BACKGROUND AND PURPOSE:Although microcephaly is the most prominent feature of congenital Zika syndrome, a spectrum with less severe cases is starting to be recognized. Our aim was to review neuroimaging of infants to detect cases without microcephaly and compare them with those with microcephaly.

IMPORTANCE Hydrocephalus is a treatable but potentially fatal complication that has not been previously described in congenital Zika syndrome (CZS).OBJECTIVE To describe the clinical features and imaging findings in 24 patients with congenital Zika syndrome (CZS) who developed hydrocephalus. DESIGN, SETTING, AND PARTICIPANTSThis case series included patients with hydrocephalus who were born in October and November 2015 and followed up until mid-2017 in the 2 largest national referral centers for CZS in Brazil. The participants included consecutively enrolled children with a clinical and laboratorial diagnosis of CZS who developed clinical and/or image findings suggestive of hydrocephalus and who were confirmed to experience increased intracranial hypertension during ventriculoperitoneal shunt procedures. MAIN OUTCOMES AND MEASURESTo retrospectively describe clinical and image findings in these 24 patients. RESULTS This multicenter cohort included 308 patients with CZS; 24 consecutive children were enrolled in this study. These children were aged between 3 to 18 months, and 13 of 24 (54%) were female. All patients presented with at least 1 positive test result for anti-Zika antibodies in cerebrospinal fluid or serum and had classic signs of CZS. At the time of hydrocephalus diagnosis, only 14 of 24 patients (58%) had symptoms and signs suggestive of hydrocephalus (mainly worsening seizures, vomiting, irritability, and/or sudden increase of head circumference percentile). Two of 24 patients (8%) had no symptoms suggestive of hydrocephalus but were found to have reduced brain volume on repeated imaging. Cerebellar or brainstem hypoplasia on baseline imaging were found in 18 of 23 patients (78%). At the second computed tomographic scan, all patients showed a marked increase of ventricular volume, compatible with communicating hydrocephalus, and reduction of brain tissue that was visibly worse than on baseline imaging for the 23 patients with repeated scans. CONCLUSIONS AND RELEVANCEWe present evidence that hydrocephalus is a complication of CZS in at least a proportion of patients. The clinical spectrum of this condition continues to evolve, but given that presenting signs and symptoms of hydrocephalus can be challenging to recognize in CZS, we provisionally recommend that high suspicion and appropriate monitoring for hydrocephalus should be part of the standard care of patients with CZS.

From January 1st up to September 30th 1990, 77 patients with leptospirosis confirmed by laboratory studies were admitted at the Infectious and Parasitic Diseases Service of the Hospital das Clínicas of the Universidade Federal de Pernambuco. Clinical manifestations had sudden onset with presence of fever, headache, chills and muscle pains. Plurisystemic involvement was observed both in the icteric and in the non-icteric patients. The neurological exam was abnormal in 70 of the patients (90.91%). Neurological findings were essentially variable. Though in a transitory form, they allowed the observation of the following clinical forms: meningoencephalitis and polyneuritis in association, meningoencephalitis, polyneuritis, and subarachnoid hemorrhage.

RESUMO -Foram estudados 50 pacientes com AIDS. Todos estes pacientes apresentavam anticorpos anti-HIV1 (ELISA) e preenchiam os critérios de pontuação OPAS/Caracas de definição de casos de AIDS em adultos. A análise do liquido cefalorraqueano (LCR) incluiu: pressão; citologia (número de células e aspectos citomorfológicos); proteína total e eletroforese; concentrações de glicose, cloretos e testes imunológicos para sífilis, toxoplasmose e infecções virais (citomegalovírus, varicela-zoster, Herpes simplex, e HI VI). Investigações bacteriológicas e micológicas (pesquisa direta e cultura), além de teste de aglutinação (látex) para Cryptococcus foram também realizados. Os testes imunológicos usados foram fixação do complemento, imunofluorescência indireta, hemaglutinação passiva e/ou ELISA. Todos os LCR foram analisados no mesmo laboratório seguindo sempre a mesma metodologia. O LCR esteve alterado em 45 pacientes (90,0%) dos 50 pacientes estudados. As principais alterações encontradas no LCR foram: aumento de gamaglobulina em 25 casos (55,5%); aumento da proteína total em 23 (51,1%); hipercitose em 22 (48,9%) e diminuição dos cloretos em 18(40,0%). A detecção de anticorpos anti-HIV1 estiveram presentes em 42 pacientes (93,3%). Toxoplasmose isolada ou associada a outros agentes foi a infecção oportunista mais freqüente, detectada em 26 casos (57,7%). O LCR deverá ser sempre analisado em todos os pacientes com AIDS, com ou sem sintomas neurológicos. PALAVRAS-CHAVE: AIDS (SIDA), líquido cefalorraqueano, infecções oportunisticas.Cerebrospinal fluid in 50 AIDS patients ABSTRACT -Fifty AIDS patients were studied. AH patients had anti-HIV antibodies (ELISA) present and met OPAS/ Caracas punctuation criteria for AIDS cases in adults. Cerebrospinal fluid (CSF) analysis included pressure, cytology (number and cytomorphological aspects), total protein and electrophoresis, glucose and chloride concentration. Bacteriological and mycological investigations were performed as well as agglutination tests for Cryptococcus. Complement fixation, indirect immunoflorescence, passive hemagglutination and/or ELISA tests were performed for syphilis, toxoplasmosis, viral and fungal infections. AH CSF analysis were made in the same laboratory following the same methodology. CSF was alterated in 45 cases (90.0%) of the 50 patients studied. The most important alterations observed were: gammaglobulin (55.5%) and total protein (51.1%) increase, hypercytosis (48.9%) and decrease of chloride concentration (40.0%). HIV antibodies were detected in 42 patients (93.3%). Toxomoplamosis, isolated or associated to other agents, was the most frequent opportunistic infection (57.7%). Cerebrospinal fluid should always be examined in AIDS patients with or without neurological symptoms.

