Resumo: FUNDAMENTOS -Ainda é de grande importância a hanseníase como problema de Saúde Pública no Brasil, devido a sua alta endemicidade. OBJETIVO -Determinar as principais características dessa enfermidade na cidade de Recife no ano de 2002. MÉTODOS -Realizou-se estudo observacional retrospectivo, mediante o preenchimento de um questionário específico, analisando-se 100 prontuários de pacientes assistidos em centro de referência do Recife em 2002. Elaborou-se um banco de dados, e a análise foi feita utilizando-se o software EPI-Info-6. Obtiveram-se as freqüências simples das variáveis, e realizou-se análise bivariada, estudando-se as diferenças entre as proporções por meio do qui-quadrado. O ponto de corte foi p<0,05. RESULTADOS -Observou-se aumento da freqüência dos casos de hanseníase com a idade (7% dos casos ocorreram em crianças e adolescentes, e 11% em maiores de 65 anos) (p<0,001). A distribuição por sexo mostrou diferença significativa (masculino 57%, feminino 43%) (p<0,001). A forma tuberculóide possui a maior prevalência, com 42% dos casos (p<0,001) e maior incidência no sexo feminino, enquanto no sexo masculino prevaleceu a dimorfa (x 2 =18,83; p<0,001). As formas paucibacilares (tuberculóide e indeterminada) apresentaram lesão única ou variação de duas a cinco lesões em 55,4% e 37,5% dos casos, respectivamente (x 2 =37,04; p<0,001). CONCLUSÕES -Foi possível constatar que a cidade ainda é uma região endêmica devido à grande incidência da forma tuberculóide no meio, indicador epidemiológico sugestivo de tendência crescente da endemia na região. Só o diagnóstico e o tratamento precoce dos casos poderão quebrar a cadeia de transmissão da doença. Palavras-chave: Hanseníase; Mycobacterium leprae; epidemiologia. Summary: BACKGROUND -As a problem of Public Health in INTRODUÇÃOA hanseníase é doença infectocontagiosa crônica e curável causada pelo bacilo de Hansen, que apresenta alta infectividade, mas baixa patogenicidade, sendo seu poder imunogênico responsável pelo alto potencial incapacitante da doença. 1 Segundo Bechelli, 2 a distribuição geográfica da hanseníase seria maior onde o padrão de vida fosse mais baixo e onde fosse mais endêmica. Em virtude de sua cronicidade e baixa letalidade, mantém ao longo dos anos a expansão endêmica em várias regiões, caracterizada pela distribuição não uniforme, o que resulta em dificuldades para o controle epidemiológico. 3,4,5 Considerada doença polimorfa, a expressão de suas manifestações clínicas reflete a relação entre o hospedeiro e o parasita. Nos indivíduos que adoecem, de acordo com a resposta imunológica específica ao bacilo, a infecção evolui de diversas maneiras. Essa resposta imune constitui um espectro que expressa as diferentes formas clínicas. 6Sua forma indeterminada é freqüentemente vista nas regiões do mundo onde a doença é endêmica ou hiperendê-mica.7 Almeida Neto 8 referia que as formas indeterminadas poderiam ser traduzidas como um estágio inicial e transitó-rio da doença, sendo encontradas em indivíduos de resposta imune não definida diante do b...
Candidemia is a frequent condition in Neonatal Intensive Care Units (NICU) and usually complicates the newborns clinical course. Several factors are responsible for candidiasis, such as prematurity and use of broad-spectrum antibiotics, and in these cases, there are the involvement of various Candida species, as C. albicans, and C. parapsilosis. However, other species as C. haemulonii has been rarely described in candidemia cases, being considered an emergent pathogen. Thus, we report a case of neonatal candidemia by C. haemulonii and a review of literature of fungemia by this yeast. The patient was a neonate with gestational age of 26 weeks and birth weight of 660 g hospitalized in a NICU from a Brazilian hospital. The identification of the etiological agent was performed by phenotypic methods, scanning electron microscopy, sequencing of the ITS region of rDNA, and mass spectrometry. Antifungal susceptibility testing was carried out according to the Clinical Laboratories and Standards Institute guidelines. The newborn was diagnosed with candidemia by C. haemulonii resistant to amphotericin B with minimal inhibitory concentration (MIC) of 8 µg/mL, sensitive to fluconazole (MIC: 8 µg/mL) and voriconazole (MIC: 0.12 µg/mL). The treatment with fluconazole (12 mg/kg/day) was established with good outcome. Candidemia by C. haemulonii is still being limited to a few sporadic cases in adults with endemic and restricted occurrences in neonates. Usually, the therapy with amphotericin B is ineffective against this species. Our results showed the importance of the mycological diagnosis associated to antifungigrama for the successful clinical management followed by important epidemiological data.
Introduction Although it is the most common agent among the fungal causes of endocarditis, Candida albicans endocarditis is rare. Objective To evaluate the efficacy of amphotericin B in the treatment of C. albicans endocarditis beyond a systematic review. Data search Articles in English, Spanish and Portuguese, conducted in the following databases: MEDLINE, LILACS, IBECS and SciELO, in humans and published in the last 25 years. Study selection Observational studies, clinical trials, and case series providing data on the amphotericin B use in patients with a C. albicans endocarditis diagnosis without age limitations. Data synthesis From the initial search (n=79), 25 articles were fully evaluated, of which 19 were excluded for meeting one or more exclusion criteria, remaining five articles (two observational studies and three case series). Patients using amphotericin B demonstrated improvement in survival rates, and its main use was in association with the surgical method as well as with caspofungin association. Conclusion Literature lacks evidence to conclude about efficacy and safety of amphotericin B in the treatment of fungal endocarditis. Randomized clinical trials are necessary to provide better evidence on the subject.
In febrile neutropenic onco-hematological patients, delayed microbiological diagnosis leads to an increase in morbidity and mortality. Identification of the microorganism changes antibiotic therapy in more than half of cases; however, in only 20-30 % of such cases pathogen isolation is achieved. This study evaluates the frequency of fungus infection and its etiology in onco-hematological patients with febrile neutropenia utilizing blood cultures and non-commercial multiplex polymerase chain reaction (MT-PCR) primers. Fifty-three febrile neutropenia episodes in 35 onco-hematological patients were observed, and the results for the first unique 30 episodes are presented. Blood cultures were positive for Candida tropicalis (one case), gram-positive bacteria (two cases), and gram-negative bacteria (four cases), showing a 23.3 % microbiological isolation rate. Multiplex-PCR pan-fungal sequence was positive in 18 cases (60 %), and further sequencing identified fugal pathogens in 11 cases (Candida glabrata and Candida parapsilosis being the most common). MT-PCR pan-fungal sequence amplification was detected in 13 of 16 patients that later received antifungal treatment for clinical reasons only, while positivity was found in 5 out of 14 patients that did not receive antifungal treatment (p = 0.02). These results show that performing in-house non-commercial MT-PCR is feasible and may provide additional information about fungal infection without the need to wait for culture results. Further research is necessary to incorporate this technology into the decision-making process.
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