Antônio Carlos Bandeira

High prevalence of giardiasis and strongyloidiasis among HIV-infected patients in Bahia, Brazil

Diarrhea due to intestinal microbial infections is a frequent manifestation among HIV-infected patients. It has been postulated that HIV-infected patients may have special types of intestinal infections, and that immune activation from such parasites may affect the progression of HIV disease. To evaluate these associations, the frequency of infections was examined in HIV-infected patients in Bahia, Brazil. To determine the potential impact of the presence of intestinal parasitic infections on HIV disease progression, a retrospective study approach was used. The medical charts of 365 HIV-infected patients who had been treated at the AIDS Clinic of the Federal University of Bahia Hospital were reviewed, and the prevalence of parasites was compared with 5,243 HIV-negative patients who had attended the hospital during the same period of time. Among HIV-infected subjects, CD(4) count, RNA plasma viral load (VL), and number of eosinophils were compared according to their stool examination results. The overall prevalence of each parasite was similar for HIV-positive and HIV-negative patients. However, the prevalence of S. stercoralis (p<10(-7)) and G. lamblia (p=0.005) was greater for HIV-infected subjects. The mean CD(4) count and viral load of HIV patients in our clinic who had stool examinations was 350 cells +/- 340 and 4.4 +/- 1.4 log RNA viral load, respectively. In this patient group there was no clear association between the level of the absolute CD(4) count or the viral load and a specific parasitic infection. The presence of an intestinal parasitic infection was not associated with faster progression of the HIV disease among HIV-infected patients. We conclude that strongyloidiasis and giardiasis are more frequent in HIV-infected patients in Bahia, Brazil. If this association is due to immune dysregulation, as has been proposed elsewhere, it must occur in patients after only minor shifts in CD(4) count from normal levels, or as a result of immune dysfunction not represented by CD(4) count. These infections do not appear to alter the progression of HIV disease.

Avaliação do conhecimento geral de médicos emergencistas de hospitais de Salvador - Bahia sobre o atendimento de vítimas com parada cardiorrespiratória

OBJETIVO: Identificar a proporcao de medicos emergencistas com habilitacao em cursos de imersao (SAVC - Suporte Avancado de Vida em Cardiologia e SAVT - Suporte Avancado de Vida no Trauma), relacionando variaveis: idade, sexo, especialidade medica, titulacao e tipo de hospital com o grau de conhecimento teorico no atendimento de vitimas de parada cardiorrespiratoria. METODOS: Foram avaliados de forma consecutiva, de novembro/2003 a julho/2004, os emergencistas de hospitais publicos e privados da cidade de Salvador - Bahia, que voluntariamente aceitaram participar do estudo. Esses responderam a um questionario construido de informacoes das variaveis de interesse: perfil do profissional, realizacao ou nao dos cursos de imersao SAVC e SAVT, avaliacao cognitiva com 22 questoes objetivas sobre ressuscitacao cardiopulmonar. Calculou-se para cada participante um valor de acertos indicado como variavel escore. Esse questionario foi validado a partir do resultado do escore dos instrutores do curso SAVC em Salvador - BA. RESULTADOS: Dos 305 medicos que responderam ao questionario, 83 (27,2%) haviam realizado o curso SAVC, tendo como media da variavel escore o valor de 14,9+3,0, comparada com os 215 medicos (70,5%) que nao o haviam feito e cuja media foi de 10,5+3,5 (p=0,0001). A media do escore dos 65 cardiologistas (21,5%) foi de 14,1+3,3, comparada com os 238 medicos (78,5%) que eram de outras especialidades, com media de 9,7+3,7(p=0,0001). Nao foi identificada diferenca da media do escore entre os medicos que haviam ou nao realizado o curso SAVT (p=0,67). CONCLUSAO: Na amostra avaliada, o conhecimento teorico sobre ressucitacao cardio-pulmonar (RCP) foi superior naqueles profissionais que realizaram o SAVC, diferente do que ocorreu naqueles que realizaram o SAVT. Os especialistas em Cardiologia que realizaram o SAVC demonstraram um conhecimento teorico superior, sobre o atendimento de vitimas de parada cardio-respiratoria (PCR), quando comparado com as demais especialidades avaliadas em conjunto - Clinica Medica, Cirurgia e Ortopedia.

Risk Factors for Infection by Extended-Spectrum Beta-Lactamase Producing Klebsiella pneumoniae in a Tertiary Hospital in Salvador, Brazil

UNLABELLED Nosocomial infection caused by extended-spectrum beta-lactamase producing Klebsiella pneumoniae (ESBL-Kp) have been frequently reported worldwide. We have no information on such problems in Bahia, Brazil. OBJECTIVES Evaluate the risk factors for nosocomial infections caused by ESBL-Kp, in a tertiary hospital, in Bahia, Brazil. MATERIAL AND METHODS We evaluated all reported cases of nosocomial infections caused by ESBL-Kp in a private, tertiary hospital, in Salvador, Brazil, from 2000 through 2004. We compared patients with a diagnosis of ESBL-Kp (cases) and patients infected by non-ESBL producing K. pneumoniae (controls). Mean age, underlying disease, and frequency of invasive procedures were compared between the two groups. History of previous use of antibiotics was also analyzed. RESULTS Based on multivariate analysis, previous use of antibiotics, diagnosis of malignant diseases, and diabetes mellitus were independent risk factors for acquisition of ESBL-Kp infection. No correlation was found for age, use of corticosteroids, diagnosis of chronic renal failure or AIDS, and infection by ESBL-Kp. CONCLUSION Our findings suggest that the use of antibiotics or underlying disease that increases the chance of antibiotic are the main risk factors for ESBL-Kp infections. Programs focusing on rational use of antibiotics are mandatory for prevention and control of such infections.

