Marcos Vinicius da Silva Pone

Lipodystrophy syndrome and cardiovascular risk factors in children and adolescents infected with HIV/AIDS receiving highly active antiretroviral therapy

OBJECTIVE To describe lipid profile, body shape changes, and cardiovascular risk factors in children and adolescents infected with HIV/AIDS receiving highly active antiretroviral therapy. METHODS We investigated 43 children and adolescents being treated with this therapy at the outpatient clinic of pediatric infectious diseases of Instituto Fernandes Figueira/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. Values of total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides were determined. We also performed glucose tolerance test and analyzed body fat distribution, nutritional status, dietary intake, and family history of cardiovascular risk. The statistical analysis was performed using Students t test. Significance level of p-value was lower than 0.05. RESULTS We found lipid abnormality in 88.3% and body shape change in 13.9% of the cases. Nutritional status was adequate (81.3%) in most of the study population. Cholesterol intake in children older than 9 years was above the recommended value. CONCLUSION Prevalence of dyslipidemia and, therefore, risk for cardiovascular diseases were high during the use of highly active antiretroviral therapy.

Screening Criteria for Ophthalmic Manifestations of Congenital Zika Virus Infection

Importance Current guidelines recommend screening eye examinations for infants with microcephaly or laboratory-confirmed Zika virus infection but not for all infants potentially exposed to Zika virus in utero. Objective To evaluate eye findings in a cohort of infants whose mothers had polymerase chain reaction–confirmed Zika virus infection during pregnancy. Design, Setting, and Participants In this descriptive case series performed from January 2 through October 30, 2016, infants were examined from birth to 1 year of age by a multidisciplinary medical team, including a pediatric ophthalmologist, from Fernandes Figueira Institute, a Ministry of Health referral center for high-risk pregnancies and infectious diseases in children in Rio de Janeiro, Brazil. Participants Mother-infant pairs from Rio de Janeiro, Brazil, who presented with suspected Zika virus infection during pregnancy were referred to our institution and had serum, urine, amniotic fluid, or placenta samples tested by real-time polymerase chain reaction for Zika virus. Main Outcomes and Measures Description of eye findings, presence of microcephaly or other central nervous system abnormalities, and timing of infection in infants with confirmed Zika virus during pregnancy. Eye abnormalities were correlated with central nervous system findings, microcephaly, and the timing of maternal infection. Results Of the 112 with polymerase chain reaction–confirmed Zika virus infection in maternal specimens, 24 infants (21.4%) examined had eye abnormalities (median age at first eye examination, 31 days; range, 0-305 days). Ten infants (41.7%) with eye abnormalities did not have microcephaly, and 8 (33.3%) did not have any central nervous system findings. Fourteen infants with eye abnormalities (58.3%) were born to women infected in the first trimester, 8 (33.3%) in the second trimester, and 2 (8.3%) in the third trimester. Optic nerve and retinal abnormalities were the most frequent findings. Eye abnormalities were statistically associated with microcephaly (odds ratio [OR], 19.1; 95% CI, 6.0-61.0), other central nervous system abnormalities (OR, 4.3; 95% CI, 1.6-11.2), arthrogryposis (OR, 29.0; 95% CI, 3.3-255.8), and maternal trimester of infection (first trimester OR, 5.1; 95% CI, 1.9-13.2; second trimester OR, 0.5; 95% CI, 0.2-1.2; and third trimester OR, 0.3; 95% CI, 0.1-1.2). Conclusions and Relevance Eye abnormalities may be the only initial finding in congenital Zika virus infection. All infants with potential maternal Zika virus exposure at any time during pregnancy should undergo screening eye examinations regardless of the presence or absence of central nervous system abnormalities.

