Chronic cavitary pneumonia by Rhodococcus equi in a highly prevalent tuberculosis country: a diagnosis challenge

Rhodococcus equi is a facultative aerobic, intracellular, non-motile, non-spore-forming, Gram-positive, weakly acid-fast coccobacillus belonging to the group of nocardioform actinomycetes. R. equi infections are rare opportunistic illnesses in patients with Acquired Immunodeficiency Syndrome (AIDS), associated with a high mortality rate. The most common clinical presentation of R. equi infections is a chronic cavitary pneumonia. Due to its acid-fastness, R. equi can be mistaken for others acid-fast organisms, as Mycobacterium tuberculosis. In turn, R. equi is also a gram-positive pleomorphic bacteria and can be mistaken for diphtheroids or Micrococcus organisms, being accidentally disregarded as oral contaminants in sputum cultures. Therefore, in Brazil, a highly prevalent tuberculosis (TB) country, pulmonary infections caused by R. equi may mimic pulmonary TB and represent a diagnostic challenge. Here, we report on a case of chronic cavitary pneumonia by R. equi in a Human Immunodeficiency Virus (HIV)-infected patient, focusing on diagnostic aspects

Mycobacterium marinum infection simulating chromomycosis: a case report

Skins infections caused by Mycobacterium marinum occur only rarely. We report one case of chronic and extensive M. marinum cutaneous infection simulating chromoblastomycosis and review the pertinent literature. A 52-year-old farmer reported a 32-year chronic skin problem on his right lower limb, resulting from contact with cacti. It consisted of skin lesion presenting with dyschromic atrophic center plate and verrucous borders with hematic crusts, extending from the knee anteriorly to the inferior third of the right leg. Mycobacterium marinum infection was detected by histopathological examination of a skin fragment, culture for mycobacteria and genetic mapping of the culture material. The patient was successfully treated with Ethambutol, Rifampicin and Trimethoprim-Sulfamethoxazole. The clinical and histopathological findings of M. marinum infection is nonspecific showing clinical polymorphism and bacilli are rarely evident on histopathological examination. Given these difficulties, it is essential to perform tissue culture in a suspicious case and it is important keep this infection in mind in patients with long-lasting indolent verrucous lesions and a history of exposure to sea water, freshwater, aquaria or fish

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Late acute pulmonary embolism after mild Coronavirus Disease 2019 (COVID-19): a case series

In late 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged as the cause of a cluster of pneumonia cases in China, and the corresponding disease was designated as Coronavirus Disease 2019 (COVID-19), spreading quickly around the world resulting in a pandemic. COVID-19 is associated with a set of coagulation abnormalities that increase the risk of thromboembolic events, especially in patients with severe/critical disease. We describe a series of five cases of mild COVID-19, treated in an outpatient clinic, which, after an apparent clinical improvement, developed acute pulmonary embolism (APE) between the third and the fourth week after the onset of symptoms, when they are mostly related to acute illness disappearance. Thromboembolic events are also a potential complication of mild COVID-19 and can manifest later in the disease course. This finding raises discussion about the prevention of thromboembolic events in selected group of patients with mild COVID-19

Chronic cavitary pneumonia by Rhodococcus equi in a highly prevalent tuberculosis country: a diagnosis challenge

ABSTRACT Rhodococcus equi is a facultative aerobic, intracellular, non-motile, non-spore-forming, Gram-positive, weakly acid-fast coccobacillus belonging to the group of nocardioform actinomycetes. R. equi infections are rare opportunistic illnesses in patients with Acquired Immunodeficiency Syndrome (AIDS), associated with a high mortality rate. The most common clinical presentation of R. equi infections is a chronic cavitary pneumonia. Due to its acid-fastness, R. equi can be mistaken for others acid-fast organisms, as Mycobacterium tuberculosis. In turn, R. equi is also a gram-positive pleomorphic bacteria and can be mistaken for diphtheroids or Micrococcus organisms, being accidentally disregarded as oral contaminants in sputum cultures. Therefore, in Brazil, a highly prevalent tuberculosis (TB) country, pulmonary infections caused by R. equi may mimic pulmonary TB and represent a diagnostic challenge. Here, we report on a case of chronic cavitary pneumonia by R. equi in a Human Immunodeficiency Virus (HIV)-infected patient, focusing on diagnostic aspects

Fatal pulmonary sporotrichosis caused by Sporothrix brasiliensis in Northeast Brazil.

