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Abstract Chronic hepatitis B is an important health problem that can progress to cirrhosis and complications such as hepatocellular carcinoma. There is approximately 290 million of people with chronic hepatitis B virus (HBV) infection worldwide, however only 10% of patients are currently identified.Most part of Brazil is considered of low prevalence of HBV infection but there are some regions with higher frequency of carriers. Unfortunately, many infected patients are not yet identified nor evaluated for treatment.The Brazilian Society of Infectious Diseases (SBI) and the Brazilian Society of Hepatology worked together to elaborate a guideline for diagnosis and treatment of hepatitis B. The document includes information regarding the population to be tested, diagnostic tools, indications of treatment, therapeutic schemes and also how to handle HBV infection in specific situations (pregnancy, children, immunosuppression, etc).Delta infection is also part of the guideline, since it is an important infection in some parts of the country.

https://doi.org/10.1016/j.bjid.2020.07.012 744 downloads

II Consenso Brasileiro em Paracoccidioidomicose - 2017
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Shikanai-Yasuda, Maria Aparecida

; Mendes, Rinaldo Pôncio

; Colombo, Arnaldo Lopes

; Telles, Flávio de Queiroz

; Kono, Adriana

; Paniago, Anamaria Mello Miranda

; Nathan, André

; Valle, Antonio Carlos Francisconi do

; Bagagli, Eduardo

; Benard, Gil

; Ferreira, Marcelo Simão

; Teixeira, Marcus de Melo

; Vergara, Mario Leon Silva

; Pereira, Ricardo Mendes

; Cavalcante, Ricardo de Souza

; Hahn, Rosane

; Durlacher, Rui Rafael

; Khoury, Zarifa

; Camargo, Zoilo Pires de

; Moretti, Maria Luiza

; Martinez, Roberto

Epidemiologia e Serviços de Saúde

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2018, Volume 27 N. spe elocation e0500001

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Resumo A paracoccidioidomicose (PCM) é uma micose sistêmica, relacionada às atividades agrícolas, com incidência e prevalência subestimadas, pela ausência de notificação em várias Unidades da Federação (UFs). A evolução insidiosa do quadro clínico pode ter como consequência sequelas graves se o diagnóstico e o tratamento não forem instituídos precoce e adequadamente. Ao lado do complexo Paracoccidioides brasiliensis (P. brasiliensis), a descrição de nova espécie, Paracoccidioides lutzii (P. lutzii), em Rondônia, onde a doença alcançou níveis epidêmicos, bem como na região Centro-Oeste e no Pará, constituem-se em desafios para a instituição do diagnóstico e a urgente disponibilização de antígenos que tenham reatividade com os soros dos pacientes. Este consenso visa atualizar o primeiro consenso brasileiro em PCM, estabelecendo recomendações para o manejo clínico do paciente, com base nas evidências conhecidas. São apresentados dados de etiologia, epidemiologia, imunopatogenia, diagnóstico, terapêutica e sequelas, enfatizando-se o diagnóstico e a terapêutica, bem como recomendações e desafios atuais nessa área do conhecimento.

Abstract Paracoccidioidomycosis is a systemic fungal disease associated with agricultural activities. Its incidence and prevalence are underestimated because of the lack of reporting in several Brazilian states. If paracoccidiodomycosis is not diagnosed and treated early and adequately, endemic fungal infection may result in serious sequelae. In addition to the Paracoccidioides brasiliensis (P. brasiliensis) complex, the appearance of a new species, Paracoccidioides lutzii (P. lutzii), in Rondônia state, where the disease has reached epidemic levels, and in the country’s Midwest region and Pará state, are challenges to diagnosis and to the urgent availability of antigens that are reactive with patients’ sera. These guidelines aim to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. The guidelines provide data on etiology, epidemiology, immunopathogenesis, diagnosis, treatment and sequelae, with emphasis on diagnosis and treatment, as well as current recommendations and challenges in this field of knowledge.

