Osteomyelitis due to Cryptococcus neoformans are described in mostly 10% of patients with disseminated cryptococcosis, being direct inoculation even more uncommon. We report the case of an ...HIV-infected patient with history of recurring itching on his scalp and repetitive local trauma. For eighteen months, he noticed a painful and slow growing lump on his scalp. He was submitted to an excisional biopsy of the lesion but no etiological diagnosis was identified. After this procedure, the post-surgical wound never completely healed. At admission, the patient presented nausea and headache for three days and an open orifice into his skull. Investigations confirmed meningitis and skull osteomyelitis caused by Cryptococcus neoformans. He was treated with bone debridement and combined systemic antifungals, showing good clinical and laboratorial outcome. Cryptococcal disease should be included in the differential diagnoses of chronic osteomyelitis in HIV-infected patients and trauma is a possible source of infection.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
A Monkeypox (MPOX) é uma doença causada pelo vírus monkeypox (MPXV), endêmico desde 1970 na África Central e Ocidental, com poucos surtos relatados fora desse continente. Em maio de 2022 observou-se ...um aumento no número de casos da doença mundialmente, com maior prevalência em homens que fazem sexo com homens (HSH) e com transmissão através de contato direto, incluindo exposição sexual. Nesse contexto, evidenciou-se a associação da MPOX com infecções sexualmente transmissíveis, tal como a infecção pelo HIV. Relatamos o caso de um homem de 26 anos, HSH, com febre alta, mialgia e cefaleia iniciados em julho de 2022, evoluindo após 1 semana com erupção de pápulas umbilicadas dolorosas em nuca e punho, com progressão para membros superiores e região anal e surgimento de vesículas e pústulas disseminadas. O paciente foi atendido no Instituto de Infectologia Emílio Ribas, em São Paulo, cidade brasileira com maior número de casos confirmados da MPOX, tendo procurado atenção médica devido à dor perianal intensa, com lesões pleomórficas. Diagnosticado com MPOX por técnica de reação em cadeia da polimerase das lesões. Apresentava infecção prévia pelo HIV-1, em uso irregular de terapia antirretroviral (TARV), com contagem de LT-CD4+ de 4 células/µL e carga viral de HIV-1 de 1.428.516 cópias/mL. Após um mês apresentou piora das lesões, complicadas com proctite, celulite perianal, necrose de área glútea e edema peniano com obstrução uretral. Observou-se evolução desfavorável, com surgimento de novas lesões diariamente durante toda a internação. Reintroduzida TARV e iniciada terapia com Tecovirimat na dose de 600 mg de 12/12h, com realização de 2 ciclos de 14 dias do antiviral sem estabilização ou remissão do quadro, mantendo resposta isomórfica em locais de manipulação, simulando um fenômeno de Koebner. Posteriormente, apresentou piora do padrão respiratório, sendo submetido a broncoscopia, na qual se observaram lesões mucosas brônquicas secundárias ao MPXV de acordo com achados histopatológicos. Paciente evoluiu ao longo da internação com múltiplas disfunções orgânicas e síndrome de reconstituição imune, com desfecho de óbito em 3 meses. O caso apresentado retrata coinfecção HIV-1 e MPXV em paciente gravemente imunossuprimido, resultando em evolução desfavorável e refratariedade à terapia antirretroviral e antiviral. Chama-se atenção, portanto, para a importância da interação de ambas as infecções no prognóstico clínico.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Histoplasmosis of the Larynx Pochini Sobrinho, Fernando; Della Negra, Marinella; Queiroz, Wladimir ...
Brazilian journal of otorhinolaryngology,
2007 Nov-Dec, Volume:
73, Issue:
6
Journal Article
Peer reviewed
Open access
The incidence of laryngeal histoplasmosis is low when compared to the total number of cases. Less than 100 cases of laryngeal histoplasmosis have been described in the medical literature. Isolated ...laryngeal involvement may lead to the misdiagnosis and mistreatment of tuberculosis or laryngeal cancer, according to some reports. The development of hoarseness in a patient with histoplasmosis or a laryngeal mass leading to hoarseness, might be suggestive of laryngeal histoplasmosis. When histoplasmosis is included among the differential diagnoses of a laryngeal lesion, the biopsy should be limited to a small tissue fragment, enough to perform histological tests. The laboratory technicians must be warned about the possibility of histoplasmosis, because special dyes have to be used to confirm this diagnosis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Since 2022, monkeypox virus (MPXV) has been causing a multinational epidemic with Brazil as one of the most affected countries.1,2 During the current mpox (formally known as monkeypox) epidemic, men ...with AIDS are at increased risk of severe illness and death, although it remains unclear whether deaths are directly attributed to MPXV.2 We report clinical and autopsy findings of two men in their early 20s, who had severe mpox associated with AIDS in São Paulo. The pathology of mpox described here is severe and includes new findings of visceral involvement by MPXV (figure and appendix pp 8–11).3–6 In both cases, autopsies showed anasarca, cavity effusions, and diffuse MPXV-mediated lesions in various organs confirmed by detectable vaccinia antigens and MPXV-DNA. Besides multiple MPXV-skin lesions with necrotic ulcers and MPXV-dermal vasculitis, the autopsies showed MPXV-induced bilateral necrotising nodular pneumonia, acute pleuritis with pleural effusion, nodular ulcerative gastrointestinal lesions, necrotic glossitis with vasogenic oedema, extensive proctitis, pancreatitis, sialoadenitis, orchitis (including germinative cells within seminiferous tubules), epididymitis, adrenalitis, and haemophagocytosis. ...in cases of HIV and MPXV coinfection, MPXV appears to be transmitted by a complex mechanism involving contact with infected skin and mucosa, and respiratory and sexual transmission, corroborating previous data on aerosol MPVX animal infection and MPXV–DNA detection in semen.8–12 These autopsies show previously undescribed findings in the pathology of human MPXV infection and are helpful to understand why people living with HIV or AIDS are under high risk for worse mpox-associated outcomes.13–15 We declare no competing interests.