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Chylothorax and chylous ascites due to juvenile paracoccidioidomycosis: a case report
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Santos, Ana Paula Freitas Bahia dos

; Russo, Tomás Varella Costa

; Pascuotte, Beatriz

; Visconde, Luis Felipe Silva

; Luetz, Adryelle Carolynne Nogueira

; Sarris, Andrey Biff

; Rocha, Matheus Dias Girão

; Puga, Fernanda Guioti

; Gaspar, Gilberto Gambero

; Bollela, Valdes Roberto

; Martinez, Roberto

Revista da Sociedade Brasileira de Medicina Tropical

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2023, Volume 56 elocation e0605-2022

Resumo: En | Texto: En | PDF: En

ABSTRACT Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides species. Chylothorax is a rare complication of PCM. A 16-year-old adolescent presented daily fever, lymphadenomegaly, sweating, weight loss, ventilatory-dependent pain, and dysphagia, which confirmed PCM. During treatment, the patient developed chylothorax and chylous ascites. Chronic inflammatory and fibrotic lymphadenopathy may obstruct lymphatic vessels, resulting in the extravasation of lymph into the abdomen or pleural cavities. Chylothorax is one of several complications of PCM and can lead to respiratory insufficiency, even in patients undergoing antifungal therapy.

https://doi.org/10.1590/0037-8682-0605-2022

Sanitary measures to contain COVID-19 spread decreased pediatric hospitalizations due to other respiratory infections in São Paulo, Brazil
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Altizani, Gabriela Marengone

; Balbão, Viviane da Mata Pasti

; Gaspar, Gilberto Gambero

; Aragon, Davi Casale

; Carmona, Fabio

Jornal de Pediatria

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Set 2022, Volume 98 Nº 5 Páginas 533 - 539

Resumo: En | Texto: En | PDF: En

Abstract Objective After the Covid-19 pandemics hit Brazil and sanitary measures were adopted to contain its dissemination, pediatric hospital admissions were apparently fewer than usual. The authors aimed to describe the time trends of public hospital admissions of children and adolescents due to respiratory infections (RIs) in São Paulo State, Brazil, before and after the adoption of sanitary measures to contain the dissemination of Covid-19. Methods Ecological, time-series study on the monthly average number of admissions per day of children and adolescents (< 16 years) admitted to public hospitals of São Paulo due to acute RIs between January 2008 and March 2021. Data from 2008 to 2019 were used to adjust the statistical model, while data from 2020 and 2021 were compared to the values predicted by the model. Results In 2020 and 2021, the number of hospital admissions was significantly lower than predicted by the time series. However, lethality was three times higher in these years, compared to the previous, and six times higher in patients with Covid-19, compared to those without the disease. Hospitalization costs in 2020 and 2021 were lower than in previous years. Conclusions These findings suggest that the sanitary measures adopted to contain the dissemination of Covid-19 also effectively reduce the transmission of other respiratory viruses. Policymakers and administrators can use this knowledge as a guide to planning preventative interventions that could decrease the number and severity of RIs and related hospital admissions in children and adolescents, decreasing the burden on the public health system.

https://doi.org/10.1016/j.jped.2022.01.005

Cryptococcosis by Cryptococcus neoformans/Cryptococcus gattii Species Complexes in non-HIV-Infected Patients in Southeastern Brazil
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Nascimento, Erika

; Barião, Patrícia Helena Grizante

; Kress, Marcia Regina von Zeska

; Vilar, Fernando Crivelenti

; Santana, Rodrigo de Carvalho

; Gaspar, Gilberto Gambero

; Martinez, Roberto

Revista da Sociedade Brasileira de Medicina Tropical

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2021, Volume 54 elocation e0169-2021

