Mulheres em situação de prostituição e covid-19: por que excluídas dos grupos vulneráveis?

This study analyzed the exposure of women engaged in prostitution in downtown São Paulo to COVID-19. This cross-sectional study had a convenience sample selected in May 2021. We interviewed 219, mostly black, middle-aged, poor women with comorbidities. Among them, 61 had shown COVID-19 symptoms, 23, tested positive for the disease, seven underwent hospitalization, and four reported post-COVID-19 complications. Only 26 (30.2%) had been vaccinated. In addition to gender, race, and class inequalities, these women suffer both from a higher risk of contracting COVID-19 due to their working conditions and from the subsequent worsening of that disease due to age and lack of vaccination.Esta pesquisa analisou a exposição de mulheres em situação de prostituição no centro de São Paulo à covid-19. Este estudo transversal contou com amostra de conveniência selecionada em maio de 2021. Entrevistou-se 219 mulheres majoritariamente negras, de meia idade, pobres e com comorbidades. Dentre essas mulheres, 61 tiveram sintomas de covid-19, 23 com teste positivo,7 foram internadas e 4 relataram complicações pós-covid-19. Somente 26 (30,2%) haviam sido vacinadas. Além das desigualdades de gênero, raça e classe, essas mulheres são expostas a um maior risco de contraírem covid-19, devido às condições de trabalho e por apresentarem doença grave relacionada à idade e falta de vacinação

In vitro antibacterial activity of bioactive glass S53P4 on multiresistant pathogens causing osteomyelitis and prosthetic joint infection

Abstract Background Conventional local treatment for medullary osteomyelitis (OM) includes insertion of antibiotic-loaded polymethylmethacrylate (PMMA) cement. Nevertheless, PMMA may delivery irregular concentration of antibiotic to surrounding tissue. We aimed to compare the in vitro antibacterial activity of Bioactive Glass (BAG) S53P4, which is a compound showing local antibacterial activity, to that of antibiotic-loaded PMMA against multidrug resistant bacteria from OM isolates. Methods We studied convenience samples of multidrug resistant (MDR) microorganisms obtained from patients presenting OM and prosthetic joint infection (PJI). Mixtures containing tryptic soy broth (TSB) and inert glass beads (2 mm), BAG-S53P4 granules (0.5–0.8 mm and < 45 mm) and Gentamicin or Vancomycin-loaded PMMA beads were inoculated with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MR-CoNS), Pseudomonas aeruginosa or Klebsiella pneumoniae isolates. Glass beads (2.0 mm) were used as a control. Antibacterial activity was evaluated by means of time-kill curve, through seeding the strains on blood agar plates, and subsequently performing colony counts after 24, 48, 72, 96, 120 and 168 h of incubation. Differences between groups were evaluated by means of two-way analysis of variance (ANOVA) and Bonferroni’s t test. Results Inhibition of bacterial growth started soon after 48 h of incubation, reached zero CFU/ml between 120 and 168 h of incubation for both antibiotic-loaded PMMA and BAG S53P4 groups, in comparison with inert glass (p < 0.05). No difference regarding time-kill curves between antibiotic-loaded PMMA and BAG S53P4 was observed. Conclusions BAG S53P4 presented antibacterial properties as much as antibiotic-loaded PMMA for MDR bacteria producing OM and PJI