Pneumocephalus and Exophthalmos Secondary To Acute Sinusitis and Nasopharyngeal Oxygen Catheter

Pneumocephalus is a well-known complication of skull trauma, certain neurosurgical procedures, and sinus neoplasms.1,2 The association between pneumocephalus and infection is very rare, usually occurring in patients with mastoiditis, chronic otitis media, and sinusitis.1,3 In a recent report, pneumocephalus and exophthalmos developed secondary to administration of oxygen by a nasopharyngeal catheter in a patient without sinusitis.4 We describe an infant admitted for treatment of bacterial pneumonia and maxillary and ethmoid sinusitis, in whom pneumocephalus and right-sided severe exophthlalmos developed while the patient was receiving oxygen by a nasopharyngeal catheter.

Cranial bone collapse in microcephalic infants prenatally exposed to Zika virus infection

Brazil has been experiencing an outbreak of Zika virus, a flavivirus transmitted by Aedes mosquitoes. Since October 2015, more than 4,000 infants,1 born to mothers suspected to have contracted this infection during pregnancy, have microcephaly1,2 and CNS malformations (figure 1), including parenchymal and periventricular calcifications, ventriculomegaly, and cortical migration anomalies.2 This suggests marked viral neurotropism. Upon performing CT, cranial malformations (figure 2) with a pointed occiput are also observed.Brazil has been experiencing an outbreak of Zika virus, a flavivirus transmitted by Aedes mosquitoes. Since October 2015, more than 4,000 infants,1 born to mothers suspected to have contracted this infection during pregnancy, have microcephaly1,2 and CNS malformations (figure 1), including parenchymal and periventricular calcifications, ventriculomegaly, and cortical migration anomalies.2 This suggests marked viral neurotropism. Upon performing CT, cranial malformations (figure 2) with a pointed occiput are also observed.

Cryptococcus gattii molecular type VGII as agent of meningitis in a healthy child in Rio de Janeiro, Brazil: report of an autochthonous case

Cryptococcus gattii causes meningoencephalitis in immunocompetent hosts, occurring endemically in some tropical and subtropical regions. Recently, this fungus was involved in an outbreak in Vancouver Island and British Columbia (Canada). In this temperate region, the VGII type is predominant. The paper describes an autochthonous case of meningoencephalitis by C. gattii VGII in a previously health child in Rio de Janeiro, considered nonendemic region of Brazil. The fungus was identified by biochemical tests and the molecular type was determined by URA5-RFLP. The present report highlights the need for clinical vigilance for primary cryptococcal meningitis in nonendemic areas.

[Non-reactive tuberculosis: a clinicopathological study].

The authors report a case of non-reactive tuberculosis diagnosed at autopsy. This is a very rare type of clinical presentation of tuberculosis and is usually associated with immunosuppression and gross abnormalities of haemopoiesis.

Clinical and laboratory signs associated to serious dengue disease in hospitalized children

OBJECTIVE To evaluate the validity of clinical and laboratory signs to serious dengue disease in hospitalized children. METHODS Retrospective cohort of children (<18 years) hospitalized with dengue diagnosis (2007-2008). Serious dengue disease was defined as death or use of advanced life support therapy. Accuracy measures and area under the receiver operating characteristic curve were calculated. RESULTS Of the total (n=145), 53.1% were female, 69% aged 2-11 years, and 15.9% evolved to the worse outcome. Lethargy had the best accuracy (positive likelihood ratio >19 and negative likelihood ratio <0.6). Pleural effusion and abdominal distension had higher sensitivity (82.6%). History of bleeding (epistaxis, gingival or gastrointestinal bleeding) and severe hemorrhage (pulmonary or gastrointestinal bleeding) in physical examination were more frequent in serious dengue disease (p<0.01), but with poor accuracy (positive likelihood ratio=1.89 and 3.89; negative likelihood ratio=0.53 and 0.60, respectively). Serum albumin was lower in serious dengue forms (p<0.01). Despite statistical significance (p<0.05), both groups presented thrombocytopenia. Platelets count, hematocrit, and hemoglobin parameters had area under the curve <0.5. CONCLUSIONS Lethargy, abdominal distension, pleural effusion, and hypoalbuminemia were the best clinical and laboratorial markers of serious dengue disease in hospitalized children, while bleeding, severe hemorrhage, hemoconcentration and thrombocytopenia did not reach adequate diagnostic accuracy. In pediatric referral hospitals, the absence of hemoconcentration does not imply absence of plasma leakage, particularly in children with previous fluid replacement. These findings may contribute to the clinical management of dengue in children at referral hospitals.

