Lemierre’s Syndrome: an atypical co-infection by Staphylococcus aureus and Mycobacterium tuberculosis

Lemierre’s syndrome (LS) stands as a rare and life-threatening condition. It is secondary to an acute oropharyngeal infection, leading to thrombosis of the internal jugular vein (IJV) and subsequent dissemination to other organs through metastatic septic emboli, predominantly affecting the lungs. While anaerobic bacterium such as Fusobacterium necrophorum typically prevail as etiological agents for this syndrome, the presented case illustrates an uncommon occurence of Lemierre’s Syndrome incited by a co-infection of Staphylococcus aureus and Mycobacterium tuberculosis in a 17-year old immunocompetent female. This highlights the importance of identifying alternative etiological agents capable of provoking this severe condition in order to provide tailored and timely therapeutic measures

Hematoma hepático volumoso em paciente com Dengue: nova complicação de uma velha doença

Introdução: Em 2022, a dengue apresentou uma taxa de incidência de 667 casos por 100 mil habitantes, chegando a cerca de quase 1,5 milhão de casos no Brasil, mostrando portanto sua grande prevalência. Manifestações não usuais têm sido descritas progressivamente, demonstrando o caráter heterogêneo desta patologia. Neste estudo, é descrito o relato inédito de uma complicação atípica de dengue, a degeneração hemorrágica de possível adenoma hepático prévio associado ainda a derrame pleural. Objetivos: Realizar descrição clínica de complicação incomum e rara de degeneração hemorrágica de grande volume de possível adenoma hepático em um paciente com dengue avaliado em um Centro Hospitalar Terciário. Metodologia: Trata-se de um relato de caso com delineamento descritivo e observacional, sem grupo controle e com caráter narrativo. Relato de caso e discussão: Paciente sexo feminino, 36 anos, branca, ex-tabagista e hipertensa, iniciou há 10 dias da admissão, febre e exantema pruriginoso, evoluindo com dor em hipocôndrio direito e sintomas constitucionais. À admissão, apresentava-se hipotensa com descompressão brusca positiva em abdome e petéquias generalizadas. Exames iniciais demonstraram anemia, plaquetopenia, elevação de enzimas canaliculares e hepáticas e em tomografia computadorizada (TC) de abdome, hematoma subcapsular em lobo hepático direito de 510 cm³. À avaliação da equipe cirúrgica, houve a hipótese de adenoma hepático com degeneração hemorrágica, com proposta conservadora. A paciente evoluiu com piora clínica e queda de nível hematimétrico, com nova TC com aumento do hematoma - 1200 cm³, sendo realizado transfusão de hemoderivados. Após 2 dias, apresentou piora laboratorial, dessaturação com necessidade de intubação orotraqueal e hipotensão com necessidade de droga vasoativa, sendo encaminhada à UTI. Apresentou Hemoculturas com Haemophilus influenzae e sorologia para dengue reagente (Anti-Dengue IgM). Ademais, viu-se em nova TC alterações pulmonares com presença de derrame pleural bilateral, consolidações permeadas por opacidades "vidro fosco" e aumento do hematoma - 1300 cm³. Levantaram-se as hipóteses de Síndrome Respiratória Aguda Grave, lesão pulmonar aguda relacionada à transfusão e sobrecarga circulatória pós-transfusional. Após medidas de suporte, evoluiu com boa resposta. Após alguns dias, paciente cursou com nova piora sendo evidenciado piora do derrame pleural (exsudato) com necessidade de drenagem. A paciente recebeu alta no 47° dia de internação. Em TC realizada pós alta, houve redução hematoma (180 cm³) e raio-X de tórax sem alterações. Conclusão: A dengue tem apresentando manifestações atípicas. Relatou-se um caso de uma complicação até então não encontrada na literatura, com desfecho favorável, a fim de aprimorar o conhecimento científico, de melhorar a assistência médica e de nortear futuros estudos e tratamentos

Zika Brazilian Cohorts (ZBC) Consortium: Protocol for an Individual Participant Data Meta-Analysis of Congenital Zika Syndrome after Maternal Exposure during Pregnancy.

