Epidemiological and clinical profile of HIV-infected patients from Southwestern Goias State, Brazil

Knowledge about epidemiological distribution patterns of HIV infection in different geographic regions is relevant to understand the dynamics of the disease in Brazil. This study aims to characterize the epidemiological and clinical profile of HIV-infected patients from Southwestern Goias State, from 2005 to 2015. A standardized questionnaire was used to collect clinical-epidemiological, virological, and immunological data from the medical records of all HIV-infected patients (n=539) who were followed at the regional reference center of Jatai, Goias State, Brazil, from 2005 to 2015. We detected the prevalence of male patients and the heterosexual route of transmission, as well as an expressive number of young women infected with HIV. The HIV infection was more prevalent in reproductive ages (55.3%). Most patients presented clinical manifestations related to HIV infection at the time of diagnosis. Twenty-four patients presented coinfection with hepatitis C virus, syphilis, hepatitis B virus, leprosy or Chagas disease. Pneumonia caused by Pneumocystis jirovecii was the most common opportunistic infection, followed by neurotoxoplasmosis, tuberculosis, and neurocryptococcosis. Combined antiretroviral therapy improved CD4+ T-cell counts: the mean CD4+ T-cell counts after treatment was twice as high as those found at the first medical appointment; and highly active antiretroviral therapy promoted viral suppression in a significant number of patients. Considering the increasing distribution of HIV infection to the interior of Brazil, this descriptive study outlines the clinical-epidemiological characteristics of HIV infection in Southwestern Goias and contributes to develop local prevention strategies and public service plans

Pessoas vivendo com HIV/Aids no Sudoeste Goiano: caracterização sociodemográfica, clínica e laboratorial no ano de 2018

Introdução: É significativo o número de pessoas vivendo com HIV (PVHIV) no Brasil, não se restringindo aos grandes centros, o que torna necessário entender as características clinicoepidemiológicas de cada região para que políticas públicas sejam estabelecidas de forma realística, prática e aplicável às suas peculiaridades. Objetivo: Caracterizar o perfil sociodemográfico, clínico e laboratorial das PVHIV que tiveram seu primeiro atendimento em um ambulatório do município de Jataí, Goiás, no ano de 2018. Método: Coletaram-se dados sociodemográficos, clínicos e laboratoriais de uma amostra de 80 prontuários de PVHIV atendidas em um ambulatório de Jataí, Goiás, no ano de 2018. Os dados foram analisados por estatística descritiva e inferencial. Resultados: Houve predomínio de homens (71,3%), idade de 16-35 anos (61,3%), solteiros (68,8%), heterossexuais (43,8%), com vínculo empregatício (70,0%) e o meio de exposição ao HIV foi pela relação sexual (97,5%). A herpes zoster se destacou como infecção oportunista (27,8%), a sífilis (76,9%) como outras infecções e o transtorno de ansiedade (30,0%) como comorbidade. Os homens, em relação às mulheres, associaram-se positivamente com o diagnóstico de outras infecções (p=0,0250) e com valores alterados para aspartato aminotransferase (p=0,0410). Já as PVHIV com atendimento por diagnóstico, em relação as por transferência/abandono, apresentaram associação positiva com a presença de carga viral detectável (p=0,0001) e circunferência abdominal adequada (p=0,0304). Conclusão: Em 2018, o atendimento para o recém diagnóstico predominou, bem como de adultos, homens, solteiros, heterossexuais e com vínculo empregatício. A herpes zoster e a sífilis foram as infecções mais presentes, o tipo de exposição ao HIV foi a relação sexual e os homens apresentaram alteração para a aspartato aminotransferase e maior presença de outras infecções. A carga viral detectável e a circunferência abdominal adequada estiveram mais presentes nos recém diagnosticados..Introduction: The number of people living with HIV (PLHIV) in Brazil is significant, and not restricted to large centers, which makes it necessary to understand the clinical and epidemiological characteristics of each region so that public policies can be established in a realistic, practical, and applicable way to the peculiarities of this disease. Objective: To characterize the sociodemographic, clinical, and laboratory profile of PLHIV who had their first consultation at an outpatient clinic in the city of Jataí, Goiás, in 2018. Methods: Sociodemographic, clinical, and laboratory data were collected from the medical records of a sample of 80 PLHIV attended at an outpatient clinic in Jataí, Goiás, in 2018. Data were analyzed using descriptive and inferential statistics. Results: There was a predominance of men (71.3%), aged 16-35 years (61.3%), single (68.8%), heterosexual (43.8%), employed (70.0%), and the route of exposure to HIV was through sexual intercourse (97.5%). Herpes zoster stood out as an opportunistic infection (27.8%), and syphilis (76.9%) as well as other infections and anxiety disorder (30.0%) as comorbidities. Men, compared to women, were positively associated with the diagnosis of other infections (p=0.0250) and with altered values for aspartate aminotransferase (p=0.0410). On the other hand, the PLHIV attended due to diagnosis, in relation to those due to transfer/abandonment, showed a positive association with the presence of detectable viral load (p=0.0001) and adequate abdominal circumference (p=0.0304). Conclusion: In 2018, consultations for newly diagnosed patients predominated, as well as for adults, men, single people, heterosexuals, and employed individuals. Herpes zoster and syphilis were the most common infections, the route of exposure to HIV was sexual intercourse, and men showed alterations in aspartate aminotransferase and a greater presence of other infections. Detectable viral load and adequate abdominal circumference were more present in newly diagnosed PLHIV

