Carcinomatose meníngea como manifestação inicial de um adenocarcinoma de vesícula biliar com tumor de Krukenberg

Descreve-se um caso de neoplasia maligna cuja manifestação inicial foi distúrbio de comportamento e quadro de irritação meníngea, simulando uma meningite subaguda ou crônica. Na investigação clínica foram detectados o comprometimento de pares cranianos e a presença de massa tumoral pélvica. Houve piora progressiva, com evolução para o óbito em duas semanas. No exame post-mortem foram diagnosticados adenocarcinoma de vesícula biliar com componente mucinoso, carcinomatose meníngea e metástase ovariana sob a forma de um tumor de Krukenberg. Os autores mostram a importância da inclusão da carcinomatose meníngea no diagnóstico diferencial de quadros neurológicos incaracterísticos, e a necessidade de exames citológicos do liquor, às vezes repetidos, para a confirmação desta hipótese diagnóstica.A case of malignant neoplasm is described in which the initial manifestations were mental dysfunction and meningeal irritation, mimicking chronic or subacute meningitis. Physical examination showed cranial nerve involvement and a pelvic tumor. There was progressive deterioration, and death occurred in 2 weeks. The autopsy revealed a gallbladder adenocarcinoma, meningeal carcinomatosis, and ovarian metastasis presenting as a Krukenberg tumor. The authors emphasize the importance of including meningeal carcinomatosis as a possibility in the differential diagnosis of non-characteristic clinical pictures, as well as the importance of the cerebrospinal fluid cytologic examination, repeated as needed, in order to confirm this diagnosis

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Estudo clínico-epidemiológico da infecção pelo parvovírus humano B19 em pacientes infectados pelo HIV acompanhados no serviço de doenças infecciosas e parasitárias do Hospital Universitário Antônio Pedro - Niterói, RJ, no período de 2001 a 2008

