Adrelírio José Rios Gonçalves

Cryptococcus neoformans varieties as agents of cryptococcosis in Brazil

The study of the clinical isolates of Cryptococcus neoformans from 83 Brazilian patients with disseminated cryptococcosis showed that 75 were C. neoformans var. neoformans and 8 were var. gattii. Twenty-seven isolates were serotyped; all 19 var. neoformans were serotype A and all 8 var. gattii were serotype B. The correlation of the varieties of C. neoformans with the presence or not of hosts predisposing conditions to the mycosis showed that: (1) cryptococcosis caused by gattii variety occurred in 7 (58.3%) of the 12 nonimmunosuppressed patients, and (2) cryptococcosis caused by neoformans variety occurred in 65 (98.5%) of the 66 AIDS patients and in all 5 patients with other immunosuppressive conditions. The comparison of the distribution of the gattii and neoformans varieties between the nonimmunosup-pressed and immunosuppressed patients showed a significant statistical difference (p < 0.01).

Hemoptise/s e síndrome de angústia respiratória do adulto como causas de morte na leptospirose: mudanças de padrões clínicos e anatomopatológicos

A leptospirose humana, uma das principais endemias/epidemias dos centros urbanos no Brasil, vem crescendo de forma dramatica nas tres ultimas decadas, com prevalencia apos enchentes causadas pelas chuvas de verao. Sao descritas as recentes modificacoes de seus padroes clinicos em nossa regiao, constituidas pelo surgimento de hemoptise/s macica/s e da sindrome de angustia respiratoria do adulto, ou de ambas associadamente. Essas evidentes mudancas situadas nas estruturas respiratorias despontaram como seria ameaca a vida e como mecanismos de morte, passando a representar entre nos, por sua grande frequencia, a principal causa de obito na leptospirose. A nova face da doenca impoe revisao dos conceitos sobre sua gravidade e especulacao sobre a patogenia dessas alteracoes. A evolucao fatal dos seis pacientes descritos, dois deles sem ictericia e sem insuficiencia renal, mostra a grandeza do desafio.

Formas graves da síndrome de Weil

Six cases of Weils disease are presented. The first two patients deserve special atention, since both presented acute abdominal surgical syndromes, as well as shock in the beginning of their disease. One of them had fulminant gastrintestinal hemorrhage leading to death. In the other 4 cases, severe icterus, acute renal insufficiency, neurologia and psychiatric manifestations prevailed in the clinical picture. All of them had peritoneal dyalisis and supportive cure. Since leptospirosis is frequent in our country it should be always included in the differential diagnosis of icterus.

Manifestações neurológicas nas endocardites infecciosas - revisão de 103 casos estudados - 84 casos do Hospital dos Servidores do Estado-R.J. (1947-1978) e 19 casos do Hospital Estadual São Sebastião-R.J. (1975-1978)

The authors make a revision of 103 cases of infectious endocarditis, 52 of which brought about neurologic manifestations. In the 52 cases showing neurologic problems, 39 died (75%), while in the other 51 cases showing no alterations of the nervous system only 18 evolved to death (35,3%). The present series of infectious endocarditis with neurologic manifestations was dominat in the mate sex. The more affected age groups were children, adolescents and young adults. Another significant peak was shown by patients more than 50 years old. For the diagnosis of infectious endocarditis in the present study, classical criteria were adopted in addition to a few other ones which were recognized to be extremely useful in the process of accumulating experience, as paralel observation was applied to those changes of etiological patterns and to those alterations of clinical specters of the disease, which resulted from many of the factors here described. The major neurologic diserders detected were meningeal manifestations, 25/52 (48,1%), behavior alterations, 20/52 (38,4%) motor phenomena (paralysis and paresis), 20/52 (38,4%), alterations of the level of consciousness (torpor or coma), plus a few less commonones, such as cephalea, 16/52 (30,7%), alterations of cranial pai rs, 14/52 (26,9%), convulsions, 10/52 (19,2%),aphasia, 7/52 (13,5%). Multiple neurologic manifestations were frequent in the same patient. These alterations were practically the opening and dominant feature of the clinical scene in many cases of acute endocardites. Most common were: meningeal syndrome, vascular syndrome and toxic encephalopathy. Due to multiple neurologic manifestations in the same patient it was difficult to establish criteria linking the neurologic lesion to the prognostic although in states of profound coma, convulsion, pronounced motor disorders, meningitis and behavior alterations, isolated or in association, this prognostic becomes rather more serious. The germ more often found in our series was the staphylococcus aureus, related to acute forms of endocardiac infection, associated with valve destructive process and serious neurologic alterations, such as meningitis, encephalitis, infarcts, hemorrhages and cerebral abscesses. A description is given of the major neurologic findings related to the pathology and of the conclusions draw upon reflexion over the material analysed and the experience collected. A review of the existing literature on the disease, from the initial to the lates studies, clearly points out to the importance of the theme to which different authors have made remarkable contributions.

