Meningoencefalite chagásica: relato de caso de doença recentemente incluida como indicativa de AIDS no Brasil

Recently, reactivation of Chagas disease (meningoencephalitis and/or myocarditis) was included in the list of AIDS-defining illnesses in Brazil. We report a case of a 52-year-old patient with no history of previous disease who presented acute meningoencephalitis. Direct examination of blood and cerebrospinal fluid (CSF) showed Trypanosoma cruzi. CSF culture confirmed the diagnosis. Serological assays for T. cruzi and human immunodeficiency virus (HIV) were positive. Despite treatment with benznidazol and supportive measures, the patient died 24 hours after hospital admission. In endemic areas, reactivation of Chagas disease should always be considered in the differential diagnosis of meningoencephalitis among HIV-infected patients, and its presence is indicative of AIDS.Recentemente, a reagudização da doença de Chagas (meningoencefalite e/ou miocardite) foi incluída na lista de doenças indicativas de aids no Brasil. Os autores relatam o caso de um paciente de 52 anos de idade, natural de área rural da Bahia e procedente de uma área urbana de São Paulo, sem história de doenças prévias e que apresentou meningoencefalite aguda. As sorologias e pesquisas parasitológicas diretas no sangue e no liquido cefalorraquideano (LCR) demonstraram presença de Trypanosoma cruzi, confirmando-se o diagnóstico mediante cultura do LCR. O teste rápido assim como os ELISA e Western Blot diagnosticaram infecção pelo vírus da imunodeficiência humana (HIV). Apesar do tratamento com benzonidazole e as medidas de suporte, o paciente faleceu 24 horas depois da admissão hospitalar. Em áreas endêmicas, a reagudização da doença de Chagas deve ser sempre considerada no diagnóstico diferencial das meningoencefalites e sua presença em pacientes com infecção pelo HIV é indicativa de aids

Soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares no município de São Paulo, 2020

OBJECTIVE: To estimate seroprevalence of SARS-CoV-2 antibodies in schoolchildren aged 4 to 14 years living in the city of São Paulo, according to clinical, demographic, epidemiological, and social variables, during the school closure period as a measure against covid-19 spread. METHODS: A serological survey was made in September 2020 with a random sample stratified by school system (municipal public, state public and private) type. A venous blood sample was collected using the Wondfo SARS-CoV-2 Antibody Test (lateral flow method) for detection of total SARS-CoV-2 virus antibodies. Semi-structured questionnaires were applied to collect clinical, demographic, social, and epidemiological data. RESULTS: Seroprevalence of SARS-CoV-2 antibodies in schoolchildren was of 16.6% (95%CI 15.4–17.8). The study found higher seroprevalence in the municipal (18.5%; 95%CI 16.6–20.6) and state (16.2%; 95%CI 14.4–18.2) public school systems compared to the private school system (11.7; 95%CI 10.0–13.7), among black and brown students (18.4%; 95%CI 16.8–20.2) and in the most vulnerable social stratum (18.5 %;95%CI 16.9–20.2). Lower seroprevalence was identified in schoolchildren who reported following the recommended protective measures against covid-19. CONCLUSION: Seroprevalence of SARS-CoV-2 antibodies is found mainly in the most socially vulnerable schoolchildren. This study can contribute to support public policies that reinforce the importance of suspending face-to-face classes and developing strategies aimed at protective measures and monitoring of the serological status of those who have not yet been included in the vaccination schedule.OBJETIVO: Estimar a soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares de quatro a 14 anos de idade residentes no município de São Paulo, segundo variáveis clínicas, demográficas, epidemiológicas e sociais, durante o período de fechamento das escolas como medida de controle da covid-19. MÉTODOS: Realizou-se um inquérito sorológico em setembro de 2020 com amostra aleatória estratificada por tipo de rede de ensino (pública municipal, pública estadual e privada). Foi coletada amostra de sangue venoso utilizando-se o teste de imunoensaio de fluxo lateral da fabricante Wondfo para detecção de anticorpos totais contra o vírus SARS-CoV-2. Aplicaram-se questionários semiestruturados para o levantamento de dados clínicos, demográficos, sociais e epidemiológicos. RESULTADOS: A soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares foi de 16,6% (IC95% 15,4–17,8). O estudo encontrou soroprevalências mais elevadas na rede pública municipal (18,5%; IC95% 16,6–20,6) e estadual (16,2%; IC95% 14,4–18,2) em relação à rede privada (11,7; IC95% 10,0–13,7) e entre escolares da raça/cor preta e parda (18,4%; IC95% 16,8–20,2) e no estrato social mais vulnerável (18,5%; IC95% 16,9–20,2). A pesquisa identificou menores soroprevalências nos escolares que relataram seguir as medidas recomendadas de proteção contra a covid-19. CONCLUSÃO: A soroprevalência de anticorpos contra o vírus SARS-CoV-2 atinge principalmente os escolares socialmente mais vulneráveis. Este estudo pode contribuir para embasar políticas públicas que reforcem a importância da suspensão das aulas presenciais e da necessidade de estratégias de medidas de proteção e acompanhamento do status sorológico daqueles que ainda não foram contemplados no calendário vacinal

