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The purpose of this case-control study was to verify the association between single nucleotide polymorphisms (SNPs) in genes encoding drug transporters related to tenofovir disoproxil fumarate (TDF) and proximal renal tubular dysfunction (PRTD), and the association between PRTD and clinical characteristics.The 'cases' met the diagnostic criteria for PRTD, determined by the presence of two or more of the following abnormalities: non-diabetic glycosuria, metabolic acidosis, increased uric acid and phosphorus excretion, decreased tubular phosphorus reabsorption and β2-microglobulinuria. We analyzed eight SNPs in ABCC2, ABCC4, ABCC10 and SLC28A2 genes. Genotyping was performed using real-time PCR.Of the 204 people living with HIV, 38 (18.6%) met the criteria for diagnosis of PRTD and 131 were male (64.2%), with a mean age of 49 years and a history of previous antiretroviral therapy for an average of 5 years. In the multivariate analysis, older individuals, TDF use, protease inhibitor, antihypertensives and anticonvulsants were associated with a risk of developing PRTD. Increased excretion of β2microglobulin was associated with the A/G genotype of rsCC8187710 from ABCC2 ( P = 0.003) and the following genotypes of ABCC4 SNPs: A/G from rs1059751 ( P = 0.023), G/G from rs1059751 ( P = 0.030) and C/C of rs3742106 ( P = 0.041). The increase in the fraction of excreted phosphorus was associated with the C/T genotype of SNCC rsP40037 from ABCC2 ( P = 0.0041).The results indicate an important relationship between SNPs associated with these markers and changes in proximal renal tubule function, and thus support their use as biomarkers for the early detection of PRTD risk.

RESUMO A substituicao cirurgica da valvula aortica e o padrao-ouro para o tratamento da estenose aortica sintomatica grave. Complicacoes diretamente relacionadas ao procedimento cirurgico sao relativamente pouco frequentes. A estenose ostial da arteria coronaria e uma complicacao rara, mas potencialmente fatal, cujo exato mecanismo patogenico e desconhecido, embora algumas hipoteses ja tenham sido propostas. Apresentamos um caso de sindrome coronariana aguda recorrente nos primeiros 12 meses apos substituicao cirurgica da valvula aortica realizada simultaneamente com cirurgia de revascularizacao do miocardio, [...]