Resumen La paracoccidioidomicosis es una micosis sistémica, relacionada con las actividades agrícolas, con incidencia y prevalencia subestimadas por la ausencia de notificación en varios estados. La evolución insidiosa del cuadro clínico puede tener como consecuencia secuelas graves si el diagnóstico y el tratamiento no se establecen precoz y adecuadamente. Al lado del complejo Paracoccidioides brasiliensis (P. brasiliensis), la descripción de nueva especie, Paracoccidioides lutzii (P. lutzii) en Rondonia, donde la enfermedad alcanzó niveles epidémicos, y en la región Centro Oeste y en Pará, se constituyen en desafíos para la institución del diagnóstico y la urgente puesta a disposición de antígenos que tengan reactividad con los sueros de los pacientes. El presente consenso tiene por objeto actualizar el primer consenso brasileño en paracoccidioidomicosis, estableciendo recomendaciones para el manejo del paciente al borde del lecho, con base en las evidencias conocidas. Se presentan datos de etiología, epidemiología, inmunopatogenia, diagnóstico, terapéutica y secuelas, enfatizando el diagnóstico y terapéutica, así como recomendaciones desafíos y actuales en esta área del conocimiento.

https://doi.org/10.5123/s1679-49742018000500001 42486 downloads

II Consenso Brasileiro em Paracoccidioidomicose - 2017
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Shikanai-Yasuda, Maria Aparecida

; Mendes, Rinaldo Pôncio

; Colombo, Arnaldo Lopes

; Telles, Flávio de Queiroz

; Kono, Adriana

; Paniago, Anamaria Mello Miranda

; Nathan, André

; Valle, Antonio Carlos Francisconi do

; Bagagli, Eduardo

; Benard, Gil

; Ferreira, Marcelo Simão

; Teixeira, Marcus de Melo

; Vergara, Mario Leon Silva

; Pereira, Ricardo Mendes

; Cavalcante, Ricardo de Souza

; Hahn, Rosane

; Durlacher, Rui Rafael

; Khoury, Zarifa

; Camargo, Zoilo Pires de

; Moretti, Maria Luiza

; Martinez, Roberto

Epidemiologia e Serviços de Saúde

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2018, Volume 27 N. spe elocation e0500001

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.5123/s1679-49742018000500001 29 downloads

Brazilian guidelines for the clinical management of paracoccidioidomycosis
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Shikanai-Yasuda, Maria Aparecida

; Mendes, Rinaldo Pôncio

; Colombo, Arnaldo Lopes

; Queiroz-Telles, Flávio de

; Kono, Adriana Satie Gonçalves

; Paniago, Anamaria M. M

; Nathan, André

; Valle, Antonio Carlos Francisconi do

; Bagagli, Eduardo

; Benard, Gil

; Ferreira, Marcelo Simão

; Teixeira, Marcus de Melo

; Silva-Vergara, Mario León

; Pereira, Ricardo Mendes

; Cavalcante, Ricardo de Souza

; Hahn, Rosane

; Durlacher, Rui Rafael

; Khoury, Zarifa

; Camargo, Zoilo Pires de

; Moretti, Maria Luiza

; Martinez, Roberto

Revista da Sociedade Brasileira de Medicina Tropical

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sep 2017, Volume 50 N. 5 Pages 715 - 740

Abstract: En | Text: En | PDF: En

Abstract Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America that is associated with rural environments and agricultural activities. However, the incidence and prevalence of paracoccidiodomycosis is underestimated because of the lack of compulsory notification. If paracoccidiodomycosis is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. While the Paracoccidioides brasiliensis ( P. brasiliensis ) complex has been known to be the causal agent of paracoccidiodomycosis, a new species, Paracoccidioides lutzii ( P. lutzii ), has been reported in Rondônia, where the disease has reached epidemic levels, and in the Central West and Pará. Accurate diagnoses and availability of antigens that are reactive with the patients’ sera remain significant challenges. Therefore, the present guidelines aims to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. This consensus summarizes etiological, ecoepidemiological, molecular epidemiological, and immunopathological data, with emphasis on clinical, microbiological, and serological diagnosis and management of clinical forms and sequelae, as well as in patients with comorbidities and immunosuppression. The consensus also includes discussion of outpatient treatments, severe disease forms, disease prevalence among special populations and resource-poor settings, a brief review of prevention and control measures, current challenges and recommendations.

https://doi.org/10.1590/0037-8682-0230-2017 10753 downloads

Histoplasmose
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Ferreira, Marcelo Simão

; Borges, Aércio Sebastião

Revista da Sociedade Brasileira de Medicina Tropical

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apr 2009, Volume 42 N. 2 Pages 192 - 198