Use of rhu-GM-CSF in pulmonary tuberculosis patients: results of a randomized clinical trial

It has been postulated that deficient or incomplete clinical and/or microbiological response to tuberculosis treatment is associated with cell-mediated immunological dysfunction involving monocytes and macrophages. A phase 2 safety trial was conducted by treating patients with either recombinant human granulocyte-macrophage colony-stimulating factor (rhu-GM-CSF) or a placebo, both in combination with anti-tuberculosis chemotherapy. Thirty-one patients with documented pulmonary tuberculosis were treated with rifampin/isoniazid for six months, plus pyrazinamide for the first two months. At the beginning of treatment, rhu-GM-CSF (125mg/M(2)) was randomly assigned to 16 patients and injected subcutaneously twice weekly for four weeks; the other 15 patients received a placebo. The patients were accompanied in the hospital for two weeks, then monthly on an out patient basis, for 12 months. Clinical outcomes were similar in both groups, with no difference in acid-fast bacilli (AFB) clearance in sputum at the end of the fourth week of treatment. Nevertheless, a trend to faster conversion to negative was observed in the rhu-GM-CSF group until the eighth week of treatment (p=0.07), after which all patients converted to AFB negative. Adverse events in the rhu-GM-CSF group were local skin inflammation and an increase in the leukocyte count after each injection, returning to normal 72 hours after rhu-GM-CSF injection. Three patients developed SGOP and SGPT > 2.5 times the normal values. All patients included in the GM-CSF group were culture negative at six months, except one who had primary TB resistance. None of the patients had to discontinue the treatment in either group. We conclude that rhu-GM-CSF adjuvant immunotherapy could be safely explored in a phase 3 trial with patients who have active tuberculosis.

Bacterial Contamination in Milk Kitchens in Pediatric Hospitals in Salvador, Brazil

Milk may represent an important source of infectious agents to hospitalized pediatric patients. To describe the bacterial microflora isolated from the hands, stools, pharynx of all workers at milk kitchens in pediatric hospitals in the city of Salvador, Brazil, as well as in the formulas prepared by them, we carried out this cross-sectional study with all 91 workers from the 20 milk kitchens of all the public and private hospitals in Salvador, Brazil. Hand and pharynx swabs and stool samples were collected from all workers, as well as samples of the milk and formulas delivered by the kitchens. All samples were cultured for the detection of pathogenic and non-pathogenic bacteria. Pathogenic bacteria were isolated from 20 (22.0%) and 8 (8.8%) cultures of the hands and pharynx of the workers, respectively. No pathogenic bacteria were isolated from stool samples. Pathogenic bacteria were isolated from 17 (18.7%) milk samples. The prevalence of pathogenic bacteria in hand swabs was significantly higher in workers from public (37.8%) than from private (6.5%) hospitals (prevalence ratio [PR]=5.8; p<0.01). Pathogenic bacteria were isolated from two (4.4%) workers from public hospitals and six (13.0%) workers from private hospitals (PR=0.38; p=0.27). Pathogenic bacteria were isolated from 11 (24.4%) milk samples from public hospitals and 6 (13.0%) from private hospitals (PR=1.9; p=0.16). A high prevalence of contamination was found, mainly on the hands of workers on units for manipulation of milk. Preventive efforts should be intensified and focus primarily on effective hand washing and continuous work supervision.

Chikungunya Virus Infection Associated with Encephalitis and Anterior Uveitis

ABSTRACT Chikungunya virus (CHIKV) is an RNA virus transmitted by Aedes mosquitoes. The clinical manifestations include fever, arthralgia, rash, and other atypical clinical findings including ocular lesions. We report the case of a 57-year-old man with meningoencephalitis and anterior uveitis due to CHIKV. The patient had developed bilateral anterior uveitis with iris atrophy and a cotton wool spot on the left eye, and his serum, urine, saliva, and cerebrospinal fluid were positive for CHIKV by RT-PCR. The spectrum of the ophthalmologic manifestations and its pathophysiology in cases of CHIKV infections needs to be better understood. Additional studies examining the ocular lesions caused by CHIKV could improve the therapeutic goals of reducing the morbidity and sequels.

Immunological Profile of HIV-Infected Patients with Tuberculosis Associated- Immune Reconstitution Inflammatory Syndrome: A Systematic Review

Objective: This study systematically reviews the literature that describes the immunological profile associated with the development of tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) in HIVinfected individuals. Methods: Between the primary and secondary searches, a total of 20 articles were selected for the final analysis. Results: The results obtained herein indicated that TB-IRIS was associated with the recovery of Mtb-specific immune response, demonstrated by an increased frequency of specific IFN-g-producing cells and specific multifunctional T-lymphocytes (TNF and IFN-γ-producing). In addition, an increased production of inflammatory cytokines and chemokines was found in TB-IRIS patients compared to non-IRIS individuals. Conclusion: These data suggest that expansion of Mtb-specific cells may not be the main factor for the occurrence of IRIS. Further studies are needed to better evaluate the dynamic of restoration of Mtb-specific memory cells and to clarify the role of innate immune responses in immunopathogenesis of TB-IRIS patients