Lilian Martins Oliveira Diniz

Impacto da terapia antirretroviral combinada no crescimento e nas taxas de hospitalização de crianças infectadas pelo HIV

OBJETIVO: Avaliar mudancas em parâmetros de crescimento e hospitalizacao em criancas infectadas pelo virus da imunodeficiencia humana (human immunodeficiency virus, HIV) em uso de terapia antirretroviral combinada. METODOS: As criancas foram avaliadas durante os primeiros 3 anos de terapia. A resposta clinica foi avaliada a cada 24 semanas com base em escores z de peso/idade e altura/idade. Modelos de regressao linear foram utilizados para identificar preditores de resposta clinica. Dados relevantes relativos a hospitalizacao dos pacientes foram obtidos retrospectivamente mediante revisao dos prontuarios clinicos. RESULTADOS: Um total de 196 criancas foram avaliadas. A media do escore z aumentou de -1,62 (±1,32) no inicio do estudo para -1,14 (±1,12) na semana 24. A media do escore z de altura/idade aumentou de -1,88 (±1,45) para -1,66 (±1,18). Foi observada associacao entre maiores escores z no inicio do estudo e maiores aumentos nos escores z de peso/idade ao longo do tempo. Cargas virais mais baixas e escores de altura/idade mais altos tambem estiveram associados com maior recuperacao do crescimento. Oitenta e cinco criancas (43,3%) foram hospitalizadas. A maioria das internacoes esteve associada a causas infecciosas, sendo apenas dois casos de infeccoes oportunistas. CONCLUSAO: A terapia combinada resultou em aumentos significativos nos escores z de peso/idade e altura/idade. A menor idade, o uso de inibidores de protease e a classificacao clinica em estagios avancados estiveram associados a uma maior efetividade do tratamento. Alem disso, o estudo demonstrou a eficacia da terapia para a reducao das taxas de hospitalizacao, morte e incidencia de infeccoes oportunistas entre criancas portadoras do HIV.

Neurological involvement in visceral leishmaniasis: case report

Visceral leishmaniasis is a severe and potentially fatal vector-borne disease. The most typical symptoms are fever, hepatosplenomegaly, weight loss, bleeding and bacterial infections. Neurological changes are rarely reported. This paper describes a child who presented with neurological signs as the first symptoms of leishmaniasis; tone was diminished and tremors in the extremities were observed. A diagnosis of visceral leishmaniasis was confirmed by parasite detection in the bone marrow. Symptoms were reversed by specific treatment. The nature of a possible mechanism of neurological involvement in visceral leishmaniasis remains unexplained.

Lymphadenitis caused by infection with an isoniazid- and rifampin-resistant strain of Mycobacterium bovis BCG in an infant with IFN-γ/IL-12 pathway defect

We report a rare case in a female infant (age, 3.5 months) with primary immunodeficiency (IFN-γ/IL-12 pathway defect) who presented with suppurative lymphadenitis after Mycobacterium bovis BCG vaccination. The strain of M. bovis BCG identified was found to be resistant to isoniazid and rifampin. The patient was treated with a special pharmacological regimen involving isoniazid (in a limited, strategic manner), ethambutol, streptomycin, and IFN-γ, after which there was complete resolution of the lesions.

Impact of HAART on growth and hospitalization rates among HIV-infected children

OBJECTIVE To evaluate HAART-associated changes in growth and hospitalization rates over time in a cohort of HIV-infected children. METHODS Children starting HAART were assessed during the first 3 years of therapy. Clinical response was assessed every 24 weeks by z scores of weight-for-age and height-for-age. Linear regression models were used to detect predictors of clinical response. Pertinent information on hospitalizations was obtained retrospectively through review of medical records. RESULTS A total of 196 children were assessed. Mean weight z score increased from -1.62 (±1.32) at baseline to -1.14 (±1.12) by week 24. Mean height z score increased from -1.88 (±1.45) at baseline to -1.66 (±1.18). Better z scores at baseline were associated with greater increases in weight z scores over time. Lower viral load and higher height z scores at baseline were also associated with improved height catch-up. Eighty-five children (43.3%) were hospitalized. Most hospitalizations were prompted by infectious disease, with only two due to opportunistic infections. CONCLUSION HAART was associated with significant increases in weight and height z scores. Younger age, the use of protease inhibitors and advanced clinical disease were associated with better outcomes. The present study demonstrated the effectiveness of HAART in significantly reducing hospitalization, death, and incidence of opportunistic infections among HIV-infected children.

