptom onset more than 48 hr (RR=12.17 [95% CI 1.3-117.2], P=0.007), and acute renal failure (RR=11.8 [95% CI 2.9-48.8], P<0.001). Among KT recipients, in-hospital acquisition was the only covariate associate with poor outcome (RR=30.0 [95% CI 2.1-421.1], P=0.004). CONCLUSIONS: No significant differences in morbidity and mortality were observed comparing KT and non-KT patients infected with pandemic H1N1 influenza A virus.

Infections after liver transplantation in adults: data from a university hospital in southern Brazil (1996-2000).

BACKGROUND: Infections after liver transplantations are the most important cause of morbi-mortality. In this study, we assessed the main characteristics of these infections in a southern Brazilian university hospital. METHODS: We conducted a retrospective cohort with 55 patients who underwent orthotopic liver transplantation between 1996 and 2000 in the "Hospital de Clínicas de Porto Alegre", Porto Alegre, RS, Brazil, to characterize the infections that occurred in the group. RESULTS: One or more infections (average 2.10) were diagnosed in 47 patients, especially during the first month after transplantation. The most common were bacteremia, intra-abdominal infections and pneumonia, predominantly with bacteria, especially Staphylococcus sp (and particularly S. aureus) and E. coli. The mortality rate attributed to infections was high: 17 cases of all deaths (total 27 deaths). Significant risk factors for infections included reoperation, diabetes, biliary stenosis and higher Child-Pugh scores. CONCLUSION: Infections remain a severe threat in liver transplant patients, and special efforts should be made to prevent and manage them correctly.

Infections after liver transplantation in adults: data from a university hospital in southern Brazil (1996-2000)

BACKGROUND: Infections after liver transplantations are the most important cause of morbi-mortality. In this study, we assessed the main characteristics of these infections in a southern Brazilian university hospital. METHODS: We conducted a retrospective cohort with 55 patients who underwent orthotopic liver transplantation between 1996 and 2000 in the "Hospital de Clínicas de Porto Alegre", Porto Alegre, RS, Brazil, to characterize the infections that occurred in the group. RESULTS: One or more infections (average 2.10) were diagnosed in 47 patients, especially during the first month after transplantation. The most common were bacteremia, intra-abdominal infections and pneumonia, predominantly with bacteria, especially Staphylococcus sp (and particularly S. aureus) and E. coli. The mortality rate attributed to infections was high: 17 cases of all deaths (total 27 deaths). Significant risk factors for infections included reoperation, diabetes, biliary stenosis and higher Child-Pugh scores. CONCLUSION: Infections remain a severe threat in liver transplant patients, and special efforts should be made to prevent and manage them correctly.

RACIONAL: Infecções são a causa principal de morbimortalidade em pacientes submetidos a transplantes hepáticos. OBJETIVO: Avaliar as principais características destas infecções em pacientes de um hospital universitário do sul do Brasil. MÉTODO: Uma coorte retrospectiva foi conduzida com os 55 pacientes transplantados hepáticos adultos cuja cirurgia foi realizada entre 1996 e 2000 no Hospital de Clínicas de Porto Alegre, RS, todos aos eventos infecciosos que ocorreram nesta população foram registrados. RESULTADOS: Uma ou mais infecções (média 2,1 episódios) foram diagnosticadas em 47 pacientes, o período de maior ocorrência destas foi o primeiro mês após a cirurgia. As infecções mais comuns foram: bacteremias, infecções intra-abdominais e pneumonias, a etiologia mais freqüente foi bacteriana, sendo os germes mais comuns os estafilicocos (em particular o S. aureus) e a E. coli. A taxa de mortalidade associada a infecções foi elevada: 17 óbitos de todos observados na coorte (27 no total). Os fatores de risco para infecção estatisticamente significantes foram: reoperação, diabetes, estenose de via biliar e classificação de Child-Pugh elevada. CONCLUSÃO: As infecções continuam sendo grave ameaça aos pacientes transplantados hepáticos e intenso esforço, que envolve o conhecimento da epidemiologia microbiológica, pesquisa e acompanhamento dos pacientes deve ser empregado, para prevenir e tratar de forma adequada estas complicações.

Infección por virus de inmunodeficiencia humana en la mujer / HIV infection in the women

La mujer constituye uno de los puntos más vulnerables en la cadena epidemiológica en la Infección por Virus de Inmunodeficiencia Humana (HIV). Dicha vulnerabilidad está determinada por factores sociopolíticos, económicos y culturales de cada país en particular, lo cual se traduce en un incremento cada vez mayor del número de casos de Infección por VIH en este sexo. Los aspectos más dramáticos de la Infección por VIH en este segmento tan especial de la población susceptible, corresponden a: 1. el mayor número de casos se observa en mujeres jóvenes con vida sexual activa. 2. el Síndrome de Inmunodeficiencia Adquirida (SIDA) es la tercera causa de muerte en mujeres con edad comprendida entre 25 y 44 años, lo cual coloca en situación de orfandad a miles de niños a nivel mundial, con un total actual de 8.2 millones de niños huérfanos por esta causa. 3. aún cuando el porcentaje de mujeres con Infección por VIH que consultan por sintomatología primaria de enfermedad ginecológica es relativamente bajo (aproximadamente 9 por ciento), una evaluación ginecológica exhaustiva, puede demostrar patología ginecológica hasta en un 83 por ciento de los casos. 4. en relación a la transmisión vertical, en algunas regiones del mundo, el hecho de saberse infectada con el HIV no cambia en la mujer la conducta ante la concepción, por lo tanto considerando que más del 86 por ciento de la Infección por VIH en niños es adquirida de madre a hijo, es la mujer uno de los elementos claves de la cadena epidemiológica donde se deben fundamentar programas integrales de prevención y tratamiento antiretroviral efectivo para garantizar de esta forma no solo una mejor calidad de vida a la mujer infectada, sino la posibilidad de disminuir la incidencia de Infección por VIH en los niños

