RESUMO
Opportunistic diseases in HIV-infected patients have changed since the introduction of highly active anti-retroviral therapy (HAART). This study aims at evaluating the frequency of associated diseases in patients with AIDS admitted to an university hospital of Brazil, before and after HAART. The medical records of 342 HIV-infected patients were reviewed and divided into two groups: group 1 comprised 247 patients before HAART and, group 2, 95 patients after HAART. The male-to-female rate dropped from 5:1 to 2:1for HIV infection. There was an increase in the prevalence of tuberculosis and toxoplasmosis, with a decrease in Kaposi's sarcoma, histoplasmosis and cryptococcosis. A reduction of in-hospital mortality (42.0% vs. 16.9%; p = 0.00002) has also occurred. An agreement between the main clinical diagnoses and autopsy findings was observed in 10 out of 20 cases (50%). Two patients with disseminated schistosomiasis and 2 with paracoccidioidomycosis are reported. Overall, except for cerebral toxoplasmosis, it has been noticed a smaller proportion of opportunistic conditions related to severe immunosuppression in the post HAART group. There was also a significant reduction in the in-hospital mortality, possibly reflecting improvement in the treatment of the HIV infection.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/mortalidade , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Contagem de Linfócito CD4 , Distribuição de Qui-Quadrado , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos RetrospectivosRESUMO
Opportunistic diseases in HIV-infected patients have changed since the introduction of highly active anti-retroviral therapy (HAART). This study aims at evaluating the frequency of associated diseases in patients with AIDS admitted to an university hospital of Brazil, before and after HAART. The medical records of 342 HIV-infected patients were reviewed and divided into two groups: group 1 comprised 247 patients before HAART and, group 2, 95 patients after HAART. The male-to-female rate dropped from 5:1 to 2:1for HIV infection. There was an increase in the prevalence of tuberculosis and toxoplasmosis, with a decrease in Kaposi's sarcoma, histoplasmosis and cryptococcosis. A reduction of in-hospital mortality (42.0 percent vs. 16.9 percent; p = 0.00002) has also occurred. An agreement between the main clinical diagnoses and autopsy findings was observed in 10 out of 20 cases (50 percent). Two patients with disseminated schistosomiasis and 2 with paracoccidioidomycosis are reported. Overall, except for cerebral toxoplasmosis, it has been noticed a smaller proportion of opportunistic conditions related to severe immunosuppression in the post HAART group. There was also a significant reduction in the in-hospital mortality, possibly reflecting improvement in the treatment of the HIV infection
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS , Fármacos Anti-HIV , Terapia Antirretroviral de Alta Atividade , Infecções Oportunistas Relacionadas com a AIDS , Brasil , Contagem de Linfócito CD4 , Distribuição de Qui-Quadrado , Mortalidade Hospitalar , Prevalência , Estudos RetrospectivosRESUMO
A combined clinical and sonographic classification of hepatosplenic schistosomiasis mansoni to be used in field-based studies is proposed herein. Seven hundred forty one individuals out of 892 (83 percent), living in an area endemic for schistosomiasis in Brazil, have been ubmitted to clinical and ultrasound examinations. Based on two stool examinations the overall prevalence for schistosomiasis in this area was 73 percent. Abdominal palpation was performed with patients in dorsal decubit, during deep breath, by two experienced physicians and a portable ultrasound was used for the evaluation of liver fibrosis, portal collaterals and spleen size. Four groups of individuals were identified using data obtained by abdominal palpation and ultrasound examination: (1) palpable spleen and intense periportal thickening in 9 individuals (1.2 percent); (2) spleen not palpable and intense periportal thickening in 15 (2 percent); (3) palpable spleen with light to moderate periportal thickening in 32 (4.3 percent), and (4) palpable spleen with a normal liver on ultrasound in 30 (4 percent). The definition of hepatosplenic schistosomiasis in field-based studies as the finding of Schistosoma mansoni eggs in the stools in an individual with splenomegaly is not acceptable anymore. Abdominal ultrasound should be combined with clinical examination to accurately identify hepatosplenics in endemic areas for schistosomiasis
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Hepatopatias Parasitárias/diagnóstico , Esquistossomose mansoni/diagnóstico , Esplenopatias/diagnóstico , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Hepatopatias Parasitárias , Hepatopatias Parasitárias/epidemiologia , Prevalência , Esquistossomose mansoni , Esquistossomose mansoni/epidemiologia , Esplenopatias , Esplenopatias/epidemiologiaRESUMO