O parvovírus humano B19 (B19V) está relacionado a diferentes quadros clínicos, dentre eles a anemia crônica em pacientes infectados pelo vírus da imunodeficiência humana (HIV). Objetivos: Determinar a soroprevalência de anticorpos IgG anti-B19V; estabelecer a frequência da soroconversão para o B19V; identificar a ocorrência de anemia prolongada nos pacientes que apresentaram soroconversão. Métodos: Foram estudados pacientes adultos, infectados pelo HIV, com amostras sanguíneas coletadas entre novembro/2001 e outubro/2008 e estocadas na soroteca do Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Antônio Pedro, Niterói, RJ, para a detecção de anticorpos IgG e IgM específicos por ensaio imunoenzimático. A avaliação clínica foi feita pela revisão de prontuários médicos. Resultados: Anticorpos IgG anti-B19V foram detectados em 164/261 pacientes (62,9%-IC-95%:56,7-68,7%). A soroprevalência não foi influenciada pelo sexo, idade, escolaridade, município de residência, linfócitos CD4+ e CD8+ , relação CD4+ /CD8+ , concentração e hemoglobina e ano de coleta da amostra sanguínea. A chance dos pacientes com carga viral do HIV<10.000 cópias/mL serem soropositivos para o B19V foi igual a 2,2 vezes a dos pacientes com carga viral ≥10.000 cópias/mL [RC: 2,21 (IC95%:1,15-4,24)]. A soroconversão foi constatada em 28 (31,8%) dos 88 pacientes; em três foi detectada a presença de IgM anti-B19V. A soroconversão foi mais frequente nas amostras coletadas em 2005 (9/28–32,1%) e 2006 (6/28–21,4%) e não variou com o sexo, idade, nível educacional, município de residência, classificação clínica do HIV, linfócitos CD4+ e CD8+ e carga viral do HIV. A chance dos pacientes que apresentaram soroconversão serem anêmicos foi igual a 5,4 vezes a dos pacientes que não apresentaram soroconversão [RC:5,40 (IC-95%:1,33-22,93)]. Em uma paciente ocorreu hidropisia e óbito fetal por toxoplasmose congênita consequente à reativação assintomática da infecção materna. A anemia prolongada foi observada em 8/28 pacientes que apresentaram soroconversão e em um deles foi relacionada exclusivamente à infecção pelo B19V. Em 20 pacientes não havia dados clínicos e laboratoriais que pudessem identificar a ocorrência de anemia prolongada. Conclusões: A prevalência de anticorpos IgG anti-B19V foi influenciada apenas pela carga viral do HIV, sendo mais elevada nos pacientes com carga viral do HIV<10.000 cópias/mL. Dos 88 (31,8%) pacientes suscetíveis ao B19V, 31,8% adquiriram a infecção, principalmente durante os períodos epidêmicos. A soroconversão para o B19V não foi influenciada pelas variáveis estudadas e estava fortemente associada à anemia na última amostra negativa para IgG anti-B19V. Anemia prolongada ocorreu em pelo menos 28,6% dos pacientes que apresentaram soroconversão. A presença de anemia prolongada, especialmente durante epidemias de B19V, deve alertar o médico para a possibilidade de infecção pelo B19V. Na era da terapia antirretroviral altamente potente, e consequente reconstituição imune, a infecção pelo B19V pode cursar com anemia prolongada de menor gravidadeHuman parvovirus B19 (B19V) gives rise to many different clinical manifestations, including chronic anemia in Human Immunodeficiency Virus (HIV)-infected patients. Objectives: to establish the seroprevalence of IgG antibodies to B19V; to find the seroconversion frequency to B19V; and to identify the occurrence of chronic anemia in patients who seroconverted to B19V. Methods: Adult HIV-infected patients with at least one blood sample stored were studied at Infectious Diseases Department, Hospital Universitário Antônio Pedro, Niterói, RJ, in order to detect IgG and IgM antibodies to B19V by enzyme-linked immunosorbent assay. Medical records were reviewed for clinical evaluation. Results: serum samples were collected between November 2001-October 2008. B19V antibodies were detected in 164 patients (62.9%, 95%-CI: 56.7-68.7%). Seroprevalence was not influenced by gender, age, educational level, municipality of residence, CD4+ and CD8+ lymphocytes, CD4+ /CD8+ ratios, hemoglobin level and year of collection of the serum samples. Patients with HIV load <10,000 opies/mL were 2.2 times more likely to be seropositive to B19V than those with viral load ≥10,000 copies/mL [OR: 2.21 (95%-CI: 1.15-4.24)]. Seroconversion was detected in 28/88 patients (31.8%); in three cases IgM anti-B19V was found; Seroconversion was more frequent in serum samples collected in 2005 (9/28, 32.1%) and 2006 (6/28, 21.4%). Seroconversion was not influenced by gender, age, educational level, municipality of residence, HIV clinical classification, CD4+ and CD8+ lymphocytes and HIV viral load. Patients who seroconverted were 5.40 times more likely to have anemia than those who did not [OR: 5.40 (95%-CI: 1.33-22.93)]. Congenital toxoplasmosis leading to hydrops fetalis and fetal death was diagnosed in one case and attributed to the asymptomatic reactivation of maternal infection. Chronic anemia was observed in 8/28 patients who seroconverted; in one of them no other cause than B19V infection was found. In 20 patients there were no clinical and laboratorial data with which to support the occurrence of chronic anemia. Conclusions: The seroprevalence IgG anti-B19V was influenced only by HIV viral load, with higher values in patients with HIV load <10,000 copies/mL. In this study 88 (31.8%) patients were susceptible to B19V infection and 31.8% of them ultimately acquired the infection, often during B19V epidemic periods. Seroconversion to B19V was not influenced by the variables studied, but was associated with anemia in the last IgG-B19V-negative serum sample. Chronic anemia occurred in at least 28.6% patients who seroconverted. The presence of chronic anemia should, especially during B19V epidemics, alert physicians to the possibility of B19V infection. In the highly active antiretroviral therapy era, and with the consequent trend to immune reconstitution, B19V infection may course with less severe chronic anemia.179f

