Fernando Raphael de Almeida Ferry

Association between antiretrovirals and thyroid diseases: a cross-sectional study.

OBJECTIVE This study aims to estimate the prevalence of thyroid diseases and anti-TPO status. We searched for an association among presence of immune reconstitution and use of stavudine, didanosine and protease inhibitors with thyroid diseases. MATERIALS AND METHODS A cross-sectional study was performed to analyze the records of 117 HIV-infected patients who had their CD4+ cell count, viral load, anti-TPO, TSH and free T4 levels collected on the same day. Immune reconstitution was considered in those whose T CD4+ count was below 200 cells/mm3, but these values increased above 200 cells/mm3 after the use of antiretrovirals. The odds ratio obtained by a 2x2 contingency table and a chi-square test were used to measure the association between categorical variables. RESULTS The prevalence of thyroid disease was 34.18%; of these, 4.34% were positive for anti-TPO. There was an association of risk between stavudine use and subclinical hypothyroidism (OR = 4.19, 95% CI: 1.29 to 13.59, X2 = 6.37, p = 0.01). Immune reconstitution achieved protection associated with thyroid disease that was near statistical significance OR = 0.45, 95% CI: 0.19 to 1.04, X2 = 3.55, p = 0.059. CONCLUSION The prevalence of thyroid disease in the sample studied was higher than what had been found in the literature, with a low positive anti-TPO frequency. The historical use of stavudine has an association of risk for the presence of subclinical hypothyroidism, and immune reconstitution has trends towards protection for the presence of thyroid diseases.

FIRST CASE OF AUTOCHTHONOUS HUMAN VISCERAL LEISHMANIASIS IN THE URBAN CENTER OF RIO DE JANEIRO: CASE REPORT

Visceral leishmaniasis is an anthropozoonosis that is caused by protozoa of the genus Leishmania, especially Leishmania (Leishmania) infantum, and is transmitted to humans by the bite of sandflies of the genus Lutzomyia, such as Lutzomyia longipalpis. There are many reservoirs, including Canis familiaris. It is a chronic infectious disease with systemic involvement that is characterized by three phases: the initial period, the state period and the final period. The main symptoms are fever, malnutrition, hepatosplenomegaly, and pancytopenia. This article reports a case of a patient diagnosed with visceral leishmaniasis in the final period following autochthonous transmission in the urban area of Rio de Janeiro. The case reported here is considered by the Municipal Civil Defense and Health Surveillance of Rio de Janeiro to be the first instance of autochthonous visceral leishmaniasis in humans in the urban area of this city. The patient was discharged and is undergoing a follow-up at the outpatient clinic, demonstrating clinical improvement.

Factors associated with a diagnosis of major depression among HIV-infected elderly patients

INTRODUCTION Acquired immunodeficiency syndrome (AIDS) is being increasingly reported among the elderly and major depression (MD) may be associated with suboptimal adherence to treatment. METHODS Cross-sectional study on factors associated with MD among 72 HIV-infected elderly individuals. RESULTS Twenty (27.7%) patients were found to have MD. The female gender (odds ratio [OR] = 10.65; p = 0.00586), a low CD4 count during the study (OR = 1.005247; p = 0.01539), and current smoking status (OR = 12.89; p = 0.01693) were independently associated with MD. CONCLUSIONS Our data underscore the need to attentively search and treat MD among HIV-infected elderly patients.

Highly aggressive squamous cell carcinoma in an HIV-infected patient

Unusually aggressive forms of cutaneous squamous cell carcinoma are being increasingly recognized as a complication of HIV infection. We report the case of a 59-year-old male patient with advanced HIV infection who presented with a highly aggressive SCC lesion over the scalp area with destruction of the underlying parietal bone and fulminant clinical progression.

Severe shoulder tendinopathy associated with levofloxacin

Fluoroquinolone (FQ)-associated tendinopathy and myopathy are uncommon but well recognized complications of the use of this class of antibacterial agents. The case of a 63-year-old previously asymptomatic female patient who developed severe left shoulder tendinopathy after surreptitiously doubling the prescribed dose of levofloxacin for the treatment of community-acquired pneumonia is reported here. Surgical stabilization with suture anchors and subacromial decompression were needed.

