Cytomegalovirus infection is a frequent complication after transplantation. This infection occurs due to transmission from the transplanted organ, due to reactivation of latent infection, or after a primary infection in seronegative patients and can be defined as follows: latent infection, active infection, viral syndrome or invasive disease. This condition occurs mainly between 30 and 90 days after transplantation. In hematopoietic stem cell transplantation in particular, infection usually occurs within the first 30 days after transplantation and in the presence of graft-versus-host disease. The major risk factors are when the recipient is cytomegalovirus seronegative and the donor is seropositive as well as when lymphocyte-depleting antibodies are used. There are two methods for the diagnosis of cytomegalovirus infection: the pp65 antigenemia assay and polymerase chain reaction. Serology has no value for the diagnosis of active disease, whereas histology of the affected tissue and bronchoalveolar lavage analysis are useful in the diagnosis of invasive disease. Cytomegalovirus disease can be prevented by prophylaxis (the administration of antiviral drugs to all or to a subgroup of patients who are at higher risk of viral replication) or by preemptive therapy (the early diagnosis of viral replication before development of the disease and prescription of antiviral treatment to prevent the appearance of clinical disease). The drug used is intravenous or oral ganciclovir; oral valganciclovir; or, less frequently, valacyclovir. Prophylaxis should continue for 90 to 180 days. Treatment is always indicated in cytomegalovirus disease, and the gold-standard drug is intravenous ganciclovir. Treatment should be given for 2 to 3 weeks and should be continued for an additional 7 days after the first negative result for viremia.

The pandemic novel influenza A (H1N1) infection was considered widespread in Brazil on July, 2009. Since then, 9.249 cases were confirmed in Brazil, most of them concentrated in São Paulo. The Hospital das Clínicas of the University of São Paulo is a reference center for H1N1 cases in São Paulo. The purpose of this review is to analyze the evidence concerning diagnosis, prevention, and treatment of novel influenza A (H1N1) infection. In addition, we propose guidelines for the management of this pandemic emphasizing Hospital das Clínicas "bundles" for the control of the pandemic novel influenza A (H1N1).

The pandemic novel influenza A (H1N1) infection was considered widespread in Brazil on July 16, 2009. Since then, 46,810 cases of acute respiratory syndrome have been reported in Brazil, most of them concentrated in São Paulo. Through September 16, we have confirmed 9,249 cases of novel influenza A H1N1in Brazil, including 699 deaths. The mortality rate observed in Brazil is 0.47/100,000 inhabitants and varies according to region. In this period, São Paulo registered 3733 cases (40.3% of the total) of novel influenza A (H1N1) infection and 327 deaths, reflecting a mortality rate of 0.79/100,000 inhabitants. The Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC) is a reference center for H1N1 cases in São Paulo. During the winter of 2009, 472 patients in this hospital were diagnosed with H1N1 infection; of these, 210 were admitted, and 16 died. To control this pandemic and to provide adequate care for these patients, the Hospital das Clínicas implemented "bundles" including prevention strategies, an epidemiologic surveillance service, availability of fast diagnosis, antiviral treatment and training of staff. The purpose of this manuscript is to describe the epidemiologic features of novel human influenza A (H1N1) infection in the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo during the winter period of the 2009 pandemic.

Os primeiros herpes-vírus a serem descritos foram os tipos 1 e 2, cuja denominação é herpes simplex 1 e 2 ou HSV-1 e HSV-2. Estes vírus possuem características biológicas particulares, tais como a capacidade de causar diferentes tipos de doenças, assim como estabelecer infecções latentes ou persistentes por toda a vida dos hospedeiros e de serem reativados causando lesões que podem se localizar no sítio da infecção primária inicial ou próxima a ele. Postula-se que a reativação deste vírus no gânglio geniculado esteja relacionada com a paralisia de Bell. Nesta situação, os vírus, que estariam latentes neste gânglio, sofreriam reativação e replicação difundindo-se pelo nervo facial e seus ramos, dentre eles o nervo corda do tímpano, que ao estimular a secreção salivar possibilitaria a identificação do DNA viral na saliva dos pacientes. Até recentemente, um grande número de pacientes eram diagnosticados como portadores de uma forma desta paralisia, chamada de idiopática ou de paralisia de Bell. Com o advento da técnica de estudo do DNA viral pelo método da reação da polimerase em cadeia (PCR), diversos autores encontraram DNA do vírus herpes simplex tipo I no líquido cefalorraquidiano, na secreção lacrimal, na saliva e nos gânglios geniculados de pacientes com paralisia de Bell. OBJETIVO: observar a prevalência do vírus herpes simplex tipo I pela técnica de PCR, na saliva de pacientes com PFP de Bell, relacionando-a com a evolução clínica destes casos. METODOLOGIA: Avaliamos 38 pacientes portadores de Paralisia Facial Periférica de Bell, que foram submetidos a anamnese, exame médico geral e otorrinolaringológico e coleta de saliva para detecção do DNA viral pela técnica de PCR. O grupo controle correspondeu a 10 adultos normais. RESULTADOS: Obtivemos positividade para o DNA viral em 11 casos dos 38 avaliados, o que corresponde a 29% da amostra. Este resultado foi estatisticamente significante se comparado ao grupo controle, no qual não foi obtido nenhum caso de positividade. CONCLUSÃO: Concluiu-se que a presença do HSV-1 na saliva de pacientes portadores de PFP de Bell indica que a reativação viral pode ser a etiologia desta doença. A detecção do vírus na saliva destes pacientes não influencia o prognóstico da doença.

The first herpes virus to be described was types 1 and 2, whose denomination is herpes simplex 1 and 2 or HSV -1 and HSV -2. These viruses have specific biological characteristics, such as the ability to cause different kinds of diseases, as well as to establish host’s latent or persistent lifetime infections and also of being reactivated, causing lesions that can be located at the same site of the initial primary infection or close to it. It is suggested that this virus reactivation in the geniculate ganglion may be related to Bell’s palsy. In this situation, the viruses that would be latent in this ganglion, would suffer reactivation and replication, then be diffused through the facial nerve and its branches, among them the chorda tympani nerve, which by stimulating salivary secretion would enable the identification of the viral DNA in the patients’ saliva. Until recently, a great number of patients was diagnosed as holders of this kind of paralysis, named idiopathic or Bell’s palsy. With the introduction of the technique studying the viral DNA by Polymerase Chain Reaction (PCR), several authors have found herpes simplex virus type I DNA in the cerebrospinal fluid, in the lachrymal secretion, in the saliva and in the geniculate ganglia of patients with Bell’s palsy. AIM: observe the occurrence of herpes simplex type I virus using PCR technique in the saliva of patients with Bell’s palsy and relating it to the clinical evolution of these cases. METHODOLOGY: We evaluated 38 patients with Bell’s palsy submitted to anamnesis, clinical and ENT examination and saliva sampling for viral DNA detection by PCR technique. The control group was ten normal adults. RESULTS: We found positive viral DNA in 11 cases out of the 38, which corresponded to 29% of the sample. This result was statistically significant if compared to the control group, in which we did not find any positive case. CONCLUSION: The end result was that the presence of HSV -1 in the saliva of patients with Bell’s palsy indicating that the viral reactivation can be the etiology of this disease. The detection of the virus in these patients’ saliva does not influence the disease prognosis.