Puerperal brain cryptococcoma in an HIV-negative woman successfully treated with fluconazole: a case report

Cryptococcus spp. cerebral abscesses are uncommon in immunocompetent subjects. The recommended induction treatment is the administration of amphotericin B plus flucytosine combined with resection for lesions ≥3cm. In this paper, we describe an HIV-negative woman diagnosed with a large cryptococcoma in the immediate postpartum period. The lesion was not resected, and due to amphotericin B intolerance, she received an extended course of fluconazole monotherapy. There was no disease recurrence during the 4 years of follow-up. The abrupt onset of her symptoms following delivery suggests that she developed a postpartum immune reconstitution syndrome. This case also demonstrates that in specific situations fluconazole monotherapy can be attempted in immunocompetent patients with cryptococcoma

Puerperal brain cryptococcoma in an HIV-negative woman

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2014-06-04T18:57:23Z No. of bitstreams: 1 Hagan JE Puerperal brain....pdf: 1140839 bytes, checksum: 3c06df73ae5d23f154cfd27b464cbab1 (MD5)Made available in DSpace on 2014-06-04T18:57:23Z (GMT). No. of bitstreams: 1 Hagan JE Puerperal brain....pdf: 1140839 bytes, checksum: 3c06df73ae5d23f154cfd27b464cbab1 (MD5) Previous issue date: 2014Yale School of Public Health. Department of Epidemiology of Microbial Diseases. New Haven, CT, USA / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilHospital Couto Maia. Secretaria de Saúde do Estado da Bahia. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilHospital Couto Maia. Secretaria de Saúde do Estado da Bahia. Salvador, BA, BrasilYale School of Public Health. Department of Epidemiology of Microbial Diseases. New Haven, CT, USA / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, BrasilCryptococcus spp. cerebral abscesses are uncommon in immunocompetent subjects. The recommended induction treatment is the administration of amphotericin B plus fl ucytosine combined with resection for lesions ≥3cm. In this paper, we describe an HIV-negative woman diagnosed with a large cryptococcoma in the immediate postpartum period. The lesion was not resected, and due to amphotericin B intolerance, she received an extended course of fl uconazole monotherapy. There was no disease recurrence during the 4 years of follow-up. The abrupt onset of her symptoms following delivery suggests that she developed a postpartum immune reconstitution syndrome. This case also demonstrates that in specifi c situations fl uconazole monotherapy can be attempted in immunocompetent patients with cryptococcom

Surveillance for leptospirosis in the Americas, 1996–2005: a review of data from ministries of health

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2012-11-14T17:23:28Z No. of bitstreams: 1 Costa Surveillance for leptospirosis....pdf: 165902 bytes, checksum: 969fe376f7967f63bb740b06ff945c4f (MD5)Made available in DSpace on 2012-11-14T17:23:28Z (GMT). No. of bitstreams: 1 Costa Surveillance for leptospirosis....pdf: 165902 bytes, checksum: 969fe376f7967f63bb740b06ff945c4f (MD5) Previous issue date: 2012Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilYale University. School of Public Health. New Haven, Connecticut, United States of AmericaWorld Health Organization. Royal Tropical Institute. Amsterdam, HolandaFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilYale University. School of Public Health. New Haven, Connecticut, United States of AmericaTo characterize current leptospirosis reporting practices in the Americas.Methods. Information was collected from the official websites of national ministries ofhealth from the Americas region and two international organizations; personal communications;and three international morbidity databases. For all sources other than the morbiditydatabases, the review was limited to official reports citing clinically suspected and laboratoryconfirmed leptospirosis cases or deaths during the period 1996–2005.Results. A total of 73 out of 1 644 reports met the selection criteria and were included inthe analysis. Published leptospirosis data were available from half of the countries/sovereignterritories (24 out of 48), and 18 of them had mandatory notification policies for leptospirosis.The sum of the median number of leptospirosis cases notified annually by the 24 countries/territories was 4 713.5, but just three countries (Brazil, Costa Rica, and Cuba) accounted for83.1% (3 920 cases) of the notifications. Eight (16.7%) countries reported deaths due to leptospirosis.The sum of the median number of deaths reported annually for the eight countrieswas 380, but 349 (91.8%) were reported by Brazil.Conclusions. Notification practices in the Americas for leptospirosis are limited. Therefore,the numbers of cases and deaths reported are not representative for the region. The lack ofleptospirosis data for many countries/territories may reflect weaknesses in certain aspects ofnational surveillance systems, including mandatory reporting policies, clinical laboratory infrastructurefor performing case confirmation, and capacity to collect reported cases. Improvedsurveillance of leptospirosis cases and deaths in the Americas is needed to allow monitoring ofregional epidemiological patterns and to estimate the burden of this important disease.(AU

