Guilherme Almeida Rosa da Silva

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.

The diet of Scinax angrensis (Lutz) tadpoles in an area of the Atlantic Forest (Mangaratiba, Rio de Janeiro) (Amphibia, Anura, Hylidae)

Scinax angrensis (Lutz, 1973) e uma especie endemica ocorrendo em florestas de encosta de baixa altitude, no sul do Estado do Rio de Janeiro, Brasil. O objetivo do presente estudo foi o de comparar a morfologia e verificar o espectro alimentar de girinos de S. angrensis de dois estagios diferenciados de desenvolvimento. A morfologia bucal dos dois estagios (27 e 37) apresentou-se similar, havendo diferenca de tamanho da abertura oral, bem como aumento das dimensoes do corpo e da cauda. A especie examinada apresentou um espectro trofico integrado por algas, protozoarios, rotiferos, microcrustaceos, nematodeos, restos de vegetais e de invertebrados, hifas de fungo e graos de areia. Foram verificadas diferencas significativas entre as dimensoes dos dois estagios, embora nao se tenha encontrado uma diferenca significativa entre as dietas, apesar de se ter observado uma preferencia diferenciada por itens planctonicos. Os resultados sugerem que a partilha de recursos alimentares esta relacionada nao so com a morfologia e ocupacao de diferentes microhabitats, mas tambem ao comportamento alimentar dos girinos. A relevância de itens importantes para a dieta natural dos girinos de S. angrensis, especialmente as algas diatomaceas e filamentosas, revela a importância da comunidade perifitica para a conservacao desta especie de anuro na Mata Atlântica.

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.

Facial botryomycosis-like pyoderma in an HIV-infected patient: remission after initiation of darunavir and raltegravir

Botryomycosis is an uncommon, chronic, suppurative, bacterial infection that primarily affects the skin and subcutaneous tissues. It has long been associated with defects of cellular immunity. We report a 28-year-old woman who presented with a chronic, ulcerated lesion with draining sinuses in the right malar region. Predisposing factors were HIV infection with poor immunological control, alcoholism, and a previous trauma to the right cheek. Several courses of antimicrobial therapy provided only partial and temporary remission. Complete clinical remission was only achieved 5 years later when a novel antiretroviral regimen composed of darunavir and raltegravir was initiated.

Olecranon Bursitis, Beau's Lines, Biett's Collarettes, and Crown of Venus

A 67-year-old human immunodeficiency virus (HIV)– infected Brazilian male patient presented with a generalized nonpruritic, confluent papulosquamous and nodular rash, first noted 7 days previously (Figure 1). The rash was so widespread that there was no spared area on the back. Some lesions around the ankles had a necrotic aspect with scale crust. There were no systemic symptoms or mucosal lesions. A painless healing chancre was evident on the penis shaft. The patient was on successful antiretroviral therapy for more than 15 years. The CD4 cell count was 666 cells/mm. Plasma HIV viral load measurements were consistently below detection limits. Previous tests were negative for syphilis. Novel studies showed a Venereal Disease Research Laboratory titer of 1:256 and fluorescent treponemal antibody absorption reactive for IgG and IgM. A diagnosis of secondary syphilis was made. It is known that HIV-infected patients with secondary syphilis are more likely to present with a concomitant genital ulcer. Skin lesions slowly regressed after three consecutive weekly administrations of 2.4 million units of intramuscular benzathine penicillin G. No Jarisch–Herxheimer reaction occurred. While on treatment, the spectrum of syphilis manifestations continued to unfold. A crown of Venus (corona

A case of chikungunya virus disease presenting with remarkable acute arthritis of a previously damaged finger joint.

Chikungunya virus (CHIKV) is a mosquito-borne arthritogenic alphavirus that has recently been introduced to Brazil. We report the case of a 36-year-old male patient from the City of Rio de Janeiro who developed molecularly-confirmed CHIKV disease and whose clinical picture was remarkable because of acute arthritis of an interphalangeal joint that had been damaged by trauma 8 years previously. This case illustrates that acute CHIKV disease may preferentially target previously damaged joints. Careful study of individual cases may provide valuable information on the presentation and management of this emerging zoonosis in Brazil.

Pyoderma Gangrenosum Simulating Necrotizing Fasciitis

Pyoderma gangrenosum received this name due to the notion that this disease was related to infections caused by bacteria in the genus Streptococcus. In contrast to this initial assumption, today the disease is thought to have an autoimmune origin. Necrotizing fasciitis was first mentioned around the fifth century AD, being referred to as a complication of erysipelas. It is a disease characterized by severe, rapidly progressing soft tissue infection, which causes necrosis of the subcutaneous tissue and the fascia. On the third day of hospitalization after antecubital venipuncture, a 59-year-old woman presented an erythematous and painful pustular lesion that quickly evolved into extensive ulceration circumvented by an erythematous halo and accompanied by toxemia. One of the proposed etiologies was necrotizing fasciitis. The microbiological results were all negative, while the histopathological analysis showed epidermal necrosis and inflammatory infiltrate composed predominantly of dermal neutrophils. Pyoderma gangrenosum was considered as a diagnosis. After 30 days, the patient was discharged with oral prednisone (60 mg/day), and the patient had complete healing of the initial injury in less than two months. This case was an unexpected event in the course of the hospitalization which was diagnosed as pyoderma gangrenosum associated with myelodysplastic syndrome.

Seabather’s eruption in Ipanema Beach, Rio de Janeiro, Brazil

In January 2017, a 28-year-old man presented with a 1-day history of burning and itching cutaneous lesions. He was concerned about the possibility of having acquired a communicable disease. The patient bathed and swam at Ipanema Beach (22°59′01′′S; 43°12′16′′W), Rio de Janeiro, the previous 4 consecutive days. On examination, around 30 erythematous papules and macules were distributed in a male swimwear pattern (Figure 1). No systemic symptoms were observed. A topical corticosteroid cream was prescribed, with complete remission of the lesions 1 week later. The rash was consistent with seabather’s eruption, a pruritic dermatitis occurring after contact with larvae of some marine animals, such as the thimble jellyfish Linuche unguiculata1. The planula larvae of this cnidarian are small enough (approximately 0.5mm) to pass through the fabric weaves of most swimwear and become trapped against the skin. External pressure or osmotic changes, including contact with freshwater, triggers the discharge of toxins by organelles called nematocysts. The diagnosis is established based on history of exposure to seawater followed by the appearance of rash in the peculiar topography of the areas covered by the bathing suit1. Possible preventive measures include the use of sunscreen under the swimwear, tight-weave (instead of open-weave) fabric, a female two-piece instead of one-piece swimsuit, and avoidance of T-shirts and showering with fresh water while wearing a contaminated suit. In Brazil, this marine envenomation is mainly reported in the coastal areas of São Paulo2 and Santa Catarina3 states. We are unaware of previous reports from the State of Rio de Janeiro.