Resumo: En | Texto: En | PDF: En

Abstract INTRODUCTION: The clinical manifestations of cryptococcosis are usually associated with the infecting agents Cryptococcus neoformans (CN) and C. gattii (CG) species complexes and the host. In this study, non-HIV-infected patients, at a university hospital in southeastern Brazil, had epidemiological and clinical data associated with cryptococcal disease and isolated Cryptococcus species: CN - 24 patients and CG - 12 patients. METHODS: The comparison was comprised of demographic data, predisposing factors, clinical and laboratory manifestations, and outcomes of cryptococcosis patients treated between 2000 and 2016. Immunocompetent and immunosuppressed patients were also compared, irrespective of the infecting species. Cryptococcus spp. were genotyped by PCR-RFLP analysis of the URA5 gene. RESULTS: Infections by the CN species complex (100% VNI genotype) were associated with drug immunosuppression and fungemia, and patients infected with the CG species complex (83% VG II and 17% VGI genotypes) had more evident environmental exposure and higher humoral response. CN and CG affected patients with or without comorbidities. CONCLUSIONS: Diabetes mellitus, other chronic non-infectious diseases, and alcoholism were likely predisposing factors for infection by both CN and CG species. Immunocompetent patients, independent of the infecting Cryptococcus species complexes, showed a higher occurrence of meningitis and a trend toward less fungal dissemination and longer survival than immunosuppressed hosts.

https://doi.org/10.1590/0037-8682-0169-2021 78 downloads

Prevalence of virological and serological markers of SARS-CoV-2 infection in the population of Ribeirão Preto, Southeast Brazil: an epidemiological survey
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Martinez, Edson Zangiacomi

; Passos, Afonso Dinis Costa

; Fabbro, Amaury Lelis Dal

; Silva, Anderson Soares da

; Escarso, Andreia Cássia

; Pazin-Filho, Antônio

; Fonseca, Benedito Antônio Lopes da

; Maciel, Benedito Carlos

; Araújo, Daniel Cardoso de Almeida e

; Clé, Diego Villa

; Gaspar, Gilberto Gambero

; Santos, Jair Lício Ferreira dos

; Ferreira, Janise Braga Barros

; Souza, João Paulo

; Mello, Luane Marques de

; Santos, Luciane Loures dos

; Passos, Luzia Márcia Romanholi

; Siconelli, Márcio Junio Lima

; Cavalli, Ricardo de Carvalho

; Santana, Rodrigo de Carvalho

; Calado, Rodrigo do Tocantins

; Scarpelini, Sandro

; Bollela, Valdes Roberto

; Floriano, Vitor Gonçalves

; Bellissimo-Rodrigues, Fernando

Revista da Sociedade Brasileira de Medicina Tropical

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2021, Volume 54 elocation e0210-2021

Resumo: En | Texto: En | PDF: En

Abstract INTRODUCTION: This epidemiological household survey aimed to estimate the prevalence of the current and past SARS-CoV-2 infections in Ribeirão Preto, a municipality of southeast Brazil. METHODS: The survey was conducted in two phases using a clustered sampling scheme. The first phase spanned May 1-3 and involved 709 participants. The second phase spanned June 11-14, 2020, and involved 646 participants. RESULTS: During the first phase, RT-PCR performed on nasopharyngeal swabs was positive at 0.14%. The serological tests were positive in 1.27% of the patients during the first phase and 2.79% during the second phase. People living in households with more than five members had a prevalence of 10.83% (95%CI: 1.58-74.27) higher than those living alone or with someone other. Considering the proportion of the positive serological test results with sex and age adjustments, approximately 2.37% (95%CI: 1.32-3.42) of the population had been cumulatively infected by mid-June 2020, which is equivalent to 16,670 people (95%CI: 9,267-24,074). Considering that 68 deaths from the disease in the residents of the city had been confirmed as at the date of the second phase of the survey, the infection fatality rate was estimated to be 0.41% (95%CI: 0.28-0.73). Our results suggest that approximately 88% of the cases of SARS-CoV-2 infection at the time of the survey were not reported to the local epidemiological surveillance service. CONCLUSIONS: The findings of this study provide in-depth knowledge of the COVID-19 pandemic in Brazil and are helpful for the preventive and decision-making policies of public managers.

https://doi.org/10.1590/0037-8682-0210-2021 117 downloads

Pre- and post-COVID-19 evaluation of antimicrobial susceptibility for healthcare-associated infections in the intensive care unit of a tertiary hospital
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Gaspar, Gilberto Gambero