Congenital toxoplasmosis transmitted by human immunodeficiency-virus infected women

We report the occurrence of congenital toxoplasmosis in three infants born to HIV infected women who had high anti-toxoplasma IgG and negative IgM during pregnancy. We briefly reviewed available literature and discussed the possible transmission mechanisms of congenital toxoplasmosis among HIV infected pregnant women. Serum samples were tested for Toxoplasma gondii IgM and IgG antibodies using commercial enzyme immunoassay and IgG-avidity tests. In the first case, fetal death occurred at 28th week of gestation. In the second case, congenital toxoplasmosis was diagnosis at 6th month of life; and in the third case, an HIV-infected newborn, congenital toxoplasmosis was asymptomatic. These cases point out to the possibility of enhanced maternal-fetal transmission of T. gondii infection by HIV-infected women chronically infected, which may have important public health consequences, considering that increasing frequency of HIV-infection has been observed among women of childbearing age around the world

Seroepidemiological study of human parvovirus B19 among human immunodeficiency virus-infected patients in a medium-sized city in Rio de Janeiro, Brazil

Parvovirus B19 (B-19) may cause chronic anaemia in immunosuppressed patients, including those infected with human immunodeficiency virus (HIV). We studied single serum samples from 261 consecutive HIV-infected patients using an enzyme immunoassay to detect IgG antibodies to B-19. The seroprevalence of B-19-IgG was 62.8%. The differences in seroprevalence across gender, age, educational categories, year of collection of the serum samples, clinical and antiretroviral therapy characteristics, CD4+ count, CD4+ and CD8+ percentage and CD4+/CD8+ ratios were neither substantial nor statistically significant. There was a non-significant, inverse association between B-19 seropositivity and plasma HIV load and haemoglobin level. Our results indicated that 37.1% of patients might be susceptible to B-19 infection and remained at risk for being infected, mainly during epidemic periods. As B-19 infection can be treated with immune globulin preparations, it may be included in the diagnostic approach toward chronic anaemia in HIV-infected patients

Clinical features and laboratory findings of human parvovirus B19 in human immunodeficiency virus-infected patients

Immunocompromised patients may develop severe chronic anaemia when infected by human parvovirus B19 (B19V). However, this is not the case in human immunodeficiency virus (HIV)-infected patients with good adherence to highly active antiretroviral treatment (HAART). In this study, we investigated the clinical evolution of five HIV-infected patients receiving HAART who had B19V infections confirmed by serum polymerase chain reaction. Four of the patients were infected with genotype 1a strains and the remaining patient was infected with a genotype 3b strain. Anaemia was detected in three of the patients, but all patients recovered without requiring immunoglobulin and/or blood transfusions. In all cases, the attending physicians did not suspect the B19V infections. There was no apparent relationship between the infecting genotype and the clinical course. In the HAART era, B19V infections in HIV-positive patients may be limited, subtle or unapparent

Parvovirus B19 seroconversion in a cohort of human immunodeficiency virus-infected patients

Erythrovirus B19 (B19V) infection may cause red cell aplasia in patients infected with human immunodeficiency virus (HIV). The introduction of highly active antiretroviral therapy (HAART) has improved the immune function of these patients by modifying the course of B19V infection. The purpose of this study was to estimate the frequency of B19 seroconversion in a cohort of HIV-infected patients and evaluate the occurrence of B19V-related anaemia during the seroconversion period. Adult HIV-infected patients were studied at a public hospital in Niterói, state of Rio de Janeiro, Brazil. IgG and IgM antibodies against B19V were detected by an enzyme-linked immunosorbent assay and B19 viraemia was assayed by polymerase chain reaction. Medical records were reviewed for any clinical evaluation of anaemia. Seroconversion was detected in 31.8% of the 88 individuals who began the study as anti-B19V IgG-negative. No clinical manifestations of B19V infection were detected during the period of seroconversion. Patients who seroconverted were 5.40 times more likely to have anaemia than those who did not [odds ratio 5.40 (95% confidence interval: 1.33-22.93)]. Anaemia was detected in eight patients. All patients recovered from anaemia by either beginning or continuing HAART, without requiring blood transfusions. In the HAART era, B19V infection may only be associated with a course of disease characterised by less severe chronic anaemia. This milder course of B19V-associated disease is likely due to the increased immune function of HAART-treated patients

