Flávio de Mattos Oliveira

Criptococose em crianças no Estado do Pará, Brasil

We report 19 cases of cryptococcosis in children, diagnosed in Belem, PA. In nine patients the variety of the etiologic agent was studied and identified as Cryptococcus neoformans var. gattii.The average age of these patients was 7.8 years (range, 5-13 years) There were 5 girls and 4 boys (ratio, 1.25:1). Amphotericin B treatment (associated with fluconazole 3 or fluocytosine 1) was given but five (56%) of these patients died in the following three months. The existence of highly endemic areas of infection by var. gattii in Para, Brazil and the severity of the disease due to this fungal variety are commented.

Histoplasmosis in Rio Grande do Sul, Brazil: a 21-year experience

Of 156 cases of histoplasmosis observed in the State of Rio Grande do Sul (Brazil), during a 21-year period (1978-1999) 137 were included in this study. Sixty-seven per cent of the patients had hematogeneous disseminated histoplasmosis, 24% had a self-limited syndrome (acute pulmonary histoplasmosis, histoplasmoma or primary pulmonary lymph node complex), and 9 per cent had chronic pulmonary histoplasmosis. Clinical, mycological, and epidemiological data were reviewed and commented.

Isolated central nervous system histoplasmosis in immunocompetent hosts: A series of 11 cases

Histoplasmosis of the central nervous system occurs in a significant percentage of patients with Histoplasma capsulatum infection, but has usually been described in association with immunosuppression and/or disseminated histoplasmosis. We aim to review the clinical and laboratory features of isolated histoplasmosis of the central nervous system in the immunocompetent host by presenting a series of 11 cases with this condition. Most of these patients presented with headache, meningeal irritation signs and mental status changes, comprising a somewhat different picture from that described in immunosuppressed patients. Moreover, almost all patients had signs of ventricular dilatation in neuroimaging studies, and 8 of the 11 patients had a ventriculoperitoneal shunt at the time of diagnosis, suggesting hydrocephalus to be an important feature of this condition and/or the possibility of shunt infection by the fungus. Immunodiffusion analysis of the cerebrospinal fluid appeared to be the most efficient way to reach the diagnosis and should be considered in immunocompetent patients with chronic lymphocytic meningitis, especially in those who have ventricular shunt or live in endemic areas of Histoplasma capsulatum.

Histoplasmose disseminada no Rio Grande do Sul

This report describes epidemiological, clinical and laboratorial aspects of 111 cases of disseminated histoplasmosis from Rio Grande do Sul over a 25-year period (1977-2002). AIDS and non-AIDS patients were analyzed was the predisposing disease in 63.1% of the patients. In both groups there were mostly men, without evidence of exposure to microfoci contaminated with Histoplasma capsulatum. The main clinical features were systemic (fever and weight loss were present in 97.1 and 92.7% of AIDS and non-AIDS cases), followed by respiratory and mucocutaneous manifestations. Seromycology (positive in 54.5% and 65.3% in AIDS and non-AIDS cases) was useful as a screening test. The high index of cutaneous involvement in AIDS patients (44.3%) compared with North American reports (p <0.01) suggests that different strains of Histoplasma capsulatum may induce different clinical manifestations of the same disease.

Microepidemia de histoplasmose em Blumenau, Santa Catarina

Acute pulmonary histoplasmosis is rarely diagnosed and is often confused with tuberculosis. Most knowledge of the disease has been derived from descriptions of epidemics in which a number of individuals were exposed to the same source of infection. Isolation of Histoplasma capsulatum var. capsulatum from soil samples is conclusive evidence of an epidemic focus. This is the first report of an outbreak of histoplasmosis, in which two cases were reported and the fungus was isolated at the focus of the epidemic, in the state of Santa Catarina. Further epidemiological studies are needed in order to determine the prevalence of the infection statewide.

Histoplasmosis in children

Histoplamosis is the most common primary systemic mycosis in the USA and is becoming more common as an opportunistic infection in HIV patients worldwide. In children the rate of asymptomatic infection is high. However, in infants with an immature immunological system, disseminated disease may occur. The clinical picture is variable depending on the immunological status. At the onset of the infection clinical manifestations are non specific (headache, fever, cough and nausea). Usually, these symptoms are self-limited and improve without treatment. However, patients with disseminated diseases present with prolonged fever, malaise, cough and weight loss. Hepatosplenomegaly is frequent in infants. Chest radiographs may be normal in 40 to 50% of patients with disseminated disease but findings such as lobar or diffuse infiltrates, cavitations, hilar adenopathy, or any combination of these may be found. Frequently, the clinical presentation is misdiagnosed as tuberculosis. Skin tests, serological reaction and specific cultures are used for diagnosis confirmation. Treatment indications and regimens are similar to those for adults, except that amphotericin B deoxycholate is usually well tolerated in children.

