A case of human rabies in the Urban Area of Ribeirão Preto, SP, Brazil

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A case of human rabies in the Urban Area of Ribeirão Preto, SP, Brazil

A 39-year old male patient was admitted to the University Hospital of the Faculty of Medicine of Ribeirão Preto with signs and symptoms of sudden dyspnea, generalized myalgia and behavioral disorders. The initial suspicion was alcohol abstinence syndrome and the patient was referred for psychiatric and neurologic care. The evolution of the patient with a worsening of signs and symptoms, presence of crises of tachypnea, agitation, difficulty to swallow, irritability and hydrophobia, and his report of having been bitten by a suspected dog raised the hypothesis of rabies. The diagnosis was confirmed by examination of a corneal impression, biological tests in the cerebrospinal fluid (CSF) and saliva and visualization of Negri bodies in nervous tissue (direct immunofluorescence). The patient evolved with agitation, aggressiveness, and worsening tachypnea intercalating with apnea, and died on the 4th day after admissio

Clinical and microbiological implications of invasive pneumococcal disease in hospitalized patients (1998–2013)

Introduction: Infections caused by Streptococcus pneumoniae (pneumococcus) still represent a challenge for health systems around the world. Objective: The objective of this study was to assess microbiological and clinical aspects in hospitalized patients with invasive pneumococcus disease between 1998 and 2013. Materials and methods: This was a retrospective study that analyzed the results of pneumococcus identification, serotyping, and susceptibility testing found in the Adolfo Lutz Institute databank. Personal variables, medical history and clinical outcome of patients admitted with invasive pneumococcal disease were analyzed. These were obtained from records of a public teaching hospital – Hospital das Clínicas Faculdade de Medicina Ribeirão Preto. Results: The sample comprised 332 patients. Patient age ranged from less than one month to 89 years old (mean 20.3 years) and the sample was predominately male. Pneumonia (67.8%) was the most common disease, accounting for 18.2% of deaths. Serotypes 14, 1, 3, 9V, 6B, 6A, 23F, 19A, 18C, 19F, 12F, and 4 were the most common (75.3%). Most patients, or 67.5%, were cured without any complication (success), 6.9% had some type of sequela (failure), and 25.6% died (failure). In the case of deaths due to meningitis, strains of fully penicillin resistant pneumococcus were isolated. Furthermore, 68.2% of patients who died presented some type of comorbidity. The 60 and older age group presented the most significant association (Odds Ratio = 4.2), with outcome failure regardless of the presence of comorbidity. Serotype 18C was the most significant risk factor both in raw analysis (Odds Ratio = 3.8) and when adjusted for comorbidity (Odds Ratio = 5.0) or age (Odds Ratio = 5.4). The same occurred with serotype 12F (respectively, Odds Ratio = 5.1, Odds Ratio = 5.0, and Odds Ratio = 4.7) Conclusion: The present findings highlight the importance of IPD among young adults and older adults. In the era of conjugate vaccines, monitoring serotypes in different age groups is essential to assess the impact and adequacy of immunization. Keywords: Streptococcus pneumoniae, Serotypes, Death, Comorbidit

Epizootia de raiva na área urbana de Ribeirão Preto, SP, Brasil Rabies epizootic in the urban area of Ribeirão Preto, São Paulo, Brazil

Este estudo objetiva descrever uma epizootia de raiva iniciada em 1995 na área urbana de Ribeirão Preto e estudar os fatores que propiciaram o seu aparecimento. Foram revistos e estudados todos os casos laboratorialmente confirmados de raiva animal ocorridos a partir de janeiro de 1995. Paralelamente, foram levantadas informações relativas à cobertura vacinal e às atividades de vigilância. Em 1995, além de um caso humano, ocorreram 58 casos de raiva animal (54 cães, três gatos e um morcego). Em 1996, foram observados vinte casos (18 cães e dois gatos). A concentração de casos foi diferente conforme as áreas distritais, com maiores valores sendo observados nas regiões mais pobres da cidade. A distribuição de casos não variou conforme os meses do ano. Baixas coberturas vacinais e quase ausência de atividades de vigilância, traduzida pelo não-envio sistemático de amostras para exames laboratoriais nos anos imediatamente anteriores a 1995, foram os fatores determinantes do aparecimento da epizootia. Este evento ilustra os riscos de se negligenciar a profilaxia permanente da raiva, mesmo numa cidade com razoável estrutura dos serviços de saúde e localizada numa das áreas de maior desenvolvimento econômico do País.<br>This report describes some epidemiological aspects of a rabies epizootic that started in 1995 in the urban area of Ribeirão Preto, SP, Brazil, and discusses its main causes. All laboratory confirmed cases were described according to a set of epidemiological variables. Simultaneously, information was raised concerning rabies vaccine coverage and epidemiological surveillance activities. In addition to one human case, 58 rabid animals were confirmed in 1995 (54 dogs, 3 cats. and 1 bat). There were 20 cases in 1996 (18 dogs and 2 cats). Geographical distribution was uneven in the city, with higher concentrations observed in the Western, Northern, and Southwestern sections, corresponding to the poorest areas. No seasonal variation was observed. The main reasons for the epizootic were low rabies vaccine coverage in animals and severe failures in epidemiological surveillance activities in the years immediately prior to 1995. This epizootic illustrates the risk of neglecting such activities, even in a city with a reasonably good health system, located in one of the most economically developed areas of the country. Vigorous preventive measures markedly reduced the number of cases