Subacute Cognitive Impairment in Individuals With Mild and Moderate COVID-19: A Case Series

Background: Previous reported neurologic sequelae associated with SARS-CoV-2 infection have mainly been confined to hospital-based patients in which viral detection was restricted to nasal/throat swabs or to IgM/IgG peripheral blood serology. Here we describe seven cases from Brazil of outpatients with previous mild or moderate COVID-19 who developed subacute cognitive disturbances. Methods: From June 1 to August 15, 2020, seven individuals 18 to 60 years old, with confirmed mild/moderate COVID-19 and findings consistent with encephalopathy who were observed >7 days after respiratory symptom initiation, were screened for cognitive dysfunction. Paired sera and CSF were tested for SARS-CoV-2 (IgA, IgG ELISA, and RT-PCR). Serum and intrathecal antibody dynamics were evaluated with oligoclonal bands and IgG index. Cognitive dysfunction was assessed by the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Clock Drawing Test (CDT). Results: All but one of our patients were female, and the mean age was 42.6 years. Neurologic symptoms were first reported a median of 16 days (IQR 15–33) after initial COVID-19 symptoms. All patients had headache and altered behavior. Cognitive dysfunction was observed mainly in phonemic verbal fluency (MoCA) with a median of six words/min (IQR 5.25–10.75) and altered visuospatial construction with a median of four points (IQR 4–9) (CDT). CSF pleocytosis was not detected, and only one patient was positive for SARS-Co Conclusions: A subacute cognitive syndrome suggestive of SARS-CoV-2-initiated damage to cortico-subcortical associative pathways that could not be attributed solely to inflammation and hypoxia was present in seven individuals with mild/moderate COVID-19

LEUCOENCEFALOPATIA MULTIFOCAL PROGRESSIVA EM PESSOAS VIVENDO COM HIV/AIDS: ESTUDO OBSERVACIONAL DE COORTE RETROSPECTIVA NO INSTITUTO DE INFECTOLOGIA EMÍLIO RIBAS, ENTRE 2011 E 2022

Introdução: A leucoencefalopatia multifocal progressiva (LEMP) é uma doença desmielinizante causada pelo vírus JC, que acomete principalmente pessoas que vivem com HIV/Aids (PVHA). A frequência e mortalidade da LEMP diminuiu após a introdução do tratamento antirretroviral combinado em países de renda alta, mas existe pouca informação sobre a LEMP em países de baixa e meia renda, incluindo o Brasil. Objetivos: (i) descrever as principais características clínicas, laboratoriais, radiológicas e evolutivas de PVHA com LEMP; e (ii) identificar as taxas de mortalidade intrahospitalar e um ano após o diagnóstico de LEMP dessa população. Métodos: Estudo observacional de coorte retrospectiva, o qual incluiu PVHA com diagnostico de LEMP, internados no IIER, entre 2011 e 2022. O diagnóstico de LEMP consistiu na presença de manifestações neurológicas e neuroradiológicas associada à identificação de DNA do vírus JC em amostras de líquor. Foram revisados os prontuários eletrônicos e físicos dos pacientes, assim como bases de dados laboratoriais e de neuroimagens. O estudo foi aprovado pelo Comité de Ética do IIER. Resultados: Foram incluídos 93 casos, 59 (63,4%) dos quais foram homens. A mediana (intervalo interquartílico -IIQ-) da idade foi 44 (35 - 49) anos. Diagnósticos prévios de infecção por HIV e de doença definidora de aids foram identificados em 89,2% e 49,5% dos casos, respectivamente. As manifestações clínicas mais comuns foram déficits motores (55,9%), alteração de linguagem (43%), e alteração de marcha (41,9%). LEMP clássica e LEMP IRIS foram identificadas em 88,2% e 11,8% dos casos, respectivamente. A mediana (IIQ) da contagem de CD4+ foi 86,5 (22-101) células/mL. Na ressonância magnética, 89,2% dos casos apresentaram múltiplas imagens com hipersinal em T2/FLAIR e 83,8% dos casos tiveram, concomitantemente, lesões infra e supratentoriais. As taxas de letalidade intrahospitalar e um ano após o diagnóstico de LEMP foram de 24,7% e 52,7%, respectivamente. Conclusão: Neste estudo, a maioria de PVHIV foi homem e tinha diagnóstico prévio de infecção pelo HIV, mas em aproximadamente a metade dos pacientes, a LEMP foi a doença definidora de aids. A maioria apresentou déficits focais, teve LEMP clássica e lesões múltiplas nas neuroimagens. Aproximadamente um de cada quatro pacientes com LEMP faleceu durante a internação e um de cada dois pacientes faleceu um após o diagnóstico dessa doença oportunista, similar ao descrito em países de renda alt

The reasons to include the serology of human T-lymphotropic virus types 1 and 2 (HTLV-1 and HTLV-2) in the clinical follow-up of patients with viral hepatitis B and C in Brazil.

BACKGROUND:The WHO established targets for 2030 to globally reduce new viral hepatitis B and C infections by 90% and deaths by 65% and recommends searching for coinfections that increase the progression of chronic liver infections towards cirrhosis and hepatocellular carcinoma. AIMS AND METHODOLOGY:This study aimed to add information concerning the influence of human T-lymphotropic virus type 1 (HTLV-1) and type 2 (HTLV-2) infections in hepatitis B and C, since in Brazil, these human retroviruses are endemic but neglected. Serum samples from 1,910 patients with hepatitis B and 1,315 with hepatitis C from São Paulo, southeast Brazil, that were previously tested and grouped for HIV and HTLV-1/-2 coinfections were analyzed for hepatitis B virus (HBV) and hepatitis C virus (HCV) loads measurements and subsequent clearance using data from laboratory records. KEY RESULTS:Briefly, the lowest HBV viral load (VL) was detected in HBV/HTLV-2 coinfected patients, regardless of whether they were infected with HIV (all comparisons p<0.05). In contrast, higher HCV VL was detected in HCV/HIV, HCV/HIV/HTLV-1/-2 coinfected patients (all p<0.05), and the lowest HCV VL was detected in HCV/HTLV-2 coinfected patients. Curiously, 61.1% of the patients with HBV/HTLV-2 coinfection had an undetectable HBV VL at the beginning of the study versus 21.4% in the patients with HBV/HTLV-1 coinfection. Although the percentages of undetectable HCV loads in HCV/HTLV-1 and HCV/HTLV-2 coinfected patients were quite similar, during follow-up, more HCV clearance was detected in patients with HCV/HTLV-2 coinfection [OR 2.65; 95% IC (1.17-5.99)]. MAJOR CONCLUSIONS:HTLV-2 positively impacts HBV and HCV viral loads and HCV clearance, while HIV and/or HTLV-1 negatively impacts HCV viral load. Thus, the search for HTLV-1/-2 in viral hepatitis B and C infected patients has virological prognostic value, which is a strong reason to suggest including HTLV serology in the follow-up of patients