Knowledge, attitudes, and practices related to Leptospirosis among urban slum residents in Brazil

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2014-03-28T18:07:28Z No. of bitstreams: 1 Navegantes AW, Knowledge, atitudes, and pratices....pdf: 469736 bytes, checksum: 6a3c3d1fbf68162baf4150cee7c160dd (MD5)Made available in DSpace on 2014-03-28T18:07:28Z (GMT). No. of bitstreams: 1 Navegantes AW, Knowledge, atitudes, and pratices....pdf: 469736 bytes, checksum: 6a3c3d1fbf68162baf4150cee7c160dd (MD5) Previous issue date: 2012Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilUniversidade Federal da Bahia. Institute of Collective Health. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilYale School of Public Health. New HavenFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilYale School of Public Health. New HavenFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilLeptospirosis disproportionately affects residents of urban slums. To understand the knowledge, attitudes, and practices regarding leptospirosis, we conducted a cross-sectional study among residents of an urban slum community in Salvador, Brazil. Of the 257 residents who were interviewed, 225 (90%) were aware of leptospirosis and more than two-thirds of respondents correctly identified the modes of disease transmission and ways to reduce exposure. However, study participants who performed risk activities such as cleaning open sewers had limited access to protective clothing such as boots (33%) or gloves (35%). Almost all respondents performed at least one activity to prevent household rat infestation, which often included use of an illegal poison. Our findings support the need for interventions targeted at the individual and household levels to reduce risk of leptospirosis until large-scale structural interventions are available to residents of urban slum communities

Cytokine response signatures in disease progression and development of severe clinical outcomes for leptospirosis.

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2014-04-01T16:45:51Z No. of bitstreams: 1 Reis AGE Cytokine....pdf: 443031 bytes, checksum: dc7eb85a412ebaeae7d6d200b4683e1e (MD5)Made available in DSpace on 2014-04-01T16:45:51Z (GMT). No. of bitstreams: 1 Reis AGE Cytokine....pdf: 443031 bytes, checksum: dc7eb85a412ebaeae7d6d200b4683e1e (MD5) Previous issue date: 2013Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Laboratório de Patologia e Biologia Molecular. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Laboratório de Patologia e Biologia Molecular. Salvador, BA, Brasil / Yale School of Public Health. Department of Epidemiology of Microbial Diseases. New Haven, Connecticut, USA.Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Laboratório de Patologia e Biologia Molecular. Salvador, BA, Brasil / Federal University of Bahia. Institute of Collective Health. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisa René Rachou. Belo Horizonte, MG, BrasilFundação Oswaldo Cruz. Centro de Pesquisa René Rachou. Belo Horizonte, MG, BrasilYale University School of Medicine. Yale University. Yale Department of Internal Medicine. New Haven, Connecticut, USAYale University School of Medicine. Yale University. Yale Department of Internal Medicine. New Haven, Connecticut, USAFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Laboratório de Patologia e Biologia Molecular. Salvador, BA, Brasil / Yale School of Public Health. Department of Epidemiology of Microbial Diseases. New Haven, Connecticut, USA.Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Laboratório de Patologia e Biologia Molecular. Salvador, BA, Brasil / Yale School of Public Health. Department of Epidemiology of Microbial Diseases. New Haven, Connecticut, USA.BACKGROUND: The role of the immune response in influencing leptospirosis clinical outcomes is not yet well understood. We hypothesized that acute-phase serum cytokine responses may play a role in disease progression, risk for death, and severe pulmonary hemorrhage syndrome (SPHS). METHODOLOGY/PRINCIPAL FINDINGS: We performed a case-control study design to compare cytokine profiles in patients with mild and severe forms of leptospirosis. Among patients hospitalized with severe disease, we compared those with fatal and nonfatal outcomes. During active outpatient and hospital-based surveillance we prospectively enrolled 172 patients, 23 with mild disease (outpatient) and 149 with severe leptospirosis (hospitalized). Circulating concentrations of pro- and anti-inflammatory cytokines at the time of patient presentation were measured using a multiplex bead array assay. Concentrations of IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, IL-17A, and TNF-α were significantly higher (P<0.05) in severe disease compared to mild disease. Among severe patients, levels of IL-6 (P<0.001), IL-8 (P = 0.0049) and IL-10 (P<0.001), were higher in fatal compared to non-fatal cases. High levels of IL-6 and IL-10 were independently associated (P<0.05) with case fatality after adjustment for age and days of symptoms. IL-6 levels were higher (P = 0.0519) among fatal cases who developed SPHS than among who did not. CONCLUSION/SIGNIFICANCE: This study shows that severe cases of leptospirosis are differentiated from mild disease by a "cytokine storm" process, and that IL-6 and IL-10 may play an immunopathogenic role in the development of life-threatening outcomes in human leptospirosis