Staphylococcus spp. is one of the major infection-associated bacteria within health care, especially in intensive care units, and one of principal cause of complication in cancer patients. This study compared the antimicrobial susceptibility profile and frequency of resistance (mecA, blaZ, ermA and ermC) and virulence (icaA, icaD and hlg) genes in Staphylococcus spp. from patients of Oncology Hospital (OH) and University Hospital (UH). The type of the ccr complex was assessed by PCR among the mecA positive isolates from the UH. Higher percentage of susceptible isolates, except for oxacillin and cefoxitin was found among the UH isolates and 27,3% vancomycin-resistant isolates were identified through the screening spot; 41 isolates displayed the MLSBc phenotype and five the MSLBi phenotype, and one isolate from the OH displayed the constitutive phenotype ermC gene. The ccr types I and II were identified with a higher frequency of ccr type I. No statistically significant difference was found in the frequency of the genes between the two groups of patients or in the two hospitals. Regarding the virulence genes, there was statistically significant difference when comparing the two hospitals. Staphylococcus spp. es una de las principales bacterias asociadas a las infecciones en la asistencia sanitaria, especialmente en las unidades de cuidados intensivos, y una de las principales causas de complicaciones en los pacientes oncológicos. Este estudio comparó el perfil de susceptibilidad antimicrobiana y la frecuencia de genes de resistencia (mecA, blaZ, ermA y ermC) y virulencia (icaA, icaD y hlg) en Staphylococcus spp. de pacientes de un Hospital Oncológico (OH) y Hospital Universitario (HU). El tipo de complejo ccr se evaluó mediante PCR entre los aislados mecA positivos de la HU. Se encontró un mayor porcentaje de aislados susceptibles, a excepción de oxacilina y cefoxitina, entre los aislados de UH y el 27,3% de los aislados resistentes a la vancomicina se identificaron mediante el método de cribado; 41 aislamientos exhibieron el fenotipo MLSBc y cinco el fenotipo MSLBi, y un aislado OH del fenotipo constitutivo exhibió el gen ermC. Se identificaron CCR tipo I y tipo II, con mayor frecuencia de CCR tipo I. No hubo diferencia estadísticamente significativa en la frecuencia genética entre los dos grupos de pacientes o en los dos hospitales. En cuanto a los genes de virulencia, hubo una diferencia estadísticamente significativa al comparar los dos hospitales. Staphylococcus spp. é uma das principais bactérias associadas a infecções na área de saúde, especialmente em unidades de terapia intensiva, e uma das principais causas de complicações em pacientes com câncer. Este estudo comparou o perfil de susceptibilidade aos antimicrobianos e a frequência de genes de resistência (mecA, blaZ, ermA e ermC) e virulência (icaA, icaD e hlg) em Staphylococcus spp. de pacientes de um Hospital Oncológico (OH) e Hospital Universitário (HU). O tipo de complexo ccr foi avaliado por PCR entre os isolados mecA positivos do HU. Maior porcentagem de isolados suscetíveis, exceto para oxacilina e cefoxitina, foi encontrada entre os isolados de UH e 27,3% dos isolados resistentes à vancomicina foram identificados através método de screening; 41 isolados exibiram o fenótipo MLSBc e cinco o fenótipo MSLBi, e um isolado do OH do fenótipo constitutivo exibiu o gene ermC. Os ccr tipos I e II foram identificados, sendo maior frequência do ccr tipo I. Não foi encontrada diferença estatisticamente significativa na frequência dos genes entre os dois grupos de pacientes ou nos dois hospitais. Em relação aos genes de virulência, houve diferença estatisticamente significativa na comparação dos dois hospitais.

Bloodstream infections remain one of the most common major complications in cancer patients. The aim of the study was to describe the etiology, phenotypic and molecular epidemiology of ICS isolates from cancer patients. Method: identification and the resistance profile were carried out using the automated biochemical method Vitek 2®. The presence and genes resistant to carbapenemases blaIMP, blaVIM, blaGIM, blaSIM, blaSPM, blaKPC, blaNDM, genes oxacilinase blaOXA-48, blaOXA-58, and the presence of ESBL genes blaSHV, blaCTX, blaTEM for Gram-negatives, as well as, mecA, vanA and vanB for Gram-positives were investigated in blood culture isolates. Result: Escherichia coli and Klebsiella pneumoniae were the most frequent pathogens. The serine-β-lactamase gene blaOXA-48 was the most frequent, followed by MβL blaSIM. blaTEM and blaCTX were the most common among ESBL. The mecA and vanA genes were found in Staphylococcus spp. and Enterococcus faecium, respectively. Candida spp showed high resistance to voriconazole and fluconazole. Conclusion: measures to prevent and control the spread of resistance genes are essential to reduce the risks of morbidity and mortality.

