Foram colhidos 1815 líquidos cefalorraquidianôs de doentes internados com meningite, no Hospital Emílio Ribas, São Paulo, durante os meses de maio a outubro de 1989. Neisseria meningitidis 56%, dos quais 44% do tipo B; Haemophilus influenzae 17%, sendo 72 % isoladas de neonatos até 3 anos; Streptococcus pneumoniae 14%, dos quais 60% isolados de recém nascidos a 1 ano de idade. O estudo citoquímico liquórico mostrou: celularidade: global > 500cel/mm³ e específica > 70%; proteínas > 90mg/dl e glicose < 45mg/dl em 90% e celularidade < 500cel/mm³ entre 2 a 6% nos três tipos de meningites avaliadas. A bacterioscopia e o citoquímico Uquóricos foram decisivos na orientação da cultura epreditivos no diagnóstico etiológico dessas meningites (Teste de Goodman).

Samples of 1815 cerebrospinal fluid (CSF) were studied in a meningitis outbreak during 1989 in São Paulo, Brazil. Neisseria meningitis 56% with 44% type B, Haemophilus influenzae 17%, from which 72% in children (days to 3-year old) and Streptococcus pneumoniae 14% from which 60% in children (day to 1- year old) of443 (24 %)of allstrains. Cytochemistry study showed: purulent or turbidity aspects in 70 to 79% positive bacterioscopy or culture of CSF; white cells count > 500/mm³; glucose < 45mg/dl; protein > 90mg/dl in 90% of all patients. We concluded that: CSF prognostic factors: (aspect and cytochemistry) were correlated with bacterial meningitis. Bacterioscopy and positive cultures were correlated to NM, SP and HI isolation from these patients (Goodman Test.)

Cento e doze aidéticos ou não com neurocriptococose, admitidos no Hospital Emílio Ribas - São Paulo, Brasil, receberam anfotericina B (AMB) - grupo III ou a associação AMB/ 5 fluorcitosina (5FC): grupos I e II. Testes de Goodman aplicados revelaram: 1. leuco e glicorraquia semelhantes nos três grupos eproteinorraquia inferior a 85mg/dlapós 1, 5g/AMB; 1. a coloração pelo método da tinta da China e a cultura para Cryptococcus neoformans, positivas até l,Og/AMB; 3. hipocalemia na monoterapia, hipo e hipercalemia durante a associação; 4. as reações adversas mais evidentes a > 0,7gAMB/250g 5FC; 5. óbitos (precoce e tardio) frequentes no grupo 1 e nos grupos I e III entre 2,5 a 4,0g de AMB; 6. remissão e morte semelhantes nos grupos. A associação terapêutica iniciale amanutençãopelo AMB conduziram à recaída tardia

A total of 112 AIDS and no AIDS cryptococcosis patients admitted at Emílio Ribas Hospital - São Paulo, Brazil, were treated with amphotericin B (AMB) or amphotericin B and 5 fluorcytosine (5FC). Age, race, predisposing and epidemiological factors, respiratory symptons were evaluated. Goodman tests applied in three patients groups (I, II and III) with associate or unique therapy revealed: 1. prognostic factors: leukocytes ang glucose showed similar response in groups I, II and 111 and protein spinal fluid after l.Sg/AMB; 2. India ink tests and Cryptococcus culture were often positive until l.Og/AMB; 3. significant hypokalemia during monotherapy. Hypo and hyperkalemia had similar data in associate therapy; 4. significant difference in adverse reactions often appeared above 0.7g AMB/250g 5FC; 5. early and late death were common in group 111 (unique) and group I (no AIDS) and III (2.5 to 4. Og) respectively; 6. similar remission and deaths were verified in AIDS/ cryptococosis. Conclusions: adverse reactions were observed above 0.75g/AMBplus 250g 5FC. Association was important in initial therapy and AMB maintenance permitted late relapses.

Observou-se a evolução de um linfonodo pulmonar na paracoccidioidomicose (PCM) aguda infantil. Doente, masculino, 6 anos, branco, natural de Curitiba (PR), procedente de Guaratinguetá (SP), que há 3 meses desenvolveu quadro gripal, febre diária, bimodal, prolongada, precedida de calafrio, acompanhada de sudorese inodora, cefaléia frontal e anorexia. Diagnosticado e tratado como pneumonia por cinco dias, sem melhora do quadro. Há 2 meses, apresentou dor óssea nos braços e articulações do pé, com edema inflamatório e emagrecimento de 6 kg em 3 meses. Exame físico revelou: peso 20 kg; estatura 120 cm; P. A. 90/60 mmHg; facies atípica, hipoativo, palidez cutâneo-mucosa (+ +), hipotrofia muscular, adenopatiageneralizada, sopro sistólico suave em foco aórtico acessório e hepatesplenomegalia. Imunodifusão com exoantígeno glicoprotéico 43 kdpositiva (1/32). A biópsia de gânglio revelou Paracoccidioides brasiliensis. A radiologia demonstrou na primeira consulta, discreto infiltrado intersticial bilateral com linfoadenomegaliapara-hilar que desaparecu em 30 dias. Observou- se, ainda, massa tumoral mediastínica superior, hiperplasia do sistema fagocítico mononuclear e lesões osteolíticas nos 60 dias iniciais da evolução.