Oxidative stress markers correlate with renal dysfunction and thrombocytopenia in severe leptospirosis.

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2015-05-25T13:30:31Z No. of bitstreams: 1 Araujo AM Oxidative....pdf: 667444 bytes, checksum: 941fcf775da07a43ac3cfbcb9695cfdc (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2015-05-25T13:54:00Z (GMT) No. of bitstreams: 1 Araujo AM Oxidative....pdf: 667444 bytes, checksum: 941fcf775da07a43ac3cfbcb9695cfdc (MD5)Made available in DSpace on 2015-05-25T13:54:00Z (GMT). No. of bitstreams: 1 Araujo AM Oxidative....pdf: 667444 bytes, checksum: 941fcf775da07a43ac3cfbcb9695cfdc (MD5) Previous issue date: 2014Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Laboratório de Patologia e Biologia Molecular. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Laboratório de Patologia e Biologia Molecular. Salvador, BA, BrasilUniversidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, BrasilFederal University of Bahia. Institute of Collective Health. Salvador, BA, BrasilYale University. New Haven. CT / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Laboratório de Patologia e Biologia Molecular. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Laboratório de Patologia e Biologia Molecular. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Laboratório de Patologia e Biologia Molecular. Salvador, BA, BrasilYale University. New Haven. CT / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Laboratório de Patologia e Biologia Molecular. Salvador, BA, BrasilLeptospirosis is a zoonotic disease that causes severe manifestations such as Weil's disease and pulmonary hemorrhage syndrome. The aim of this study was to evaluate whether reactive oxygen species (ROS) production and antioxidant reduced glutathione (GSH) levels are related to complications in patients hospitalized with leptospirosis. The ROS production and GSH levels were measured in blood samples of 12 patients and nine healthy controls using chemiluminescence and absorbance assays. We found that ROS production was higher and GSH levels were lower in leptospirosis patients compared with healthy individuals. Among patients, GSH depletion was correlated with thrombocytopenia and elevated serum creatinine, whereas a strong positive correlation was observed between ROS production and elevated serum potassium. Additional investigation of the biological significance of ROS production and GSH levels is warranted as they may guide the development of novel adjuvant therapies for leptospirosis targeting oxidative stres

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Widespread diversity deficits of coral reef sharks and rays

A global survey of coral reefs reveals that overfishing is driving resident shark species toward extinction, causing diversity deficits in reef elasmobranch (shark and ray) assemblages. Our species-level analysis revealed global declines of 60 to 73% for five common resident reef shark species and that individual shark species were not detected at 34 to 47% of surveyed reefs. As reefs become more shark-depleted, rays begin to dominate assemblages. Shark-dominated assemblages persist in wealthy nations with strong governance and in highly protected areas, whereas poverty, weak governance, and a lack of shark management are associated with depauperate assemblages mainly composed of rays. Without action to address these diversity deficits, loss of ecological function and ecosystem services will increasingly affect human communities