CASE STUDY OF A PATIENT WITH HIV-AIDS AND VISCERAL LEISHMANIASIS CO-INFECTION IN MULTIPLE EPISODES

SUMMARYReport of a 45-year-old male farmer, a resident in the forest zone of Pernambuco, who was diagnosed with human immunodeficiency virus (HIV) in 1999 and treated using antiretroviral (ARV) drugs. In 2005, the first episode of visceral leishmaniasis (VL), as assessed by parasitological diagnosis of bone marrow aspirate, was recorded. When admitted to the hospital, the patient presented fever, hepatosplenomegaly, weight loss, and diarrhea. Since then, six additional episodes of VL occurred, with a frequency rate of one per year (2005-2012, except in 2008). In 2011, the patient presented a disseminated skin lesion caused by the amastigotes of Leishmania, as identified by histopathological assessment of skin biopsy samples. In 2005, he was treated with N-methyl-glucamine-antimony and amphotericin B deoxycholate. However, since 2006 because of a reported toxicity, the drug of choice was liposomal amphotericin B. As recommended by the Ministry of Health, this report emphasizes the need for HIV patients living in VL endemic areas to include this parasitosis in their follow-up protocol, particularly after the first infection of VL.

USEFULNESS OF kDNA PCR IN THE DIAGNOSIS OF VISCERAL LEISHMANIASIS REACTIVATION IN CO-INFECTED PATIENTS

SUMMARYIt is important to develop new methods for diagnosing relapses in the co-infection of visceral leishmaniasis (VL) and HIV to enable earlier detection using less invasive methods. We report a case of a co-infected patient who had relapses after VL treatment, where the qualitative kDNA PCR showed a good performance. The kDNA PCR seems to be a useful tool for diagnosing VL and may be a good marker for predicting VL relapses after treatment of co-infected patients with clinical symptoms of the disease.

OCCUPATIONAL EXPOSURES TO BODY FLUIDS AND BEHAVIORS REGARDING THEIR PREVENTION AND POST-EXPOSURE AMONG MEDICAL AND NURSING STUDENTS AT A BRAZILIAN PUBLIC UNIVERSITY

A cross-sectional study was conducted to assess the frequencies and characteristics of occupational exposures among medical and nursing students at a Brazilian public university, in addition to their prevention and post-exposure behavior. During the second semester of 2010, a self-administered semi-structured questionnaire was completed by 253/320 (79.1%) medical students of the clinical course and 149/200 (74.5%) nursing students who were already performing practical activities. Among medical students, 53 (20.9%) suffered 73 injuries, which mainly occurred while performing extra-curricular activities (32.9%), with cutting and piercing objects (56.2%), in the emergency room (39.7%), and as a result of lack of technical preparation or distraction (54.8%). Among nursing students, 27 (18.1%) suffered 37 injuries, which mainly occurred with hollow needles (67.6%) in the operating room or wards (72.2%), and as a result of lack of technical preparation or distraction (62.1%). Among medical and nursing students, respectively, 96.4% and 48% were dissatisfied with the instructions on previously received exposure prevention; 48% and 18% did not always use personal protective equipment; 67.6% and 16.8% recapped used needles; 49.3% and 35.1% did not bother to find out the source patient's serological results post-exposure; and 1.4% and 18.9% officially reported injuries. In conclusion, this study found high frequencies of exposures among the assessed students, inadequate practices in prevention and post-exposure, and, consequently, the need for training in “standard precautions” to prevent such exposures.

Diferença de susceptibilidade à infecção com T. Cruzi entre espécies de triatomíneos alimentados em cão, tatu e camundongo infectados

Diversas espécies de triatomíneos foram alimentadas em cão, tatu e camundongos infectados pelo T. cruzi, para verificação de suas susceptibilidades. Em cão T. infestans e P. megistus se infectaram melhor. Em tatus T. iníestans e T. brasiliensis acusaram melhores índices de infecção, enquanto em camundongos as espécies de Rhodnius e T. brasiliensis foram as melhores infectadas. A positividade dos xenos não pareceu obrigatoriamente relacionada com a riqueza da parasitemia evidenciada através da hemoscopia direta. A positividade dos xenos em camundongos variou de 26 a 96%. Quando a mesma espécie de triatomineos foi usada em tipos diversos de animais, pareceu haver uma tendência para apresentarem diferentes taxas de infecções, de acordo com o animal empregado. Dessa forma, a susceptibilidade dos triatomíneos poderia estar dependente dos fatores: cepa do tripanosoma, espécie e fase do triatomíneo e o tipo do animal infectante.

Fase crônica cardíaca fibrosante da Tripanossomíase cruzi experimental no cão

Os autores documentam a cardiopatia difusa fibrosante, com todos os sintomas clínicos e dados de autópsia pertinentes à insuficiência cardíaca congestiva, em um dos 21 cães infectados com a cepa Colombiana (cinco morreram na fase aguda e quatro continuam vivos) e cinco, dos 13 infectados com a cepa Berenice-78 (oito morreram na fase aguda), num período de oito anos de observação. Em vista destes resultados, os autores sugerem que o cão possa vir a ser um modelo experimental, adequado para o estudo da história natural da doença de Chagas, preenchendo os requisitos estabelecidos pelo Comitê Assessor de Doença de Chagas do Programa Especial de Pesquisa e Treinamento em Doenças Tropicais da Organização Mundial de Saúde.

Radiographic features of pulmonary tuberculosis in patients infected by HIV: is there an objective indicator of co-infection?