Molecular diversity of human parvovirus B19 during two outbreaks of erythema infectiosum in Brazil

Submitted by Sandra Infurna ([email protected]) on 2018-02-22T11:01:41Z No. of bitstreams: 1 david_brown_etal_IOC_2017.pdf: 989914 bytes, checksum: 05d63f4ff76c56a0be9d7df76a1b9b67 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2018-02-22T11:18:50Z (GMT) No. of bitstreams: 1 david_brown_etal_IOC_2017.pdf: 989914 bytes, checksum: 05d63f4ff76c56a0be9d7df76a1b9b67 (MD5)Made available in DSpace on 2018-02-22T11:18:50Z (GMT). No. of bitstreams: 1 david_brown_etal_IOC_2017.pdf: 989914 bytes, checksum: 05d63f4ff76c56a0be9d7df76a1b9b67 (MD5) Previous issue date: 2017Universidade Federal Fluminense. Instituto Biomédico. Departamento de Microbiologia e Parasitologia. Niterói, RJ, Brasil.Universidade Federal Fluminense. Instituto Biomédico. Departamento de Microbiologia e Parasitologia. Niterói, RJ, Brasil / Universidade Federal Fluminense. Faculdade de Medicina. Programa de Pós Graduação em Ciências Médicas. Niterói, RJ, Brasil.Universidade Federal Fluminense. Faculdade de Medicina. Disciplina de Doenças Infecciosas e Parasitárias. Niterói, RJ, Brasil.Universidade Federal Fluminense. Instituto Biomédico. Departamento de Microbiologia e Parasitologia. Niterói, RJ, Brasil.Universidade Federal Fluminense. Instituto Biomédico. Departamento de Microbiologia e Parasitologia. Niterói, RJ, Brasil.Universidade Federal Fluminense. Faculdade de Medicina. Disciplina de Doenças Infecciosas e Parasitárias. Niterói, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Vírus Respiratórios e Sarampo. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Vírus Respiratórios e Sarampo. Rio de Janeiro, RJ. Brasil.Universidade Federal Fluminense. Faculdade de Medicina. Programa de Pós Graduação em Ciências Médicas. Niterói, RJ, Brasil / Universidade Federal Fluminense. Faculdade de Medicina. Disciplina de Doenças Infecciosas e Parasitárias. Niterói, RJ, Brasil.This study was conducted to provide information on the genetic diversity of human parvovirus B19 (B19V) circulating in the municipality of Niterói, Rio de Janeiro, Southeast Brazil during 1996-2006, a period with two distinct outbreaks of B19V infection: 1999-2000 and 2004-2005. A total of 27 sera from patients with erythema infectiosum and five sera from HIV-infected patients that tested positive for B19V DNA during the study period were analyzed. To genotype B19V strains, a semi-nested PCR for partial amplification of the capsid gene was performed and sequence analysis revealed that 31 sequences belonged to subgenotype 1a (G1a) of the main genotype 1 and one sequence was characterized as subgenotype 3b (G3b). The phylogenetic tree supported the division of the G1a into two well-defined clades with 1.3% of divergence. The low diversity of the G1a strains may be explained by the fact that all patients had acute B19V infection and 30/32 sera were collected during two distinct outbreaks. The G3b strain was from an HIV-infected patient who seroconverted to anti-B19 IgG antibodies in September/2005. This is the first report of G3b in the state of Rio de Janeiro