Revista Do Instituto De Medicina Tropical De Sao Paulo最新文献

A 52-year-old female patient suffering from chronic suppurative otitis media had a bacterial strain isolated from her ear swab specimens, which could not be identified using conventional methods, but it was eventually identified as Kerstersia gyiorum via whole genome sequencing (WGS). Antimicrobial drug susceptibility testing was conducted on the isolated strain and the results demonstrated its susceptibility to a range of antimicrobial drugs, including ofloxacin, ceftriaxone, and other agents. However, resistance to chloramphenicol was observed. The patient was treated with ofloxacin, ceftriaxone, and dexamethasone, resulting in an improvement in symptoms. This report describes the first documented case of Kerstersia gyiorum causing chronic suppurative otitis media in China. WGS provided definitive species identification in which conventional methods failed, demonstrating its critical role in diagnosing atypical pathogens.

Pregnant and postpartum women are considered at increased risk for severe COVID-19. However, information about disease progression and management in this population is scarce. This study aims to describe sociodemographic, clinical, and radiological characteristics of pregnant and postpartum women admitted to intensive care due to severe COVID-19, emphasizing respiratory outcomes. This is a retrospective, descriptive cohort study evaluating consecutive admissions of pregnant and postpartum women to an infectious diseases intensive care unit due to confirmed or suspected COVID-19, from May 2020 to June 2022. Numerical variables were described by median and interquartile range (IQR), and categorical variables, by frequency and percentage. Missing data were excluded from the analysis. A total of 101 admissions were recorded (85 pregnant and 16 postpartum women), with most patients in their second or third trimester. Forty-seven women (46.5%) required invasive mechanical ventilation (IMV), most of whom (62.1%) showed at least 50% of lung involvement on CT scans and requiring neuromuscular blocking agents (89.1%). Lethality was 15.8% in the cohort and 34.0% among women who required IMV. Pregnant and postpartum women are at risk of developing severe COVID-19, with high mortality and need for IMV and neuromuscular blocking. They should be prioritized in public health policies addressing COVID-19.

Brucellosis is a zoonotic disease caused by Brucella species In pregnant women, this disease may lead to adverse obstetric outcomes, such as abortion, preterm delivery, intrauterine fetal death (IUFD), and congenital brucellosis. However, only a few studies have reported IUFD due to Brucella. In our case, one woman residing in Guangxi Province, China-a non-endemic region-developed symptoms 11 months after exposure. The disease manifested during her pregnancy-Brucella melitensis was identified via blood culture and confirmed by MALDI-TOF mass spectrometry. Despite receiving antibiotic treatment for brucellosis, she subsequently experienced IUFD. Additionally, we reviewed cases of IUFD secondary to brucellosis in the literature published until December 2024. Only three cases from the literature were enrolled in this study, which demonstrates that Brucella-related IUFD can occur in non-endemic zones, underscoring the need for increased clinical awareness.

Guaramiranga, Ceara State, Brazil, a tourist city 105.5 km from the capital Fortaleza, was a pilot site for vaccinating 100% of its 4,002 adult population with the first dose against COVID-19. The city received 3,328 CoronaVac, 1,685 AstraZeneca, and 174 Pfizer-BioNTech doses (5,187 in total). Vaccination with the first dose occurred from January 20, 2021 to April 1, 2022. This study analyzed hospitalized patients' epidemiological, clinical, and laboratory characteristics and deaths from COVID-19 in Guaramiranga from March 2020 to December 2022. In total, nine cases required hospitalization, seven of which resulted in death. Patients' median age at death equaled 87 (64-95) years. Only one was male, and five had incomplete vaccination schedules before their hospitalization. Hypertension and diabetes configured the most frequent comorbidities, whereas common symptoms at admission included fever (four cases), cough (four cases), and dyspnea (five cases). Of these nine patients, 4 received anticoagulants and corticosteroids; 6, oxygen supplementation; 2, oseltamivir; and 3, empirical antibiotic for pneumonia. The mean interval between the last vaccine dose and hospitalization totaled 128 days (28-326; SD 137). These findings highlight incomplete vaccination, a prolonged interval since last doses, comorbidities, and advanced age as key factors associated with severe cases and deaths and emphasize the protective role of high vaccination coverage.

Behçet's disease (BD) is a chronic and multisystem disorder characterized by recurrent oral and genital ulcers, along with ocular, cutaneous, vascular, gastrointestinal, and neurologic manifestations. The etiology is thought to involve an autoimmune response triggered by infectious or environmental factors in genetically predisposed individuals. Mycobacterium tuberculosis has been proposed as a potential trigger for BD, although this association remains rarely reported. We show a compelling case of a patient with BD diagnostic criteria who subsequently developed mediastinal tuberculous lymphadenitis, which was initially suspected as disease activity. This case underscores the importance of considering tuberculosis in BD patients with new or worsening symptoms despite appropriate therapy.