Case report: juvenile paracoccidioidomycosis with intestinal involvement

Introduction: Contact of Paracoccidioides sp. with the human organism presents in a variety of clinical forms of the disease. Intestinal clinical manifestation is found in 10 to 30% of cases, commonly in juvenile form. This case report seeks to describe a patient with juvenile paracoccidioidomycosis with atypical intestinal involvement. Case report: A 14 years old woman with an updated vaccination schedule and no reports of chronic diseases, allergies or continued use of medications, presented a diarrheal condition that was characterized by pasty stools, where episodes became gradually more intense, associated with episodes of hematochezia, retroauricular lymphadenopathy on the right, as well as shivering and fever. A colonoscopy revealed multiple polypoid formations, ulcerations and friability throughout the colon. After biopsy results, the diagnosis of Paracoccidioidomycosis with intestinal involvement was established. Due to the wasting syndrome, anemia and persistent diarrhea, the patient was hospitalized for blood transfusion and intravenous treatment with conventional Amphotericin B. Discussion: Unlike what was presented by the patient in this case, involvement of the gastrointestinal tract is uncommon in paracoccidioidomycosis. This disease presents a range of clinical manifestations, which makes diagnosis difficult. Since this type of infection is not always considered, it may result in underdiagnosed cases, especially in women and young adults. The prognosis depends on the initial severity of the disease, the presence of comorbidities and the treatment used. Conclusion: Especially for the intestinal form, earlier treatment will better the results. The disease has a good chance of effective treatment using antifungal therapy

Opportunistic and non-opportunistic intestinal parasites in HIV/ AIDS patients in relation to their clinical and epidemiological status in a specialized medical service in Goiás, Brazil

Patients infected with the Human Immunodeficiency Virus (HIV) often have opportunistic infections, among which strongyloidiasis and coccidiosis are the most common parasitic infections that aggravate their health status. This study examined the prevalence of intestinal parasites, particularly of Strongyloides stercoralis and intestinal coccidia in patients with the Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) who were treated at the Specialized Assistance Service (SAE) of Jataí, State of Goiás, Brazil, and analyzed its correlation with clinical, laboratory, and socio-epidemiological parameters. A total of 270 stool samples were analyzed by the Lutz technique, Rugai’s method, Agar Plate Culture, Ritchie’s method and specific staining, Ziehl-Neelsen modified technique, Kinyoun’s method and the rapid safranin method. The prevalence of intestinal parasites was 28.88% including 3.8% of S. stercoralis, Cryptosporidium sp. and Cystoisospora belli. There was a significant positive correlation between intestinal parasites and the clinical status and the use of antiretroviral therapy (ART), smoking, CD4+ lymphocyte counts and sexual orientation. In conclusion, the widespread use of antiretroviral therapy and health assistance contributed to the low prevalence of S. stercoralis and coccidiosis in patients with HIV/ AIDS who were followed up at the SAE