Resumo Fundamento Pacientes com HIV têm maior probabilidade de apresentar doenças cardiovasculares quando comparados à população em geral. Objetivo Este foi um estudo de caso-controle que teve como objetivo avaliar quais fatores estavam associados a uma redução na espessura médio-intimal da carótida (IMT) da carótida e ao aumento na dilatação mediada por fluxo (DMF) da artéria braquial em pacientes com HIV que receberam atorvastatina + aspirina por um período de 6 meses. Métodos Foi realizada uma análise secundária de um ensaio clínico, que incluiu pessoas vivendo com HIV e baixo risco cardiovascular. Um total de 38 pacientes alocados para o braço de intervenção e tratados por 6 meses com uma combinação de atorvastatina + aspirina foram incluídos. Todos os participantes foram submetidos a ultrassonografia da carótida e da artéria braquial, tanto no início quanto no final do estudo. Os casos que responderam com aumento >10% da dilatação braquial (DMF) e redução da espessura médio-intimal da carótida (IMT) foram considerados casos, e aqueles que não responderam foram considerados controles. Avaliamos os fatores associados às respostas positivas obtidas através da IMT e DMF. Resultados A redução do IMT não se associou significativamente a nenhum dos fatores de risco avaliados: idade (p = 0,211), sexo (p = 0,260), tabagismo (p = 0,131) ou tempo de diagnóstico do HIV (p = 0,836). Um aumento na DMF foi significativamente associado com a idade entre aqueles na faixa etária de 40-59 anos, p = 0,015 (OR = 4,37; IC 95%: 1,07-17,79). Conclusões Os indivíduos mais velhos foram mais propensos a apresentar um aumento na DMF após 6 meses de tratamento com atorvastatina + aspirina. Abstract Background Patients with HIV are more likely to present with cardiovascular disease when compared to the general population. Objective This was a case-control study that aimed to assess which factors were associated with a reduction in the carotid intima-media thickness (IMT) and an increase in the brachial artery flow-mediated dilation (FMD) in HIV patients who received atorvastatin + aspirin during a period of 6 months. Methods A secondary analysis of a clinical trial was conducted, which included people living with HIV infection and low cardiovascular risk. A total of 38 patients allocated to the intervention arm and treated for 6 months with a combination of atorvastatin + aspirin were included. All participants underwent a carotid and brachial artery ultrasound, both at the beginning and the end of the study. Cases that responded with an increase of >10% of the brachial dilatation (FMD) and reduction of the carotid intima-media thickness (IMT) were considered cases, and those who did not respond were considered controls. We assessed the factors associated with the positive responses obtained through IMT and FMD. Results A reduction in the IMT was not significantly associated with any of the evaluated risk factors: age (p=0.211), gender (p=0.260), smoking (p=0.131) or time since HIV diagnosis (p=0.836). An increase in the FMD was significantly associated with age amongst those in the 40-59 age group, p = 0.015 (OR = 4.37; 95% CI: 1.07-17.79). Conclusions Older individuals were more likely to present with an increased FMD after 6 months of treatment with atorvastatin + aspirin.

Background: Bloodstream infections are among the most frequent and serious complications in patients with haematological malignancies. Case presentation: A patient diagnosed with acute myeloid leukemia was admitted to the hospital for chemotherapy induction, developed several episodes of febrile neutropenia. Had bloodstream infection with at least four strains of Gram-negative bacteria, including Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumanii. The majority showed resistance to ampicillin, cefepime, ceftriaxone, ciprofloxacin and sulfamethoxazole/trimethoprim. blaTEM and blaSIM were detected in P. aeruginosa, blaTEM, blaCTX and blaOXA-48 in E. coli, blaCTX, blaKPC, blaNDM, blaSIM and blaOXA-48 in K. pneumoniae and blaOXA-48 in A. baumannii. Conclusions: The patient was treated with meropenem for 10 days, without progressing from fever episodes, evolved to death. Antecedentes: las infecciones del torrente sanguíneo se encuentran entre las complicaciones más frecuentes y graves en pacientes con neoplasias hematológicas. Presentación del caso: Un paciente diagnosticado con leucemia mieloide aguda fue ingresado en el hospital para inducción de quimioterapia, desarrolló varios episodios de neutropenia febril. Tenía una infección del torrente sanguíneo con al menos cuatro cepas de bacterias gramnegativas, incluidas Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae y Acinetobacter baumanii. La mayoría mostró resistencia a ampicilina, cefepima, ceftriaxona, ciprofloxacina y sulfametoxazol / trimetoprima. blaTEM y blaSIM se detectaron en P. aeruginosa, blaTEM, blaCTX y blaOXA-48 en E. coli, blaCTX, blaKPC, blaNDM, blaSIM y blaOXA-48 en K. pneumoniae y blaOXA-48 en A. baumannii. Conclusiones: El paciente fue tratado con meropenem durante 10 días, sin progresar de episodios febriles, evolucionó hasta la muerte. Introdução: As infecções da corrente sanguínea estão entre as complicações mais frequentes e graves em pacientes com doenças hematológicas malignas. Apresentação do caso: Um paciente com diagnóstico de leucemia mielóide aguda foi admitido no hospital para indução de quimioterapia, desenvolveu vários episódios de neutropenia febril. Teve infecção da corrente sanguínea com pelo menos quatro cepas de bactérias Gram-negativas, incluindo Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae e Acinetobacter baumanii. A maioria mostrou resistência a ampicilina, cefepima, ceftriaxona, ciprofloxacina e sulfametoxazol/trimetoprima. blaTEM e blaSIM foram detectados em P. aeruginosa, blaTEM, blaCTX e blaOXA-48 em E. coli, blaCTX, blaKPC, blaNDM, blaSIM e blaOXA-48 em K. pneumoniae e blaOXA-48 em A. baumannii. Conclusões: O paciente foi tratado com meropenem por 10 dias, sem evolução de episódios febris, evoluindo a óbito.

