Immune reconstitution inflammatory syndrome in HIV and sporotrichosis coinfection: report of two cases and review of the literature

We report 2 cases of patients with immune reconstitution inflammatory syndrome (IRIS) associated with cutaneous disseminated sporotrichosis and human immunodeficiency virus (HIV) coinfection. The patients received specific treatment for sporotrichosis. However, after 4 and 5 weeks from the beginning of antiretroviral therapy, both patients experienced clinical exacerbation of skin lesions despite increased T CD4+ cells (T cells cluster of differentiation 4 positive) count and decreased viral load. Despite this exacerbation, subsequent mycological examination after systemic corticosteroid administration did not reveal fungal growth. Accordingly, they were diagnosed with IRIS. However, the sudden withdrawal of the corticosteroids resulted in the recurrence of IRIS symptoms. No serious adverse effects could be attributed to prednisone. We recommend corticosteroid treatment for mild-to-moderate cases of IRIS in sporotrichosis and HIV coinfection with close follow-up

Identificação molecular de bartonella henselae em paciente com SIDA soronegativo para doença da arranhadura do gato no Rio de Janeiro, Brasil

Submitted by Rodrigo Senorans ([email protected]) on 2015-04-22T16:43:23Z No. of bitstreams: 1 MOLECULAR IDENTIFICATION OF Bartonella henselae IN A SERONEGATIVE CAT SCRATCH DISEASE PATIENT WITH AIDS IN RIO DE JANEIRO, BRAZIL.pdf: 336144 bytes, checksum: 32d4441f4678489c606525e767614d6a (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-04-27T16:06:18Z (GMT) No. of bitstreams: 1 MOLECULAR IDENTIFICATION OF Bartonella henselae IN A SERONEGATIVE CAT SCRATCH DISEASE PATIENT WITH AIDS IN RIO DE JANEIRO, BRAZIL.pdf: 336144 bytes, checksum: 32d4441f4678489c606525e767614d6a (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-04-29T16:41:16Z (GMT) No. of bitstreams: 1 MOLECULAR IDENTIFICATION OF Bartonella henselae IN A SERONEGATIVE CAT SCRATCH DISEASE PATIENT WITH AIDS IN RIO DE JANEIRO, BRAZIL.pdf: 336144 bytes, checksum: 32d4441f4678489c606525e767614d6a (MD5)Made available in DSpace on 2015-05-08T16:14:05Z (GMT). No. of bitstreams: 1 MOLECULAR IDENTIFICATION OF Bartonella henselae IN A SERONEGATIVE CAT SCRATCH DISEASE PATIENT WITH AIDS IN RIO DE JANEIRO, BRAZIL.pdf: 336144 bytes, checksum: 32d4441f4678489c606525e767614d6a (MD5) Previous issue date: 2014Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hantaviroses e Rickettsioses. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hantaviroses e Rickettsioses. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hantaviroses e Rickettsioses. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hantaviroses e Rickettsioses. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hantaviroses e Rickettsioses. Rio de Janeiro, RJ, BrasilBartonella henselae está associada a um amplo espectro de manifestações clínicas, incluindo a doença da arranhadura de gato, endocardite, e meningoencefalite, em pacientes imunocompetentes e imunocomprometidos. Relatamos o primeiro caso confirmado por método molecular de B. henselae em um paciente com SIDA no estado do Rio de Janeiro, Brasil. Apesar da sequência de DNA de B. henselae ser detectada pela reação em cadeia da polimerase em uma biópsia do linfonodo, soros das fases aguda e convalescente foram não reativos.Bartonella henselae is associated with a wide spectrum of clinical manifestations, including cat scratch disease, endocarditis and meningoencephalitis, in immunocompetent and immunocompromised patients. We report the first molecularly confirmed case of B. henselae infection in an AIDS patient in state of Rio de Janeiro, Brazil. Although DNA sequence of B. henselae has been detected by polymerase chain reaction in a lymph node biopsy, acute and convalescent sera were nonreactive

Acute juvenile Paracoccidioidomycosis: A 9-year cohort study in the endemic area of Rio de Janeiro, Brazil

<div><p>Background</p><p>Paracoccidioidomycosis (PCM) is a systemic mycosis caused by pathogenic dimorphic fungi of the genus <i>Paracoccidioides</i>. It is the most important systemic mycosis in Latin America and the leading cause of hospitalizations and death among them in Brazil. Acute PCM is less frequent but relevant because vulnerable young patients are affected and the severity is usually higher than that of the chronic type.</p><p>Methods</p><p>The authors performed a retrospective cohort study from 2001 to 2009 including acute juvenile PCM patients from a reference center in Rio de Janeiro, Brazil. Clinical, epidemiological, diagnostic, therapeutic, and prognostic data were reported.</p><p>Results</p><p>Twenty-nine patients were included. The average age was 23 years old and the male to female ratio was 1:1.07. All cases were referred from 3 of 9 existing health areas in the state of Rio de Janeiro, predominantly from urban areas (96.5%). Lymph nodes were the most affected organs (100%), followed by the skin and the spleen (31% each). Twenty-eight patients completed treatment (median 25 months) and progressed to clinical and serological cure; 1 death occurred. Twenty-four patients completed 48-month median follow-up. Four patients abandoned follow-up after the end of treatment. The most frequent sequela was low adrenal reserve. <i>Paracoccidioides brasiliensis</i> S1 was identified by partial sequencing of the <i>arf</i> and <i>gp43</i> genes from 4 patients who presented a viable fungal culture.</p><p>Conclusion</p><p>Acute juvenile PCM is a severe disease with a high rate of complications. There are few cohort clinical studies of acute PCM in the literature. More studies should be developed to promote improvement in patients’ healthcare.</p></div

Affected organs in acute juvenile PCM cases from this study.

<p>Affected organs in acute juvenile PCM cases from this study.</p

Therapeutic regimen prescribed for the treatment of 29 acute juvenile PCM cases from this study.

<p>AMB (amphotericin B) and SMZ/TMP (sulfamethoxazole/trimethoprim). Others: itraconazole + SMZ/TMP; AMB + SMZ/TMP; and AMB + fluconazole + SMZ/TMP.</p

Clinical specimens from which PCM was diagnosed.

<p>Clinical specimens from which PCM was diagnosed.</p

Serological and therapeutic results in 29 acute juvenile PCM patients.

<p>Serological and therapeutic results in 29 acute juvenile PCM patients.</p

Demographic, clinical, and prognostic profile in 29 acute juvenile PCM patients.

<p>Demographic, clinical, and prognostic profile in 29 acute juvenile PCM patients.</p

Lymph node and skin involvement in 2 patients from the present study.

<p>(A) Cervical lymph node enlargement with a “bull’s neck” appearance in a female patient. (B) The same patient after 35 months of amphotericin B, itraconazole, and sulfamethoxazole/trimethoprim treatment. (C) Extensive ulcerative skin lesions on the face of a male patient. (D) The same patient after 48 months of sulfamethoxazole/trimethoprim treatment. Photographs by ACFV were obtained for registration of the patients’ recovery. Both individuals agreed to have their photographs taken and published.</p