Pérsio Godoy

Opportunistic infections in patients with aids admitted to an university hospital of the Southeast of Brazil

Opportunistic diseases in HIV-infected patients have changed since the introduction of highly active anti-retroviral therapy (HAART). This study aims at evaluating the frequency of associated diseases in patients with AIDS admitted to an university hospital of Brazil, before and after HAART. The medical records of 342 HIV-infected patients were reviewed and divided into two groups: group 1 comprised 247 patients before HAART and, group 2, 95 patients after HAART. The male-to-female rate dropped from 5:1 to 2:1for HIV infection. There was an increase in the prevalence of tuberculosis and toxoplasmosis, with a decrease in Kaposis sarcoma, histoplasmosis and cryptococcosis. A reduction of in-hospital mortality (42.0% vs. 16.9%; p = 0.00002) has also occurred. An agreement between the main clinical diagnoses and autopsy findings was observed in 10 out of 20 cases (50%). Two patients with disseminated schistosomiasis and 2 with paracoccidioidomycosis are reported. Overall, except for cerebral toxoplasmosis, it has been noticed a smaller proportion of opportunistic conditions related to severe immunosuppression in the post HAART group. There was also a significant reduction in the in-hospital mortality, possibly reflecting improvement in the treatment of the HIV infection.

Coronary Giant Cell Arteritis and Acute Myocardial Infarction

Giant cell arteritis (GCA) is a systemic immune-mediated granulomatous vasculitis of large- and medium-sized arteries mainly affecting elderly people. Death from GCA alone is rare and usually results of ruptured aorta. In this paper is reported a case of a 83-year-old woman who unexpectedly died during treatment of GCA. Necropsy revealed inflammatory involvement of the coronary arteries with left descendent anterior artery thrombosis, myocardial infarct and rupture of the anterior wall of the left ventricle, as well as hemopericardium and cardiac tamponade. Myocardial infarction leading to sudden death is an exceptional complication of GCA.

Paracoccidioidomicose e síndrome de imunodeficiência adquirida: relato de necropsia

The case of a 59-year-old man with generalized paracoccidioidomycosis and acquired immunodeficiency syndrome without previous clinical diagnosis was observed at necropsy. There was fungal dissemination on multiple organs, particularly in the lymph nodes, characterizing the acute reactivation of an old infection. This is an additional case to be added to the few already on record.

Associação timoma e estrongiloidíase intestinal grave

A 59-years-old man with thymoma and severe intestinal strongyloidiasis is reported. The authors pointed out a possible influence of immunological response related with thymoma in the development of hyperinfection by Strongyloides stercoralis. Key-words: Thymoma and strongyloidiasis. Strongyloides stercoralis. Thymoma Thymoma and severe intestinal strongyloidiasis association Pérsio Godoy, Christian Marcellus Camargos Campos, Guilherme Costa e Lúcia Porto Fonseca de Castro Revista da Sociedade Brasileira de Medicina Tropical 31:481-485, set-out, 1998. 482 A associação timoma e estrongiloidíase não parece representar mera casualidade, embora assim considerado no único caso localizado na literatura consultada6. O timoma tem sido responsabilizado por infecções oportunísticas devido a insuficiência da resposta imunitária celular, cuja patogênese não está bem esclarecida. Alem disso, constitui relevante fator a hipogamaglobulinemia, presente em 5% dos casos desse tumor7 17 18. Por seu turno, é bem reconhecida a ocorrência de formas graves de estrongiloidíase em pacientes imunodeprimidos4 12 15, não obstante sua prevalência na SIDA permaneça controvertida2. Em tais circunstâncias, surge hiperativação da auto-infecção e conseqüente invasão larvária maciça do intestino grosso, com a possibilidade do desenvolvimento de lesões extra-intestinais pela disseminação linfohematogênica4.A 59-years-old man with thymoma and severe intestinal strongyloidiasis is reported. The authors pointed out a possible influence of immunological response related with thymoma in the development of hyperinfection by Strongyloides stercoralis.A 59-years-old man with thymoma and severe intestinal strongyloidiasis is reported. The authors pointed out a possible influence of immunological response related with thymoma in the development of hyperinfection by Strongyloides stercoralis.

Envolvimento renal na associação salmonella-Schistosoma mansoni

The responses of Plasmodium falciparum to antimalarial drugs were evaluated through the in vitro test using blood sample collected from patients of 7 municipalities of the south of Para State. Sixty nine microtests for chloroquine and mefloquine, 62 for amodiaquine and 61 for quinine were pet formed. The results showed a high resistancefor chloroquine (71%), a relatively low resistance level for amodiaquine (25.8%) and little resistance to quinine (8.2%). For mefloquine 100% of sensitivity wasfound.