RESUMO -Entre 1-janeiro e 30-setembro-1990 foram estudados 77 pacientes com diagnóstico de leptospirose, admitidos no S D l P / U F P E . O exame neurológico foi anormal em 70 (90,91%) dos pacientes. O exame do LCR, realizado em 67 (87%) dos pacientes, foi anormal em 64 (95,52), tendo como achado mais freqüente a pleocitose. Não houve diferença significativa no comportamento do LCR nas diversas formas clínicas neurológicas observadas, nem quando comparadas as formas ictéricas com as não ictéricas. Bastante significativos foram os resultados da reação de microaglutinação para leptospirose no LCR.PALAVRAS-CHAVE: leptospirose, sistema nervoso, líquido cefalorraqueano, reação de microaglutinação. Involvement of the nervous system in leptospirosis: II Cerebrospinal fluid examination.SUMMARY -From January 1st up to September 30th 1990, 77 patients with leptospirosis diagnosis confirmed by laboratory studies were admitted at the Infectious and Parasitic Disease Service of the Hospital das Clínicas of the Universidade Federal de Pernambuco. The neurological exam was abnormal in 70 of the patients (90.91%). The cerebrospinal fluid (CSF) examination was carried out on 67 (87%) of the patients; it was abnormal in 64 (95.52%) yielding hypercytosis in the majority of cases. There was no difference in the CSF behavior in report to the several neurological forms nor in relation to the icteric or non-icteric forms of the disease. Significant were the results for the microscopic agglutination tests for leptospirosis in the CSF.

From January 1st up to September 30th 1990, 77 patients with leptospirosis were admitted at the Infectious and Parasitic Diseases Service of the Hospital das Clínicas of the Universidade Federal de Pernambuco. The majority (64) were male patients, and average age was 28 years old. Serovars icterohaemorrhagic and canicola were the most frequent. CSF examination was performed in 67 (87.0%) patients and it was abnormal in 64 (95.52%). Micro-agglutination test for leptospirosis with live antigens was performed in CSF, as well as immunological tests for syphilis, cysticercosis and schistosomiasis for differential diagnosis. Concerning the serovar identification, results of microagglutination test for leptospirosis in CSF were significant considering the similitude of responses when compared to those found for blood samples.

RESUMO -Os autores realizaram 200 punções cervicais laterais em pacientes comatosos sem agitação psicomotora, comprovando ser este novo método uma alternativa da punção sub-¬ occipital, tendo sido bem sucedidos em 90% dos casos. Os acidentes hemorrágicos ocorridos foram do tipo venoso e de pequena intensidade, não causando quaisquer efeitos colaterais aos pacientes, nem alterações na realização do exame do LCR. Picada da artéria vertebral não foi observada. Punções em cadáveres demonstraram que essa artéria dista um centímetro anteriormente ao trajeto da agulha para a realização da punção.Cervical lateral punction as a new method for cerebrospinal fluid collection: the city of Recife and its metropolitan area experience.

RESUMO -Embora não esteja definitivamente comprovada que a severidade da malária esteja associada com o vírus da imunodeficiência humana (HIV), sabe-se que a infecção pelo Plasmodium falciparum pode favorecer uma rápida evolução da infecção pelo HIV. Além disso a associação da malária com HIV/AIDS, do ponto de vista clínico, pode ser extremamente grave face a ocorrência de outros microorganismos e/ou neoplasias, o que piora a evolução e prognóstico dos pacientes. A concomitância do vírus HIV com o Plasmodium em zonas endêmicas de malária, é uma possibilidade que deve ser sempre pensada, visto que a sua transmissão está relacionada a fatores de risco ligados aos comportamentos das pessoas, que nem sempre são logo revelados e/ou identificados. Os autores descrevem um caso de malária cerebral porPlasmodium vivaxe Plasmodiumfalciparum em um paciente com AIDS. Descrevem sua evolução clínica e terapêutica. PALAVRAS-CHAVE: malária cerebral, AIDS (SIDA).Cerebral malaria and AIDS: case report ABSTRACT -Although it has not been definitely proven that the severity of malaria is associated to human immunodeficiency virus (HIV) we know that infection through Plasmodium falciparum can favor a rapid evolution of the HIV infection. Besides, association of malaria with HIV/AIDS from a clinical point of view can be clinically severe in the face of the occurrence of other microorganisms or neoplasias, which worsens the evolution and prognosis of the affected patients. The concurrence of HIV with Plasmodium in malaria endemic zones is a possibility which should always be taken into consideration, since transmission is related to risk factors caused by people's behavior which are not always promptly revealed and/or identified. The authors report one case of brain malaria infection by Plasmodium vivax and Plasmodium falciparum in a patient with AIDS. They describe the clinical evolution and therapy.KEY WORDS: cerebral malaria, AIDS.A malária é doença infecciosa febril, de evolução potencialmente grave, causada por protozoários do gênero Plasmodium. O homem pode ser infectado por quatro espécies