Estudo transversal da letalidade da hantavirose no estado de Goiás, 2007-2013

Resumo OBJETIVO: descrever o perfil epidemiológico e clínico da hantavirose e analisar fatores associados à letalidade em Goiás, Brasil. MÉTODOS: foi conduzido um estudo transversal com dados do Sistema de Informação de Agravos de Notificação (Sinan), referentes ao período de 2007 a 2013, no estado de Goiás. Regressão logística foi empregada para estimar razões de chances (OR) com intervalos de confiança de 95% (IC95%). RESULTADOS: foram notificados 1.171 casos suspeitos de hantavirose e 73 (6,2%) confirmados. Entre os confirmados, observou-se maior frequência entre homens (n=50), febre como sintoma mais frequente (n=70) e elevada proporção de hospitalizações (n=68). A taxa de letalidade foi de 57,5%. Foram fatores associados ao óbito: insuficiência respiratória aguda (IRpA) (OR=3,6; IC95%1,2;10,6), hemoconcentração (OR=3,3; IC95%1,1;7,9) e não uso do respirador mecânico (OR=3,4; IC95%1,3;9,1). Após ajuste, a IRpA permaneceu associada ao óbito (OR=3,4; IC95%1,0;11,6). CONCLUSÃO: foi identificada alta taxa de letalidade, associada principalmente com insuficiência respiratória

Opportunistic and non-opportunistic intestinal parasites in HIV/ AIDS patients in relation to their clinical and epidemiological status in a specialized medical service in Goiás, Brazil

ABSTRACT Patients infected with the Human Immunodeficiency Virus (HIV) often have opportunistic infections, among which strongyloidiasis and coccidiosis are the most common parasitic infections that aggravate their health status. This study examined the prevalence of intestinal parasites, particularly of Strongyloides stercoralis and intestinal coccidia in patients with the Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) who were treated at the Specialized Assistance Service (SAE) of Jataí, State of Goiás, Brazil, and analyzed its correlation with clinical, laboratory, and socio-epidemiological parameters. A total of 270 stool samples were analyzed by the Lutz technique, Rugai’s method, Agar Plate Culture, Ritchie’s method and specific staining, Ziehl-Neelsen modified technique, Kinyoun’s method and the rapid safranin method. The prevalence of intestinal parasites was 28.88% including 3.8% of S. stercoralis, Cryptosporidium sp. and Cystoisospora belli. There was a significant positive correlation between intestinal parasites and the clinical status and the use of antiretroviral therapy (ART), smoking, CD4+ lymphocyte counts and sexual orientation. In conclusion, the widespread use of antiretroviral therapy and health assistance contributed to the low prevalence of S. stercoralis and coccidiosis in patients with HIV/ AIDS who were followed up at the SAE

PIELONEFRITE XANTOGRANULOMATOSA COMPLICADA COM FÍSTULA DUODENAL DE ALTO DÉBITO: RELATO DE CASO

A pielonefrite xantogranulomatosa (PNX) é uma infecção crônica rara que resulta em destruição do parênquima renal e fibrose, sendo responsável por apenas 1% dos casos de pielonefrite. Ocorre predominantemente em mulheres com idade entre 50-60 anos. Sua apresentação clínica e laboratorial é inespecífica, mas possui evolução grave e necessita de tratamento cirúrgico. Devido sua singularidade, o caso em questão demonstra merecido destaque. Paciente do sexo feminino, 35 anos, previamente hígida, apresentou-se com queixa de dor em flanco direito de forte intensidade, com irradiação para hipogástrio, associada a náuseas, vômitos e perda ponderal de 10 kg. O quadro iniciou-se há 2 meses, porém com piora há 10 dias e refratário ao uso de analgésicos e anti-inflamatórios. A Tomografia Computadorizada de abdome com contraste demonstrou rim direito com dimensões aumentadas, afilamento da espessura cortical, hidronefrose, microcálculos e coleção no polo superior, medindo 6,5 × 5,8 × 4,5cm. O resultado da urocultura solicitada foi negativo, todavia paciente já em uso de Piperacilina-Tazobactam há 1 dia. Foi avaliada pela Urologia, sendo optado por implante de Cateter Duplo J e otimização de antibioticoterapia para posterior programação cirúrgica. Após 3 dias de internação, foi submetida à nefrectomia radical à direita. Entretanto, paciente sem melhora clínica, cursando com febre, taquicardia e hipotensão em uso de drogas vasoativas, evoluiu para choque séptico de foco abdominal com necessidade de laparotomia exploradora para drenagem de abscesso pélvico e coleções retroperitoneais. Foi evidenciada fístula duodenal de alto débito com indicação de nutrição parenteral total e jejunostomia à Wietzel. Paciente recebeu alta após 115 dias de internação hospitalar, tendo finalizado múltiplos antibióticos de amplo espectro no período. O anatomopatológico obtido através de nefrectomia confirmou a hipótese de PNX com a presença de cálculos, dilatação do sistema pielocalicial preenchida por material purulento, abscedação, colônias bacterianas com histiócitos xantomatosos, infiltrado inflamatório crônico difuso, atrofia e esclerose glomerular. Devido suas manifestações clínicas variáveis e curso agressivo com rápida progressão para nefrectomia e, em virtude do difícil diagnóstico por mimetizar o carcinoma renal e doenças granulomatosas, a PNX é uma variante cujo conhecimento se faz necessário como diagnóstico diferencial dentro do espectro de patologias inflamatórias/infecciosas renais

