Hemophagocytic lymphohistiocytosis secondary to AIDS-related histoplasmosis and visceral leishmaniasis.

Hemophagocytic Lymphohistiocytosis (HLH) is a rare, highly aggressive syndrome involving dysregulated immune response. Most cases are secondary to underlying diseases including infections, autoimmune disorders and malignancies. The burden of disease of histoplasmosis and leishmaniosis associated with advanced HIV is still significant in low-and-middle income countries (LMIC). We present a case of histoplasmosis and leishmaniasis associated HLH in a man with an AIDS diagnosis.

Score clínico simple para el uso racional de ecografía pulmonar en pacientes ambulatorios con COVID-19 / Simple clinical score for rational use of lung ultrasound in COVID-19 outpatient settings

INTRODUCCIÓN: Debido a la rápida expansión mundial del COVID-19, se crearon Unidades Febriles de Urgencia (UFU) para la atención ambulatoria y estratificación del riesgo clínico de los pacientes. La ecografía pulmonar ha cobrado un interés creciente como método sensible para la detección de neumonía. El objetivo fue desarrollar un score simple y sensible de riesgo clínico de neumonía durante la primera ola de COVID-19. MÉTODOS: Se realizó un estudio de corte transversal sobre una cohorte de adultos con diagnóstico confirmado de COVID-19 asistidos en la UFU de un hospital general de la ciudad de Buenos Aires entre mayo y agosto de 2020. Se efectuó el análisis bivariado y multivariado de variables sociodemográficas y clínicas para la construcción y validación interna de un score predictivo de neumonía. RESULTADOS: El análisis final incluyó a 936 pacientes; 17,6% presentaron ecografía compatible con neumonía. El score incluyó 5 variables estadísticamente significativas: edad ≥50 años (3 puntos), tos (2 puntos), ausencia de odinofagia (1 punto), disnea (2 puntos) y saturación de oxígeno ≤95% (3 puntos). Para un punto de corte ≥3 la sensibilidad fue 80,5% y el valor predictivo negativo 93,3%, con buen desempeño en cohorte de derivación y de validación (área bajo curva ROC 0,79 y 0,76, respectivamente). DISCUSIÓN: Este score podría ser una herramienta útil para estratificar el riesgo clínico de neumonía en el ámbito prehospitalario y evitar la realización de imágenes con <3 puntos.

Simple clinical score for rational use of lung ultrasound in COVID-19 outpatient settings / Score clínico simple para el uso racional de ecografía pulmonar en pacientes ambulatorios con covid-19

RESUMEN INTRODUCCIÓN: Debido a la rápida expansión mundial del COVID-19, se crearon Unidades Febriles de Urgencia (UFU) para la atención ambulatoria y estratificación del riesgo clínico de los pacientes. La ecografía pulmonar ha cobrado un interés creciente como método sensible para la detección de neumonía. El objetivo fue desarrollar un score simple y sensible de riesgo clínico de neumonía durante la primera ola de COVID-19. MÉTODOS: Se realizó un estudio de corte transversal sobre una cohorte de adultos con diagnóstico confirmado de COVID-19 asistidos en la UFU de un hospital general de la ciudad de Buenos Aires entre mayo y agosto de 2020. Se efectuó el análisis bivariado y multivariado de variables sociodemográficas y clínicas para la construcción y validación interna de un score predictivo de neumonía. RESULTADOS: El análisis final incluyó a 936 pacientes; 17,6% presentaron ecografía compatible con neumonía. El score incluyó 5 variables estadísticamente significativas: edad ≥50 años (3 puntos), tos (2 puntos), ausencia de odinofagia (1 punto), disnea (2 puntos) y saturación de oxígeno ≤95% (3 puntos). Para un punto de corte ≥3 la sensibilidad fue 80,5% y el valor predictivo negativo 93,3%, con buen desempeño en cohorte de derivación y de validación (área bajo curva ROC 0,79 y 0,76, respectivamente). DISCUSIÓN: Este score podría ser una herramienta útil para estratificar el riesgo clínico de neumonía en el ámbito prehospitalario y evitar la realización de imágenes con <3 puntos.

ABSTRACT INTRODUCTION: Due to the rapid global expansion of COVID-19, Febrile Emergency Units (FEU) were created in the outpatient setting to stratify the clinical risk of patients. Pulmonary ultrasound has gained a growing interest as a sensitive method for the detection of pneumonia. This study aimed to at developing a simple and sensitive score to assess the risk of pneumonia during the first COVID-19 wave. METHODS: A cross-sectional study was conducted in a cohort of adult patients with laboratory-confirmed COVID-19, who received care at the FEU of a general hospital in the city of Buenos Aires from May through August 2020. Bivariate and multivariate analyses of sociodemographic and clinical variables were performed to build and internally validate a pneumonia predictive score. RESULTS: The final analysis included 936 patients; 17.6% had ultrasound compatible with pneumonia. The score included 5 statistically significant variables: age ≥50 years (3 points), cough (2 points), absence of odynophagia (1 point), dyspnea (2 points) and oxygen saturation ≤95% (3 points). A cut-off point ≥3 showed a sensitivity of 80.5% and a negative predictive value of 93.3%, with good discriminatory capacity both in derivation and validation cohorts (area under ROC curve 0.79 and 0.76, respectively). DISCUSSION: This score could be a useful tool to stratify the clinical risk of pneumonia in the pre-hospital setting and avoid imaging studies with a score <3.

