First case report of monkeypox in Brazil: clinical manifestations and differential diagnosis with sexually transmitted infections.

In 2022, an outbreak of monkeypox is being reported in non-endemic areas, with unusual clinical manifestations. The detailed clinical description of the first patient that received the diagnosis of monkeypox in Brazil is reported here, whose clinical manifestations can easily lead to misdiagnosis of sexually transmitted infections. A 41 years old male presented to an emergency room with a vesicular rash with eight days of evolution. He had traveled to Portugal and Spain and reported non-penetrative sexual involvement with three different male individuals. On the third day of symptoms, he sought medical care and received empirical treatment directed to sexually transmitted infections. As the symptoms did not improve, he sought medical attention at an infectious disease referral center presenting, on admission, an ulcerated penile lesion with central necrotic crusts, a disseminated pleomorphic skin rash and an oropharyngeal ulcer. The monkeypox diagnosis was suspected due to the characteristics of the lesions and the history of intimate contact with casual partners, and it was later confirmed by sequencing the almost complete monkeypox genome. The patient was hospitalized for pain control, which required opiate administration. He developed a secondary bacterial infection on the penile lesions, which were treated with oral antibiotics. He was discharged after 14 days, with lesions in process of re-epithelialization. Given the current outbreak, we must consider the possibility of monkeypox in patients with suggestive lesions, anywhere on the body (including the genitals), added to an epidemiological link or history of intimate contact with strangers or casual partners.

Shotgun metagenomic sequencing of the first case of monkeypox virus in Brazil, 2022.

Monkeypox virus (MPXV), a zoonotic virus endemic to the African continent, has been reported in 33 non-endemic countries since May 2022. We report an almost complete genome of the first confirmed case of MPXV in Brazil. Shotgun metagenomic sequencing was completed in 18 hours, from DNA extraction to consensus sequence generation.

First case report of monkeypox in Brazil: clinical manifestations and differential diagnosis with sexually transmitted infections

ABSTRACT In 2022, an outbreak of monkeypox is being reported in non-endemic areas, with unusual clinical manifestations. The detailed clinical description of the first patient that received the diagnosis of monkeypox in Brazil is reported here, whose clinical manifestations can easily lead to misdiagnosis of sexually transmitted infections. A 41 years old male presented to an emergency room with a vesicular rash with eight days of evolution. He had traveled to Portugal and Spain and reported non-penetrative sexual involvement with three different male individuals. On the third day of symptoms, he sought medical care and received empirical treatment directed to sexually transmitted infections. As the symptoms did not improve, he sought medical attention at an infectious disease referral center presenting, on admission, an ulcerated penile lesion with central necrotic crusts, a disseminated pleomorphic skin rash and an oropharyngeal ulcer. The monkeypox diagnosis was suspected due to the characteristics of the lesions and the history of intimate contact with casual partners, and it was later confirmed by sequencing the almost complete monkeypox genome. The patient was hospitalized for pain control, which required opiate administration. He developed a secondary bacterial infection on the penile lesions, which were treated with oral antibiotics. He was discharged after 14 days, with lesions in process of re-epithelialization. Given the current outbreak, we must consider the possibility of monkeypox in patients with suggestive lesions, anywhere on the body (including the genitals), added to an epidemiological link or history of intimate contact with strangers or casual partners.

Shotgun metagenomic sequencing of the first case of monkeypox virus in Brazil, 2022

ABSTRACT Monkeypox virus (MPXV), a zoonotic virus endemic to the African continent, has been reported in 33 non-endemic countries since May 2022. We report an almost complete genome of the first confirmed case of MPXV in Brazil. Shotgun metagenomic sequencing was completed in 18 hours, from DNA extraction to consensus sequence generation.

Neurocisticercose: aspectos neurológicos e psicológicos / Neurocysticercosis: neurologic and psychological aspects

Este artigo discute algumas características psicológicas envolvidas na vivência da neurocisticercose, especialmente quando o paciente se encontra hospitalizado. A cisticercose é uma doença cuja infestação depende geralmente de condições higiênicas, sanitárias e educacionais precárias. Está largamente disseminada em nosso país. O paciente infestado tem a sua auto-estima rebaixada, além de inúmeras conseqüências psicológicas, médicas e sociais. Afeta diretamente o ego, debilitando-o em sua estrutura, fragilizando de maneira contundente o exercício de suas funções, inclusive seu repertório de defesas. Esse ego fragilizado pode, em muitos casos, utilizar de medidas extremas, levando-o a uma desesperada fragmentação, que será notada de forma clara no fracasso das suas funções, explicitando-se no fracasso de apreensão da realidade, na desorientação espacial, na confusão temporal, nos processos de pensamento, no pouco controle dos impulsos agressivos e no desenvolvimento de um quadro psicótico, com a presença de delírios e alucinações.

Angiomatose bacilar com comprometimento osseo: relato de caso e revisão de literatura / Bone lesions due to bacillary angiomatosis: case report and literature review

Bacillary angiomatosis is an infectious disease characterized by proliferation of small blood vessels in the skin and visceral organs of immunodeficient patients, mainly those infected with the human immunodeficiency v¡rus. ln this report, a 41-year-old man with seropositivity for HIV-1 presented with a five-months history of pain, edema, and movement restriction of his left wrist, elbow, knee, and ankle. In addition, he had nodular and ulcerated bleeding lesions in his right arm and leg, and a granulomatous nasal lesion. He had lost 8 kg in this five months period. He had sought an orthopedic medical center where long bone roentgenograms revealed diffuse lytic lesions, and bone scan showed uptake in left wrist, knee, and ankle. These findings were consistent with either neoplasm or osteomyelitis. During investigation, seropositivity for HIV-1 was detected. The patient was then referred to the Em¡lio Ribas lnfectious Diseases lnstitute [Instituto de Infectologia Em¡lio Ribas]. Histologic examination of bone and skin biopsy showed changes which are typical in bacillary angiomatosis cases. Electron microscopy findings were compatible with Bartonella species. Immunohistochemistry identified the bacteria as Bartonella quintana. Therapy with 2 g erythromycin per day was initiated. Cutaneous and osseous lesions were gradually resolved over the two ensuing months