Epidemiological and clinical profile of HIV-infected patients from Southwestern Goias State, Brazil

ABSTRACT Knowledge about epidemiological distribution patterns of HIV infection in different geographic regions is relevant to understand the dynamics of the disease in Brazil. This study aims to characterize the epidemiological and clinical profile of HIV-infected patients from Southwestern Goias State, from 2005 to 2015. A standardized questionnaire was used to collect clinical-epidemiological, virological, and immunological data from the medical records of all HIV-infected patients (n=539) who were followed at the regional reference center of Jatai, Goias State, Brazil, from 2005 to 2015. We detected the prevalence of male patients and the heterosexual route of transmission, as well as an expressive number of young women infected with HIV. The HIV infection was more prevalent in reproductive ages (55.3%). Most patients presented clinical manifestations related to HIV infection at the time of diagnosis. Twenty-four patients presented coinfection with hepatitis C virus, syphilis, hepatitis B virus, leprosy or Chagas disease. Pneumonia caused by Pneumocystis jirovecii was the most common opportunistic infection, followed by neurotoxoplasmosis, tuberculosis, and neurocryptococcosis. Combined antiretroviral therapy improved CD4+ T-cell counts: the mean CD4+ T-cell counts after treatment was twice as high as those found at the first medical appointment; and highly active antiretroviral therapy promoted viral suppression in a significant number of patients. Considering the increasing distribution of HIV infection to the interior of Brazil, this descriptive study outlines the clinical-epidemiological characteristics of HIV infection in Southwestern Goias and contributes to develop local prevention strategies and public service plans

Impact on mortality of being seropositive for hepatitis C virus antibodies among blood donors in Brazil: A twenty-year study.

IntroductionHepatitis C virus (HCV) infection is a major health problem associated with considerable risk of mortality in different regions of the world. The purpose of this study was to investigate the contribution of HCV infection on all-cause and liver-related mortality, in a large cohort of blood donors in Brazil.MethodsThis is a retrospective cohort study of blood donors from 1994 to 2013, at Fundação Pró-Sangue-Hemocentro de São Paulo (FPS). This cohort included 2,892 and 5,784 HCV antibody seropositive and seronegative donors, respectively. Records from the FPS database and the Mortality Information System (SIM: a national database in Brazil) were linked through a probabilistic record linkage (RL). Mortality outcomes were defined based on ICD-10 (10th International Statistical Classification of Diseases and Related Health Problems) codes listed as the cause of death on the death certificate. Hazard ratios (HRs) were estimated for outcomes using Cox multiple regression models.ResultsWhen all causes of death were considered, RL identified 209 deaths (7.2%) among seropositive blood donors and 190 (3.3%) among seronegative blood donors. Donors seropositive for HCV infection had a 2.5 times higher risk of death due to all causes (95% CI: 1.76-2.62; pConclusionsAll-cause and liver-related mortality rate was increased among blood donors seropositive for HCV compared with the mortality rate among seronegative blood donors. Our data confirms HCV as a relevant cause of death in Brazil and also suggest that interventions directed at following patients even after access to specific drug treatment are urgent and necessary