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A histoplasmose é uma micose causada por fungo dimórfico, o Histoplasma capsulatum. É considerada classicamente uma micose endêmica, embora o fungo tenha um comportamento oportunístico em pacientes com depressão da imunidade celular. O homem adquire a infecção através da inalação de conídeos presentes na natureza (cavernas com morcegos, galinheiros, etc). O quadro clínico pode variar, desde infecções assintomáticas até quadros graves disseminados, que acometem pacientes com Aids, transplantados ou com neoplasias hematológicas. O diagnóstico baseia-se no encontro do fungo em fluidos orgânicos (escarro, sangue, líquor) ou tecidos (histopatologia), na cultura de materiais biológicos e na sorologia. O tratamento das formas agudas graves, respiratória crônica ou de formas localizadas pode ser feito com azólicos orais (itraconazol) e nas disseminadas, a Anfotericina B (preferencialmente as formulações lipídicas) constitui a droga da eleição para iniciar a terapia. A histoplasmose representa, hoje uma das micoses sistêmicas mais importantes nas Américas, com ampla distribuição em todas as regiões do Brasil.

Histoplasmosis is a fungal infection caused by the dimorphic fungus Histoplasma capsulatum. It is classically considered an endemic mycosis, even though the fungus has an opportunistic behavior in immunocompromised patients. People acquired the infection through the inhalation of conidial forms present in the environmental, such as caves dwelling bats and soils inhabited by chickens. The clinical features may vary from asymptomatic infections to disseminated severe forms that affect patients with acquired immunodeficiency syndrome or hematological malignancies and allograft recipients. The diagnosis is based on the detection of the fungus in organic fluids (sputum, blood, liquor) or tissues (histopathological assays), in the culture of biological samples and serological assays. The treatment of severe chronic respiratory acute or localized forms can be performed with oral azolic (itraconazol) and in the disseminated forms, the amphotericin B (preferentially the lipidic formulations) consists in the elected drug to initiate the therapy. Nowadays, histoplasmosis represents one of the most important systemic mycosis in the Americas, with broad distribution in all regions of Brazil.

208022 downloads Cited 28 times in SciELO

Malaria outbreaks in a non-endemic area of Brazil, 2005
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Limongi, Jean Ezequiel

; Chaves, Kátia Maria

; Paula, Márcia Beatriz Cardoso de

; Costa, Fabíola Corrêa da

; Silva, Alcides de Assis e

; Lopes, Íris de Sousa

; Pajuaba Neto, Adalberto de Albuquerque

; Sales, José Maria

; Rodrigues, Fernando

; Resende, Maria Angélica Montes

; Ferreira, Marcelo Simão

Revista da Sociedade Brasileira de Medicina Tropical

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jun 2008, Volume 41 N. 3 Pages 232 - 237

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Em março de 2005, um morador do município de Monte Alegre de Minas, Estado de Minas Gerais, sem histórico de viagem para área endêmica de malária foi diagnosticado com infecção por Plasmodium vivax e a transmissão vetorial no local foi suspeitada. A investigação epidemiológica identificou outros 10 casos com transmissão local e todos relacionados ao caso de malária importada detectado na região. A área de potencial exposição foi às margens do rio Tejuco, local freqüentado por garimpeiros, muitos sabidamente, oriundos de estados com transmissão de malária. Nos casos autóctones, Plasmodium vivax e Plasmodium falciparum foram diagnosticados. A investigação entomológica identificou Anopheles (Nyssorhynchus) darlingi, Anopheles (Nyssorhynchus) albitarsis, Anopheles (Nyssorhynchus) triannulatus e Anopheles (Nyssorhynchus) parvus. Após o primeiro surto, outros três casos autóctones foram notificados no município de Monte Alegre de Minas no mesmo ano. A ocorrência desses surtos alerta sobre a importância de sistemas de vigilância em áreas não endêmicas para a malária.