The primary complex like Ghon was observed in a child's clinical roentgenographic study. C.S., white, male, 6 years old, was born in Curitiba (PR), Brazil and living in Guaratingueta (SP), Brazil, developed "common cold", bimodal diary fever, chills, shake and sweats. Dyspnea, cough with general fymphadenopathy. Foot and right shoulder artralgies. Six months ago visited a cave, equitation practice, dog and cat contacts and notransfusion, frontal sweats, fever (38.4°C). T.A. was 8/6, tachicardia in generalizated fymphadenopathy. Cardiopulmonary system was normal, mesogastric tumoral mass, hepatesplenomegaly and no ascitis. Bone marrow with eosinophilia; nodule demonstred presence of P. brasiliensis; hypoalbuminemia; hyperglobulinemia; anemia; leukocytosis with eosinophilia. Immunodiffusion with exoantigen 43 kd of P. brasiliensis was 1/32. Primary complex like Ghon was observed in interstitial pneumonia followed by mediastinic and mesogastric mass (35 to 40 days). Clavicular osteolythic lesions (45 to 60 days) appeared during paracoccidioidomycosis therapy. Recovery was observed 2 months after treatment of acute infantile paracoccidioidomycosis.

Trata-se de paciente do sexo feminino, com 59 anos de idade, procedente de Itaporanga (SP), diabética e nefropata crônica, internada em virtude de surtos de pielonefnte e insuficiência renal aguda. Dentre outras medidas terapêuticas, recebeu transfusão de sangue. Cerca de dois dias após a última transfusão (sangue oriundo de doador, posteriormente identificado como chagásico) encontraram-se formas tripomastigotas de Trypanosoma cruzi em lâmina preparada para execução de hemograma. Iniciou-se tratamento com Benzonidazol. A paciente cursou para, pleuropneumonia e de secreção purulenta cirúrgica isolou-se Klebsiella spp. A septicemia conduziu a paciente ao êxito letal. Nenhuma lesão tecidual foi observada no miocárdio, no sistema nervoso central, adrenal ou nos demais órgãos examinados.

D.E. O., a 59 years old white female bom in Paranagua (PR), came from Itaporanga with Kimmelstiel Wilson nephropathy diabetes and pyelonephritis with acute renal failure followed by a nephrectomy. Anaemia and malnutrition led to blood transfusions before and after surgery. On the 34th day, she developed high fever, prostration, agressivity with mental confusion, abdominal cramps and diarrhea. Trypanosomes were seen in peripheral blood smears. Haemoculture and xenodiagnosis was positive. A complement fixation test was negative. Benznidazole (6 mg/kg/day) was started. During treatment she presented pulmonary infection and a surgical purulent secretion showed Klebsiella sp. Despite intensive medical care she died of sepsis. Autopsy revealed evidence of diabetes mellitus (glomerulosclerosis, hepatic lesions, pancreatic fibrosis and generalised arteriolar disease). No chagasic lesions were detected in the heart, central nervous system, adrenal or other tissues.

In the present study, clinic and serologic aspects of 47 paracoccidioidomycosis patients were reviewed. The clinic-radiologie-laboratorial data of each patient were obtained from the medical chart before, during and after therapy with Amphotericin B. The age of the patients ranged between 13 to 50 years; the ratio male: female was 10:1. The most frequently associated diseases were alcoholism and tabagism; tuberculosis was present in 14.2% of the cases. Most patients came from Botucatu of adjacent towns (central area of the State of São Paulo). Cough with sputum production, dyspnea and anorexia were the most frequent clinic manifestations. All 47 patients, but 5 presented pulmonary involvement which showed the radiologic pattern of interstitial exudate nodular type and fibrocicatritial lesions in 85.7%. There was associated emphysema in 37.7% of the patients. Blood urea, creatinin and kaliemia increased during therapy with Amphotericin B. Clinic-laboratorial follow-up showed electrocardiographic changes in 13, hypertension in 9 and hyperreactivity in Thorn test in 1 patient. Complement fixation was the best serologic test for monitoring patients with paracoccidioidomycosis. Incomplete dosage of Amphotericin B led to therapeutic ineffectivenes.