Revisão de 45 casos de tuberculose miliar em adultos - estudos clínicopatológicos

The aa. studied 45 cases of miliary tuberculosis in adults; 42 were selected from a total of 4.900 necropsies. A clinical-pathological correlation was made showing its relative frequency in a General Hospital as well as a low incidence of clinical suspicion of this disease due to its mimmetitation with other pathological conditions. A histopathological classification was proposed by the aa. and the frequency of the organs involved was mentioned. A ternptative explanation about the pathogenic mechanism of the disease was considered. A review of the general problems involved with miliary tuberculosis is also considered.

Pneumonia por bacilo de Friedlander

The authors present a case of pneumonia by Friedlanders bacillus. They emphasize its main complieations and prognostic, describing the natural history of the disease and radiological picture, because they are important clues for the diagnosis. An analysis of the principal radiological signs of the condition is carried out and considered for differential diagnosis. They call attention for the multiplicity of microorganisms able to produce pulmonary necrosis, and finally state the role of Klebsiella as an etiological agent in the todays hospital infections, also giving a therapeutic approach for the acute forms.

Aspectos gerais das septicemias e bacteriemias estafilocócicas no adulto

Systemic infections by staphylococcus in 25 adult patients is reviewed. In all cases observed the germ identified bacteriologically as Staphylococcus aureus was isolated in blood culture in 17 cases. Clinical picture of septicemia with metastatic lesions mainly to the lungs and presenting the classical clinicai findings of multiple septic pulmonary infarts was observed in 18 cases. The most frequent cardiovascular complications were: myocarditis, endocarditis, shock and acute cor pulmonale. Meningitis, convulsions and coma were the outstandig neurological complications. The most frequent portal of entry was through skin infection (48% of our cases). In 20% of the cases criminal abortion was responsible for inception of the systemic infection. Pathological study in 4 cases is presented. The biological characteristics of the germ are paramount in the understanding of physiopathology of the systemic infection and in the understanding of the clinical picture as is discussed at length. The pathogenesis, clinical aspects and fundamentals of the therapeutic approach are briefly considered.

Bacteremias por bacilos gram-negativos

Gram-negative infection is a serious complication and a great deal of attention has been paid to it lately. The aa. present 31 cases of gram-negative infection. The most common organisms were Escherichia coli and Klebsiella-Aerobacter (58% of the cases) followed by the Pseudomonas group. Males were more affected than females. In 61,3% of the cases the urinary tract was the site of infection. Previous treatment occurred in several patients the most important being antibioties, steroids and cytostaties. The most frequent predisposing diseases were diabetes mellitus and malignancy. Urinary tract manipulation (with previous infection or wihout it), gastrointestinal surgery and urinary or biliary obstruetion were main precipitants. Chilis, fever and low blood pressure were the most frequent clinicai manif estations. Shock ocurred in 58% of the cases, which is a very high incidence when compared with other statisties. Acute renal insuficiency, super-infection and metastatie lung infection also ocurred. General therapeutic consideralions as well as antibiotic administration schedules are suggested by the authors. Mortality due to simple bacteremia was 30,7%, the association of bacteremia and shock raised this figure to 72,2%. Pseudomonas infection gave 100% mortality.