In March 2005, a resident of the municipality of Monte Alegre de Minas, State of Minas Gerais, without any history of traveling to endemic areas for malaria, was diagnosed with Plasmodium vivax infection and local mosquito-borne transmission was suspected. The epidemiological investigation identified another 10 cases with local transmission and all of them were related to the imported malaria case that was detected in this region. The potential exposure site was the banks of the river Tejuco, an area frequented by mineral prospectors. Some of these prospectors were known to have come from states with malaria transmission. In the autochthonous cases, Plasmodium vivax and Plasmodium falciparum were diagnosed. Entomological investigation identified Anopheles (Nyssorhynchus) darlingi, Anopheles (Nyssorhynchus) albitarsis, Anopheles (Nyssorhynchus) triannulatus and Anopheles (Nyssorhynchus) parvus. After the first outbreak, another three autochthonous cases were notified in municipality of Monte Alegre de Minas, in the same year. The occurrence of these outbreaks highlights the importance of surveillance systems in areas that are nonendemic for malaria.

3027 downloads Cited 5 times in SciELO

Paracoccidioidomicose no Hospital Universitário de Brasília
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Campos, Maria Vitoria Silva

; Penna, Gerson Oliveira

; Castro, Cleudson Nery de

; Moraes, Mario Augusto Pinto de

; Ferreira, Marcelo Simão

; Santos, João Barberino

Revista da Sociedade Brasileira de Medicina Tropical

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apr 2008, Volume 41 N. 2 Pages 169 - 172

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Foram estudados 76 pacientes com paracoccidioidomicose, assistidos no Hospital Universitário de Brasília, entre 1984 e 2005. O gênero masculino representou 82,9% e a média de idade foi 42 anos. Atividades agropecuárias caracterizaram 54,9% dos pacientes. Entre pacientes com a forma crônica, 87% eram tabagistas e 55,3% etilistas. Em 71 pacientes sem co-infecção por HIV/aids: a) houve recidiva da paracoccidioidomicose em 21 (29,6%); b) a forma crônica ou mista acometeu 77,5% dos pacientes, com predominância de comprometimento orofaríngeo (70,9%) e pulmonar (67,3%), além de lesões linfonodais (29,8%), laríngeas (27,3%) e cutâneas (16,4%); c) na forma aguda/subaguda, predominou o comprometimento linfonodal (81,3%), seguido por lesões cutâneas (43,8%), resultando doença grave em 62,5% e moderada em 37,5%. Cinco pacientes tinham co-infecção por HIV/aids, dos quais três tiveram a infecção fúngica disseminada associada a acentuada imunodepressão.

Seventy-six paracoccidioidomycosis patients attended at the university hospital of Brasília from 1984 to 2005 were studied. 82.9% were male and the mean age was 42 years. 54.9% of the patients were engaged in farming activities. Among the patients with the chronic form, 87% were smokers and 55.3% consumed alcohol. Among 71 patients without HIV/AIDS coinfection: a) paracoccidioidomycosis was recurrent in 21 (29.6%); b) the chronic or mixed form affected 77.5% of patients, predominantly in the oropharynx (70.9%) and lungs (67.3%), with lymph node lesions in 29.8%, laryngeal lesions in 27.3% and cutaneous lesions in 16.4%; c) in the acute/subacute form, lymph node lesions predominated (81.3%), followed by cutaneous lesions in 43.8%, which resulted in severe disease in 62.5% and moderate disease in 37.5%. Five patients had HIV/AIDS coinfection and three of them presented disseminated fungal infection together with marked immunosuppression.

3686 downloads

Serological reactivity of different antigenic preparations of Leishmania (Leishmania) amazonensis and the Leishmania braziliensis complex
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Gomes-Silva, Adriano

; Souza, Maria Aparecida

; Afonso-Cardoso, Sandra Regina

; Andrade, Lívia Resende

; Dietze, Reynaldo

; Lemos, Elenice

; Belli, Alejandro

; Favoreto Júnior, Silvio

; Ferreira, Marcelo Simão

Revista da Sociedade Brasileira de Medicina Tropical

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apr 2008, Volume 41 N. 2 Pages 135 - 141