Despite great advances in our knowledge of the consequences of Zika virus to human health, many questions remain unanswered, and results are often inconsistent. The small sample size of individual studies has limited inference about the spectrum of congenital Zika manifestations and the prognosis of affected children. The Brazilian Zika Cohorts Consortium addresses these limitations by bringing together and harmonizing epidemiological data from a series of prospective cohort studies of pregnant women with rash and of children with microcephaly and/or other manifestations of congenital Zika. The objective is to estimate the absolute risk of congenital Zika manifestations and to characterize the full spectrum and natural history of the manifestations of congenital Zika in children with and without microcephaly. This protocol describes the assembly of the Consortium and protocol for the Individual Participant Data Meta-analyses (IPD Meta-analyses). The findings will address knowledge gaps and inform public policies related to Zika virus. The large harmonized dataset and joint analyses will facilitate more precise estimates of the absolute risk of congenital Zika manifestations among Zika virus-infected pregnancies and more complete descriptions of its full spectrum, including rare manifestations. It will enable sensitivity analyses using different definitions of exposure and outcomes, and the investigation of the sources of heterogeneity between studies and regions

Low sensitivity of the tourniquet test for differential diagnosis of dengue: an analysis of 28,000 trials in patients

Abstract Background The aim of this study was to evaluate the utility of the tourniquet test (TT) for dengue diagnosing. To our knowledge, no previous study with such a large sample, of this duration, with as many laboratory methods referenced, or relating the results of the TT to the 2009 WHO classification of severity has been conducted thus far. Methods In this study, we analyzed the records of 119,589 suspected dengue cases in a Brazilian city, with 30,670 confirmed cases. The Cohen’s Kappa test was applied to evaluate the degree of agreement between the tests, and the sensitivity and specificity was calculated for the TT. Results Twenty-eight thousand six hundred thirty-five TT were performed. No association between the outcome of the TT and greater severity of infection, according to the 2009 guideline, was observed (P = 0.28); furthermore, relevant agreement with the final diagnosis (κ = 0.01; 95 % CI = 0.00 to 0.02) or individually with the IgM enzyme-linked immunoassay was not observed (κ = 0.05; 95 % CI = 0.04 to 0.06), and was even lower with PCR (κ = 0.27; 95 % CI = 0.06 to 0.49). Most importance of the TT was shown in relation to specificity (88.9 %; 95 % CI = 0.88 to 0.89) and negative predictive value (70.3 %; CI 95 % = 0.70 to 0.71). Conclusions TT was more effective in detecting cases that were truly negative than positive. These results suggest that the TT should not be used as diagnosis of dengue

Digestive forms of Chagas disease and carcinogenesis: a study of association

The authors analyze the relation between gastrointestinal carcinogenesis and Chagas disease, based on detailed review of the literature. To this end, epidemiological, experimental and human material pathology description studies have been selected. The article discusses the possibility of protection being afforded by not fully known morphokinetic cellular, immune and neuroendocrine factors that would be secondary to plexus degeneration. Also aspects related to the parasite-host interaction from the viewpoint of epithelial modulation of colonic mucosa and its antitumor implications are presented. Finally, it exposes the pathophysiological mechanism of esophageal cancer development in patients with mega-organ. In conclusion, chagasic colopathy, especially the intrinsic neuronal damage, is a study model that can contribute to the understanding of colorectal carcinogenesis.Os autores analisam a relação entre carcinogênese gastrintestinal e doença de Chagas, com base em revisão pormenorizada da literatura. Para tal, foram selecionados estudos epidemiológicos, experimentais e de descrição anatomopatológica com material humano. O artigo discute a possibilidade de a proteção ser conferida por fatores celulares morfocinéticos, imunológicos e neuroendócrinos não totalmente conhecidos e que seriam secundários à degeneração plexular. Também são apresentados aspectos relacionados à interação parasito-hospedeiro, sob o ponto de vista da modulação epitelial da mucosa colônica, e suas implicações antitumorais. Por fim, expõe-se o mecanismo fisiopatológico de desenvolvimento da neoplasia de esôfago em pacientes com megaesôfago. Conclui-se que a colopatia chagásica, especialmente o dano neuronal intrínseco, constitui modelo de estudo que pode contribuir no entendimento da carcinogênese colorretal

