Estudo de 30 casos de histoplasmose no Estado de Mato Grosso do Sul, Brasil

Thirty cases of histoplasmosis observed at the University Hospital of the Federal University of Mato Grosso do Sul (HU-UFMS) from January 1998 to December 2005 are reported. Most (83.3%) of the patients were men, average 33.4 years old, 63.3% of them were born and living in Mato Grosso do Sul and 83.3% presented AIDS as an underlying disease. In almost all cases (96.7%) the disease occurred in its disseminated form and the most frequent clinical manifestations were: fever (83.3%), weight loss (70.0%), cough (63.3%), hepatomegaly and splenomegaly (40.0%), and lymph node enlargement (36.7%). The laboratory diagnosis was obtained in 29 patients by isolation of Histoplasma capsulatum from various clinical specimens cultivated in Sabouraud dextrose and brain heart infusion agar and in 16 patients the fungus was observed by direct microscopy of Giemsa-stained smears. The observed mortality was 40%. This is the first report in the literature of the occurrence of histoplasmosis in Mato Grosso do Sul State.Foram estudados 30 casos de histoplasmose observados no estado de Mato Grosso do Sul - HU-UFMS, no período de janeiro de 1998 a dezembro de 2005. Os pacientes eram, na maioria, homens (83,3%) jovens (média de 33,4 anos de idade), naturais e procedentes de Mato Grosso do Sul (63,3%) e tinham AIDS como principal doença subjacente (83,3%). Houve predomínio da forma disseminada (96,7%) e as manifestações clínicas mais freqüentes foram: febre (83,3%), emagrecimento (70,0%) tosse (63,3%), hepatoesplenomegalia (40,0%) e linfonodomegalia (36,7%). O diagnóstico laboratorial foi obtido por exame microscópio direto de esfregaços corados pela técnica de Giemsa, em 16 pacientes, e isolamento de H. capsulatum em cultivo nos meios de agar Sabouraud dextrose e agar infusão de cérebro e coração, de materiais diversos, em 29 pacientes. A letalidade observada foi de 40%. O trabalho apresenta, pela primeira vez na literatura, a ocorrência de histoplasmose-doença no Estado de Mato Grosso do Sul

Características clínicas e epidemiológicas de 123 casos de criptococose observados em Mato Grosso do Sul, Brasil

To identify the clinical and epidemiological profile of cryptococcosis diagnosed at the University Hospital of the Federal University of Mato Grosso do Sul, Brazil, medical records of 123 patients admitted from January 1995 to December 2005 were analyzed. One hundred and four cases (84.5%) had HIV infection, six (4.9%) had other predisposing conditions and 13 (10.6%) were immunocompetent. Male patients predominated (68.3%) and their age ranged from 19 to 69 years (mean: 35.9). Most patients (73.2%) were born and lived lifelong in the state of Mato Grosso do Sul. Involvement of the central nervous system occurred in 103 patients (83.7%) and headache and vomiting were the most frequent symptoms. In 77 cases it was possible to identify the Cryptococcus species: 69 (89.6%) C. neoformans and eight (10.4%) C. gattii. Amphotericin B was the drug of choice for treatment (106/123), followed by fluconazole in 60% of cases. The overall lethality rate was 49.6%, being 51% among the HIV infected patients and 41.2% among the non-HIV infected (p >; 0.05). Although cryptococcosis exhibited in our region a similar behavior to that described in the literature, the detection of an important rate of immunocompetent individuals and five C. gattii cryptococcosis in HIV-infected patients is noteworthy.O perfil clínico-epidemiológico de 123 casos de criptococose diagnosticados no Hospital Universitário da Universidade Federal de Mato Grosso do Sul, no período de janeiro de 1995 até dezembro de 2005, foi estudado retrospectivamente. Cento e quatro (84,9%) casos tinham associação com HIV, seis (4,9%) tinham outra condição predisponente e 13 (10,6%) eram imunocompetentes. Houve predomínio do sexo masculino (68,3%) e a idade variou de 19 a 69 anos (média de 35,9 anos). A maioria (73,2%) era natural e procedente de Mato Grosso do Sul. O envolvimento do sistema nervoso central ocorreu em 103 (83,7%) pacientes e os sintomas mais freqüentes foram cefaléia e vômitos. Em 77 casos foi possível identificar a espécie do agente, sendo 69 (89,6%) C. neoformans e oito (10,4%) C. gattii. O antifúngico mais utilizado foi anfotericina B (106/123) seguido de fluconazol em aproximadamente 60% dos casos. A taxa de letalidade foi de 49,6%, sendo 51% entre os pacientes infectados pelo HIV e 41,2% entre os não infectados pelo HIV (p >; 0,005). Apesar da criptococose observada em nossa região apresentar comportamento semelhante ao descrito na literatura, chama a atenção a importante taxa da micose em imunocompetentes e cinco casos de infecção por C. gattii em pacientes HIV-positivos