Visceral leishmaniasis in São Paulo State and prognostic factors for death, 1999 to 2005

Introdução: A LVA é considerada doença emergente no estado de São Paulo, a partir do ano de 1999. Objetivos: Analisar os casos autóctones no estado de São Paulo, entre 1999 e 2005, e identificar fatores associados à letalidade. Métodos: Estudo de coorte retrospectivo de casos por meio da análise de dados do Sistema de Informação de Agravos de Notificação (SINAN) e de prontuários médicos. Foram comparados os óbitos às curas, segundo características biológicas, clínicas e laboratoriais, para identificar fatores associados à letalidade. O modelo de regressão logística foi utilizado para determinar a Odds Ratio ajustada para óbito. Resultados: Foram avaliados 376 prontuários médicos de 559 casos autóctones informados no SINAN. 53 óbitos foram comparados a 323 curas. Foi observada alta incidência de casos em crianças até dez anos e alta letalidade em maiores de 50 anos, com letalidade média, no período, de 12%. As principais causas de morte foram sepse, hemorragia, insuficiência hepática e arritmias decorrentes da cardiotoxicidade pelo uso dos antimoniais. A análise multivariada identificou os seguintes fatores com maior risco de morte: anemia grave (hemoglobina =2,0mg/ml), febre por mais de 60 dias, idade acima de 50 anos, manifestações hemorrágicas, diarréia, alterações cardíacas e infecções bacterianas. Conclusões: A identificação de fatores associados ao óbito por LVA é necessária para implementar estratégias de prevenção e controle da doença e redução da letalidade.lntroduction: Visceral leishmaniasis is an emerging infectious disease in São Paulo State since 1999. Objectives: Determine prognostic factors for death from visceral leishmaniasis in São Paulo state, Brazil, since 1999 to 2005. Methods: A cohort retrospectiva study was conducted by data analysis of National System of Comunicable Diseases (SINAN) and by data analysis of medical records. A comparison between fatal cases and survivors from visceral leishmaniasis was performed for clinical, laboratories and biological features. Association between variables and death was assessed by univariable analysis and the model of multiple logistic regression to determine adjust odds ratio for death, controlling confound bias. Results: Data analysis of 376 medical files from 559 reported cases on SINAN identified 53 fatal cases and 323 survivors between 1999 and 2005 in São Paulo state. Visceral leishmaniasis was often in childreen under ten years and fatality was high in old ages, above fifty years. The fatality rate between 1999 and 2005 was 12%. The main death causes were sepsis, bleeding, liver failure and cardiotoxicity due treatment. Variables significantly associated with death were severe anemia (hemoglobin <5,0g/dl), bleeding, heart failures, jaundice, diarrhea, fever for more than sixty days, age more than fifty and bacterial infections. Conclusions: ldentifying prognostic factors are needed to provide health policies and possible strategies of control and prevention of disease and reduce fatality rates of visceral leishmaniasis

Surveillance system for healthcare-associated endophthalmitis at state level in a middle- income country: preliminary results

Purpose: To describe the implementation process and the preliminary results of a surveillance system for healthcare-associated endophthalmitis (SIVEN). Methods: This is a case study of the implementation of a surveillance system for healthcare-associated endophthalmitis (SIVEN). The SIVEN is a structured system that enables surveillance of cases of healthcare-associated endophthalmitis after intraocular procedures (IPs), developed and coordinated by the Division of Hospital Infection (DHI) at the State Health Department, São Paulo, Brazil. The implementation process included a pilot phase, followed by the scaling-up phase. Data were reported monthly to DHI by participating health facilities (HFs) that performed IPs in the state of São Paulo, Brazil from September 2017 to December 2019. Results: Among the 1,483 eligible HFs, 175 engaged in the study (participation rate of 11.8%), reporting 222,728 IPs performed, of which 164,207 were cataract surgery and 58,521 were intravitreal injections. The overall incidence rate of endophthalmitis reported was 0.05% (n=105; 80 cases after cataract surgery and 25 cases after intravitreal injections). HFs incidence rates ranged from 0.02% to 4.55%. Most cases were caused by gram-positive bacteria, mainly Staphylococcus spp. In 36 (46.2%) of the cases there was no bacterial growth; no sample was collected in 28 (26.7%) cases. SIVEN enabled the identification of an outbreak of four cases of endophthalmitis after intravitreal injections. Conclusion: The SIVEN proved to be operationally viable and efficient for monitoring cases of endophthalmitis at state level

Cerebral tuberculomas in AIDS patients: a forgotten diagnosis? Tuberculomas cerebrais em pacientes com AIDS: um diagnóstico esquecido?