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Antígeno total de Leishmania (Leishmania) amazonensis e isolado do complexo Leishmania brazilienis, assim como suas respectivas frações antigênicas obtidas por cromatografia de afinidade em coluna de concanavalina-A ligada a sepharose e Jacalina ligada a agarose foram avaliadas por ensaio imunoenzimático ELISA. Para tanto, foram utilizadas amostras de soros de 229 pacientes agrupadas em leishmaniose tegumentar americana (nº=58), leishmaniose visceral (nº=28), doença de Chagas (nº=49), malaria (nº=32), tuberculose (nº=13) e voluntários saudáveis (nº=49). Houve maior reatividade das amostras de leishmaniose tegumentar americana com a utilização dos antígenos obtidos do isolado do complexo Leishmania braziliensis quando comparado com antígenos de Leishmania amazonensis (p<0,001). Observou-se ainda que a sensibilidade do teste ELISA variou de 60 a 95% entre os antígenos obtidos do isolado do complexo Leishmania braziliensis. Houve acentuada reatividade inespecífica das amostras de soros com a utilização das frações antigênicas ligantes de Concanavalina-A e Jacalina de ambos os complexos Leishmania em comparação aos demais antígenos (p<0,001). Os resultados apresentados no presente trabalho sugerem que a utilização de antígenos homólogos aumentam a eficiência de detecção de imunoglobulina anti-Leishmania o que pode ser de grande valia para o propósito de diagnóstico.

Total antigen from Leishmania (Leishmania) amazonensis and isolates from the Leishmania braziliensis complex, along with their respective antigenic fractions obtained by affinity chromatography on concanavalin-A-Sepharose and jacalin-agarose columns evaluated using immunoenzymatic ELISA assay. For this, serum samples from 229 patients were used, grouped as American tegmental leishmaniasis (nº=58), visceral leishmaniasis (nº=28), Chagas disease (nº=49), malaria (nº=32), tuberculosis (nº=13) and healthy volunteers (nº=49). Samples from American tegmentary leishmaniasis showed higher reactivity with antigens isolated from the Leishmania braziliensis complex than with antigens from Leishmania amazonensis (p<0.001). ELISA assays showed a sensitivity range from 60% to 95% with antigens isolated from the Leishmania braziliensis complex. There was marked nonspecific reactivity among serum samples with the use of antigenic fractions binding with concanavalin-A and jacalin from both Leishmania complexes, in comparison with other antigens (p<0.001). The results presented in this study suggest that the use of homologous antigens increases the efficiency of anti-Leishmania immunoglobulin detection, which may be very valuable for diagnostic purposes.

3039 downloads Cited 1 time in SciELO

Consensus of the Brazilian Society of Infectious Diseases on the management and treatment of hepatitis C
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Araújo, Evaldo Stanislau Affonso de

; Mendonça, João Silva

; Barone, Antonio Alci

; Gonçales Junior, Fernando Lopes

; Ferreira, Marcelo Simão

; Focaccia, Roberto

; Pawlotsky, Jean-Michel

Brazilian Journal of Infectious Diseases

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oct 2007, Volume 11 Suppl. 1 Pages 1 - 5

Abstract: En | Text: En | PDF: En

1519 downloads

10.

Treatment of chronic hepatitis C in treatment-naïve patients
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Ferreira, Marcelo Simão

Brazilian Journal of Infectious Diseases

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oct 2007, Volume 11 Suppl. 1 Pages 45 - 49

Abstract: En | Text: En | PDF: En

2609 downloads Cited 1 time in SciELO

11.

Consensus of the Brazilian Society of Infectious Diseases on the management and treatment of hepatitis C
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Araújo, Evaldo Stanislau Affonso de

; Mendonça, João Silva

; Barone, Antonio Alci

; Gonçales Junior, Fernando Lopes

; Ferreira, Marcelo Simão

; Focaccia, Roberto

; Pawlotsky, Jean-Michel

Brazilian Journal of Infectious Diseases

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oct 2007, Volume 11 N. 5 Pages 446 - 450

Abstract: En | Text: En | PDF: En

1789 downloads

12.

