Rogério de Jesus Pedro

Use of praziquantel in patients with schistosomiasis mansoni previously treated with oxamniquine and/ or hycanthone: resistance of Schistosoma mansoni to schistosomicidal agents.

Fourteen patients with active schistosomiasis mansoni in spite of previous treatment with oxamniquine and/or hycanthone were treated with praziquantel, single oral dose of 45 to 50 mg/kg body-weight. All underwent clinical, laboratory and electrocardiographic examination before and after treatment. Untoward effects (dizziness, drowziness, nausea and abdominal pain) were observed in ten. Laboratory findings disclosed no significant alteration and the electrocardiograms showed no abnormalities. Monthly follow-up examinations of 13 patients for six consecutive months showed parasitological cure in all. Before praziquantel treatment strains of Schistosoma mansoni were isolated from two patients, one treated three times with oxamniquine and the other with hycanthone once and oxamniquine twice. Progenies of these strains were maintained in Biomphalaria glabrata and mice. Groups of these infected mice were then treated with oxamniquine, hycanthone, niridazole and praziquantel and results compared with the BH strain maintained in our laboratory for many years. Schistosomicidal activity was assessed by the localization of worms in the portal vein system and oogram changes. Progenies from the strains isolated in this study were resistant to oxamniquine and hycanthone but sensitive to niridazole and praziquantel. The BH strain was sensitive to all four drugs. The serial runs of S. mansoni strains through intermediate and definitive hosts have not influenced their reactions to these schistosomicides.

Primary Antiretroviral Drug Resistance among HIV Type 1-Infected Individuals in Brazil

Infection with drug-resistant human immunodeficiency virus type 1 (HIV-1) has been documented in all countries that have surveyed for it and may result in an unfavorable response to therapy. The prevalence and characteristics of individuals with transmitted resistance to antiretroviral drugs have been scarcely described in Brazil. We performed antiretroviral resistance testing prior to initiation of therapy in 400 subjects enrolled from 20 centers in 13 Brazilian cities between March and September 2007. Genotyping was conducted using PCR-amplified HIV pol products by automated sequencing, and genotype interpretation was done according to the IAS-USA consensus. Of 400 eligible participants, 387 (95.8%) were successfully tested. Seven percent of antiretroviral-naive patients carried viruses with one or more major mutation associated with drug resistance. The prevalence of these mutations was 1.0% for protease inhibitors, 4.4% for nonnucleoside reverse transcriptase inhibitors, and 1.3% for nucleoside reverse transcriptase inhibitors. The frequency of multidrug resistance among the resistant strains was 13.6%. Among subjects infected with drug-resistant virus, the majority were infected with subtype B viruses (91%). Subjects from the city of São Paulo had higher transmitted resistance mutations compared to the rest of the country. Reporting a partner taking antiretroviral medications was associated with a higher chance of harboring HIV variants with major drug resistance mutations [odds ratio = 2.57 (95% confidence interval, 1.07-6.16); p = 0.014]. Resistance testing in drug-naive individuals identified 7% of subjects with mutations associated with reduced susceptibility to antiretroviral drugs. Continued surveillance of drug-resistant HIV-1 in Brazil is warranted when guidelines for HIV prophylaxis and treatment are updated. Resistance testing among drug-naive patients prior to treatment initiation should be considered, mainly directed at subjects whose partners are already on antiretroviral therapy.