Choque séptico puerperal por Streptococcus β-hemolítico e síndrome de Waterhouse-Friderichsen

An exceptional case of a 15-year-old puerpera with septic shock caused by Group A beta-hemolytic Streptococcus and Waterhouse-Friderichsen syndrome is reported. The findings were observed at the necropsy. The characteristics of the diagnosis, pathogenesis and evolution of this puerperal infection (sepsis), associated with adrenal hemorrhage and insufficiency are reviewed in this paper.

Estudo sobre a contribuição da autópsia como método diagnóstico

INTRODUCAO: As taxas hospitalares de autopsias vem diminuindo mundialmente, atingindo niveis criticos no Hospital das Clinicas da Universidade Federal de Minas Gerais (HC-UFMG) no que concerne a autopsias nao-perinatais. OBJETIVO: Verificar se houve diminuicao da relevância da autopsia no HC-UFMG. METODOLOGIA: Realizou-se estudo comparativo entre diagnosticos clinicos e post mortem, estabelecendo taxas de discordância com impacto terapeutico ou prognostico em duas amostras aleatorias de 80 autopsias realizadas no HC-UFMG nos anos 1970 e outras 80 nos anos 1990, incluindo procedimentos perinatais e nao-perinatais. RESULTADOS: Autopsias nao-perinatais (adultos e criancas) predominaram na decada de 1970. As perinatais (natimortos e neomortos) predominaram na decada de 1990, com discordâncias em 56% dos casos. Discordâncias parciais, com correta classificacao de malformacoes congenitas pela autopsia, foram as mais frequentes. Nao houve discordâncias na maioria das autopsias de criancas na decada de 1970; entretanto, a maioria destas na amostra da decada de 1990 revelou discordâncias. Em relacao aos adultos, a frequencia de erros diagnosticos nao apresentou alteracoes significativas entre as decadas de 1970 (68%) e 1990 (57%). Infeccoes bacterianas e tromboembolismo pulmonar constituiram frequentes condicoes nao diagnosticadas clinicamente na decada de 1970; nos anos 90, os diagnosticos nao formulados em vida formaram grupo heterogeneo de doencas. CONCLUSAO: A autopsia permanece util como metodo diagnostico, apesar de restritamente utilizada na atualidade. E necessaria elevacao das taxas de autopsias nao-perinatas para evitar os efeitos deleterios de sua ausencia no ensino, na pesquisa e no controle de qualidade da assistencia medica.

Associação de leishmaniose visceral e hepatite B de curso fulminante: relato de um caso

The case of a 20-year-old man with hepatoesplenomegaly, fever and severe hepatic insufficiency is reported. Histopathological and immunohistochemical studies of tissue specimens obtained at autopsy led to diagnosis of visceral leishmaniasis and fulminant hepatitis B. The authors pointed out a possible influence of immunological response related with visceral leishmaniasis in development of severe hepatic involvement by hepatitis B virus.

Lupus eritematoso sistêmico e salmonelose pulmonar persistente

A 40-years-old ivoman witb systemic lupus eiythematosus and severe pulmonaiy nontyphoid salmonellosis (Salmonella Typhimurium), is reported In addition the patient had incomplete septal cirrhosis. The authors pointed out a possible incluence of Salmonella infection in the development of immune complex diseases.

[Case 3/2006--progressive respiratory failure in a 33 year-old man with heart disease and remarkable somatic dysmorphism].

Editor da Seção: Alfredo José Mansur (ajmansur@incor.usp.br) Editor Convidado: Luiz Otávio Savassi Rocha Editores Associados: Desidério Favarato (dclfavarato@incor.usp.br) Vera Demarchi Aiello (anpvera@incor.usp.br) Trata-se de um homem (C.J.S.) de 33 anos que, em 19/06/2001, apresentando intensa agitação psicomotora, deu entrada no Serviço de Pronto Atendimento do Hospital das Clínicas da UFMG, com história de um a dois dias de evolução caracterizada por chiado no peito (referido como “crise asmática”), tosse persistente (pouco produtiva, com expectoração mucosa), dispnéia e provável febre. Era etilista contumaz, mas não cultivava o hábito de fumar. Havia menção a tratamento cirúrgico para correção de “hérnia” e biopsia (a céu aberto) para esclarecimento de doença hepática, realizada em 1976 (resultado não disponível).