Development of simple and sensitive score to assess the risk of pneumonia in Covid-19 patients

ABSTRACT Background: Severe pneumonia is the most common cause of intensive care unit (ICU) admission and death due to novel coronavirus (SARS-CoV-2) respiratory disease (COVID-19). Due to its rapid outbreak, units for the evaluation of febrile patients in the pre-hospital setting were created. Objective: The objective of the study was to develop a sensitive and simple tool to assess the risk of pneumonia in COVID-19 patients and thus select which patients would require a chest imaging study. Materials and Methods: We conducted a cross-sectional study in a cohort of individuals with suspected COVID-19 evaluated in a public academic healthcare center in Buenos Aires city. All adult patients with positive RT-PCR assay for SARS-COV2 between April 24 and May 19 of 2020 were included in the study. Pneumonia was defined as the presence of compatible signs and symptoms with imaging confirmation. Univariate and multivariate logistic regression was performed. A risk indicator score was developed. Results: One hundred and forty-eight patients were included, 71 (48%) received the diagnosis of pneumonia. The final clinical model included four variables: age ≥ 40 years, cough, absence of sore throat, and respiratory rate ≥ 22. To create the score, we assigned values to the variables according to their ORs: 2 points for respiratory rate ≥ 22 and 1 point to the other variables. The AUC of the ROC curve was 0.80 (CI 95% 0.73-0.86). A cutoff value of 2 showed a sensitivity of 95.7% and a specificity of 43.24%. Conclusion: This sensible score may improve the risk stratification of COVID-19 patients in the pre-hospital setting. (REV INVEST CLIN. 2021;73(1):52-8)

Development of Simple and Sensitive Score to Assess the Risk of Pneumonia in COVID-19 Patients.

BACKGROUND: Severe pneumonia is the most common cause of intensive care unit (ICU) admission and death due to novel coronavirus (SARS-CoV-2) respiratory disease (COVID-19). Due to its rapid outbreak, units for the evaluation of febrile patients in the pre-hospital setting were created. OBJECTIVE: The objective of the study was to develop a sensitive and simple tool to assess the risk of pneumonia in COVID-19 patients and thus select which patients would require a chest imaging study. MATERIALS AND METHODS: We conducted a cross-sectional study in a cohort of individuals with suspected COVID-19 evaluated in a public academic healthcare center in Buenos Aires city. All adult patients with positive RT-PCR assay for SARS-COV2 between April 24 and May 19 of 2020 were included in the study. Pneumonia was defined as the presence of compatible signs and symptoms with imaging confirmation. Univariate and multivariate logistic regression was performed. A risk indicator score was developed. RESULTS: One hundred and forty-eight patients were included, 71 (48%) received the diagnosis of pneumonia. The final clinical model included four variables: age >- 40 years, cough, absence of sore throat, and respiratory rate >- 22. To create the score, we assigned values to the variables according to their ORs: 2 points for respiratory rate >- 22 and 1 point to the other variables. The AUC of the ROC curve was 0.80 (CI 95% 0.73-0.86). A cutoff value of 2 showed a sensitivity of 95.7% and a specificity of 43.24%. CONCLUSION: This sensible score may improve the risk stratification of COVID-19 patients in the pre-hospital setting.

COVID-19 associated with AIDS-related disseminated histoplasmosis: a case report.

Limited information is available concerning the coexistence of COVID-19 and opportunistic infections in people living with HIV. The possible association of COVID-19 with AIDS-related respiratory diseases should be considered, particularly in patients with advance immunosuppression. We report the case of a male patient with AIDS-related disseminated histoplasmosis associated with COVID-19.

Integrated models of care for people who inject drugs and live with hepatitis C virus: A systematic review.