Paracoccidioidomicose e infecção pelo virus da imunodeficiência humana

Sao apresentados dois casos de paracoccidioidomicose, um em paciente com a sindrome da imunodeficiencia adquirida e o outro em paciente com infeccao pelo HIV. Trata-se dos primeiros relatos em que esta associacao e descrita na literatura. No primeiro, a micose se evidenciou durante o acompanhamento de paciente com AIDS, que passou a apresentar hepato-esplenomegalia e febre elevada. A ecografia, radiografia simples e tomografia computadorizada do abdomen, demonstraram nodulos solidos, alguns calcificados, no parenquima esplenico. A puncao aspirativa da medula ossea confirmou o diagnostico; o conjunto dos achados caracterizou a forma aguda disseminada da paracoccidioidomicose, a qual levou o paciente ao obito. No segundo relato, em paciente com infeccao pelo HIV, a proposito de investigacao de tumoracao na regiao inguinal e fossa iliaca a direita, constatou-se a associacao de doenca de Hodgkin, tipo celularidade mista e paracoccidioidomicose. Avalia-se a importância destes relatos frente a expansao da infeccao pelo HIV e estima-se que mais casos venham a ser relatados em pacientes com AIDS, procedentes de areas endemicas desta micose. Propoe-se a inclusao da paracoccidioidomicose como infeccao oportunistica potencial em pacientes HIV positivos nestas areas.We present two cases of paracoccidioidomycosis, one occurring in an AIDS patient and the other in an HIV infected man. This is the first report of such association. The first patient, which was already followed for HIV infection (group IV-A) presented with high fever and hepatosplenomegaly. Plain X-ray, ultrasound and CT-scan of the abdomen showed solid nodules in the spleen, some of them with calcification. Both the direct smear and the culture of a bone marrow aspiration revealed Paracoccidioides brasiliensis. The patient died of acute disseminated Paracoccidioidomycosis. The second patient, a man anti-HIV seropositive presented with a mass on the right lower abdomen and inguinal region. A biopsy of the mass showed the association of Hodgkins disease of the mixed cellularity type and paracoccidioidomycosis. With the expanding AIDS epidemic we believe this report emphasizes the need to consider Paracoccidioidomycosis in HIV infected persons in countries where this mycosis is endemic. We also suggest the inclusion of Paracoccidioidomycosis as a potential opportunistic infection in these areas.We present two cases of paracoccidioidorrvycosis, one occurring in an AIDS patient and the other in an HIV infected man. This is the first report of such association. The first patient, which was already followed for HIV infection (group IV-A) presented with high fever and hepatosplenomegaly. Plain X-ray, ultrasound and CT-scan of the abdomen showed solid nodules in the spleen, some of them with calcification. Both the direct smear and the culture of a bone marrow aspiration revealed Paracoccidioides brasiliensis. The patient died of acute disseminated Paracoccidioidomycosis. The second patient, a man anti-HIV seropositive presented with a mass on the right lower abdomen and inguinal region. A biopsy of the mass showed the association of Hodgkins disease of the mixed cellularity type and paracoccidioidomycosis. With the expanding AIDS epidemic we believe this report emphasizes the need to consider Paracoccidioidomycosis in HIV infected persons in countries where this mycosis is endemic. We also suggest the inclusion of Paracoccidioidomycosis as a potential opportunistic infection in these areas.

Staphylococcus aureus nasal colonization in HIV outpatients: Persistent or transient?

BACKGROUND Staphylococcus aureus nasal carriage in HIV patients remains incompletely characterized. The aim of the present study was to describe epidemiologic and molecular features of S. aureus nasal colonization in HIV outpatients. METHODS HIV outpatients with no history of hospitalization within the previous 2 years were screened for S aureus nasal colonization. Three samples were collected from each patient, and the risk factors for colonization were assessed. Nasal carriage was classified as persistent colonization, transient colonization, or no colonization. Persistent colonization was subdivided into simple (same DNA profile) or multiple (different DNA profiles) using pulsed-field gel electrophoresis (PFGE) for genotyping the strains of S. aureus. RESULTS A total of 111 patients were evaluated, of which 70 (63.1%) had at least 1 positive culture for S aureus. Patients in clinical stages of AIDS were more likely to be colonized than non-AIDS patients (P = .02). Among the patients with S aureus nasal carriage, 25.2% were transient carriers and 39.4% were persistent carriers. PFGE analysis showed that the persistent colonization was simple in 24 patients and multiple in 17 patients. CONCLUSION The HIV patients had a high rate of S. aureus nasal colonization. The most common characteristic of colonization was simple persistent colonization showing the same genomic profile.

Prevalence and risk factors for hepatitis C virus (HCV) infection among pregnant Brazilian women

Objectives: To determine the prevalence and the risk factors associated with HCV infection among women at childbirth, and to assess potential for infectivity of anti‐HCV‐positive women. Methods: A total of 6995 women were interviewed and screened for HCV antibodies. Association and logistic regression analyses were conducted. Results: The anti‐HCV prevalence was 1.5% by EIA‐3 and 0.8% by RIBA‐3; HCV‐RNA (RT‐PCR) was detected in 74% of the RIBA‐positive samples. Blood transfusion, race (blacks), alcohol abuse, a history of STD and anti‐HBc positivity were independent risk factors for HCV positivity. Except for parenteral exposure, independent predictors of anti‐HCV were a history of STD, anti‐HBc positivity, a sex partner with multiple sex partners and a sex partner with a history of hepatitis. Conclusions: The prevalence of anti‐HCV is higher in pregnant women than in blood donors. Sexual exposure may facilitate the spread of HCV and there is a high potential for mother‐to‐infant transmission.

Evolução fatal da co-infecção doença de Chagas/Aids: dificuldades diagnósticas entre a reagudização da miocardite e a miocardiopatia chagásica crônica

Chagas disease is a type of parasitosis caused by the protozoan Trypanosoma cruzi, and it is transmitted by triatomine insects. This disease is found between the southern United States to Argentina and approximately 14 million people in Latin America are believed to be infected, predominantly with the chronic form of the disease. Reactivation of Chagas disease can occur among immunosuppressed patients, as has been observed among AIDS patients. In one such case, we observed cardiac decompensation with severe ventricular dysfunction and arrhythmias. This case was thought to be reactivation of Chagas disease in the myocardium, since the xenodiagnosis was positive. Specific treatment for Trypanosoma cruzi was administered, consisting of benznidazole, but the course of treatment was not completed because the patient died due to cardiopathic complications. The necropsy showed the usual stigmas of chronic Chagas cardiopathy, such as fibrosing myocarditis and a decreased number of neurons in the digestive system. There were no amastigote forms of Trypanosoma cruzi in any of the tissue samples studied. Therefore, reactivation of Chagas disease was not demonstrated but, rather, the natural evolution of chronic Chagas cardiopathy was demonstrated.