Schistosoma mansoni infection is likely to be responsible for a significant proportion of cases of myelopathy occurring in areas where schistosomiasis is endemic. The aim of this study is to describe the clinical, laboratory and therapeutic data of 23 patients with schistosomal myeloradiculopathy. The medical records of 23 patients with schistosomal myelopathy admitted to two general hospitals of Belo Horizonte (MG), in Brazil, from 1995 to 1999, were reviewed retrospectively. Seventeen patients were male (74 percent). The mean age for the whole group was 27 years. Lower limb weakness and associated lumbar and/or lower limb pain were reported by 20 patients (87 percent), and 16 (70 percent) were unable to walk. All individuals presented urinary retention and 19 (83 percent) complained of intestinal dysfunction. The treatment was based on the association of antischistosomal drugs and corticosteroids. Five patients (22 percent) presented a full response to treatment, 13 (57 percent) partial response without functional limitations and 4 (17 percent) partial improvement with limitations or no response. Three out of the 4 patients who stopped steroids before 45 days of treatment developed recurrence of the symptoms and signs of myelopathy. Our cases demonstrate the severe presentation of the disease and the data disclosed here suggest that treatment with steroids should be kept for months after clinical improvement
Assuntos
Humanos , Animais , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Neuroesquistossomose/parasitologia , Radiculopatia/parasitologia , Schistosoma mansoni/isolamento & purificação , Corticosteroides/uso terapêutico , Neuroesquistossomose/diagnóstico , Neuroesquistossomose/tratamento farmacológico , Radiculopatia/diagnóstico , Radiculopatia/tratamento farmacológico , Estudos Retrospectivos , Esquistossomicidas/uso terapêutico , Esteroides/uso terapêutico , Resultado do TratamentoRESUMO
Parasitic diseases which during their course in the host switch the immune system from a T helper 1 to a T helper 2 response may be detrimental to the host, contributing to granuloma formation, eosinophilia, hyper-IgE, and increased susceptibility to bacterial and fungal infections. Patients and animals with acute schistosomiasis and hyper-IgE in their serum develop pyogenic liver abscess in the presence of bacteremia caused by Staphylococcus aureus. The Salmonella-S. mansoni association has also been well documented. The association of tropical pyomyositis (pyogenic muscle abscess) and pyogenic liver abscess with Toxocara infection has recently been described in the same context. In tropical countries that may be an interesting explanation for the great morbidity of bacterial diseases. If the association of parasitic infections and pyogenic abscesses and/or fungal diseases are confirmed, there will be a strong case in favor of universal treatment for parasitic diseases to prevent or decrease the morbidity of superinfection with bacteria and fungi
Assuntos
Humanos , Animais , Camundongos , Masculino , Feminino , Abscesso Hepático , Doenças Parasitárias , Abscesso Hepático/etiologia , Abscesso Hepático/imunologia , Abscesso Hepático/patologia , Doenças Parasitárias/complicações , Doenças Parasitárias/imunologia , Doenças Parasitárias/patologiaRESUMO
Os conceitos de dengue clássico, com ou sem hemorragia, e da febre hemorrágica do dengue (FHD) que, pode cursar sem fenômenos hemorrágicos, com ou sem síndrome do choque do dengue (SCD) säo revistos neste artigo. As definiçöes clássicas propostas, úteis em outros tempos, geram confusäo e dificultam a tomada de decisöes no momento do tratamento dos pacientes com as formas graves da doença porque deixaram de incorporar novos conceitos e avanços terapêuticos. A classificaçäo do dengue proposta neste trabalho, e apresentada em fluxograma, incorpora os conceitos atuais de sepse, síndrome da resposta inflamatória sistêmica (SIRS) e síndrome da angústia respiratória do adulto (SARA). A nova classificaçäo serve de guia para orientar a conduta terapêutica inicial e aproxima o tratamento do dengue aos protocolos e rotinas já implantados nos diversos centros hospitalares de urgência, facilitando a atuaçäo dos serviços de saúde em situaçöes de surtos epidêmicos
Assuntos
Humanos , Dengue , Dengue Grave , Síndrome do Desconforto Respiratório , Síndrome de Resposta Inflamatória SistêmicaRESUMO
