scholarly journals Intestinal microsporidiosis in HIV-positive patients with chronic unexplained diarrhea in Rio de Janeiro, Brazil: diagnosis, clinical presentation and follow-up

1996 ◽  
Vol 38 (2) ◽  
pp. 97-102 ◽  
Author(s):  
Patrícia Brasil ◽  
Fernando C. Sodré ◽  
Tullia Cuzzi-Maya ◽  
Maria Clara G.F.S. Gutierrez ◽  
Haroldo Mattos ◽  
...  
Keyword(s):  
Rio De Janeiro ◽  
Clinical Presentation ◽  
Chronic Diarrhea ◽  
Hiv Positive ◽  
Intestinal Infection ◽  
Bowel Movements ◽  
Advanced Stages ◽  
Initial Improvement ◽  
Intestinal Microsporidiosis

After the diagnosis of two cases of microsporidial intestinal infection in 1992, in Rio de Janeiro, we have started looking for this parasite in HIV-infected patients with chronic unexplained diarrhea. We have studied 13 patients from Hospital Evandro Chagas, IOC-FIOCRUZ. Fecal specimens from these patients were examined for the presence of Cryptosporidia and Microsporidia, in addition to routine examination. Spores of Microsporidia were found in the stools of 6 (46.1%) of the 13 patients studied, with 2 histological jejunal confirmations. The Microsporidia-infected patients presented chronic diarrhea with about 6 loose to watery bowel movements a day. Five infected patients were treated with Metronidazole (1.5 g/day). They initially showed a good clinical response, but they never stopped eliminating spores. After about the 4th week of therapy, their diarrhea returned. Two patients utilized Albendazole (400 mg/day-4 weeks) with a similar initial improvement and recurrence of the diarrhea. Intestinal Microsporidiosis seems to be a marker of advanced stages of AIDS, since 5 of our 6 infected patients were dead after a 6 month period of follow-up. The present study indicates that intestinal microsporidiosis may be a burgeoning problem in HIV-infected patients with chronic diarrhea in Brazil, which deserves further investigation.

scholarly journals A 3-YEAR FOLLOW-UP OF A BRAZILIAN AIDS PATIENT WITH PROTRACTED DIARRHEA CAUSED BY Enterocytozoon bieneusi

1998 ◽  
Vol 40 (4) ◽  
pp. 215-218 ◽  
Author(s):  
Patrícia BRASIL ◽  
Daurita D. DE PAIVA ◽  
Dirce B. DE LIMA ◽  
Edson Jurado DA SILVA ◽  
José Mauro PERALTA ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Chronic Diarrhea ◽  
Antiviral Treatment ◽  
Laboratory Diagnosis ◽  
Enterocytozoon Bieneusi ◽  
Hiv Positive ◽  
Opportunistic Pathogens ◽  
Microsporidian Parasite ◽  
The World

Enterocytozoon bieneusi is the most prevalent microsporidian parasite that causes gastrointestinal infection in persons with AIDS. Microsporidia are increasingly recognized as important opportunistic pathogens all over the world but in Brazil only few cases have been reported due either to the non awareness of the clinical presentation of the disease or to difficulties in the laboratory diagnosis. We report a 3-year follow-up of a Brazilian HIV-positive patient in whom microsporidial spores were detected in stools and were identified as E. bieneusi using electron microscopy and PCR. The patient presented with chronic diarrhea, CD4 T-lymphocytes count below 100/mm3 and microsporidial spores were consistently detected in stools. Albendazole was given to the patient in several occasions with transient relief of the diarrhea, which reappeared as soon as the drug was discontinued. Nevertheless, a diarrhea-free period with weight gain up to 18 Kg occurred when a combination of nucleoside and protease inhibitors was initiated as part of the antiviral treatment.

scholarly journals Clinical and diagnostic aspects of intestinal microsporidiosis in HIV-infected patients with chronic diarrhea in Rio de Janeiro, Brazil

2000 ◽  
Vol 42 (6) ◽  
pp. 299-304 ◽  
Author(s):  
Patrícia BRASIL ◽  
Dirce Bonfim de LIMA ◽  
Daurita Darci de PAIVA ◽  
Maria Stella de Castro LOBO ◽  
Fernando Campos SODRÉ ◽  
...  
Keyword(s):  
Rio De Janeiro ◽  
Intestinal Tract ◽  
Chronic Diarrhea ◽  
Enterocytozoon Bieneusi ◽  
Intestinal Infection ◽  
Chain Reaction ◽  
Transmission Electron ◽  
Polymerase Chain ◽  
Parasitic Pathogens ◽  
Intestinal Microsporidiosis