Study of Complications of Varicella-Zoster Virus Infection in Hospitalized Children at a Reference Hospital for Infectious Disease Treatment

OBJECTIVES Varicella is a disease with potentially severe complications. We aimed to investigate characteristics of hospitalized children with varicella in Brazil in the prevaccine period and to identify predictors for requiring intensive care treatment. METHODS A prospective cohort study was conducted from May 2011 to April 2014. Patients up to 13 years of age with varicella diagnosis were included. Information was collected through interview and review of medical records. Logistic regression analysis was performed. RESULTS A total of 669 patients were admitted. The median age of subjects was 2.7 years (range 0-14 years) with a predominance of boys (56.6%). The main causes of hospitalization were bacterial complications (77.7%), viral complications (11.4%), and at-risk patients (10.9%). Main bacterial complications were skin infection and pneumonia. Main viral complications were herpes zoster, cerebellitis, and encephalitis. Most at-risk patients used corticosteroids or had a diagnosis of leukemia. At-risk patients were hospitalized earlier (P < .01) and remained hospitalized for longer periods (P = .03). A total of 44 patients (6.6%) were admitted to the ICU, and 5 (0.8%) died of septic shock. Thrombocytopenia was associated with more severe illness in patients with bacterial infections (P = .001). The long-time interval between onset of infection and admission was associated with the need for intensive care in all groups (P = .007). CONCLUSIONS Secondary bacterial infection is the main cause of hospitalization, and thrombocytopenia in these patients leads to worse outcomes. Difficulties of access to the health system and delay in medical care are determining factors of greater severity in this population.

Infection surveillance in pediatric hematopoietic stem cell transplantation recipients

To describe the profile of reported healthcare‐associated infections (HAIs) in pediatric patients submitted to hematopoietic stem cell transplantation (HSCT) at a reference center.

Cross-sectional study of clinical and laboratorial aspects of congenital infections attended at a reference Center in Belo Horizonte, MG, 2012-2014

Introduction: congenital infections are results of microorganisms transmitted to the fetus by the infected pregnant. Most newborn infants infected during pregnancy or labor have no sings of congenital disease. However, these infections may cause perinatal and infancy morbidity and mortality. Objective: to determine the prevalence of congenital infections in newborns and infants attended at the CTR/DIP Orestes Diniz (Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias Orestes Diniz) and to analyse the laboratorial methods used for diagnosis of congenital disease of assisted children. Methods: cross-sectional study conducted in an Infectious Diseases Reference Center where it was evaluated the charts of infants with suspected congenital infection. Diagnosis confirmation was based on serological tests, molecular biology and signs and Cross-sectional study of clinical and laboratorial aspects of congenital infections attended at a reference Center in Belo Horizonte, MG, 2012-2014 Roberta Maia de Castro Romanelli1, Ericka Viana Machado Carellos2, Mariana Antunes Faria Lima3, Lilian Oliveira Diniz2, Andrea Luchesi de Carvalho4, Eduarda Almeida Wakabayashi5, Tais Marina de Souza5, Natalia Pinto Ribeiro6, Camila Nakaya5, GabrielaMafra de Oliveira5, João Paulo Tomaz da Cunha Sacramento6, Gláucia Manzan de Queiroz Andrade7 Estudo transversal do perfil das infecções congênitas atendidas entre 2012 e 2014 em um centro de referência em Belo Horizonte, Minas Gerais DOI: 10.5935/2238-3182.20160016