; Ferreira, Lécio Rodrigues

; Feliciano, Cinara Silva

; Campos Júnior, Cláudio Penido

; Molina, Fabiana Murad Rossin

; Vendruscolo, Andrea Cristina Soares

; Bradan, Giovana Marcão Araújo

; Lopes, Nátali Artal Padovani

; Martinez, Roberto

; Bollela, Valdes Roberto

Revista da Sociedade Brasileira de Medicina Tropical

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2021, Volume 54 elocation e0090-2021

Resumo: En | Texto: En | PDF: En

Abstract INTRODUCTION: Antimicrobial resistance has worsened since the onset of COVID-19. METHODS: This study involved patients admitted to the adult intensive care unit (ICU) of a tertiary hospital. Pre- and post-COVID-19 data were analyzed. The healthcare-related infections (HCRIs) reported between January 2018 and January 2020 and during the pandemic between February and July 2020 were compared. RESULTS: Antimicrobial resistance increased during the pandemic, especially for Klebsiella pneumoniae isolates, with a rate increase from 5% to 50% for Polymyxin B. CONCLUSIONS: The susceptibilities of the main pathogens associated with HCRIs in the ICU changed and should be considered in managing severe COVID-19.

https://doi.org/10.1590/0037-8682-0090-2021 298 downloads

Paracoccidioidomycosis due to Paracoccidioides lutzii complicated with adrenal injury and pulmonary arterial hypertension
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Gaspar, Gilberto Gambero

; Cocio, Tiago Alexandre

; Guioti-Puga, Fernanda

; Nascimento, Erika

; Fabro, Alexandre Todorovic

; Kress, Marcia Regina von Zeska

; Bagagli, Eduardo

; Martinez, Roberto

Revista do Instituto de Medicina Tropical de São Paulo

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2020, Volume 62 elocation e89

Resumo: En | Texto: En | PDF: En

ABSTRACT Paracoccidioidomycosis caused by Paracoccidioides lutzii is endemic in the Midwest of Brazil and its clinical spectrum is still little known due to the recent identification of this fungal species. A patient resident in Southeast Brazil, but who had lived for many years in the Midwest region, presented with skin injuries, chronic cough and bilateral adrenal involvement. Paracoccidioides spp. was isolated in culture from a skin lesion biopsy. This isolate was later identified as P. lutzii using gene sequencing. A favorable initial response to treatment with itraconazole was observed, but a few weeks later, the patient developed respiratory failure and worsening of lung lesions. Evaluation by computed tomography and echocardiography were suggestive of pulmonary arterial hypertension, and a bronchoscopic biopsy showed peribronchial remodeling. The patient completed the antifungal treatment but maintained the respiratory dysfunction. The reported case shows that P. lutzii can be isolated from patients in a geographic area far from the place of infection acquisition and that, as P. brasiliensis , it can cause adrenal injury and cardio-respiratory complications as a consequence of excessive necrosis and fibrosis.

https://doi.org/10.1590/s1678-9946202062089 385 downloads

Minimum concentration of Amphotericin B in serum according to the formulation, dose, and daily or prolonged intermittent therapeutic regimen
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Schiave, Leticia Aparecida

; Nascimento, Erika

; Gaspar, Gilberto Gambero

; Vilar, Fernando Crivelenti

; Martinez, Edson Zangiacomi

; Gaitani, Cristiane Masetto de

; Martinez, Roberto

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volume 53 elocation e20180463