The objectives of this study were to determine both the prevalence of microsporidial intestinal infection and the clinical outcome of the disease in a cohort of 40 HIV-infected patients presenting with chronic diarrhea in Rio de Janeiro, Brazil. Each patient, after clinical evaluation, had stools and intestinal fragments examined for viral, bacterial and parasitic pathogens. Microsporidia were found in 11 patients (27.5%) either in stools or in duodenal or ileal biopsies. Microsporidial spores were found more frequently in stools than in biopsy fragments. Samples examined using transmission electron microscopy (n=3) or polymerase chain reaction (n=6) confirmed Enterocytozoon bieneusi as the causative agent. Microsporidia were the only potential enteric pathogens found in 5 of the 11 patients. Other pathogens were also detected in the intestinal tract of 21 patients, but diarrhea remained unexplained in 8. We concluded that microsporidial infection is frequently found in HIV infected persons in Rio de Janeiro, and it seems to be a marker of advanced stage of AIDS.

scholarly journals Treatment Outcomes and Predictive Factors for Multidrug-Resistant TB and HIV Coinfection in Rio De Janeiro State, Brazil

2020 ◽  
Author(s):  
Marcela Lopes Bhering ◽  
Raquel Duarte ◽  
Afrânio Kritski
Keyword(s):  
Treatment Outcomes ◽  
Rio De Janeiro ◽  
Protective Factor ◽  
Multidrug Resistant ◽  
Hiv Positive ◽  
Loss To Follow Up ◽  
Factors Associated ◽  
Hiv Coinfection ◽  
Mdr Tb

Abstract Background: This study aims to identify and compare factors associated with the unfavorable treatment of MDR-TB patients with HIV coinfection in the State of Rio de Janeiro (RJ), Brazil.Methods: A retrospective cohort study with data from TB-MDR patients notified between 2000 and 2016 in RJ. Clinical and epidemiological characteristics and treatment outcomes of patients with HIV positive, negative, and unknown were compared. Bivariate and multivariate Cox hazard regression analysis was conducted to identify factors associated with unfavorable treatment results in patients MDR-TB / HIV positive. Results: Of 2,269 cases, 1,999 (88.1%) had a negative result for HIV, 156 (6.9%) positive and 114 (5.0%) unknown. The proportion of unfavourable outcomes was 43.7% among HIV negative, 52.6% among HIV positive and 43.9% among HIV unknown. Regarding MDR-TB / HIV positive cases, the unfavorable outcomes more prevalent were loss to follow up (24.4%) and death (23.1%). Previous MDR-TB treatment was associated with unsuccess and death. Illicit drugs use was a risk factor for unsuccess and loss to follow up. The six-month culture conversion was a protective factor for unsuccess and death. Administration of antiretroviral therapy was a protective factor for unsuccess, death and failure. The risk of XDR-TB cases for failure was six times higher than that of MDR-TB patients. All XDR-TB / HIV positive cases had unfavorable outcomes.Conclusions: Early identification and immediate initiation of appropriate treatment are key to reducing unfavorable outcomes among MDR-TB / HIV positive. The high proportions of loss to follow-up and death may reflect difficulties in monitoring treatment, due to poor integration between the TB and HIV programs. In addition, none of XDR-TB / HIV positive patient had therapeutic success, highlighting the urgency to incorporate new drugs for the treatment of multidrug-resistant TB by Brazil's Ministry of Health.

scholarly journals Specific parameters for formation of the tuberculosis risk group among children with HIV infection in a big city

2021 ◽  
Vol 99 (2) ◽  
pp. 21-28
Author(s):  
L. F. Shamuratova ◽  
T. A. Sevostyanova ◽  
A. I. Mazus ◽  
E. V. Tsyganova ◽  
E. M. Serebryakov ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Risk Group ◽  
Hiv Positive ◽  
Migrant Population ◽  
Hiv Positive Women ◽  
Tuberculosis Prevention ◽  
Big City ◽  
Advanced Stages ◽  
Tuberculosis Risk

The objective of the study: to establish specific parameters for formation of tuberculosis risk group in HIV positive children of 0-17 years old in order to plan tuberculosis prevention activities.Subjects and methods. The main statistical rates on tuberculosis, HIV infection and their combination in children of 0-17 years old for 2009-2018 were studied. All new cases of TB/HIV co-infection were analyzed in children of 0-17 years old in Moscow for 2004-2018.Results. While the incidence of tuberculosis and HIV infection among children has been decreasing in Moscow over a 10-year period (2009-2018), the group with advanced risk to develop tuberculosis due to HIV infection is growing, both due to children born by HIV positive women (by 1.8 times), and children with confirmed HIV infection (by 2.1 times), which is partly explained by intensive migration in the big city.In the structure of the followed up of children with HIV infection, it has been established that the number and proportion of the following categories tend to grow: children above 8 years old; those at the stage of secondary diseases and advanced stages of HIV infection; and migrants from other regions.In 2004-2018, the combination of tuberculosis and HIV infection was detected most often among children aged 8-11 years (14/34; 41.2%), who had not previously been tested for HIV infection, and among people who had lived outside of Moscow before the disease was detected (16/34; 47.1%). The most severe forms of HIV/TB co-infection including fatal ones, were also observed among children from the migrant population without regular medical follow-up.