Infección nosocomial por Trichosporon asahii: revisión clínica de 22 casos

Resumen Presentamos una serie de 22 casos de infeccion nosocomial por Trichosporon asahii , detectados en un periodo de seis anos (1999-2005). Los pacientes presentaron edades entre 6 y 72 anos, con un promedio de 47,3 anos y con leve predominio de hombres. Las enfermedades subyacentes, fueron insuficiencia respiratoria, cancer, diabetes, insuficiencia renal cronica, cirrosis y sida. Las condiciones predisponentes fueron antibioticoterapia, ventilacion mecanica, sonda vesical, cateter, corticoides, trasplantes, inmunosupresores, quimioterapia, granulocitopenia, procedimiento quirurgico y dialisis peritoneal ambulatoria continua. Los antifungicos mas utilizados fueron el fluconazol y la anfotericina B. Algunos pacientes recibieron varios antifungicos. Cinco pacientes no fueron tratados con antifungicos y un paciente recibio factor de estimulacion de colonias granulociticas (G-CSF). De los 22 pacientes, nueve presentaron mejoria clinica, otros nueve pacientes fallecieron y de cuatro pacientes se desconoce su evolucion. T. asahii es un patogeno emergente en pacientes inmunodeficientes y su presencia en las muestras clinicas de estos no debe ser considerada una colonizacion por el importante riesgo de infeccion invasora. En aquellos pacientes susceptibles de padecer una Trichosporon osis se debe mantener alto grado de sospecha y vigilancia clinica para el diagnostico de esta infeccion.

Associação entre paracoccidioidomicose e câncer

OBJECTIVE To analyze the association between paracoccidioidomycosis (Pcm) and cancer in a series of 25 cases and to review the literature on this topic. METHODS A retrospective review of 25 cases diagnosed with Pcm and cancer, retrieved from a series of 808 consecutive adult patients diagnosed with Pcm based on tests conducted in the Mycology Laboratory of the Santa Casa Complexo Hospitalar, in the city of Porto Alegre, Brazil, between 1972 and 2007. The diagnosis of Pcm was confirmed by means of direct microscopic examination, histopathological examination or immunodiffusion test. All cancer cases were confirmed by histopathological or cytopathological examination. RESULTS Respiratory symptoms were the principal complaints of the patients evaluated. Pulmonary involvement predominated, followed by skin and lymph node involvement. The most prevalent tumor was bronchial carcinoma, in 15 patients, followed by other types of carcinoma, and 1 patient had Hodgkins lymphoma. In 16 patients (64%), the site of the Pcm was the same as that of the tumor. In most cases, Pcm treatment consisted of the isolated administration of sulfanilamide, sulfamethoxazole-trimethoprim, ketoconazole, itraconazole or amphotericin B. The most common treatment for cancer was surgery, followed by radiotherapy and chemotherapy. Of the 25 patients, 12 were cured of Pcm, and 4 died. In 9 patients, the final outcome was unknown. In the general population of the area under study, the prevalence of lung cancer was significantly higher in smokers with Pcm than in smokers without Pcm (p < 0.001). CONCLUSIONS A diagnosis of Pcm appears to increase the risk of lung cancer.

Cryptococcus gattii fungemia: report of a case with lung and brain lesions mimicking radiological features of malignancy

A 64-year-old apparently immunocompetent white man developed lung and brain lesions of disseminated cryptococcosis. The radiologic features mimicked those of lung cancer metastatic to the central nervous system. C. gattii was recovered from cultures of bronchoalveolar lavage fluid, brain biopsy, and blood. The same fungus was recovered from pulmonary and brain specimens at autopsy. Serum and cerebrospinal fluid cryptococcal antigen tests were diagnostic in our case and should be included in the diagnostic evaluation of unexplained pulmonary and cerebral lesions. A literature search showed few reports of fungemia by this species of Cryptococcus, contrasting to C. neoformans.

The spectrum of computerized tomography (CT) findings in central nervous system (CNS) infection due to Cryptococcus neoformans var. gattii in immunocompetent children

Cranial CT scans of eleven immunocompetent children with central nervous system (CNS) infection due to Cryptococcus neoformans var. gattii were retrospectively reviewed. These children had an average age of 8.8 years and positive culture for C. n. var. gattii in cerebrospinal fluid. The most common signs and symptoms were headache, fever, nuchal rigidity, nausea and vomiting. No normal cranial CT was detected in any patient. Hypodense nodules were observed in all patients. The remaining scan abnormalities were as follows: nine had diffuse atrophy, six had hydrocephalus, and five had hydrocephalus coexistent with diffuse atrophy.