A man, 26 years-old, presented fever, mental confusion and a progressively worsening headache 6 days prior to admission. The CSF study was suggestive of meningoencephalitis, the PCR study revealed presence of HSV-1 and ZIKV, while other immunology tests were negative. ZIKV was also identified in serum. The MRI showed temporal lobe hyper-intensity in FLAIR-weight sequence with areas of contrast enhancement and the electroencephalogram showed slow wave activity in such region. Patient was treated with acyclovir and supportive measures and had good clinical outcome at evaluation after 6 months. Neurological spectrum of ZIKV manifestations is wide, but meningoencephalitis is not frequent. Co-infection HSV-1 plus ZIKV was not yet related in humans, but there is increased cellular damage caused by association of ZIKV and herpes virus family infection. ZIKV may facilitate infection or recrudescence by other viruses or cause concurrently neuronal injury by direct or indirect mechanisms. We suggest that clinicians attempt new manifestations related to ZIKV and include this agent in differential diagnosis of neurological diseases even when other agents were identified. Keywords: Zika virus, Human herpesvirus 1, Meningoencephalitis, Case report

INTRODUCTION The incidence of syphilis has increased since the 1970s. METHODS This was a descriptive and analytical cross-sectional study with a non-probabilistic sample. RESULTS: Of 973 patients with human immunodeficiency virus, 179 (18.4%) tested positive for both human immunodeficiency virus and syphilis, 84.8% were men, 50.9% were aged between 36 and 50 years, 47.8% with syphilis were diagnosed with human immunodeficiency virus for 10-20 years, and 40.3% received antiretroviral therapy for 10-20 years. CONCLUSIONS The prevalence of syphilis in patients with human immunodeficiency virus is higher than expected, making it urgent to adopt efficient public health measures.

Objective The purpose of this study is to investigate the prevalence of MRSA among people living with HIV/AIDS (PLHA) being monitored in a tertiary outpatient hospital in the state of Pernambuco, in the Brazilian Northeast. Results Staphylococcus aureus was isolated from a nasal swab and found in 31.4% of the individuals (95% CI 27.3–35.5), of whom 4.4% (95% CI 8.5–19.5) were MRSA, as confirmed by the presence of the mecA gene. For individuals whose S. aureus was recovered, the mean age was 41.5 years; 93.6% were on antiretroviral treatment. This group had CD4 cell counts > 200 (92%) and viral load ≤ 100 copies (79.1%). Use of antimicrobial agents in the past 12 months was found among 21% of the individuals, and 24.2% reported use of illicit drugs at lease once in their lifetime. Prevalence of nasal colonization by MSSA (26.7%) and MRSA (4.4%) was higher in comparison to other studies of this population; nevertheless, we were unable to establish factors associated with risk. Electronic supplementary material The online version of this article (10.1186/s13104-018-3899-z) contains supplementary material, which is available to authorized users.