Antiretroviral Treatment-Associated Labia Majora Lipohypertrophy: A Rare Case and Plastic Surgical Treatment Options

2017 ◽  
Vol 2 (1) ◽  
pp. 43
Author(s):  
Akmal Hisham ◽  
Devananthan Ilenghoven ◽  
Wan Syazli Wan Ahmad Kamal ◽  
Salina Ibrahim ◽  
Shah Jumaat Mohd Yussof
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Daily Living ◽  
Treatment Options ◽  
Hiv Positive ◽  
Highly Active ◽  
Labia Majora ◽  
The Face ◽  
Central Fat

The emergence of highly active antiretroviral therapy (HAART) has revolutionized the prognosis of HIV-infected patients. However, the extended use of HAART is associated with a disfiguring complication termed lipodystrophy, a disorder of body fat maldistribution causing peripheral fat loss (lipoatrophy) and central fat accumulation (lipohypertrophy). Lipoatrophy commonly affects the face, legs, buttocks and arm, whilst lipohypertrophy frequently favours the abdomen, breast and dorsocervical region. To our knowledge, we present only the second documented case in the literature of a labia majora lipohypertrophy in a HIV-positive patient receiving long-term HAART. The severity of labial abnormality caused significant physical and functional morbidities. Labiaplasty with dermolipectomy of the labia majora and excisional lipectomy of the mons pubis was successfully performed. At a 6-month follow-up, patient had no recurrence with resolution of symptoms and resumption of normal activities of daily living (ADL).

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

Necrosis avascular

2020 ◽  
Vol 63 (2) ◽  
pp. 18-23
Author(s):  
Alejandro Jardón Gómez ◽  
Ana Cristina King ◽  
Carlos Pacheco Díaz
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Femoral Fracture ◽  
Open Fracture ◽  
Clinical Presentation ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Young Population ◽  
Steroid Use

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

scholarly journals When less is more: a daring conservative approach to postpneumonectomy oesophago-pleural fistula

2019 ◽  
Vol 30 (1) ◽  
pp. 146-148
Author(s):  
Lara Girelli ◽  
Elena Prisciandaro ◽  
Niccolò Filippi ◽  
Lorenzo Spaggiari
Keyword(s):  
Clinical Presentation ◽  
Clinical Status ◽  
High Morbidity ◽  
Conservative Approach ◽  
Chronic Fistula ◽  
Less Is More ◽  
Primary Surgery ◽  
History Of ◽  
Uncommon Complication

Abstract Oesophago-pleural fistula is an uncommon complication after pneumonectomy, usually related to high morbidity and mortality. Due to its rarity and heterogeneous clinical presentation, its diagnosis and management are challenging issues. Here, we report the case of a patient with a history of pneumonectomy for a tracheal tumour, who developed an asymptomatic oesophago-pleural fistula 7 years after primary surgery. In consideration of the patient’s good clinical status and after verifying the preservation of respiratory and digestive functions, a bold conservative approach was adopted. Five-year follow-up computed tomography did not disclose any sign of recurrence of disease and showed a stable, chronic fistula.

scholarly journals Present and Future of Parkinson’s Disease in Spain: PARKINSON-2030 Delphi Project

2021 ◽  
Vol 11 (8) ◽  
pp. 1027
Author(s):  
Diego Santos García ◽  
Marta Blázquez-Estrada ◽  
Matilde Calopa ◽  
Francisco Escamilla-Sevilla ◽  
Eric Freire ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
New Technologies ◽  
Management Strategies ◽  
Multidisciplinary Teams ◽  
Modified Delphi ◽  
Advanced Stages ◽  
Diagnostic Capacity ◽  
Socio Economic Impact

Parkinson’s disease (PD) is a chronic progressive and irreversible disease and the second most common neurodegenerative disease worldwide. In Spain, it affects around 120.000–150.000 individuals, and its prevalence is estimated to increase in the future. PD has a great impact on patients’ and caregivers’ lives and also entails a substantial socioeconomic burden. The aim of the present study was to examine the current situation and the 10-year PD forecast for Spain in order to optimize and design future management strategies. This study was performed using the modified Delphi method to try to obtain a consensus among a panel of movement disorders experts. According to the panel, future PD management will improve diagnostic capacity and follow-up, it will include multidisciplinary teams, and innovative treatments will be developed. The expansion of new technologies and studies on biomarkers will have an impact on future PD management, leading to more accurate diagnoses, prognoses, and individualized therapies. However, the socio-economic impact of the disease will continue to be significant by 2030, especially for patients in advanced stages. This study highlighted the unmet needs in diagnosis and treatment and how crucial it is to establish recommendations for future diagnostic and therapeutic management of PD.

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