The human immunodeficiency virus (HIV) infection epidemics increased the prevalence, multi-drug resistance and disseminated forms of tuberculosis. The central nervous system (CNS) tuberculosis has high mortality and morbidity, and it is usually divided into diffuse (meningitis) and localized (tuberculoma and abscess) forms. We report three cases of cerebral tuberculomas in AIDS patients: one with definitive diagnosis, confirmed with histopathology, and two with probable diagnosis, based on clinical information, radiological images, Mycobaterium tuberculosis isolation out of the CNS and adequate response to antituberculous treatment. Further, we discuss diagnostic, therapeutic and prognostic issues of tuberculomas, with emphasis in the distinction from cerebral tuberculous abscesses. Despite of their infrequent presentation, tuberculomas should be considered in the differential diagnosis of cerebral expansive lesions in patients with AIDS.A epidemia da infecção pelo vírus da imunodeficiência humana (HIV) aumentou a prevalência, multiresistência e formas disseminadas da tuberculose. O acometimento neurológico da tuberculose apresenta elevada morbidade e mortalidade, classificando-se em formas difusas (meningite) e localizadas (tuberculoma e abscesso). Relatamos três casos de tuberculomas cerebrais em pacientes com AIDS: um deles com diagnóstico definitivo, confirmado com histopatologia e dois com diagnóstico provável, baseado em informação clínica, radiológica, isolamento de Mycobaterium tuberculosis fora do sistema nervoso central e adequada resposta ao tratamento tuberculostático. Discutimos também aspectos diagnósticos, terapêuticos e prognósticos dos tuberculomas, enfatizando suas diferenças com os abscesos tuberculosos cerebrais. Apesar de serem relatados de forma infreqüente, os tuberculomas devem sempre ser considerados no diagnóstico diferencial das lesões expansivas cerebrais em pacientes com AIDS

Risk factors for death from Influenza A(H1N1)pdm09, State of São Paulo, Brazil, 2009.

This case-control study aimed to assess the risk factors for death from influenza A(H1N1)pdm09 in patients with laboratory confirmation, who had severe acute respiratory illness-SARI and were hospitalized between June 28th and August 29th 2009, in the metropolitan regions of São Paulo and Campinas, Brazil. Medical charts of all the 193 patients who died (cases) and the 386 randomly selected patients who recovered (controls) were investigated in 177 hospitals. Household interviews were conducted with those who had survived and the closest relative of those who had died. 73.6% of cases and 38.1% of controls were at risk of developing influenza-related complications. The 18-to-59-year age group (OR = 2.31, 95%CI: 1.31-4.10 (reference up to 18 years of age)), presence of risk conditions for severity of influenza (OR = 1.99, 95%CI: 1.11-3.57, if one or OR = 6.05, 95%CI: 2.76-13.28, if more than one), obesity (OR = 2.73, 95%CI: 1.28-5.83), immunosuppression (OR = 3.43, 95%CI: 1.28-9.19), and search for previous care associated with the hospitalization (OR = 3.35, 95%CI: 1.75-6.40) were risk factors for death. Antiviral treatment performed within 72 hours of the onset of symptoms (OR = 0.17, 95%CI: 0.08-0.37, if within 48hours, and OR = 0.30, 95%CI: 0.11-0.81, if between 48 and 72 hours) was protective against death. The identification of high-risk patients and early treatment are important factors for reducing morbi-mortality from influenza

Severe influenza A(H1N1)pdm09 in pregnant women and neonatal outcomes, State of Sao Paulo, Brazil, 2009

<div><p>To investigate the factors associated with death and describe the gestational outcomes in pregnant women with influenza A(H1N1)pdm09, we conducted a case-control study (deaths and recovered) in hospitalized pregnant women with laboratory-confirmed influenza A(H1N1)pdm09 with severe acute respiratory illness (SARI) in the state of São Paulo from June 9 to December 1, 2009. All cases were evaluated, and four controls that were matched by the epidemiological week of hospitalization of the case were randomly selected for each case. Cases and controls were selected from the National Disease Notification System-SINAN Influenza-web. The hospital records from 126 hospitals were evaluated, and home interviews were conducted using standardized forms. A total of 48 cases and 185 controls were investigated. Having had a previous health visit to a healthcare provider for an influenza episode before hospital admission was a risk factor for death (adjusted OR (<i>OR</i>_<i>adj</i><i>)</i> of 7.93, 95% CI 2.19–28.69). Although not significant in the multiple analysis (<i>OR</i>_<i>adj</i> of 2.13, 95% CI 0.91–5.00), the 3^rd trimester deserves attention, with an OR = 2.22, 95% CI 1.13–4.37 in the univariate analysis. Antiviral treatment was a protective factor when administered within 48 hours of symptom onset (<i>OR</i>_<i>adj</i> = 0.16, 95% CI 0.05–0.50) and from 48 to 72 hours (<i>OR</i>_<i>adj</i> = 0.09, 95% CI 0.01–0.87). There was a higher proportion of fetal deaths and preterm births among cases (p = 0.001) and live births with low weight (p = 0.019), compared to control subjects who gave birth during hospitalization. After discharge, control subjects had a favorable neonatal outcome. Early antiviral treatment during the presence of a flu-like illness is an important factor in reducing mortality from influenza in pregnant women and unfavorable neonatal outcomes. It is important to monitor pregnant women, particularly in the 3^rd trimester of gestation, with influenza illness for diagnosis and early treatment.</p></div