Taenia solium metacestode immunodominant peptides recognized by IgG antibodies in cerebrospinal fluid and serum paired samples from patients with active and inactive neurocysticercosis
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Barcelos, Ivanildes Solange da Costa

; Moura, Leandro Pajuaba de

; Costa, Vinicius Paulino da

; Ferreira, Marcelo Simão

; Costa-Cruz, Julia Maria

Memórias do Instituto Oswaldo Cruz

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sep 2007, Volume 102 N. 6 Pages 713 - 717

Abstract: En | Text: En | PDF: En

The aim of this study was to test if serological distinction between patients with active and inactive neurocysticercosis (NCC), could be accomplished by the recognition of immunodominant peptides in total saline antigenic extract of Taenia solium metacestodes by IgG antibody in cerebrospinal fluid (CSF) and serum paired samples. CSF and serum samples of 10 each, active NCC patients, inactive NCC, and individuals with other neurological disorders, were used to recognize the antigenic peptides by western blot (WB). In the active NCC the 28-32 and 39-42 kDa peptides were more frequently detected in CSF than in sera (p < 0.05). The 47-52, 64-68, and 70 kDa antigens showed high frequencies in both samples from patients with active NCC. All the CSF samples of inactive NCC and other neurological disorder (control) patients tested negative, while serum samples from these last two groups recognized mainly the 80, 86, 95, and 98 kDa bands. This finding eliminates the use of the high molecular weigh bands (> 80 kDa) for diagnosis of NCC. The final conclusions were that the difference between active and inactive NCC may be done with the detection of peptides only in the CSF samples and that the 47-52, 64-68, and 70 kDa bands may be included as specific markers for active NCC when detected in CSF samples by WB using total saline extract of T. solium metacestode.

2026 downloads Cited 1 time in SciELO

13.

Avanços no tratamento da hepatite pelo vírus B
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Ferreira, Marcelo Simão

; Borges, Aércio Sebastião

Revista da Sociedade Brasileira de Medicina Tropical

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aug 2007, Volume 40 N. 4 Pages 451 - 462

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Nos últimos anos, houve um grande progresso no tratamento da hepatite B crônica. Cinco drogas são hoje aprovadas para tratamento dessa virose: intérferon alfa, lamivudina, adefovir, entecavir e telbivudina. Os intérferons (convencionais ou peguilados) foram as primeiras drogas utilizadas no tratamento dessas infecções podendo levar a resposta sustentada (perda do DNA-VHB e do AgHbe) em até um terço dos casos tratados. Um grande número de análogos de nucleosídeos/nucleotídeos estão no momento, disponíveis para tratar a hepatite B; a eficácia da lamivudina, o primeiro análogo de nucleosídeo utilizado, é limitada pela elevada incidência de resistência. O adefovir tem eficácia comparável à lamivudina porém baixa freqüência de resistência. Entecavir e tenofovir também se mostram muito ativos em controlar a replicação do vírus da hepatite B, e estão associados com mínimo desenvolvimento de resistência, mesmo em tratamento prolongados. Outras drogas, tais como telbivudina, emtricitabina e clevudine, se tornarão em futuro próximo, novas armas no controle dessa virose. Co-infectados HIV/VHB representam um grupo de doentes de difícil manuseio e que hoje se beneficiam com combinações de drogas no esquema anti-retroviral potente que devem atuar em ambas as viroses. O desenvolvimento de antivirais mais potentes e novas associações de medicamentos, conjuntamente com a melhor compreensão dos mecanismos de resistência do vírus da hepatite B a terapia são importantes conquistas para melhorar a eficácia do tratamento e diminuir no futuro, a carga global de portadores do vírus da hepatite B.

Over the last years there has been considerable progress in the treatment of chronic hepatitis B. Five drugs are now approved for the treatment of this virosis: interferon alpha, lamivudine, adefovir, entecavir and telbivudine. Interferons (conventional or PEG) were the first medicine used in the treatment of hepatitis being able to lead the persistent response (loss of DNA-HBV and of AgHbe) to up to one third of treated cases. A large number of nucleoside/nucleotide analogues are, at present, available to treat hepatitis B. The efficacy of lamivudine, the first nucleoside analogue used, is limited by the high rate of resistance. Adefovir has efficacy comparable to that of lamivudine, but with low resistance rate. Entecavir and tenofovir have also been particularly active in the control of hepatitis B virus replication and are associated with minimal resistance development, even during long treatment regimens. Other drugs, such as telbivudine, emtricitabine and clevudine, will become new treatment options in the near future. Individuals co-infected with HIV/HBV are particularly difficult to manage and are nowadays able to benefit from combinations of drugs of the HAART therapy, which should be effective towards both viruses. The development of more potent antiviral drugs as well as new drug combinations, together with a better understanding of hepatitis B virus resistance mechanisms are important milestones to improve treatment efficacy and to diminish, in the future, the global burden of hepatitis B virus.