A associaçäo entre o abscesso hepático e a esquistosomose mansônica foi confirmada por estudos clínicos e experimentais. Outros parasitos, como a larva de Toxocara canis, podem causar alteraçöes imunológicas sistêmicas e estruturais nos órgaos acometidos que favorecem a instalaçäo e o crescimento da bactéria. A piomiosite tropical, o abscesso hepático piogênico e o abscesso renal säo doenças freqüentes nos países tropicais e muitas vezes näo se encontra doença de base que poderia explicá-las. A síndrome de larva migrans visceral é causada pela presença no organismo humano de larvas de vermes que têm outros animais como hospedeiro definitivo sendo a T. canis o agente mais comum. As larvas migram por vários órgäos causando reaçäo inflamatória na forma de granuloma com necrose tecidual. Nesta revisäo discutem-se os possíveis mecanismos de interaçäo entre o hospedeiro, o parasito e a bactéria que podem favorecer a formaçäo de abscessos nos órgäos acometidos pela larva de T. canis e resumem-se alguns resultados preliminares de trabalho clínico-experimental realizado durante os últimos quatro anos para definir o papel deste parasito na patogenia dos abscessos
Assuntos
Humanos , Masculino , Feminino , Abscesso Hepático/etiologia , Rim/microbiologia , Larva Migrans Visceral , Miosite/etiologia , Infecções Estafilocócicas , Toxocara canis/patogenicidade , Toxocaríase , Interações Hospedeiro-Parasita , Staphylococcus aureusRESUMO
The medical records of patients with AIDS admitted to a general hospital in Brazil from 1989 to 1997 were reviewed retrospectively with the aim at defining the frequency and etiology of fever of undetermined origin (FUO) in HIV-infected patients of a tropical country and to evaluate the usefulness of the main diagnostic procedures. 188 (58.4 percent) out of 322 patients reported fever at admission to hospital and 55 (17.1 percent) had FUO. Those with FUO had a mean CD4+ cell count of 98/ml. A cause of fever was identified for 45 patients (81.8 percent). Tuberculosis (32.7 percent), Pneumocystis carinii pneumonia (10.9 percent), and Mycobacterium avium complex (9.1 percent) were the most frequent diagnoses. Other infectious diseases are also of note, such as cryptococcal meningitis (5.5 percent), sinusitis (3.6 percent), Salmonella-S. mansoni association (3.6 percent), disseminated histoplasmosis (3.6 percent), neurosyphilis (1.8 percent), and isosporiasis (1.8 percent). Four patients had non-Hodgkin's lymphoma (7.3 percent). We conclude that an initial aggressive diagnostic approach should be always considered because biopsies (lymph node, liver and bone marrow) produced the highest yield in the diagnosis of FUO and the majority of the diagnosed diseases are treatable. The association of diseases is common and have contributed to delay the final diagnosis of FUO in most cases. In our study area the routine request of hemocultures for Salmonella infection and the investigation of cryptococcal antigen in the serum should be considered.
Assuntos
Humanos , Febre de Causa Desconhecida/etiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Síndrome da Imunodeficiência Adquirida/patologia , Febre de Causa Desconhecida/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/sangue , Estudos Retrospectivos , Síndrome da Imunodeficiência Adquirida/sangue , Técnicas e Procedimentos DiagnósticosRESUMO
Os autores relatam o caso de um jovem com piomiosite tropical grave, eosinofilia e hiperimunoglobulinemia E. O paciente relatou historia de contato com um cao e o teste de ELISA para Toxocara canis revelou-se positivo. O Staphylococcus aureus foi a unica bacteria isolada da secrecao purulenta obtida dos abscessos musculares. Sugere-se que a piomiosite tropical possa ser iniciada pela presenca das larvas desse ou de outros parasitos com tropismo para os musculos. As alteracoes imunologicas e estruturais nos musculos acometidos pelas larvas e a presenca de bacteriemia podem favorecer a instalacao da bacteria e o desenvolvimento da piomiosite
Assuntos
Humanos , Animais , Adolescente , Cães , Doenças Transmissíveis/parasitologia , Larva Migrans Visceral/diagnóstico , Pioderma/parasitologia , Abscesso/etiologia , Edema/etiologia , Ensaio de Imunoadsorção Enzimática , Eritema/etiologia , Febre/etiologia , Seguimentos , Larva Migrans Visceral/sangue , Larva Migrans Visceral/parasitologia , Músculos/parasitologia , Miosite/parasitologia , Dor/etiologiaRESUMO
In hospital-based series viral hepatitis B has been frequently described in association with schistosomiasis whilst in field-based studies the association has not been confirmed. The association between schistosomiasis and Salmonella bacteraemia has been well documented. More recently, acute schistosomiasis has been shown to be a facilitating factor in the genesis of pyogenic liver abscesses caused by Staphylococcus aureus. New evidences indicate an interaction between the acquired immunodeficiency syndrome (AIDS) and schistosomiasis. In this paper, data on the association of schistosomiasis with other infections are updated.