Fernando Costa Araújo

Zika virus epidemic in Brazil. I. Fatal disease in adults: Clinical and laboratorial aspects

BACKGROUND Zika virus (ZIKV) was first detected in Brazil in May 2015 and the country experienced an explosive epidemic. However, recent studies indicate that the introduction of ZIKV occurred in late 2013. Cases of microcephaly and deaths associated with ZIKV infection were identified in Brazil in November, 2015. OBJECTIVES To determine the etiology of three fatal adult cases. STUDY DESIGN Here we report three fatal adult cases of ZIKV disease. ZIKV infection in these patients was confirmed by cells culture and/or real-time reverse transcriptase polymerase chain reaction (RT-qPCR) and by antigen detection using immunohistochemical assay. Samples of brain and other selected organs taken at autopsy from three patients were also analyzed by histopathological and immunohistological examination. RESULTS The first patient, a 36-year-old man with lupus and receiving prednisone therapy, developed a fulminant ZIKV infection. At autopsy, RT-qPCR of blood and tissues was positive for ZIKV RNA, and the virus was cultured from an organ homogenate. The second patient, a previously healthy female, 16 years of age, presented classic symptoms of Zika fever, but later developed severe thrombocytopenia, anemia and hemorrhagic manifestations and died. A blood sample taken on the seventh day of her illness was positive RT-PCR for ZIKV RNA and research in the serum was positive for antinuclear factor fine speckled (1/640), suggesting Evans syndrome (hemolytic anemia an autoimmune disorder with immune thrombocytopenic purpura) secondary to ZIKV infection. The third patient was a 20-year-old woman hospitalized with fever, pneumonia and hemorrhages, who died on 13days after admission. Histopathological changes were observed in all viscera examined. ZIKV antigens were detected by immunohistochemistry in viscera specimens of patients 1 and 3. These three cases demonstrate other potential complications of ZIKV infection, in addition to microcephaly and Guillain-Barre syndrome (GBS), and they suggest that individuals with immune suppression and/or autoimmune disorders may be at higher risk of developing severe disease, if infected with ZIKV.

Evaluation of cases of pemphigus vulgaris and pemphigus foliaceus from a reference service in Pará state, Brazil

BACKGROUND Pemphigusis a bullous, rare and chronic autoimmune disease. There are two major forms of pemphigus: vulgaris and foliaceus. Epidemiological data and clinical outcome in patients diagnosed in the Brazilian Amazon states are still rare. OBJECTIVES To study the occurrence of the disease during the study period and analyze the epidemiological profile of patients, the most common subtype of pemphigus, and the clinical evolution of patients. METHODS Retrospective analysis of medical records of hospitalized patients with pemphigus foliaceus and pemphigus vulgaris in the period from 2003 to 2010 in Dermatology Service of Hospital Fundação Santa Casa de Misericórdia do Pará, Belém, Northern Brazil. RESULTS We found a total of 20 cases of pemphigus during the study period, 8 of which were of foliaceus pemphigus and 12 of vulgaris pemphigus. Pemphigus foliaceus had the predominance of male patients (75%), showed satisfactory clinical evolution, and was characterized by absence of pediatric cases. Pemphigus vulgaris affected more women (66.7%), showed mean hospital stay of 1 to 3 months (50%), and there were three cases of death (25%). The prescribed immunosuppressive drugs included prednisone with or without combination of azathioprine and/or dapsone. Sepsis was associated with 100% of the deaths. CONCLUSIONS The occurrence of the disease is rare, there are no familiar/endemic outbreaks in the sample. Evolution is usually favorable, but secondary infection is associated with worse prognosis. The choice of best drugs to treat pemphigus remains controversial.

O aprender e o orientar na atenção primária: relato de experiência de um semestre de atividades no PET-Saúde

The Educational Program for Health Work (PET-Saude) promotes the formation of tutorial learning groups in strategic areas for the Unified National Health System. This study aimed to report on an experiment with a semester of activities experienced by students from the Federal University in Para (UFPA) that were part of a multi-professional team in the PET-Saude project in Ananindeua. This project promotes activities that value learning and humanized care. Learning activities involving students include talks and complementary training, discussion of scientific articles, and follow-up of activities at the Primary Care Unit. Primary Care is a learning area for students in the health professions, and their participation in the arena is a major gain for the community, which receives valuable health information.

Avaliação dermatológica de agentes comunitários de saúde sujeitos à fotoexposição em região tropical do Brasil

Aims: To investigate skin lesions associated with or aggravated by sun exposure in community health workers in two municipalities in the metropolitan region of Belem, State of Para, Brazil, relating the lesions to some sociodemographic variables, and to assess the use of sun protection.Methods: A cross-sectional study was carried out with 11 Family Health Centers in Belem and Ananindeua selected by non-probabilistic convenience sampling. All workers answered a questionnaire and were clinically examined for the presence of skin lesions caused by sun exposure, in addition to having sun exposure variables and their sociodemographic profile assessed. The data were analyzed by the chi-square test, Fisher’s exact test with Yates’ correction, and Student’s t test. A p value ≤ 0.05 was considered to be statistically significant. Results: A total of 83 workers were assessed, most of whom were female (75.9%), aged between 30 and 40 years (44.6%), single (47%), with completed high school education (69.8%), and family income between 1 and 2 minimum wages (67.5%), working in the profession for over 10 years (48.2%). Among the respondents, 83% reported daily sun exposure in their working activity, 47% were exposed for more than four hours, and 73.5% were exposed to the sun at the most critical time (between 10 and 4 o’clock). 56.6% used some kind of protection against sun exposure, and 27.7% reported using sunscreen on a daily basis. The dermatologic evaluation also revealed that 97.6% of workers had many skin lesions caused by sun exposure. Melanosis was the most common diagnosis.Conclusions: Skin lesions were frequent among community health workers and sun exposure during working hours appears to have played a remarkable role. Workers showed difficulty adopting protective behaviors. Occupational health policies and actions targeted at the prevention of aggravating factors among community health workers should be encouraged.

Manifestações dermatológicas em uma casuística de doença hepática crônica de um hospital de referência em Belém, Estado do Pará, Brasil

Hematopathic patients can often be asymptomatic or may present symptoms in a light or nonspecific way, without clear indicators of a hepatocellular lesion. The skin lesions can be the first or even the only sing of liver disease. This study aims to detect and describe the main skin lesions in series of patients with liver diseases treated at a reference hospital for liver disease in Belém, Pará State, Brazil, from October 2011 to June 2012. Fifty-eight patients were investigated, most of them were female, in the fifth decade of life. Viral hepatitis B and C were the most frequent liver disease and 91.4% of patients had dermatological findings during the investigation, with 40 different types of dermatological diagnoses and grouped into 13 major groups of skin illness. Xerosis was the most common dermatological finding in liver disease (34.5%). Chronic liver diseases are related to a number of extrahepatic manifestations, many of them are cutaneous and may help to identify silent cases of those serious diseases.