31775 downloads Cited 2 times in SciELO

14.

Síndrome cardiopulmonar por hantavírus no Triângulo Mineiro e Alto Paranaíba, Minas Gerais, 1998-2005: aspectos clínico-epidemiológicos de 23 casos
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Limongi, Jean Ezequiel

; Costa, Fabíola Corrêa da

; Paula, Márcia Beatriz Cardoso de

; Pinto, Rogério de Melo Costa

; Oliveira, Maria de Lourdes Aguiar

; Pajuaba Neto, Adalberto de Albuquerque

; Borges, Aércio Sebastião

; Ferreira, Marcelo Simão

Revista da Sociedade Brasileira de Medicina Tropical

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jun 2007, Volume 40 N. 3 Pages 295 - 299

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Foram analisados os achados epidemiológicos, clínicos, laboratoriais e terapêuticos de 23 casos de síndrome cardiopulmonar por hantavírus, identificados sorologicamente ou por imunohistoquímica em hospitais do município de Uberlândia, Minas Gerais. Febre (100%), dispnéia (100%) e mialgias (78%) foram os sintomas mais frequentemente observados nesta casuística. Os sinais físicos mais prevalentes foram hipotensão (65%) e taquicardia (65%). Achados laboratoriais mais comuns incluíram trombocitopenia (96%), hemoconcentração (83%) e leucocitose (74%). Valores anormais de enzimas hepáticas foram encontrados em todos os pacientes testados e alterações em radiografias de tórax foram muito (95,6%) freqüentes. Em 55,5% dos pacientes, foi necessário intubação orotraqueal e suporte hemodinâmico. O presente estudo confirmou o padrão sazonal da síndrome cardiopulmonar por hantavírus na região de Uberlândia e o envolvimento, no ciclo de transmissão da doença, de grupos profissionais considerados de baixo risco de infecção. A alta (39%) taxa de letalidade e a gravidade da doença observadas neste estudo podem estar associadas ao atendimento tardio dos pacientes.

The epidemiological, clinical, laboratory and treatment findings from 23 cases of hantavirus cardiopulmonary syndrome were analyzed. These cases were identified either serologically or immunohistochemically in hospitals in the municipality of Uberlândia, State of Minas Gerais. Fever (100%), dyspnea (100%) and myalgia (78%) were the symptoms most frequently observed in this sample. The most prevalent physical signs were hypotension (65%) and tachycardia (65%). The most common laboratory findings included thrombocytopenia (96%), hemoconcentration (83%) and leukocytosis (74%). Abnormal values for liver enzymes were found in all the patients tested and abnormalities in chest radiography were very frequent (95.6%). In 55.5% of the patients, orotracheal intubation and hemodynamic support were required. The present study confirmed the seasonal pattern of hantavirus cardiopulmonary syndrome in the Uberlândia region and the involvement of professional groups who are considered to be at low risk of infection, in the transmission cycle of the disease. The high lethality rate (39%) and the severity of the disease observed in this study may be related to attending to these patients at a late stage.

3168 downloads Cited 4 times in SciELO

15.

Abdominal wall protrusion following herpes zoster
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Ruiz Junior, Facundo Burgos

; Shinosaki, Jullyanna Sabrysna Morais

; Marques Junior, Wilson

; Ferreira, Marcelo Simão

Revista da Sociedade Brasileira de Medicina Tropical

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apr 2007, Volume 40 N. 2 Pages 234 - 235

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Apresenta-se caso de uma paciente de 62 anos com paresia abdominal segmentar, confirmada por eletroneuromiografia, conseqüente a uma radiculopatia devida a zoster. A paresia resolveu-se completamente em três meses. O reconhecimento desta complicação do zoster, passível de confusão com hérnia abdominal, é importante para o diagnóstico desta condição auto-limitada, sem a utilização de procedimentos desnecessários.

We present the case of a 62-year-old woman with abdominal segmental paresis consequent to radiculopathy caused by zoster, which was confirmed by electroneuromyography. The paresis resolved completely within three months. Recognition of this complication caused by zoster, which is easily misdiagnosed as abdominal herniation, is important for diagnosing this self-limited condition and avoiding unnecessary procedures.

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