Visceral leishmaniasis (VL) is a potentially fatal disease, occurring in 76 countries, 12 of which are located in the Americas, with approximately 3,500 new cases annually registered in Brazil. Active visceral leishmaniasis is characterized by an intense inflammatory reaction with a low cell-mediated immune response and a high production of specific and non-specific antibodies. Antibodies are not associated with effective protective mechanisms but have been used widely in diagnostic tests. In this study, we analyzed the immunoglobulin G (IgG) response against crude antigens of Leishmania infantum by using automated western capillary blot in patients with active and clinically cured VL, individuals residing in an endemic area and patients with Chagas disease. The method allowed an accurate analysis of the antibody response. Our results demonstrated that antibody reactivity to L. infantum antigens in the 20-142 kDa range effectively distinguished active VL from clinically cured cases and Chagas disease, although these antigens were not exclusively recognized by patients with active VL. The automated western capillary blot proved to be a useful tool for differentiating patients with active VL from individuals living in endemic areas and those with Chagas disease, highlighting its potential application in serological diagnostics.

Currently, at least 22 species of Bartonella are known to cause diseases in humans, with Bartonella henselae being the main one. Among the clinical manifestations associated with bartonellosis, cutaneous vasculitis is rare, but it can be severe. We report the case of a 9-year-old child who presented with cervical lymphadenopathy, arthritis, epididymitis, and cutaneous vasculitis as clinical manifestations of systemic bartonellosis, with positive detection of B. henselae in blood and skin fragment using species-specific conventional polymerase chain reaction (PCR) techniques. Vasculitis caused by Bartonella spp. occurs due to the endothelial tropism of the bacteria and can mimic systemic vasculitis with positive anti-neutrophil cytoplasmic antibodies (ANCA). Furthermore, we found just one previous report about epididymitis related to B. henselae infection, and arthritis is also considered an unusual manifestation of the infection. This case emphasizes the need to consider bartonellosis among differential diagnoses when faced with presentations of purpura, cutaneous vasculitis, arthritis, or epididymitis.

Candidemia poses a significant challenge for hospitalized neonates with an increase in morbidity and mortality. However, candidemia caused by Candida haemulonii in newborns is rare but fatal. We report such a case in China and performed a literature review. A neonate with a gestational age of 31+6 weeks and a birth weight of 1,420g was diagnosed with C. haemulonii candidemia. The infectious agent was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and sequencing of the internal transcribed spacer region. The in vitro antifungal susceptibility testing indicated high minimal inhibitory concentrations for fluconazole (>128 µg/mL), voriconazole (>8 μg/mL), and amphotericin B (>4 µg/mL). Fortunately, the newborn was successfully treated with fluconazole. After a literature review of C. haemulonii candidemia, we found that the risk factors of the candidemia might involve premature, low birth weight, invasive therapeutic devices, broad-spectrum antimicrobial agents, and parenteral nutrition infusion. This study will broaden our knowledge on neonatal candidemia caused by C. haemulonii.

Paracoccidioidomycosis (PCM) configures a deep mycosis caused by Paracoccidioides spp., a neglected tropical disease. We describe a fatal case of PCM that manifested itself as osteomyelitis with thrombosis in the iliac artery in a man with frequent contact with an endemic region in Sao Paulo, Brazil. A 67-year-old man living in an endemic area presented with osteomyelitis of the femur and iliac artery thrombosis on admission to the hospital. Computed tomography of the chest showed multiple cavitated pulmonary nodules. The patient rapidly progressed to irreversible respiratory failure. The autopsy showed disseminated PCM and iliac artery thrombosis. Laboratory investigation confirmed P. brasiliensis infection with a strain identified in Sao Paulo as P. brasiliensis complex by phylogenetic analysis. Atypical PCM remains a diagnostic challenge. Increased awareness of the sites of infection and its clinical presentations will improve patient management.

This study aimed to investigate the relationship between inflammatory factors, pathogen distribution, and prognosis in patients with septic shock admitted to the emergency department of internal medicine. A total of 140 patients with septic shock admitted to the emergency department of The Third People's Hospital of Chengdu, China, from January 2021 to January 2023 were selected for analysis of the distribution of pathogens and infection sites. Patients were divided into death (36 cases) and survival groups (104 cases) based on their condition after 28 days of treatment. A total of 174 pathogenic bacteria strains were cultured, including 124 Gram-negative bacteria (71.26%) and 43 Gram-positive bacteria (24.71%). The main infection sites were the lungs (33.57%) and the abdominal and gastrointestinal tracts (25.00%). The distribution of pathogens and infection sites in the survival and death groups were compared (P > 0.05). The regression equation predicted patient mortality, with the area under the ROC curve of 0.860 (95% CI: 0.792-0.929; P < 0.05), and sensitivity and specificity of 88.90% and 73.10%, respectively. Pathogen distribution in patients with septic shock in the internal medicine emergency department was not related to prognosis; however, inflammatory factors such as CRP and PCT were predictive of outcomes. Along with age, APACHE II score, and SOFA score, they demonstrated significant prognostic value for patient mortality.