Micoses profundas em transplantados renais: indicaçäo de alerta clínico / Deep mycosis in kidney transplantation: indication of alert clinic

A imunossupressao dada a receptores de transplantes renais torna-os suscetíveis a infecçoes oportunísticas. Os autores estudaram o impacto das micoses profundas numa populaçao de 502 transplantados renais (525 transplantes) num período de 20 anos.Vinte e quatro receptores (4,6 por cento) desenvolveram micose profunda. Histoplasmose e criptococose foram as micoses mais prevalentes e as maiores responsáveis pela relativamente alta percentagem de óbitos observada (5O por cento). Revisao sobre métodos diagnósticos e de tratamento das mesmas é apresentada.Transplantados renais com micose profunda representam possivelmente um grupo imunossuprimido em excesso que deve ser seguido de perto para se tentar evitar mortalidade excessiva.

Fungemias en pacientes críticamente enfermos / Fungemia in patients critically illness

En las últimas décadas y debido al uso de potentes antibióticos de amplio espectro, el empleo de técnica invasivas, tanto diagnósticas como terapéuticas y la mayor sobrevida de pacientes inmunosuprimidos han traido como consecuencia un incremento significativo en la frecuencia de infecciones micóticas sistémicas, que como microorganismos oportunistas, representan una importante causa de morbi-mortalidad en pacientes críticammente enfermos. Esta revisión tiene el objetivo de hacer énfasis en los principales aspectos tanto etiológicos, diagnósticos, terapéuticos y especialmente preventivos, que sirvan de guía práctica para el manejo de esta preocupante patología

Cytomegalovirus and Pneumocystis carinii pneumonia in children with acquired immunodeficiency syndrome.

To ascertain the effect of cytomegalovirus (CMV) infection on the course of Pneumocystis carinii pneumonia (PCP) in children with acquired immunodeficiency syndrome (AIDS), we reviewed the charts of all children with AIDS who also had a lung biopsy specimen or a bronchoalveolar lavage specimen cultured for CMV at the time PCP was diagnosed. The data indicate that children with AIDS and PCP whose cultures are positive for CMV do not have a poorer prognosis during a first episode of PCP compared with children whose cultures are negative for CMV.

[The importance of tuberculosis in the acquired immunodeficiency syndrome. The clinical and therapeutic aspects]. / La importancia de la tuberculosis en el síndrome de inmunodeficiencia adquirida. Aspectos clínicos y terapéuticos.

These is presented a study of 50 patients suffering TB and AIDS. The universe was divided in two: group I, when TB was considered the first manifestation of AIDS; (27 males and 2 females). Group II, when TB was preceded by some opportunistic infection, some kind of cancer, or some clinical symptoms compatible with wasting syndrome; (20 males and 1 female). There was no difference between the two groups regarding epidemiology, since homo-bisexuality was the most frequent among males. Neither were significantly different the clinical features of TB in both groups, and the most frequent symptoms were: fever, productive cough and painful lymphadenopathy. Both groups showed miliary infiltration on the lung X-rays; lymph nodes were the most frequent extrapulmonary localization. The only significant difference was found when the mortality was compared group I, 10 patients (34.4%) vs 16 (76%) from group II (p less than 0.01). An other part of the study is related with the efficacy of rifampin and isoniazide (31 cases), compared to their efficiency when these drugs are used combined with a third one (10 cases); the results showed no significant difference.

El estudio histopatológico como auxiliar diagnóstico en el SIDA / Histopathologycal studios as diagnosis auxiliar in the AIDS

Para mostrar la utilidad del estudio histopatológico, se revisó la información de 134 pacientes infectados con el VIH, atendidos en el Hospital Regional Núm. 45 del Instituto Mexicano del Seguro Social de Guadalajara, Jalisco; de éstos, se seleccionaron 32 para su análisis y presentación. La candidiasis (46.87%), tuberculosis (40.62%) y el sarcoma de Kaposi (25%) fueron las complicaciones más frecuentes del síndrome de inmunodeficiencia adquirida. Se compararon los resultados con la bibliografía nacional e internacional. Se sugiere considerar el hábitat geográfico de los enfermos en el diagnóstico diferencial de las enfermedades complicantes y, finalmente, se enfatiza la necesidad de utilizar la biopsia y el estudio postmortem, como auxiliares importantes de diagnóstico en medios como el nuestro