SYPHILIS AND HIV INFECTION: PROZONE EFFECT IN A PATIENT WITH NEUROSYPHILIS

É apresentado um caso de sífilis secundária prolongada com envolvimento neurológico assintomático em um paciente infectado pelo HIV. Paciente do sexo masculino, 26 anos de idade, com diagnóstico de infecção pelo HIV há três anos, apresentando há um ano lesões cutâneas nos pés e nas mãos, alopecia, febre, artralgia, perda ponderal de 8 Kg e VDRL negativo. Durante a internação, o VDRL foi de 1:1024 e VDRL positivo no líquor. Foi tratado com penicilina cristalina com excelente resposta clínica. O diagnóstico de sífilis deve ser considerado nos pacientes infectados pelo HIV com quadro clínico exuberante, mesmo quando o VDRL for negativo. PALAVRAS-CHAVE – Doenças sexualmente transmissíveis; HIV; Neurossífilis; Sífilis. We report a case of prolonged secondary syphilis with asymptomatic neurological involvement in HIV- -infected patient. A 26-year-old male patient who was diagnosed three years earlier with HIV infection presented with skin lesions on the feet and hands, alopecia, fever, arthralgia, weight loss of 8 Kg which began one year before and had a negative VDRL. During hospitalization, his VDRL was 1:1024 and a CSF-VDRL positive. The patient had an excel- lent clinical response to treatment with crystalline penicillin. The syphilis diagnosis should be considered in HIV-infected patients with severe clinical disease, even when the VDRL is negative. KEYWORDS – Sexually transmitted diseases; HIV infections; Neurosyphilis; Syphilis.

Risk factors associated with death in Brazilian children with severe dengue: a case-control study

Objective: The purpose of this case-control study was to evaluate risk factors associated with death in children with severe dengue. Methods: The clinical condition of hospitalized patients with severe dengue who died (cases, n = 18) was compared with that of hospitalized patients with severe dengue who survived (controls, n = 77). The inclusion criteria for this study were age under 13 years; hospital admission in São Luis, northeastern Brazil; and laboratory-confirmed diagnosis of dengue. Results: Severe bleeding (hemoptysis), a defining criterion for dengue severity, was the factor most strongly associated with death in our study. We also found that epistaxis and persistent vomiting, both included as warning signs in the World Health Organization (WHO) classification of dengue, were strongly associated with death. No significant association was observed between any of the laboratory findings and death. Conclusions: The finding that epistaxis and persistent vomiting were also associated with death in children with severe dengue was unexpected and deserves to be explored in future studies. Because intensive care units are often limited in resource-poor settings, any information that can help to distinguish patients with severe dengue with a higher risk to progress to death may be crucial

Risk factors associated with death in Brazilian\ud children with severe dengue: a case-control study

Objective:\ud \ud The purpose of this case-control study was to evaluate risk factors associated with death in children with severe dengue.\ud \ud Methods:\ud \ud The clinical condition of hospitalized patients with severe dengue who died (cases, n = 18) was compared with that of hospitalized patients with severe dengue who survived (controls, n = 77). The inclusion criteria for this study were age under 13 years; hospital admission in São Luis, northeastern Brazil; and laboratory-confirmed diagnosis of dengue.\ud \ud Results:\ud \ud Severe bleeding (hemoptysis), a defining criterion for dengue severity, was the factor most strongly associated with death in our study. We also found that epistaxis and persistent vomiting, both included as warning signs in the World Health Organization (WHO) classification of dengue, were strongly associated with death. No significant association was observed between any of the laboratory findings and death.\ud \ud Conclusions:\ud \ud The finding that epistaxis and persistent vomiting were also associated with death in children with severe dengue was unexpected and deserves to be explored in future studies. Because intensive care units are often limited in resource-poor settings, any information that can help to distinguish patients with severe dengue with a higher risk to progress to death may be crucial.This research was funded by grants BICUFMA 00366/07, BIC-UFMA 00377/07 and BD-00266/09 from Fundac¸a˜o de Amparo a` Pesquisa e ao Desenvolvimento Cientı´fico e Tecnolo´gico do Maranha˜o (FAPEMA), Sa˜o Luı´s, Maranha˜ o, Brazil. GFS was the recipient of a junior research fellowship in 2007-2008 from the Universidade Federal do Maranha˜o, Sa˜o Luı´s, Maranha˜ o, Brazil. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript