ABSTRACT Four cases of people living with HIV/AIDS (PLWHA) with calcified cerebral toxoplasmosis associated with perilesional edema causing a single episode of neurological manifestations have recently been reported. Here, we describe the first detailed description of perilesional edema associated with calcified cerebral toxoplasmosis causing three episodes of neurological manifestations in a PLWHA, including seizures in two of them. These recurrences occurred over approximately a decade. Throughout this period, the patient showed immunological and virological control of the HIV infection, while using antiretroviral therapy regularly. This case broadens the spectrum of an emerging presentation of calcified cerebral toxoplasmosis, mimicking a well-described finding of neurocysticercosis in immunocompetent hosts. HIVAIDS AIDS PLWHA (PLWHA reported Here them decade period infection regularly welldescribed well described hosts

ABSTRACT BACKGROUND: Syphilis is a major public health issue worldwide. In people living with human immunodeficiency virus (PLHIV), there are higher incidences of both syphilis and neurosyphilis. The criteria for referring PLHIV with syphilis for lumbar puncture is controversial, and the diagnosis of neurosyphilis is challenging. OBJECTIVE: To describe the knowledge, attitudes, and practices of infectious disease specialists and residents in the context of care for asymptomatic HIV-syphilis coinfection using close-ended questions and case vignettes. DESIGN AND SETTING: Cross-sectional study conducted in three public health institutions in São Paulo (SP), Brazil. METHODS: In this cross-sectional study, we invited infectious disease specialists and residents at three academic healthcare institutions to answer a self-completion questionnaire available online or in paper form. RESULTS: Of 98 participants, only 23.5% provided answers that were in line with the current Brazilian recommendation. Most participants believed that the criteria for lumbar puncture should be extended for people living with HIV with low CD4+ cell counts (52.0%); in addition, participants also believed that late latent syphilis (29.6%) and Venereal Disease Research Laboratory (VDRL) titers ≥ 1:32 (22.4%) should be conditions for lumbar puncture in PLHIV with no neurologic symptoms. CONCLUSION: This study highlights heterogeneities in the clinical management of HIV-syphilis coinfection. Most infectious disease specialists still consider syphilis stage, VDRL titers and CD4+ cell counts as important parameters when deciding which patients need lumbar puncture for investigating neurosyphilis.

Abstract Background Concomitant neurological diseases in people living with HIV/AIDS (PLWHA) is a challenging subject that has been insufficiently evaluated by prospective clinical studies. The goal of the present study was to identify the clinical characteristics and outcomes of PLWHA with cerebral toxoplasmosis and neurological co-infections. Methods We conducted a prospective observational cohort study at a tertiary teaching center in São Paulo, Brazil, from January to July 2017. Hospitalized PLWHA aged ≥ 18 years with cerebral toxoplasmosis were consecutively enrolled. A standardized neurological examination was performed at admission and weekly until discharge or death. Diagnosis and treatment followed institutional routines; neuroradiology, molecular diagnosis, neurosurgery, and the intensive care unit (ICU) were available. The main outcomes were neurological coinfections and in-hospital death. Results We included 44 (4.3%) cases among 1,032 hospitalized patients. The median age was 44 (interquartile range [IQR]: 35-50) years, and 50% (n = 22) of the patients were male. The median CD4+ T lymphocyte count was of 50 (IQR: 15-94) cells/mm3. Multiple lesions on computed tomography were present in 59% of the cases. Neurological coinfections were diagnosed in 20% (n = 9) of the cases, and cytomegalovirus was the most common etiology (encephalitis: n = 3; polyradiculopathy: n = 2). Longer hospital stays (30 versus 62 days; p= 0.021) and a higher rate of ICU admissions (14% versus 44%; p= 0.045) were observed among PLWHA with neurological coinfections in comparison to those without them. The rate of in-hospital mortality was of 13.6% (n = 6) (coinfection group: 33%; no coinfection group: 8.6%; p= 0.054). Conclusion Neurological c-infections were common among PLWHA with cerebral toxoplasmosis, and cytomegalovirus was the main copathogen. The group of PLWHA with neurological co-infections underwent longer hospital stays and more frequent intensive care unit admissions. Additionally, this group of patients tended to have higher in-hospital mortality rate. HIVAIDS HIV AIDS (PLWHA studies coinfections. co infections. infections Paulo Brazil 2017 1 enrolled death routines neuroradiology diagnosis neurosurgery (ICU available inhospital 4 4.3% 43 3 (4.3% 1032 032 1,03 interquartile IQR [IQR] 3550 35 35-50 22 male CD4 CD 5 (IQR 1594 15 94 15-94 cellsmm3 cellsmm cells mm3 mm cells/mm3 59 20 9 encephalitis (encephalitis polyradiculopathy 2. 2 . 2) 30 (3 6 days p 0.021 0021 0 021 14% 14 (14 44% 0.045 0045 045 them 136 13 13.6 33% 33 8.6% 86 8 0.054. 0054 0.054 054 0.054) cinfections c copathogen Additionally 201 4.3 (4.3 103 03 1,0 [IQR 355 35-5 159 15-9 cells/mm ( 0.02 002 02 (1 0.04 004 04 13. 8.6 005 0.05 05 4. (4. 10 1, 35- 15- 0.0 00 8. (4 0.