Mayaro fever in an HIV-infected patient suspected of having Chikungunya fever

Abstract Arboviruses impose a serious threat to public health services. We report a case of a patient returning from a work trip to the Amazon basin with myalgia, arthralgia, fever, and headache. During this travel, the patient visited riverside communities. Both dengue and Chikungunya fevers were first suspected, tested for, and excluded. Mayaro fever was then confirmed by reverse transcription polymerase chain reaction followed by next-generation sequencing and phylogenetic reconstruction. The increased awareness of physicians and consequent detection of Mayaro virus in this case was only possible due a previous surveillance program with specific health personnel training about these neglected arboviruses

Mayaro fever in an HIV-infected patient suspected of having Chikungunya fever

Abstract Arboviruses impose a serious threat to public health services. We report a case of a patient returning from a work trip to the Amazon basin with myalgia, arthralgia, fever, and headache. During this travel, the patient visited riverside communities. Both dengue and Chikungunya fevers were first suspected, tested for, and excluded. Mayaro fever was then confirmed by reverse transcription polymerase chain reaction followed by next-generation sequencing and phylogenetic reconstruction. The increased awareness of physicians and consequent detection of Mayaro virus in this case was only possible due a previous surveillance program with specific health personnel training about these neglected arboviruses

Fungal Colitis by Paracoccidioides brasiliensis: a case report

Paracoccidioidomycosis (PBM) is an infection caused by a dimorphic fungus called Paracoccidioides brasiliensis. It occurs in Latin America, with incidence of 1 to 3 per 100,000 inhabitants in endemic areas. The digestive tract is usually not affected, but when it occurs, it may lead to events similar to colorectal neoplasm and inflammatory bowel disease (IBD). This is a case report of a 68-year-old female patient, with diarrhea without blood or mucus for 6 months, weight loss of 8 kg over the period. Abdominal ultrasonography showed some mass in the right colon, suggestive of cancer and liver perihilar lymph node. Colonoscopy showed lesions suggestive of Crohn's disease. Biopsy showed chronic granulomatous colitis of fungal etiology: Paracoccidioidomycosis. The patient did not tolerate oral treatment with itraconazole and subsequently sulfadiazine, requiring hospital admission for the treatment with amphotericin B. The presence of Paracoccidioidomycosis in the digestive tract may be associated with bloody diarrhea, mucus, rectal hemorrhage, abdominal pain, malabsorption syndrome. Histopathological studies show the fungus and a chronic inflammatory infiltrate and granulation tissue. The differential diagnoses are tuberculosis, colorectal cancer and inflammatory bowel disease. The treatment is oral antifungal (itraconazole, sulfadiazine) or intravenous (amphotericin B) based. The case has caused diagnostic confusion between colon cancer (clinical and US) and Crohn's disease (colonoscopy).<br>Paracoccidioidomicose (PBM) é uma infecção causada por um fungo dimórfico: Paracoccidioides brasiliensis. Ocorre na América Latina, com incidência de 1 a 3 por 100.000 habitantes em áreas endêmicas. O acometimento do trato digestivo é infrequente, sendo que pode levar a manifestações semelhantes à neoplasia colorretal e doença inflamatória intestinal (DII). Relatamos o caso da paciente feminina, 68 anos, com diarreia sem sangue ou muco há seis meses, com perda ponderal de 8 kg no período. Ultrassom abdominal evidenciou massa em cólon direito sugestiva de neoplasia e linfonodomegalia peri-hilar hepática. A colonoscopia evidenciou lesões sugestivas de doença de Crohn. A biopsia mostrou colite crônica granulomatosa de etiologia fúngica: Paracoccidioidomicose. A paciente não tolerou tratamento oral com itraconazol e, posteriormente, sulfadiazina. Necessitou de internação para tratamento com anfotericina B. O acometimento da PBM no trato digestivo pode cursar com diarreia muco-sanguinolenta, retorragia, dor abdominal e síndrome de má absorção. O estudo histopatológico mostra o fungo e um infiltrado inflamatório crônico com tecido de granulação. Os diagnósticos diferenciais são tuberculose, câncer colorretal e doença inflamatória intestinal. O tratamento é feito com antifúngicos orais (itraconazol, sulfadiazina) ou endovenosos (anfotericina B). O caso levou à confusão diagnóstica entre câncer de cólon (US e quadro clínico) e doença de Crohn (colonoscopia)