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides spp. It can occur as an acute/subacute form (A/SAF), a chronic form (CF) and rarely as a mixed form combining ...the features of the two aforementioned forms in an immunocompromised patient. Here, we report a 56-year-old male patient with CF-PCM who presented with atypical manifestations, including the development of an initial esophageal ulcer, followed by central nervous system (CNS) lesions and cervical and abdominal lymphatic involvement concomitant with severe SARS-CoV-2 infection. He was HIV-negative and had no other signs of previous immunodeficiency. Biopsy of the ulcer confirmed its mycotic etiology. He was hospitalized for treatment of COVID-19 and required supplemental oxygen in the intensive unit. The patient recovered without the need for invasive ventilatory support. Investigation of the extent of disease during hospitalization revealed severe lymphatic involvement typical of A/SAF, although the patient`s long history of high-risk exposure to PCM, and lung involvement typical of the CF. Esophageal involvement is rare in non-immunosuppressed PCM patients. CNS involvement is also rare. We suggest that the immunological imbalance caused by the severe COVID-19 infection may have contributed to the patient developing atypical severe CF, which resembles the PCM mixed form of immunosuppressed patients. Severe COVID-19 infection is known to impair the cell-mediated immune response, including the antiviral response, through T-lymphopenia, decreased NK cell counts and T-cell exhaustion. We hypothesize that these alterations would also impair antifungal defenses. Our case highlights the potential influence of COVID-19 on the course of PCM. Fortunately, the patient was timely treated for both diseases, evolving favorably.
Background. IMPAACT P1066 is a phase I/II open-label multicenter trial to evaluate pharmacokinetics, safety, tolerability, and efficacy of multiple raltegravir formulations in human immunodeficiency ...virus (HIV)–infected youth. Methods. Dose selection for each cohort (I: 12 to <19 years; II: 6 to <12 years; and III: 2 to <6 years) was based on review of short-term safety (4 weeks) and intensive pharmacokinetic evaluation. Safety data through weeks 24 and 48, and grade ≤3 or serious adverse events (AEs) were assessed. The primary virologic endpoint was achieving HIV RNA <400 copies/mL or ≥1 log 10 reduction between baseline and week 24. Results. The targeted pharmacokinetic parameters (AUC 0-12h and C 12h ) were achieved for each cohort, allowing dose selection for 2 formulations. Of 96 final dose subjects, there were 15 subjects with grade 3 or higher clinical AEs (1 subject with drug-related DR psychomotor hyperactivity and insomnia); 16 subjects with grade 3 or higher laboratory AEs (1 with DR transaminase elevation); 14 subjects with serious clinical AEs (1 with DR rash); and 1 subjects with serious laboratory AEs (1 with DR transaminase increased). There were no discontinuations due to AEs and no DR deaths. Favorable virologic responses at week 48 were observed in 79.1% of patients, with a mean CD4 increase of 156 cells/μL (4.6%). Conclusions. Raltegravir as a film-coated tablet 400 mg twice daily (6 to <19 years, and ≥25 kg) and chewable tablet 6 mg/kg (maximum dose 300 mg) twice daily (2 to <12 years) was well tolerated and showed favorable virologic and immunologic responses. Clinical Trials Registration. NCT00485264.
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BFBNIB, NUK, PNG, UL, UM, UPUK
Brazil is facing increasing cycles of numbers of infected people and deaths resulting from coronavirus disease 2019 (COVID-19). This situation involves a series of factors, including the behavior of ...the population, that can be decisive for controlling the disease.
To determine the knowledge, attitudes and practices of the Brazilian population regarding COVID-19.
Cross-sectional survey-type study, conducted using a population sample from different Brazilian states.
A quantitative, descriptive and analytical approach was used. Sampling was done according to convenience and via snowballing. The data collection instrument was a knowledge, attitudes and practices system.
1,655 people from all over Brazil participated in the survey; 80% were living in the southern region and 70.15% were female. More than 90% had knowledge and good attitudes relating to the means of transmission, preventive care and symptoms associated with COVID-19, although their knowledge and attitudes were not fully reflected in daily practices, for which there was lower adherence (80%). Greater knowledge was correlated with older participants, larger number of children, female sex and marital status; better attitude, with female sex and complete higher education; and better practices, with greater age, larger number of children and female sex.
A large part of the population has general knowledge about COVID-19, but not all knowledge was applied in practice. Older people, females and university graduates stood out as the best informed and most committed to controlling the disease.
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