Resumo Antecedentes Coinfecções neurológicas em pessoas que vivem com HIV/AIDS (PVHA) é um tema que não foi suficientemente avaliado em estudos clínicos prospectivos. Nosso objetivo foi identificar as características clínicas e os desfechos de PVHA com toxoplasmose cerebral e coinfecções neurológicas. Métodos Estudo prospectivo de coorte observacional conduzido em um centro de ensino terciário de São Paulo, Brasil, entre janeiro e julho de 2017. Foram incluídos consecutivamente PVHA internadas com ≥ 18 anos e toxoplasmose cerebral. Realizou-se exame neurológico padronizado na admissão e semanalmente até a alta/óbito. Tanto o diagnóstico quanto o tratamento seguiram a rotina institucional; neurorradiologia, diagnóstico molecular, neurocirurgia e Unidade de Terapia Intensiva (UTI) estavam disponíveis. Os principais desfechos foram coinfecções neurológicas e óbitos hospitalares. Resultados Incluímos 44 (4,3%) casos entre 1.032 pacientes internados. A idade mediana foi de 44 (intervalo interquartil [IIQ]: : 35-50) anos, e 50% (n = 22) dos pacientes eram do sexo masculino. A contagem mediana de linfócitos T CD4+ foi de 50 (IIQ:15-94) células/mm3. Múltiplas lesões na tomografia computadorizada foram observadas em 59% dos casos. Coinfecções neurológicas foram diagnosticadas em 20% (n = 9) dos casos, sendo o citomegalovírus a etiologia mais comum (encefalite: n = 3; polirradiculopatia: n = 2). Observou-se maior tempo de internação (26 versus 62 dias; p= 0,021) e uma taxa mais alta de admissão à UTI (14% versus 44%; p= 0,045) em PVHA com coinfecções neurológicas em comparação àquelas sem coinfecção. A mortalidade intra-hospitalar foi de 13,6% (n = 6) (grupo com coinfecções: 33% versus grupo sem coinfecção: 8,6%; p= 0,054). Conclusão Coinfecções neurológicas foram comuns em PVHA com toxoplasmose cerebral, sendo o citomegalovírus o principal copatógeno. O grupo de PVHA com coinfecções neurológicas apresentou maior tempo de internação, maior taxa de internações na UTI, e tendência a maior taxa de mortalidade intra-hospitalar. HIVAIDS HIV AIDS (PVHA prospectivos Paulo Brasil 2017 1 Realizouse Realizou se altaóbito óbito alta/óbito institucional neurorradiologia molecular (UTI disponíveis hospitalares 4 4,3% 43 3 (4,3% 1032 032 1.03 internados intervalo IIQ [IIQ] 3550 35 35-50 22 masculino CD4 CD 5 IIQ1594 15 94 (IIQ:15-94 célulasmm3 célulasmm células mm3 mm células/mm3 59 20 9 encefalite (encefalite polirradiculopatia 2. 2 . 2) Observouse Observou 26 (2 6 dias p 0,021 0021 0 021 14% 14 (14 44% 0,045 0045 045 coinfecção intrahospitalar intra hospitalar 136 13 13,6 33 8,6% 86 8 0,054. 0054 0,054 054 0,054) copatógeno intrahospitalar. hospitalar. 201 4,3 (4,3 103 03 1.0 [IIQ 355 35-5 IIQ159 (IIQ:15-9 células/mm ( 0,02 002 02 (1 0,04 004 04 13, 8,6 005 0,05 05 4, (4, 10 1. 35- IIQ15 (IIQ:15- 0,0 00 8, (4 IIQ1 (IIQ:15 0, (IIQ:1 (IIQ: (IIQ

ABSTRACT AIDS-related disseminated histoplasmosis (DH) can cause septic shock and multiorgan dysfunction with mortality rates of up to 80%. A 41-year-old male presented with fever, fatigue, weight loss, disseminated skin lesions, low urine output, and mental confusion. Three weeks before admission, the patient was diagnosed with HIV infection, but antiretroviral therapy (ART) was not initiated. On day 1 of admission, sepsis with multiorgan dysfunction (acute renal failure, metabolic acidosis, hepatic failure, and coagulopathy) was identified. A chest computed tomography showed unspecific findings. Yeasts suggestive of Histoplasma spp. were observed in a routine peripheral blood smear. On day 2, the patient was transferred to the ICU, where his clinical condition progressed with reduced level of consciousness, hyperferritinemia, and refractory septic shock, requiring high doses of vasopressors, corticosteroids, mechanical ventilation, and hemodialysis. Amphotericin B deoxycholate was initiated. On day 3, yeasts suggestive of Histoplasma spp. were observed in the bone marrow. On day 10, ART was initiated. On day 28, samples of peripheral blood and bone marrow cultures revealed Histoplasma spp. The patient stayed in the ICU for 32 days, completing three weeks of intravenous antifungal therapy. After progressive clinical and laboratory improvement, the patient was discharged from the hospital on oral itraconazole, trimethoprim-sulfamethoxazole, and ART. This case highlights the inclusion of DH in the differential diagnosis of patients with advanced HIV disease, septic shock and multiorgan dysfunction but without respiratory failure. In addition, it provides early in-hospital diagnosis and treatment and comprehensive management in the ICU as determining factors for a good outcome. AIDSrelated AIDS related (DH 80 80% 41yearold yearold 41 year old fever fatigue loss lesions output confusion admission infection (ART initiated acute failure acidosis coagulopathy identified findings spp smear 2 consciousness hyperferritinemia vasopressors corticosteroids ventilation hemodialysis 3 10 28 days improvement itraconazole trimethoprimsulfamethoxazole, trimethoprimsulfamethoxazole trimethoprim sulfamethoxazole, sulfamethoxazole trimethoprim-sulfamethoxazole disease addition inhospital outcome 8 4

Abstract Background Progressive multifocal leukoencephalopathy (PML) - immune reconstitution inflammatory syndrome (IRIS) in people living with HIV/AIDS (PLWHA) has been rarely described in low- and middle-income countries. Objective To describe the prevalence of PML-IRIS among PLWHA with PML and its main features in a tertiary hospital in Brazil. Methods We performed a retrospective cohort study. We included PLWHA with PML-IRIS patients admitted at Instituto de Infectologia Emílio Ribas, São Paulo, Brazil, between 2011 and 2021. We retrieved information on neurological manifestations, neuroimaging findings, treatments, and outcomes. Results We identified 11 (11.8%) PML-IRIS cases among 93 patients with definite PML. Eight (73%) cases were men and had a median (IQR) age of 41 (27–50) years. Seven (63.6%) patients developed unmasking PML-IRIS and 4 (36.4%) had paradoxical PML-IRIS. The median (IQR) time from initiation of combined antiretroviral therapy (cART) to IRIS diagnosis was 49 (30–70) days. Ten (90.9%) patients received corticosteroids. There were 4 (36%) in-hospital deaths and 3 were associated with hospital-acquired pneumonia. Among the 7 (64%) patients who survived, 5 (71.5%) had sequelae at discharge. One year after the PML-IRIS diagnosis, 6 (54.5%) patients were alive. Conclusion The prevalence of PML-IRIS was 11.8%. Most patients had unmasking PML-IRIS. In-hospital mortality and morbidity were high. One-year survival was similar to that described in some high-income countries. (PML (IRIS HIVAIDS HIV AIDS (PLWHA low middleincome middle income countries PMLIRIS Brazil study Ribas Paulo 201 2021 manifestations findings treatments outcomes 1 11.8% 118 8 (11.8% 9 73% 73 (73% IQR (IQR 27–50 2750 27 50 (27–50 years 63.6% 636 63 (63.6% 36.4% 364 36 (36.4% PMLIRIS. IRIS. cART (cART 30–70 3070 30 70 (30–70 days 90.9% 909 90 (90.9% corticosteroids 36% (36% inhospital hospitalacquired acquired pneumonia 64% 64 (64% survived 71.5% 715 71 (71.5% discharge 54.5% 545 54 (54.5% alive Inhospital In high Oneyear highincome 20 202 11.8 (11.8 (73 27–5 275 2 (27–5 63.6 (63.6 36.4 (36.4 30–7 307 (30–7 90.9 (90.9 (36 (64 71.5 (71.5 54.5 (54.5 11. (11. (7 27– (27– 63. (63. 36. (36. 30– (30– 90. (90. (3 (6 71. (71. 54. (54. (11 ( (27 (63 (30 (90 (71 (54 (1 (2 (9 (5

Resumo Antecedentes A síndrome inflamatória de reconstituição imune (SIRI) da leucoencefalopatia multifocal progressiva (LEMP) em pessoas vivendo com HIV/Aids (PVHA) foi raramente descrita em países de baixa e média renda. Objetivo Descrever a prevalência da SIRI-LEMP- em PVHA com LEMP e suas principais características em um hospital no Brasil. Métodos Foi realizado um estudo de coorte retrospectivo. Incluímos PVHA com SIRI-LEMP admitidos no Instituto de Infectologia Emílio Ribas, São Paulo, Brasil, entre 2011 e 2021. Recuperamos informações sobre manifestações neurológicas, neuroimagem, tratamento e desfecho. Resultados Identificamos 11 (11,8%) casos de SIRI-LEMP entre 93 pacientes com LEMP definitiva. Oito (73%) casos eram homens e a mediana de idade (amplitude interquartile - AIQ) foi de 41 (27–50) anos. Sete (63,6%) pacientes desenvolveram SIRI-LEMP “desmascarada” e 4 (36,4%) casos apresentaram SIRI-LEMP “paradoxal”. A mediana de tempo (AIQ) desde o início da terapia antirretroviral combinada (cART) até o diagnóstico de SIRI foi de 49 (30–70) dias. Dez (90,9%) pacientes receberam corticoide. Houve 4 (36%) óbitos intra-hospitalares e 3 foram associados à pneumonia hospitalar. Dos 7 (64%) pacientes que sobreviveram, 5 (71,5%) ficaram com sequelas na alta. Um ano após o diagnóstico de SIRI-LEMP, 6 (54,5%) pacientes estavam vivos. Conclusão A prevalência de SIRI-LEMP foi de 11,8%. A maioria dos pacientes apresentava SIRI-LEMP “desmascarada”. A mortalidade e morbidade hospitalar foram altas. A sobrevida em 1 ano foi semelhante à descrita em alguns países de alta renda. (SIRI (LEMP HIVAids HIV Aids (PVHA renda SIRILEMP Brasil retrospectivo Ribas Paulo 201 2021 neurológicas neuroimagem desfecho 11,8% 118 8 (11,8% 9 definitiva 73% 73 (73% amplitude AIQ 27–50 2750 27 50 (27–50 anos 63,6% 636 63 (63,6% desmascarada “desmascarada 36,4% 364 36 (36,4% paradoxal. paradoxal . “paradoxal” (AIQ cART (cART 30–70 3070 30 70 (30–70 dias 90,9% 909 90 (90,9% corticoide 36% (36% intrahospitalares intra hospitalares 64% 64 (64% sobreviveram 71,5% 715 71 (71,5% SIRILEMP, LEMP, 54,5% 545 54 (54,5% vivos desmascarada. altas 20 202 11,8 (11,8 (73 27–5 275 2 (27–5 63,6 (63,6 36,4 (36,4 “paradoxal 30–7 307 (30–7 90,9 (90,9 (36 (64 71,5 (71,5 54,5 (54,5 11, (11, (7 27– (27– 63, (63, 36, (36, 30– (30– 90, (90, (3 (6 71, (71, 54, (54, (11 ( (27 (63 (30 (90 (71 (54 (1 (2 (9 (5

Abstract Background Chronic meningitis (CM) is characterized by neurological symptoms associated with the evidence of cerebrospinal fluid pleocytosis lasting > 4 weeks. Studies on the management of CM in Brazil are scarce. Objective To critically review the literature on CM and propose a rational approach in the Brazilian scenario. Methods Narrative literature review discussing the epidemiology, clinical evaluation, basic and advanced diagnostic testing, and empirical and targeted therapy for the most relevant causes of CM. The present review was contextualized with the local experience of the authors. In addition, we propose an algorithm for the management of CM in Brazil. Results In Brazil, tuberculosis and cryptococcosis are endemic and should always be considered in CM patients. In addition to these diseases, neurosyphilis and other endemic conditions should be included in the differential diagnosis, including neurocysticercosis, Baggio-Yoshinari syndrome, and endemic mycosis. After infectious etiologies, meningeal carcinomatosis and autoimmune diseases should be considered. Unbiased and targeted methods should be used based on availability and clinical and epidemiological data. Conclusion We propose a rational approach to CM in Brazil, considering the epidemiological scenario, systematizing the etiological investigation, and evaluating the timely use of empirical therapies. (CM weeks scarce scenario epidemiology evaluation testing authors patients diagnosis neurocysticercosis BaggioYoshinari Baggio Yoshinari syndrome mycosis etiologies data investigation therapies

Resumo Antecedentes A meningite crônica (MC) é caracterizada por sintomas neurológicos associados à evidência de pleiocitose do líquido cefalorraquidiano por > 4 semanas. Os estudos sobre o manejo da MC no Brasil são escassos. Objetivo Rever criticamente a literatura sobre MC e propor uma abordagem racional no cenário brasileiro. Métodos Revisão da literatura narrativa discutindo a epidemiologia, avaliação clínica, testes diagnósticos básicos e avançados, além da terapia empírica e direcionada para as causas mais relevantes do MC. A presente revisão foi contextualizada com a experiência local dos autores. Além disso, propomos um algoritmo para o manejo da MC no Brasil. Resultados No Brasil, a tuberculose e a criptococose são endêmicas e devem ser sempre consideradas em pacientes com MC. Além destas doenças, a neurossífilis e outras condições endêmicas devem ser incluídas no diagnóstico diferencial, incluindo: neurocisticercose, síndrome de Baggio-Yoshinari e micoses endêmicas. Após etiologias infecciosas, devem ser consideradas a carcinomatose meningeal e doenças autoimunes sistêmicas. Métodos diagnósticos devem ser utilizados com base na disponibilidade, nos dados clínicos e nos dados epidemiológicos. Conclusão Propomos uma abordagem racional para a MC no Brasil, considerando o cenário epidemiológico, sistematizando a investigação etiológica e avaliando o uso oportuno de terapias empíricas. (MC semanas escassos brasileiro epidemiologia clínica avançados autores disso diferencial incluindo neurocisticercose BaggioYoshinari Baggio Yoshinari infecciosas sistêmicas disponibilidade epidemiológicos epidemiológico empíricas

RESUMO. O tratamento antirretroviral tem aumentado significativamente a sobrevida de pacientes contaminados pelo HIV-1. Entretanto, com o aumento da sobrevida, observam-se frequentemente alterações cognitivas associadas ao HIV nessa população. As manifestações clínicas das alterações do HIV podem variar em decorrência de diversos aspectos, entre eles a via de transmissão do vírus. Diversos estudos têm apontado alterações neurológicas prematuras em pacientes contaminados por via vertical, enquanto a manifestação de danos cognitivos em adultos pode levar um tempo maior. Objetivo: O objetivo deste estudo foi verificar a prevalência das alterações cognitivas em pacientes com HIV via transmissão vertical após a era da terapia antirretroviral altamente ativa e o desempenho cognitivo desses pacientes comparado ao de um grupo de pacientes contaminados por via sexual. Métodos: Foram avaliados 48 pacientes, sendo 25 com transmissão vertical e 23 com transmissão sexual no período entre maio de 2013 e fevereiro de 2015, no Instituto de Infectologia Emílio Ribas. Foram aplicados testes neuropsicológicos para avaliar o desempenho cognitivo, escalas para avaliar sintomas de ansiedade e depressão e questionário sociodemográfico. Resultados: Os resultados demonstraram que a frequência de comprometimento cognitivo em pacientes contaminados via transmissão vertical foi maior do que naqueles contaminados via transmissão sexual. Conclusões: Essas descobertas sugerem que os efeitos deletérios do vírus HIV na formação do sistema nervoso central repercutem de forma mais acentuada do que em pacientes que o adquiriram após a vida adulta.

ABSTRACT. Antiretroviral treatment has significantly increased the survival of patients infected with HIV-1. However, with increased survival, cognitive changes associated with HIV are frequently observed in this population. The clinical manifestations of HIV changes can vary as a result of several aspects, including the virus transmission route. Several studies have pointed out premature neurological changes in vertically infected patients, while the manifestation of cognitive damage in adults may take a longer time. Objective: The aim of this study was to verify the prevalence of cognitive changes in patients with HIV via vertical transmission after the highly active antiretroviral therapy and the cognitive performance of these patients compared to a group of sexually infected patients. Methods: A total of 48 patients were evaluated, 25 with vertical transmission and 23 with sexual transmission, between May 2013 and February 2015 at the Institute of infectology Emilio Ribas. Neuropsychological tests were applied to assess cognitive performance, scales to assess symptoms of anxiety and depression, and sociodemographic questionnaire. Results: The results demonstrate that the frequency of cognitive impairment in vertically transmitted patients was higher than in sexually transmitted patients. Conclusions: These findings suggest that the deleterious effects of the HIV virus on the development of the central nervous system reverberate more strongly than in patients who acquire it after adulthood.

Summary Chitosan in pearls and acidic pH (Q) has the ability to adsorb arsenic (As) from water. The Q could adsorb the As found in the soil solution. The objective of this research was to evaluate the chelating capacity of Q adjusted to acidic and neutral pH to decrease the concentration of soluble As in two Fluvisols. To carry out the experiment, Q was conditioned at two pH (5 and 7) with the addition of sulfuric acid and Q was left untreated for use as a control. Four treatments were tested (soils without Q, with untreated Q, with Q adjusted to pH 5 and with Q adjusted to pH 7). Each treatment was conducted in quadruplicate, making 16 experimental units for each soil. Each experimental unit consisted of 500 g of soil packed in a plastic bag, to which a phosphate fertilizer (200 mg kg‑1) was added and brought to field capacity, leaving it to stand for 48 h. Upon completion of the resting time, 0.063 g of Q of the corresponding treatment and its respective replicate were added to each bag, leaving them in incubation for 48 h at a temperature of 25 °C. The experimental design used was completely random. To the soils, the soluble As content was determined by an extraction with deionized water and the extracted was measured by the method of atomic absorption spectrophotometry with hydride generation. The data was subjected to an analysis of variance and a test of means (Tukey, P ≤ 0.05). The results showed that the chitosan adjusted with sulfuric acid at pH 5, (QpH5) adsorbed the greatest amount of soluble As (640%). Which represents an alternative for the recovery of soils contaminated with As.

Resumen El quitosano en perlas y pH ácido (Q) tiene la capacidad de adsorber arsénico (As) del agua. El Q podría adsorber el As que se encuentra en la solución del suelo. El objetivo de esta investigación fue evaluar la capacidad quelatante del Q ajustado a pH ácido y neutro para disminuir concentración de As soluble en dos Fluvisoles. Para llevar a cabo el experimento se acondicionó Q a dos pH (5 y 7) con la adición de ácido sulfúrico y se dejó Q sin tratar para usarlo como testigo. Se ensayaron cuatro tratamientos (suelos sin Q, con Q sin tratar, con Q ajustado a pH 5 y con Q ajustado a pH 7). Cada tratamiento se condujo por cuadruplicado, haciendo un total de 16 unidades experimentales para cada suelo. Cada unidad experimental consistió de 500 g de suelo empaquetado en una bolsa de plástico, a la cual se le añadió un fertilizante fosfatado (200 mg kg‑1) y se llevó a capacidad de campo, dejándola reposar por 48 h. Al cumplirse el tiempo de reposo, se agregaron a cada bolsa 0.063 g de Q del tratamiento correspondiente y su respectiva réplica, dejándolas en incubación durante 48 h a una temperatura de 25 °C. El diseño experimental empleado fue completamente al azar. A los suelos se les determinó el contenido de As soluble mediante una extracción con agua desionizada y lo extractado se midió por el método de espectrofotometría de absorción atómica con generación de hidruros. Los datos se sometieron a un análisis de varianza y una prueba de medias (Tukey, P ≤ 0.05). Los resultados demostraron que el quitosano ajustado con ácido sulfúrico a pH 5, (QpH5) adsorbió la mayor cantidad de As soluble (640%). Lo que representa una alternativa de recuperación de suelos contaminados con As.