BACKGROUND:A relevant case of pulmonary sporotrichosis due to Sporothrix brasiliensis is reported in a 50-year-old immunocompetent woman who had no history of skin trauma, but was in close contact with several stray cats at her nap time. The patient was hospitalized after 7 months of illness. The survey was conducted for pulmonary tuberculosis, an endemic disease in Brazil. She presented multiple central pulmonary nodules images, with central cavitation. METHODOLOGY/PRINCIPAL FINDINGS:The patient bronchoalveolar lavage was cultured and Sporothrix sp. growth was obtained. Then, the isolate (LMMM1097) was accurately identified to the species level by using species-specific polymerase chain reaction (PCR). Molecular diagnosis revealed that the emerging species Sporothrix brasiliensis was the agent of primary pulmonary sporotrichosis and the patient was treated with Amphotericin B lipid complex, but presented severe clinical symptoms and the fatal outcome was observed at day 25 after hospitalization. CONCLUSIONS/SIGNIFICANCE:Our report adds important contributions to the clinical-epidemiological features of sporotrichosis, showing the geographic expansion of the agent within different regions of Brazil and a rare clinical manifestation (primary pulmonary sporotrichosis) caused by the emerging agent S. brasiliensis in an immunocompetent female patient

IMUNIDADE CONTRA O VÍRUS DA HEPATITE A ENTRE GAYS E OUTROS HOMENS QUE FAZEM SEXO COM HOMENS USUÁRIOS DE PROFILAXIA PRÉ-EXPOSIÇÃO AO HIV

Introdução/Objetivo: A hepatite A é uma doença infectocontagiosa causada pelo vírus da hepatite A (HAV), que é transmitido mormente via fecal-oral, incluindo sexo oral-anal. Entre usuários de profilaxia pré-exposição ao HIV (PrEP HIV) no Brasil, dos quais 83% são gays e HSH, recomenda-se avaliar a susceptibilidade ao HAV por sorologia para fins de prevenção. Este estudo teve por objetivo avaliar a prevalência de anticorpos Anti-HAV IgG/total entre gays e HSH em uso de PrEP HIV e caracterizar suas práticas sexuais. Métodos: Estudo transversal, realizado entre agosto/2021 e junho/2023, envolvendo gays e HSH ≥ 18 anos, usuários de PrEP HIV, atendidos no principal Serviço de Atendimento Especializado (SAE) do Rio Grande do Norte. Através de um instrumento de coleta padronizado, coletaram-se dados do prontuário sobre aspectos socioeconômicos, práticas sexuais e o resultado da sorologia Anti-HAV IgG/total. O tamanho amostral foi calculado em 185 participantes, com base em prevalência prévia de 62,3% de Anti-HAV IgG/total entre HSH, limite de confiança de ± 7%, erro tipo-α = 5% e erro tipo-β = 20%. Os resultados foram apresentados em proporções e seus intervalos de confiança de 95%. O estudo foi aprovado no comitê de ética sob CAAE n° 31650520.0.2005.5292. Resultados: Participaram do estudo 287 usuários (49,5% daqueles atualmente atendidos no SAE). A mediana de idade foi de 31 anos [IQ = 27-36). Declararam-se negros em 53,7% [43,9-62,7%] e brancos em 45,3% [39,7-50,9%]. Em sua maioria, eram solteiros (82,6% [78,4-86,8%]), residentes em Natal (76,7% [71,8-81,5%]) e homens cis (98,6% [97,2-100%]), tinham > 11 anos de estudo (87,8% [84,0-91,6%]) e renda ≤ 3 salários mínimos (59,9% [54,0-65,5%]). Na inclusão do estudo 64,5% [54,0-75,3%] já usavam PrEP HIV há, pelo menos, 6 meses. Em 62,4% [56,4-68,4%] dos participantes, os anticorpos Anti-HAV IgG/total foram reagentes. Sexo anal desprotegido foi relatado por 83,9% [79,0-88,0%] dos usuários. Em algum momento da vida, frequentar sauna foi relatado por 39,0% [33,1-45,3%], usar sex toys com parcerias em 22,3% [17,4-27,9%] e praticar fisting em 19,9% [15,3-25,1%] dos usuários. Práticas de fingering e sexo oral-anal em algum momento da vida foram relatados por 59,9% [54,0-65,2%] e 92,7% [89,2-95,5%], respectivamente. Conclusão: A prevalência de imunidade contra o HAV entre a população de gays e HSH em uso de PrEP HIV está abaixo dos níveis estimados (> 70%) necessários para impedir transmissão viral sustentada e futuros surtos