Carpal tunnel syndrome after chikungunya infection

Chikungunya virus (CHIKV) is an arbovirus of the Togaviridae family, genus Alphavirus. It has attracted increasing attention in the last decade for its global spread and large number of epidemics. Infection with CHIKV causes debilitating inflammatory rheumatism. Carpal tunnel syndrome (CTS) is a focal neuropathy frequently associated with compression of the median nerve in the wrist and rheumatic disorders. A case of CHIKV infection with severe arthritis and CTS in a 41-year-old Brazilian woman is reported. The patient had a history of fever (38.5–40 8C), followed by severe pain and swelling in her right knee, with difficulty performing a flexion movement. The pain intensity increased within 24 h and spread to the knee, wrist, fingers, and feet. One week later, stiffness and constant tingling began in the left hand, which was relieved with movement. The cramp was more frequent at night and was associated with a cold sensation in the tips of the left fingers. At that time, the patient complained of pain in the shoulder joints, with greater intensity on the left side, and stiffness in the neck. She had no history of other comorbidities. Forty-five days after the onset of symptoms, there was a bilateral decreased tactile sensitivity at the thenar eminence, as well as an inability of both thumb opponency and bending of the last two phalanges of the left index finger (Figure 1). Routine blood analysis was normal. RT-PCR was negative for Zika virus (ZIKV) and CHIKV in serum and urine, and for dengue

Mucocutaneous Leishmaniasis/HIV Coinfection Presented as a Diffuse Desquamative Rash

Leishmaniasis is an infectious disease that is endemic in tropical areas and in the Mediterranean. This condition spreads to 98 countries in four continents, surpassing 12 million infected individuals, with 350 million people at risk of infection. This disease is characterized by a wide spectrum of clinical syndromes, caused by protozoa of the genus Leishmania, with various animal reservoirs, such as rodents, dogs, wolves, foxes, and even humans. Transmission occurs through a vector, a sandfly of the genus Lutzomyia. There are three main clinical forms of leishmaniasis: visceral leishmaniasis, cutaneous leishmaniasis, and mucocutaneous leishmaniasis. The wide spectrum of nonvisceral forms includes: localized cutaneous leishmaniasis, a papular lesion that progresses to ulceration with granular base and a large framed board; diffuse cutaneous leishmaniasis; mucocutaneous leishmaniasis, which can cause disfiguring and mutilating injuries of the nasal cavity, pharynx, and larynx. Leishmaniasis/HIV coinfection is considered an emerging problem in several countries, including Brazil, where, despite the growing number of cases, a problem of late diagnosis occurs. Clinically, the cases of leishmaniasis associated with HIV infection may demonstrate unusual aspects, such as extensive and destructive lesions. This study aims to report a case of mucocutaneous leishmaniasis/HIV coinfection with atypical presentation of diffuse desquamative eruption and nasopharyngeal involvement.

Cutaneous tuberculous gummas in a patient with polymyositis

Metastatic tuberculous abscesses or cutaneous tuberculous gummas occur mostly by reactivation of ancient cutaneous foci and is triggered mainly by pharmacological immunosuppression, diabetes mellitus, alcoholism or acquired immunodeficiency syndrome. The present case report refers to a 33-year-old male patient with polymyositis and a previous diagnosis of treated pulmonary tuberculosis. He presented cutaneous abscesses and fever months after the tuberculosis regimen. The patient was diagnosed as metastatic tuberculous abscesses associated with immunosuppression as result of polymyositis treatment.

Acute gouty arthritis as a manifestation of immune reconstitution inflammatory syndrome after initiation of antiretroviral therapy

Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected subjects initiating antiretroviral therapy most commonly involves new or worsening manifestations of previously subclinical or overt infectious diseases. Reports of non-infectious IRIS are much less common but represent important diagnostic and treatment challenges. We report on a 34-year-old HIV-infected male patient with no history of gout who developed acute gouty arthritis in a single joint one month after initiating highly active antiretroviral therapy.

The role of ear mites of the genus Raillietia (Acari: Raillietiidae) in otitis of domestic ruminants

This paper presents a hypothesis on the involvement of species of the genus Raillietia Trouessart in the pathology of parasitic otitis in domestic ruminants. The chelicerae and claws of the tarsi are structures that contribute significantly towards producing primary lesions. The movable digits of the chelicerae accidentally injure the epithelium that lines the ear canal, while the claws of the tarsi perforate the epithelium, allowing the mites to affix themselves while feeding. The lesions in the epithelium caused by the chelicerae and the claws favor multiplication of the bacteria that inhabit the ear canal, resulting in typical cases of otitis.