RESUMO Introdução: A hepatite C pode ser definida como uma doença infecciosa, que se desenvolve por uma atividade inflamatória, que pode gerar um comprometimento no Sistema Nervoso Central, podendo ocasionar prejuízos cognitivos e sintomas de depressão. Objetivo: O objetivo deste estudo foi verificar o desempenho cognitivo de pacientes com hepatite C crônica antes e após o tratamento com simeprevir, sofosbuvir e daclatasvir. Métodos: Foi realizado um estudo prospectivo em três etapas: antes, logo após o tratamento e seis meses depois. Foram avaliados 58 pacientes em acompanhamento clínico no Instituto de Infectologia Emílio Ribas, em São Paulo, Brasil. Foram utilizados os seguintes instrumentos: questionário sociodemográfico, Escala de Lawton, Inventário de Depressão de Beck e uma bateria de testes neuropsicológicos que avaliaram: função intelectual, memória, atenção, função executiva e velocidade motora e de processamento). Para análise estatística, foram utilizadas as análises descritas (média, frequência e desvio padrão), qui-quadrado e ANOVA. Resultados: A maioria dos participantes era do sexo masculino (n=30, 51,7%), com média de 58,23±8,79 anos, escolaridade média de 9,75±4,43 anos. Comparando os resultados das avaliações neuropsicológicas (antes, logo após a finalização dos medicamentos e seis meses), observou-se melhora significativa em relação à aquisição de novos conhecimentos (p=0,03), memória visual tardia (p=0,01) e tendência em relação a atenção alternada (p=0,07). Conclusão: O tratamento do vírus da hepatite C melhorou o desempenho cognitivo, principalmente em relação à memória.

ABSTRACT Background: Hepatitis C can be defined as an infectious disease that develops an inflammatory activity, which may cause an impairment in the central nervous system, may cause cognitive impairments and symptoms of depression. Objective: The objective of this study was to verify the cognitive performance of patients with chronic hepatitis C before and after treatment with simeprevir, sofosbuvir, and daclatasvir. Methods: A prospective study was carried out in three stages: before, right after treatment, and six months after. Fifty-eight patients under clinical follow-up were evaluated at the Emílio Ribas Infectology Institute, in São Paulo, Brazil. The following instruments were used: sociodemographic questionnaire, Lawton’s Scale, Beck’s Depression Inventory, and a battery of neuropsychological tests that evaluated: intellectual function, memory, attention, executive function, and motor and processing speed). For statistical analysis, the analyses described (mean, frequency, and standard deviation), chi-square, and ANOVA were used. Results: Most of the participants were male (n=30, 51.7%), with a mean of 58.23±8.79 years, mean schooling of 9.75±4.43 years. Comparing the results of neuropsychological evaluations (before, just after completion of drugs, and six months), a significant improvement was observed in relation to the acquisition of new knowledge (p=0.03), late visual memory (p=0.01), and tendency towards alternate attention (p=0.07). Conclusion: The treatment of the hepatitis C virus improved cognitive performance, especially in relation to memory.

ABSTRACT Osteomyelitis due to Cryptococcus neoformans are described in mostly 10% of patients with disseminated cryptococcosis, being direct inoculation even more uncommon. We report the case of an HIV-infected patient with history of recurring itching on his scalp and repetitive local trauma. For eighteen months, he noticed a painful and slow growing lump on his scalp. He was submitted to an excisional biopsy of the lesion but no etiological diagnosis was identified. After this procedure, the post-surgical wound never completely healed. At admission, the patient presented nausea and headache for three days and an open orifice into his skull. Investigations confirmed meningitis and skull osteomyelitis caused by Cryptococcus neoformans. He was treated with bone debridement and combined systemic antifungals, showing good clinical and laboratorial outcome. Cryptococcal disease should be included in the differential diagnoses of chronic osteomyelitis in HIV-infected patients and trauma is a possible source of infection.