BACKGROUND: Despite the key role that people who inject drugs (PWID) play in the hepatitis C virus (HCV) epidemic, HCV treatment rates among this population have been historically low. Integrated models of HCV and substance use care have the potential to overcome some barriers to access; however, the evidence base is uncertain. This systematic review assesses the impacts of integrated HCV and substance use services on engagement in HCV care among PWID. METHODS: We searched five databases up to December 2018 to identify original quantitative studies evaluating the impacts of co-location of HCV and substance use services on engagement in the HCV cascade of care among adult PWID. We conducted a narrative synthesis, categorizing models based on patient entry point (a: HCV facility, b: substance use disorder (SUD) facility, and c: other facilities), and levels of integrated services offered (a: HCV/substance use testing only, b: HCV/substance use treatment, and c: testing/treatment + other services). RESULTS: A total of 46 articles corresponding to 44 original studies were included. Almost all studies (n = 42) were conducted in high-income countries and only six studies in the Direct-Acting Antiviral (DAA) era. Twenty-six studies discussed the integration of services at SUD facilities, one at HCV facilities, and seventeen at other facilities. Analysis of included studies indicated that overall integrated care resulted in improved engagement in HCV care (e.g., testing, treatment uptake and cure). However, the quality of evidence was predominantly low to moderate. CONCLUSIONS: Available evidence suggests that integration of HCV and substance use services may improve engagement along the continuum of HCV care among PWID. Given limitations in data quality, and very few studies conducted in the DAA era and in low- and middle-income settings, further research is urgently needed to inform strategies to optimize HCV care access and outcomes among PWID globally.

Cryptococcal meningitis: an unusual presentation of primary HIV infection.

Acute HIV infection presenting as severe opportunistic disease is a very uncommon event associated with more rapid HIV progression and higher mortality. We describe the case of a patient with cryptococcal meningitis in the setting of primary HIV infection.

Bilateral acute angle closure in a patient with dengue fever: a case report.

We report the case of a 46-year-old female patient who presented with bilateral acute angle closure during the course of dengue infection. Dengue diagnosis was confirmed by serological tests. The patient had plateau iris configuration identified by ultrasound biomicroscopy. This is the second reported case with this condition during dengue fever and the first to describe the characteristics of the angle.

Bilateral acute angle closure in a patient with dengue fever: a case report / Fechamento de ângulo agudo bilateral em paciente com dengue: relato de um caso

ABSTRACT We report the case of a 46-year-old female patient who presented with bilateral acute angle closure during the course of dengue infection. Dengue diagnosis was confirmed by serological tests. The patient had plateau iris configuration identified by ultrasound biomicroscopy. This is the second reported case with this condition during dengue fever and the first to describe the characteristics of the angle.

RESUMO Os autores relatam o caso de uma mulher de 46 anos que teve fechamento agudo de ângulo bilateral durante a infecção por dengue. O diagnóstico de dengue foi confirmado por testes sorológicos. A paciente teve configuração de íris em platô confirmada pela biomicroscopia ultrassônica. Esse é o segundo caso descrevendo essa condição durante um episódio de dengue e o primeiro a descrever as características do ângulo.

Infección tuberculosa meníngea (meningitis tuberculosa) en un paciente con sida y la aplicación del GeneXpert como herramienta diagnóstica / Tuberculous meningitis in a patient with aids and the application of GeneXpert as a diagnostic too

La infección por VIH incrementa la posibilidad de contraer tuberculosis; el riesgo resulta mayor para las formas extrapulmonares y dentro de estas, la meníngea. La infección por VIH no modifica las manifestaciones neurológi-cas pero disminuye significativamente la supervivencia. El método molecu-lar GeneXpert MTB/RIF (CEPHEID, USA), implementado en 2010, es un mé-todo de amplificación del ácido nucleico para Mycobacterium tuberculosis, en tiempo real, con la determinación adicional de la resistencia a rifampicina.Caso clínico: paciente con VIH de diagnóstico reciente que manifes-tó enfermedad consuntiva. El cuadro inicial fue de compromiso pulmo-nar y luego meníngeo; en ambos casos el método GeneXpert MTB/RIF detectó Mycobacterium tuberculosis resistente a rifampicina. Se utili-zaron drogas de segunda línea, por la presunción de estar frente a una tuberculosis multiresistente, por definición resistente al menos a iso-niacida y rifampicina. Desarrolló hidrocefalia y profundas secuelas.Conclusiones: este método molecular permitió la detección rápida de la tuberculosis, la implementación de medidas de aislamiento así como con-trol de la infección y el inicio temprano de una terapéutica más eficaz, tan-to en la forma pulmonar como meníngea

HIV infection increases the risk of developing any form of tuberculosis, but the risk is greater for meningitis and the extrapulmonary form. HIV infection does not alter the neurological manifestations, but significantly decreases survival. The GeneXpert MTB / RIF (CEPHEID, USA), implemented in 2010, is a real time PCR for Mycobacterium tuberculosis, with rifampicin sensitivity.Case report: patient with recent diagnosed HIV, stating wasting disease. The original picture involved lung and then meningeal compromise: In both cases the Xpert MTB / RIF detected the presence of Mycobacterium tuberculosis rimfapicin resistant. Second-line drugs were used by the presumption of being faced with multidrug-resistant tuberculosis that, by definition, is resistant to at least isoniazid and rifampin. Patient developed hydrocephalus and was severe aftermath.Conclusions: This molecular method allowed the rapid detection of tuberculosis, implementation of isolation measures as infection control and the early onset of a more effective therapy, both in the pulmonary form and the meningeal