Abordagem diagnóstica e terapêutica da toxoplasmose em gestantes e as repercussões no recém-nascido

Objective: To analyze the diagnostic and therapeutic approach of pregnant women with positive IgM test for toxoplasmosis and the follow-up of their children in a public hospital of Rio de Janeiro, Brazil. Methods: This cross-sectional retrospective study from 2003 to 2006 enrolled 98 pregnant women with positive IgM test for toxoplasmosis and 99 children. The follow-up of the children with or without congenital infection was reviewed, as well as the clinical presentation of those with congenital infection and the laboratory tests used to diagnose the infection by Toxoplasma gondii during pregnancy. Results: Toxoplasmosis was diagnosed in the second and third trimesters of pregnancy in 76 patients. In 36 pregnant women, determination of the serum levels of IgM was the only laboratory method used to diagnose the infection. Low

Positive reaction for cysticercosis and multicentric anaplastic oligoastrocytoma

IntroductionAn unusual case of positive immunological testing for cysticercosis in the cystic fluid obtained from an anaplastic oligoastrocytoma is presented.Case reportA 15-year-old boy was admitted with multiple brain lesions. The biggest was a cyst with a mural node and neurocysticercosis was suspected. In order to relieve intracranial pressure, the cyst was punctured and the immunological testing for cysticercosis was positive, reinforcing the clinical suspicion and leading to a clinical trial with albendazole and steroids. As the patient deteriorated the cystic lesion was removed and the diagnosis of anaplastic oligoastrocytoma was established. A second lesion was eventually approached and the histopathological diagnosis of both specimens concurred.DiscussionAlthough some authors believe that chronic inflammatory changes following neurocysticercosis could induce the formation of brain tumors, this association may be a mere coincidence. In our case no clinical evidence of a prior infestation by Cysticercus was found. In fact, an exhaustive examination of the specimens did not reveal any areas of inflammatory reaction. We believe that the similarity of the glioma and cysticercosis antigens may be the cause of the positive reactions in the cystic fluid.

Persistence of Zika Virus After Birth: Clinical, Virological, Neuroimaging, and Neuropathological Documentation in a 5-Month Infant With Congenital Zika Syndrome

During the Zika epidemic in Brazil, a baby was born at term with microcephaly and arthrogryposis. The mother had Zika symptoms at 10 weeks of gestation. At 17 weeks, ultrasound showed cerebral malformation and ventriculomegaly. At 24 weeks, the amniotic fluid contained ZIKV RNA and at birth, placenta and maternal blood were also positive using RT-qPCR. At birth the baby urine contained ZIKV RNA, whereas CSF at birth and urine at 17 days did not. Seizures started at 6 days. EEG was abnormal and CT scan showed cerebral atrophy, calcifications, lissencephaly, ventriculomegaly, and cerebellar hypoplasia. Bacterial sepsis at 2 months was treated. A sudden increase in head circumference occurred at 4 months necessitating ventricle-peritoneal shunt placement. At 5 months, the infant died with sepsis due to bacterial meningitis. Neuropathological findings were as severe as some of those found in neonates who died soon after birth, including hydrocephalus, destructive lesions/calcification, gliosis, abnormal neuronal migration, dysmaturation of nerve cells, hypomyelination, loss of descending axons, and spinal motor neurons. ZIKV RNA was detected only in frozen brain tissue using RT-qPCR, but infected cells were not detected by in situ hybridization. Progressive gliosis and microgliosis in the midbrain may have contributed to aqueduct compression and subsequent hydrocephalus. The etiology of progressive disease after in utero infection is not clear and requires investigation.