Resumo: En | Texto: En | PDF: En

Abstract INTRODUCTION: The therapeutic efficacy of daily amphotericin B infusion is related to its maximum concentration in blood; however, trough levels may be useful in intermittent regimens of this antifungal drug. METHODS : High performance liquid chromatography (HPLC) was used to determine the minimum concentration (Cmin) of amphotericin B in the serum of patients receiving deoxycholate (D-Amph) or liposomal amphotericin B (L-AmB) for the treatment of cryptococcal meningitis (n=28), histoplasmosis (n=8), paracoccidioidomycosis (n=1), and leishmaniasis (n=1). RESULTS: Daily use of D-Amph 30 to 50 mg or L-AmB 50 mg resulted in a similar Cmin, but a significant increase ocurred with L-AmB 100 mg/day. The geometric mean Cmin tended to decrease with a reduction in the dose and frequency of intermittent L-AmB infusions: 357 ng/mL (100 mg 4 to 5 times/week) > 263 ng/mL (50 mg 4 to 5 times/week) > 227 ng/mL (50 mg 1 to 3 times/week). The impact on Cmin was variable in patients whose dose or therapeutic scheme was changed, especially when administered the intermittent infusion of amphotericin B. The mean Cmin for each L-AmB schedule of intermittent therapy was equal or higher than the minimum inhibitory concentration of amphotericin B against Cryptococcus isolates from 10/12 patients. The Cmin of amphotericin B in patients with cryptococcal meningitis was comparable between those that survived or died. CONCLUSIONS: By evaluating the Cmin of amphotericin B, we demonstrated the therapeutic potential of its intermittent use including in the consolidation phase of neurocryptococcosis treatment, despite the great variability in serum levels among patients.

https://doi.org/10.1590/0037-8682-0463-2018 1761 downloads

Human pulmonary dirofilariasis with secondary myocarditis
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Doltrário, Andréa Beltrami

; Valim, Natalí Caneli

; Dellaspora, Ellen Aparecida Pereira Barboza

; Gaspar, Gilberto Gambero

; Puga, Fernanda Guioti

; Fabro, Alexandre Todorovic

; Brunaldi, Mariângela Ottoboni

; Martinez, Roberto

Revista da Sociedade Brasileira de Medicina Tropical

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2019, Volume 52 elocation e20180461

Resumo: En | Texto: En | PDF: En

Abstract Dirofilariasis is a little-known zoonosis, with dogs and cats as definitive hosts. It is caused by nematodes and transmitted by mosquito bites. We report the case of a 67-year-old man with a consumptive syndrome with two subpleural pulmonary opacities. A transthoracic lung biopsy revealed a Dirofilaria worm. Myocardial nuclear magnetic resonance (NMR) demonstrated dilated cardiomyopathy after myocarditis related to dirofilariasis. Human infection is rare and occurs accidentally. The most common radiological alteration is a mainly subpleural coin lesion. Dirofilariasis is a neglected emergent disease and knowledge about it is important for differential diagnoses from neoplastic pulmonary nodules.

https://doi.org/10.1590/0037-8682-0461-2018 952 downloads

STAPHYLOCOCCUS AUREUS IN NURSING PROFESSIONALS AND THE MICROORGANISM’S SUSCEPTIBILITY PROFILE TO ANTIMICROBIALS
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Lopes, Letícia Pimenta

; Pio, Daiana Patrícia Marchetti

; Reinato, Lílian Andreia Fleck

; Gaspar, Gilberto Gambero

; Prado, Marinésia Aparecida do

; Gir, Elucir

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2017, Volume 26 Nº 2 elocation e00400016

Resumo: En Es Pt | Texto: En Es Pt | PDF: En | PDF: Es | PDF: Pt

ABSTRACT Objective: to identify the carrier’s state and the susceptibility profile of Staphylococcus aureus isolated from saliva and nasal secretion of nursing professionals to antibiotics. Method: cross-sectional study that used saliva and nasal secretion samples of 100 nursing professionals who provide care for patients with HIV/Aids. Results: forty-three percent of the participants presented positive saliva or nasal secretion samples for Staphylococcus aureus. Of the 74 nasal secretion samples with Staphylococcus aureus, 14.9% presented oxacillin resistance; 91.9% presented penicillin resistance; 44.6% presented erythromycin resistance, and 41.9% presented clindamycin resistance. Of the 12 positive saliva samples, 16.7% presented oxacillin resistance; 100.0% presented penicillin resistance; 33.4% presented erythromycin resistance, and 25.0% presented clindamycin resistance. Conclusion: nursing professionals, once aware of their carrier state of multi-resistant microorganisms, will supervise their care practices and more efficiently adopt measures for prevention and control of the epidemiological chain of these bacteria in their work environment.