Hepatites pós-transfusionais na cidade de Campinas, SP, Brasil: II. Presença dos anticorpos anti-HBc e anti-HCV em candidatos a doadores de sangue e ocorrência de hepatites pós-transfusionais pelo vírus C nos receptores de sangue ou derivados

We have analysed anti-HBc and anti-HCV antibodies in serum samples from 799 donors which had their blood or derivates transfused to 111 recipients. Anti-HBc and anti-HCV were reactive in respectively 9 and 2.1% of the donors tested. We have observed that among the 111 recipients, 44 had received at least one positive anti-HBc unit and 67 had been transfused only with negative anti-HBc, units. The risk of developing hepatitis C virus was 4.5 times higher for the recipients who received at least one positive anti-HBc unit. If the test for anti-HBc had been made for the blood donors in the serological screening, about 56% of the HCV cases in the recipients could have been avoided. The population of recipients who received at least one reacting unit of anti-HCV, presented a risk 29 times higher of developing this hepatitis, as compared to the transfused recipients with all anti-HCV negative units. Testing blood from donors for anti-HCV would avoid 79% of the post-transfusional HCV cases. Brazilian candidates to blood donors seem to be carriers either simultaneously or sequentially to hepatitis virus B and C, since 44.4% of the positive anti-HCV were also positive for anti-HBc. Testing for anti-HBc and anti-HCV in blood screening must be indicated in order to prevent post-transfusional hepatitis transmission in our community.

Polirradiculoneurite e malária: relato de um caso

Case report of a patient who three weeks after a Plasmodium falciparum malaria presented the Guillain-Barre syndrome. There was a severe type of polyradiculoneuritis with tetraplegia and involvement of several cranial nerves (VI, VII, IX, X) evolving to death. The Guillain-Barre syndrome has been considered a immune disorder with several eliciting antigenic stimuli. The case suggests that protozoan may be one these antigenic factors.Case report of a patient who three weeks after a Plasmodium falciparum malaria presented the Guillain-Barré syndrome. There was a severe type of polyradiculoneuritis with tetraplegia and involvement of several cranial nerves (VI, VII, IX, X) evolving to death. The Guillain-Barré syndrome has been considered a immune disorder with several eliciting antigenic stimuli. The case suggests that protozoan may be one these antigenic factors.

Randomized, double-blind trial comparing indinavir alone, zidovudine alone and indinavir plus zidovudine in antiretroviral therapy-naive hiv-infected individuals with CD4 cell counts between 50 and 250/mm3

Treatment with indinavir has been shown to result in marked decreases in viral load and increases in CD4 cell counts in HIV-infected individuals. A randomized double-blind study to evaluate the efficacy of indinavir alone (800 mg q8h), zidovidine alone (200 mg q8h) or the combination was performed to evaluate progression to AIDS. 996 antiretroviral therapy-naive patients with CD4 cell counts of 50-250/mm3 were allocated to treatment. During the trial the protocol was amended to add lamivudine to the zidovudine-containing arms. The primary endpoint was time to development of an AIDS-defining illness or death. The study was terminated after a protocol-defined interim analysis demonstrated highly significant reductions in progression to a clinical event in the indinavir-containing arms, compared to the zidovudine arm (p<0. 0001). Over a median follow-up of 52 weeks (up to 99 weeks), percent reductions in hazards for the indinavir plus zidovudine and indinavir groups compared to the zidovudine group were 70% and 61%, respectively. Significant reductions in HIV RNA and increases in CD4 cell counts were also seen in the indinavir-containing groups compared to the zidovudine group. Improvement in both CD4 cell count and HIV RNA were associated with reduced risk of disease progression. All three regimens were generally well tolerated.

Listeriosis and AIDS: case report and literature review

Listeriosis is a not uncommon infection in humans, usually associated with immunodeficient states and with newborns. However, relatively few cases have been reported in HIV-infected patients. This scarcity of reported cases has aroused interest in the association of listeriosis and AIDS. In this paper we present a case of meningitis and septicemia caused by Listeria monocytogenes in a female patient with AIDS. A review of recent medical literature indicates that association of listeriosis and AIDS may be more common than it seems. Recent research in host-parasite interaction in listerial infection suggests an important role for tumor necrosis factor (TNF) and for integralin, a bacterial protein, in modulating listerial disease in AIDS patients. Inadequate diagnosis may be in part responsible for the scarcity of reports.