COINFECÇÃO MPOX/HIV-1 EM PACIENTE GRAVEMENTE IMUNOSSUPRIMIDO: UMA EVOLUÇÃO CATASTRÓFICA

A Monkeypox (MPOX) é uma doença causada pelo vírus monkeypox (MPXV), endêmico desde 1970 na África Central e Ocidental, com poucos surtos relatados fora desse continente. Em maio de 2022 observou-se um aumento no número de casos da doença mundialmente, com maior prevalência em homens que fazem sexo com homens (HSH) e com transmissão através de contato direto, incluindo exposição sexual. Nesse contexto, evidenciou-se a associação da MPOX com infecções sexualmente transmissíveis, tal como a infecção pelo HIV. Relatamos o caso de um homem de 26 anos, HSH, com febre alta, mialgia e cefaleia iniciados em julho de 2022, evoluindo após 1 semana com erupção de pápulas umbilicadas dolorosas em nuca e punho, com progressão para membros superiores e região anal e surgimento de vesículas e pústulas disseminadas. O paciente foi atendido no Instituto de Infectologia Emílio Ribas, em São Paulo, cidade brasileira com maior número de casos confirmados da MPOX, tendo procurado atenção médica devido à dor perianal intensa, com lesões pleomórficas. Diagnosticado com MPOX por técnica de reação em cadeia da polimerase das lesões. Apresentava infecção prévia pelo HIV-1, em uso irregular de terapia antirretroviral (TARV), com contagem de LT-CD4+ de 4 células/µL e carga viral de HIV-1 de 1.428.516 cópias/mL. Após um mês apresentou piora das lesões, complicadas com proctite, celulite perianal, necrose de área glútea e edema peniano com obstrução uretral. Observou-se evolução desfavorável, com surgimento de novas lesões diariamente durante toda a internação. Reintroduzida TARV e iniciada terapia com Tecovirimat na dose de 600 mg de 12/12h, com realização de 2 ciclos de 14 dias do antiviral sem estabilização ou remissão do quadro, mantendo resposta isomórfica em locais de manipulação, simulando um fenômeno de Koebner. Posteriormente, apresentou piora do padrão respiratório, sendo submetido a broncoscopia, na qual se observaram lesões mucosas brônquicas secundárias ao MPXV de acordo com achados histopatológicos. Paciente evoluiu ao longo da internação com múltiplas disfunções orgânicas e síndrome de reconstituição imune, com desfecho de óbito em 3 meses. O caso apresentado retrata coinfecção HIV-1 e MPXV em paciente gravemente imunossuprimido, resultando em evolução desfavorável e refratariedade à terapia antirretroviral e antiviral. Chama-se atenção, portanto, para a importância da interação de ambas as infecções no prognóstico clínico

Interferon-γ release assay as a sensitive diagnostic tool of latent tuberculosis infection in patients with HIV: a cross-sectional study

Abstract Background In developing countries, tuberculosis (TB) is a major public health problem and the leading cause of death among patients with HIV (Human Immunodeficiency Virus). Until 2001, the tuberculin skin test (TST) was the only available tool for the diagnosis of latent tuberculosis infection (LTBI), but false-negative TST results are frequently reported. Recently, the interferon-γ (IFN-γ) release assay (IGRA) has gained ground because it can detect the IFN-γ secreted by circulating lymphocytes T cells when stimulated by specific TB antigens. However, the role of IGRA in the diagnosis of LTBI in HIV-infected patients has not been well established. Methods This cross-sectional study compared the accuracy of TST (performed by the Mantoux method) and IGRA (QuantiFERON-TB Gold In-Tube, Cellestis, Carnegie, Australia) on the diagnosis of LTBI among patients with HIV. LTBI is defined by LTBI risk and at least one positive test (TST or IGRA), without clinical evidence of active TB. We also assessed the accuracy of TST and IGRA among HIV patients with high and low risk for LTBI. Results Among 90 HIV patients, 80 met the study criteria for LTBI, fifty-nine (73.7%) patients were TST positive, 21 (26.2%) were negative, whereas 75 patients (93.7%) were IGRA positive, and five (6.2%) were negative. TST showed poor agreement with the diagnosis of LTBI (Kappa: 0.384), while IGRA demonstrated good agreement (Kappa: 0.769). Among 69 patients with high risk and 21 with low risk for LTBI, TST was positive in 48 (69.5%) and 11 (52.4%), while IGRA was positive in 68 (98.5%) and 7 (33.3%) patients, respectively. There were no association between TST and the level of risk (P = 0,191). Conversely, we observed a strong association between the IGRA and risk for LTBI (p < 0.001). Conclusions Compared to TST, IGRA positivity is consistent with the risk of TB infection and seems to be a better diagnostic tool for LTBI in HIV-infected patients

Chronic skull osteomyelitis due to Cryptococcus neoformans: first case report in an HIV-infected patient

ABSTRACT Osteomyelitis due to Cryptococcus neoformans are described in mostly 10% of patients with disseminated cryptococcosis, being direct inoculation even more uncommon. We report the case of an HIV-infected patient with history of recurring itching on his scalp and repetitive local trauma. For eighteen months, he noticed a painful and slow growing lump on his scalp. He was submitted to an excisional biopsy of the lesion but no etiological diagnosis was identified. After this procedure, the post-surgical wound never completely healed. At admission, the patient presented nausea and headache for three days and an open orifice into his skull. Investigations confirmed meningitis and skull osteomyelitis caused by Cryptococcus neoformans. He was treated with bone debridement and combined systemic antifungals, showing good clinical and laboratorial outcome. Cryptococcal disease should be included in the differential diagnoses of chronic osteomyelitis in HIV-infected patients and trauma is a possible source of infection