OCCUPACIONAL EXPOSURE WITH POTENTIALLY HAZARDOUS BIOLOGICAL MATERIAL AMONG WORKERS IN HOSPITAL SERVICES

Pesquisa descritiva, quantitativa, que se propôs a levantar a frequência de acidentes ocupacionais, envolvendomateriais biológicos potencialmente contaminados, que ocorreram entre os profissionais que atuam em um hospital deensino e caracterizar aqueles que acometeram a equipe de higienização e limpeza e lavanderia. Foram analisadas 238 fichasde investigações de acidentes de trabalho do Serviço de Epidemiologia do período de 2004 a 2009. Destas, 10,9% (26/239)correspondiam a acidentes ocorridos com profissionais da limpeza hospitalar, 2,5% de profissionais da lavanderia. Foipredominante o sexo feminino, faixa etária de 30-40 anos, do tipo percutâneo, destacando-se os quirodáctilos como a áreacorporal mais atingida e o líquido potencialmente contaminado foi o sangue. Três grandes pilares de assistência devem serfortalecidos: o sistema de informação para subsidiar a política institucional, a formação continuada dos profissionais quegeram resíduos perfurantes e a aquisição de materiais com dispositivos de segurança.This is a descriptive and quantitative research which aimed to study the annual frequency of workplaceaccidents that occurred among health professionals and to characterize the occurrence of work acidentes involvinghospital hygiene staff. 238 professional accidents’ reports were analyzed, from the Epidemiology Department in an UniversityHospital, from 2004-2009. From the total, 10,9% (26/238) corresponded to accidents with hygiene staff , and 2,5% with theones who worked at the laundry service. Data were gathered from the form of Surveillance System PSBio. It was observedthat there was a greater frequency of accidents, especially among the female workers, aged from 30-40 years, withpredominance of percutaneous exposure, especially the fingers as the most affected part of the body. Three pillars ofassistance should be strengthened: the information system to support the institutional policy, continuing education ofprofessionals who generate perforating residues and purchase of materials with safety devices.Investigación descriptiva, cuantitativa, que se propuso a levantar la frecuencia de accidentes ocupacionales,envolviendo materiales biológicos potencialmente contaminados, que ocurrieron entre los profesionales que actúan en unhospital de enseñanza y caracterizar aquellos acometieron el equipo de higienización y limpieza y lavandería. Fueronanalizados 238 informes de expedientes de accidentes de trabajo del Servicio de Epidemiología entre 2004-2009. De estos,10.9% (26/239) correspondían a accidentes ocurridos con profesionales de la limpieza hospitalaria, 2.5% de profesionalesde la lavandería. Fue predominante el sexo femenino, faja etaria de 30-40 años, del tipo percutáneo, destacándose losquirodáctilos como área corporal más afectada y el líquido potencialmente contaminado fue la sangre. Tres grandes pilaresde ayuda deben ser fortalecidos: el sistema de información para subsidiar la política institucional, la formación continuadade los profesionales que generan residuos perforadores y la compra de materiales con dispositivos de seguridad

Correction: Performance of rK39-based immunochromatographic rapid diagnostic test for serodiagnosis of visceral leishmaniasis using whole blood, serum and oral fluid.

[This corrects the article DOI: 10.1371/journal.pone.0230610.]

Standardization and Prevalence of the Booster Phenomenon: Evaluation Using a Two-Step Skin Test with 43 kDa Glycoprotein in Individuals from an Endemic Region of Paracoccidioidomycosis

Background We estimated the occurrence rate of the booster phenomenon by using an intradermal test with 43 kDa glycoprotein in an endemic area of paracoccidioidomycosis in the central-west region of Brazil. Methods Individuals who had a negative result on a survey performed by using an intradermal test with 43 kDa glycoprotein in an endemic area of paracoccidioidomycosis underwent a second intradermal test after 10–15 days to determine the presence or absence of the booster phenomenon. Statistical analyses were performed using the Chi-square test, Chi-square for linear trend test, Student’s t test, and binomial test; p < 0.05 was considered significant. Results For the first time, we reported the occurrence of the booster phenomenon to an intradermal reaction caused by 43 kDa glycoprotein at a rate of 5.8–8.4%, depending on the test’s cutoff point. This suggests that a cutoff point should be considered for the booster phenomenon in intradermal tests with 43 kDa glycoprotein: a difference of 6–7 mm between readings according to the first and second tests, depending on the purpose of the evaluation. Conclusion The results indicate that the prevalence of paracoccidioidal infection in endemic areas is underestimated, as the booster phenomenon has not been considered in epidemiological surveys for this infection.Health Department of the Municipality of Jaraguari (Mato Grosso do Sul, Brazil)Post-Graduation Program for Health and Development of the Central-West Region BrazilUniv Fed Mato Grosso do Sul, Fac Med, Cidade Univ S-N, BR-79070900 Campo Grande, BrazilFundacao Oswaldo Cruz, Evandro Chagas Clin Res Inst, Lab Immunol & Immunogenet, BR-21040360 Rio De Janeiro, BrazilUniv Fed Sao Paulo, Fac Med, Clin Hosp, Med Mycol Lab, BR-04023062 Sao Paulo, BrazilUniv Estadual Paulista, Fac Med Botucatu, Dept Trop Dis, Botucatu, SP, BrazilUniv Fed Sao Paulo, Fac Med, Clin Hosp, Med Mycol Lab, BR-04023062 Sao Paulo, BrazilWeb of Scienc