RESUMEN Objetivo: identificar el estado del cargador y el perfil de susceptibilidad a los antibióticos de los Staphylococcus aureus aislados de la saliva y de la secreción nasal de los profesionales de enfermería. Método: estudio transversal, que utilizó muestras de saliva y secreción nasal, obtenidas de 100 profesionales de enfermería que asisten a personas con VIH/SIDA. Resultados: se identificó que 43,0% de los participantes presentaron muestras de saliva y/o secreción nasal positiva por Staphylococcus aureus. De las 74 muestras de secreción nasal con Staphylococcus aureus, 14,9% presentaron resistencia a la oxacilina; 91,9% a la penicilina; 44,6% a la eritromicina y 41,9% a la clindamicina. De las 12 muestras de saliva positivas, 16,7% fueron resistentes a la oxacilina; 100% a la penicilina; 33,4% a la eritromicina y 25,0% a la clindamicina. Conclusión: se cree que el profesional al obtener conocimiento de su estado de portador del microorganismos multi-resistentes, pasará a supervisar sus prácticas asistenciales y adoptar con mayor eficacia las medidas para la prevención y el control de la cadena epidemiológica de estas bacterias en el ambiente laboral.

RESUMO Objetivo: identificar o estado de carreador e o perfil de suscetibilidade aos antibióticos dos Staphylococcus aureus isolados da saliva e da secreção nasal dos profissionais de enfermagem. Método: estudo transversal, que utilizou amostras de saliva e secreção nasal, obtidas de 100 profissionais de enfermagem que assistem pessoas com HIV/aids. Resultados: identificou-se que 43,0% dos participantes apresentaram amostras de saliva e/ou de secreção nasal positivas para Staphylococcus aureus. Das 74 amostras de secreção nasal com Staphylococcus aureus, 14,9% apresentaram resistência à oxacilina; 91,9% à penicilina; 44,6% à eritromicina e 41,9% à clindamicina. Das 12 amostras de saliva positivas, 16,7% foram resistentes à oxacilina; 100,0% à penicilina; 33,4% à eritromicina e 25,0% à clindamicina. Conclusão: o profissional ao obter conhecimento de seu estado de carreador de microrganismos multirresistentes, passará a supervisionar suas práticas assistenciais e adotar com mais eficiência as medidas para a prevenção e o controle da cadeia epidemiológica dessas bactérias no ambiente laboral.

https://doi.org/10.1590/0104-07072017000400016 16 downloads

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STAPHYLOCOCCUS AUREUS IN NURSING PROFESSIONALS AND THE MICROORGANISM’S SUSCEPTIBILITY PROFILE TO ANTIMICROBIALS
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Lopes, Letícia Pimenta

; Pio, Daiana Patrícia Marchetti

; Reinato, Lílian Andreia Fleck

; Gaspar, Gilberto Gambero

; Prado, Marinésia Aparecida do

; Gir, Elucir

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2017, Volume 26 Nº 2 elocation e00400016

Resumo: Pt En Es | Texto: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.1590/0104-07072017000400016 21592 downloads

11.

Secular trends in Klebsiella pneumoniae isolated in a tertiary-care hospital: increasing prevalence and accelerated decline in antimicrobial susceptibility
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Santana, Rodrigo de Carvalho

; Gaspar, Gilberto Gambero

; Vilar, Fernando Crivelenti

; Bellissimo-Rodrigues, Fernando

; Martinez, Roberto

Revista da Sociedade Brasileira de Medicina Tropical

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Abr 2016, Volume 49 Nº 2 Páginas 177 - 182