ABSTRACT Symptomatic forms of toxoplasmosis are a serious public health problem and occur in around 10-20% of the infected people. Aiming to improve the molecular diagnosis of symptomatic toxoplasmosis in Brazilian patients, this study evaluated the performance of real time PCR testing two primer sets (B1 and REP-529) in detecting Toxoplasma gondii DNA. The methodology was assayed in 807 clinical samples with known clinical diagnosis, ELISA, and conventional PCR results in a 9-year period. All samples were from patients with clinical suspicion of several features of toxoplasmosis. According to the minimum detection limit curve (in CT), REP-529 had greater sensitivity to detect T. gondii DNA than B1. Both primer sets were retrospectively evaluated using 515 DNA from different clinical samples. The 122 patients without toxoplasmosis provided high specificity (REP-529, 99.2% and B1, 100%). From the 393 samples with positive ELISA, 146 had clinical diagnosis of toxoplasmosis and positive conventional PCR. REP-529 and B1 sensitivities were 95.9% and 83.6%, respectively. Comparison of REP-529 and B1 performances was further analyzed prospectively in 292 samples. Thus, from a total of 807 DNA analyzed, 217 (26.89%) had positive PCR with, at least one primer set and symptomatic toxoplasmosis confirmed by clinical diagnosis. REP-529 was positive in 97.23%, whereas B1 amplified only 78.80%. After comparing several samples in a Brazilian referral laboratory, this study concluded that REP-529 primer set had better performance than B1 one. These observations were based after using cases with defined clinical diagnosis, ELISA, and conventional PCR.

The spectrum of neurological complications associated with human immunodeficiency virus type 1 (HIV-1) infection is broad. The most frequent etiologies include primary diseases (caused by HIV itself) or secondary diseases (opportunistic infections or neoplasms). Despite these conditions, HIV-infected patients are susceptible to other infections observed in patients without HIV infection. Here we report a rare case of a brain abscess caused by Staphylococcus aureus in an HIV-infected patient. After drainage of the abscess and treatment with oxacilin, the patient had a favorable outcome. This case reinforces the importance of a timely neurosurgical procedure that supported adequate management of an unusual cause of expansive brain lesions in HIV-1 infected patients.

Aim:This study evaluated the use of polymerase chain reaction for cryptococcal meningitis diagnosis in clinical samples.Materials and methods:The sensitivity and specificity of the methodology were evaluated using eight Cryptococcus neoformans/C. gattiispecies complex reference strains and 165 cere- brospinal fluid samples from patients with neurological diseases divided into two groups: 96 patients with cryptococcal meningitis and AIDS; and 69 patients with other neurological opportunistic diseases (CRL/AIDS). Two primer sets were tested (CN4-CN5 and the multiplex CNa70S-CNa70A/CNb49S-CNb-49A that amplify a specific product for C. neoformansand another for C. gattii).Results:CN4-CN5 primer set was positive in all Cryptococcusstandard strains and in 94.8% in DNA samples from cryptococcal meningitis and AIDS group. With the multiplex, no 448-bp product of C. gattiiwas observed in the clinical samples of either group. The 695 bp products of C. neoformanswere observed only in 64.6% of the cryptococcal meningitis and AIDS group. This primer set was negative for two standard strains. The specificity based on the negative samples from the CTL/AIDS group was 98.5% in both primer sets.Conclusions:These data suggest that the CN4/CN5 primer set was highly sensitive for the identification of C. neoformans/C. gattiispecies complex in cerebrospinal fluid samples from patients with clinical suspicion of cryptococcal meningitis.

OBJECTIVES: To assess the virologic and immunological response of darunavir/ritonavir plus optimized background therapy in highly antiretroviral-experienced HIV-infected patients in Brazil. METHODS: Prospective cohort study carried out in a tertiary center in Sao Paulo, Brazil. Three-class antiretroviral-experienced patients with confirmed virologic failure began darunavir/ritonavir plus optimized background therapy (nucleoside/tide reverse transcriptase inhibitors ± raltegravir ± enfuvirtide ± maraviroc) after performing a genotypic resistance assay. Clinical evaluation and laboratory tests were collected at baseline and at weeks 12, 24, and 48. Multivariate analysis was performed to identify predictors of virologic response at 48 weeks. RESULTS: Ninety-two patients were included. The median of darunavir resistant mutation was 1 (range 0-6). The median genotypic sensitivity score in the optimized background therapy was 2 (interquartile range 1-2). At week 48, 83% (95% CI: 75-90%) had an HIV RNA level <50 copies/mL and the median CD4 cell count was 301 (interquartile range 224-445) cells/mm³. Baseline HIV RNA >100 000 copies/mL was inversely associated with virologic success at week 48 (HR: 0.22, 95% CI: 0.06-0.85, p = 0.028). CONCLUSIONS: Darunavir/ritonavir plus optimized background therapy was a highly effective salvage regimen under clinical routine conditions in a referral center in Brazil, which is similar to the reported in high-income countries.