This study aimed to compare the radiographic characteristics of patients with pulmonary tuberculosis (TB) and human immunodeficiency virus (HIV) infection with those of HIV-negative patients. In all, 275 TB patients attending the outpatients clinics at the University Hospital/UFPE, were studied from January 1997 to March 1999. Thirty nine (14.2%) of them were HIV+, with a higher frequency of males in this group (p=0.044). Seventy-five percent of the HIV+ patients and 19% of the HIV- had a negative tuberculin test (PPD) (p < 0.001). The proportion of positive sputum smears in the two groups was similar. The radiological finding most strongly associated with co-infection was absence of cavitation (p < 0.001). It may therefore be concluded that the lack of cavitation in patients with pulmonary TB may be considered a useful indicator of the need to investigate HIV infection. This approach could contribute to increasing the effectiveness of local health services, by offering appropriate treatment to co-infected patients.

Identification of Leishmania chagasi from skin in Leishmania/HIV co-infection: a case report

A case of HIV/Leishmania co-infection presenting both visceral and cutaneous manifestations is reported. Leishmania infection was confirmed by conventional methods (parasitological approach and serology) and by PCR. Leishmania chagasi isolated from the skin lesion was characterized by enzyme electrophoresis and by restriction fragment length polymorphism of the internal transcribed spacer of the ribosomal gene.

Mercury exposure and malaria prevalence among gold miners in Pará, Brazil

Economic development, including resource extraction, can cause toxic exposures that interact with endemic infectious diseases. Mercury is an immunotoxic metal used in the amalgamation of gold, resulting in both occupational exposures and environmental pollution. A cross-sectional medical survey was conducted in 1997 on 135 garimpeiros in Para, Brazil, because of their risks of both mercury exposure and malaria transmission. Mean levels of blood and urine mercury were well above non-exposed background levels. Twenty-six subjects had malaria parasitemia: Health symptoms consistent with mercury exposure were reported, but neither symptoms nor signs correlated with mercury levels in blood or urine. We did not find a dose response relationship between mercury exposure and likelihood of prevalent malaria infection, but there was a possible reduction in acquisition of immunity that may be associated with conditions in gold mining, including mercury exposure.

Co-infecção HIV e vírus da hepatite B: prevalência e fatores de risco

Este trabalho objetiva estimar a prevalência da infecção pelo vírus da hepatite B e analisar possíveis fatores de risco em 401 pacientes infectados pelo vírus da imunodeficiência humana, atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Os participantes responderam a um questionário que visava levantar variáveis gerais e fatores de risco para hepatite B. Os resultados dos exames sorológicos para os marcadores HBsAg, anti-HBcAg total, anti-HBsAg e anti-HCV foram obtidos dos prontuários dos pacientes. A prevalência global dos marcadores para o HBV foi 40,9%, com valores de 8,5% para o HBsAg, 39,7% para o anti-HBcAg total e de 5,5% para o anti-HBsAg. As variáveis que mostraram associação com a infecção pelo HBV foram: idade, nível superior de escolaridade, antecedente de icterícia, tempo passado como presidiário, existência de parceiro homossexual e positividade para o anti-HCV. A co-infecção HBV/HCV esteve presente em 20,4% dos participantes deste estudo.

Serological screening and toxoplasmosis exposure factors among pregnant women in South of Brazil

Serological screening and evaluation of exposure factors for Toxoplasma gondii transmission were conducted in 2126 pregnant women from southern Brazil. Specific antibodies against Toxoplasma gondii were presented by 74.5% (n=1583) of the pregnant women evaluated. Contact with soil was found to be the major factor for infection.

Evidência do cão como reservatório da leptospirose humana: isolamento de um sorovar, caracterização molecular e utilização em inquérito sorológico

A leptospirose canina é conhecida como enfermidade de Stuttgard desde 1898, sendo os cães, depois dos roedores, considerados como a segunda principal fonte de infecção para o homem. O isolamento de um sorovar patogênico da urina de um cão, laboratorial e clinicamente identificado como tendo leptospirose, e sua utilização para testar amostras de soro de casos de leptospirose humana e canina, evidenciou a sua importância no ecossistema da região sul do Brasil. Os resultados do teste de soroaglutinação microscópica indicaram que 100% das amostras de soro humano de 12 pacientes do banco de soro de 2001 do Centro de Controle de Zoonoses, que haviam reagido com títulos que variaram de 25 a 3.200 para o sorovar canicola, e 72% das amostras de 105 soros caninos do mesmo banco de soro, também reagiram contra o novo isolado. O título médio e mediana dos soros humanos testados com a bateria de antígenos recomendada pela OMS, foi respectivamente 630 e 100, ao passo que os testados com o isolado foi de 1.823 e 400. Nos soros caninos, os títulos foram respectivamente de 347 e 100 para a bateria e de 1.088 e 200 para o isolado.

Co-infecção humana pelo plasmódio e o vírus da hepatite B: aspectos clínicos, sorológicos e imunológicos

A Amazônia é conhecida pela elevada prevalência de infecção pelo vírus da hepatite B, contribui também com mais de 90% dos casos de malária do país. É proposto que a ocorrência de co-infecções seja importante e que na associação ocorram alterações na história natural dessas enfermidades. O estudo avalia 545 pacientes com malária, em Coari, AM: 333 (61,1%) pelo Plasmodium vivax, 193 (35,4%) pelo Plasmodium falciparum e 19 (3,5%) com infecção mista. A prevalência do AgHBs foi 4,2% e a do anti-HBc total 49,7%. Os pacientes sororreativos para o VHB, não apresentaram diferenças clínicas dos outros pacientes com malária, nem associação a sinais clássicos de comprometimento hepático. Apesar de não ter sido detectada associação estatisticamente significativa, os indivíduos AgHBs reativos apresentaram baixas parasitemias e índices de reatividade de anticorpos mais elevados, sugerindo a possibilidade da resposta imune em um indivíduo co-infectado ser diferenciada e favorecer variações em relação à parasitemia e produção de anticorpos.