Resumo: En | Texto: En | PDF: En

Abstract: INTRODUCTION Klebsiella pneumoniae has become an increasingly important etiologic agent of nosocomial infections in recent years. This is mainly due to the expression of virulence factors and development of resistance to several antimicrobial drugs. METHODS This retrospective study examines data obtained from the microbiology laboratory of a Brazilian tertiary-care hospital. To assess temporal trends in prevalence and antimicrobial susceptibility, K. pneumoniae isolates were analyzed from 2000 to 2013. The relative frequencies of K. pneumoniae isolation were calculated among all Gram-negative bacilli isolated in each period analyzed. Susceptibility tests were performed using automated systems. RESULTS: From 2000-2006, K. pneumonia isolates comprised 10.7% of isolated Gram-negative bacilli (455/4260). From 2007-2013, this percentage was 18.1% (965/5331). Strictly considering isolates from bloodstream infections, the relative annual prevalence of K. pneumoniae increased from 14-17% to 27-32% during the same periods. A progressive decrease in K. pneumoniae susceptibility to all antimicrobial agents assessed was detected. Partial resistance was also observed to antimicrobial drugs that have been used more recently, such as colistin and tigecycline. CONCLUSIONS Our study indicates that K. pneumoniae has become a major pathogen among hospitalized patients and confirms its recent trend of increasing antimicrobial resistance.

https://doi.org/10.1590/0037-8682-0072-2016 1945 downloads

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Induction and nosocomial dissemination of carbapenem and polymyxin-resistant Klebsiella pneumoniae
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Gaspar, Gilberto Gambero

; Bellissimo-Rodrigues, Fernando

; Andrade, Leonardo Neves de

; Darini, Ana Lúcia

; Martinez, Roberto

Revista da Sociedade Brasileira de Medicina Tropical

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Ago 2015, Volume 48 Nº 4 Páginas 483 - 487

Resumo: En | Texto: En | PDF: En

INTRODUCTION:Polymyxins are antimicrobial agents capable of controlling carbapenemase-producing Klebsiella pneumoniae infection.METHODS: We report a cluster of four patients colonized or infected by polymyxin-resistant and Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae.RESULTS: Three patients were hospitalized in adjacent wards, and two were admitted to the intensive care unit. The index case maintained prolonged intestinal colonization by KPC-producing K. pneumoniae. Three patients received polymyxin B before the isolation of polymyxin-resistant K. pneumoniae.CONCLUSIONS: Colonization by KPC-producing K. pneumoniae and previous use of polymyxin B may be causally related to the development of polymyxin-resistant microorganisms.

https://doi.org/10.1590/0037-8682-0041-2015 2097 downloads

13.

Evaluation of the predictive indices for candidemia in an adult intensive care unit
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Gaspar, Gilberto Gambero

; Menegueti, Mayra Gonçalves

; Auxiliadora-Martins, Maria

; Basile-Filho, Anibal

; Martinez, Roberto

Revista da Sociedade Brasileira de Medicina Tropical

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Fev 2015, Volume 48 Nº 1 Páginas 77 - 82

Resumo: En | Texto: En | PDF: En

INTRODUCTION: To evaluate predictive indices for candidemia in an adult intensive care unit (ICU) and to propose a new index. METHODS: A prospective cohort study was conducted between January 2011 and December 2012. This study was performed in an ICU in a tertiary care hospital at a public university and included 114 patients staying in the adult ICU for at least 48 hours. The association of patient variables with candidemia was analyzed. RESULTS: There were 18 (15.8%) proven cases of candidemia and 96 (84.2%) cases without candidemia. Univariate analysis revealed the following risk factors: parenteral nutrition, severe sepsis, surgical procedure, dialysis, pancreatitis, acute renal failure, and an APACHE II score higher than 20. For the Candida score index, the odds ratio was 8.50 (95% CI, 2.57 to 28.09); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.78, 0.71, 0.33, and 0.94, respectively. With respect to the clinical predictor index, the odds ratio was 9.45 (95%CI, 2.06 to 43.39); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.89, 0.54, 0.27, and 0.96, respectively. The proposed candidemia index cutoff was 8.5; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.77, 0.70, 0.33, and 0.94, respectively. CONCLUSIONS: The Candida score and clinical predictor index excluded candidemia satisfactorily. The effectiveness of the candidemia index was comparable to that of the Candida score.

https://doi.org/10.1590/0037-8682-0292-2014 4387 downloads

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