This study aims to report the diagnostic course and treatment of a fast-growing mycobacteria infection after cesarean delivery. We report the case of a 37-year-old woman admitted to the Infectious Diseases’ Clinic of the Hospital das Clinicas da Universidade Federal de Pernambuco, Pernambuco State, Brazil, four months after a cesarean section, presenting with healing difficulties and located pain outside the surgical site. The first diagnosis was a probable rejection of the sutures that were not absorbed, but based on the clinical signs, reported history, complementary laboratory tests and no response to treatment with the conventional antibiotic therapy (cephalosporins/quinolones) prescribed, the ultimate diagnosis was a mycobacteriosis caused by Micobacterium fortuitum. Since fast-growing mycobacteria do not easily penetrate host tissues, they is mainly related to post-trauma or post-surgical procedures. It is extremely important to call attention to these occurrences in the gynecological-obsthetric field. Treatment for mycobacteriosis is often complicated because of the side effects of antibiotics, especially the ototoxicity of amikacin.

Introdução: Infecção da corrente sanguínea (ICS) por Enterococcus resistente à vancomicina (VRE) é uma complicação grave em pacientes com tumor sólido. Objetivo: Descrever o aspecto clínico e molecular do isolado Enterococcus resistente a vancomicina em paciente com tumor de cólon. Métodos: O isolado de VRE foi identificado e analisado quanto ao perfil antimicrobiano a partir de hemocultura processado por método automatizado vitek®, posteriormente foi submetida para a detecção do gene de resistência à vancomicina, vanA. Resultado: O isolado Enterococcus faecium apresentou resistência à amicacina, eritromicina e vancomicina. O gene VanA foi identificado e iniciado o tratamento com teicoplanina seguida de daptomicina sem sucesso a paciente evoluiu a óbito.

A infecção pelo protozoário Lophomonas spp é uma condição rara, com pouco mais de 250 casos descritos no mundo, nenhum deles no Brasil. Esta infecção está associada em sua grande maioria a estados de imunossupressão e a condições de higiene precárias em países subdesenvolvidos. O objetivo desde artigo é relatar o primeiro caso brasileiro de lofomoníase broncopulmonar em indivíduo do sexo masculino concomitantemente a Síndrome Respiratória Aguda Grave (SRAG) pelo novo coronavírus (SARS-CoV-2) e tuberculose pulmonar. Durante a investigação do quadro respiratório, paciente apresentou nódulo solitário cavitado em exame de imagem, sendo submetido a lavado broncoalveolar que evidenciou a presença do protozoário do gênero Lophomonas spp. Foi iniciado tratamento medicamentoso com Metronidazol durante 14 dias, havendo melhora clínica, com interrupção da febre e posterior extubação. Dessa forma, se faz importante considerar a variedade de possibilidades etiológicas nos quadros infecciosos do trato respiratório que não respondem a terapêutica convencional empregada para pneumonias bacterianas e fúngicas.

Cutaneous leishmaniasis (CL), also known as American cutaneous leishmaniasis (ACL), is characterized by cutaneous or mucosal involvement, most often without visceral involvement. It is considered an occupational disease in forest workers, explaining the high prevalence of CL among Brazilian Army soldiers training in the Amazon Rainforest, highway construction workers, prospectors, hunters, and oil industry and wood workers. The skin lesion occurs approximately 2 weeks to 2 years after the insect bite and is most common in exposed areas of the skin such as the forearms, legs, neck, and face. Initially, there is a small erythematous papule that, during the evolution, develops into a plaque or nodule, with frequent enlargement of satellite lymph nodes. Renal dysfunction related to visceral leishmaniasis is well described in the literature with variable reports, ranging from nonspecific alterations, identified in the urine summary, to several types of glomerulopathies. A urinary concentration defect due to the heavy metal present in the drug has already been described, as well as acute kidney injury (AKI) due to massive deposition of immunocomplexes in the glomeruli through the leishmania breakdown by antimonial agents. Tubular defects have been confirmed in ACL patients through the screening for urinary exosomes, and the most often studied are AQP2, NHE3, NKCC2, H+ -K+ ATPase, and pendrin. CL treatment aims to reduce the risk of mucosal form development and disease dissemination, accelerate disease resolution, reduce the risk of lesion recurrence, attenuate the destructive effects of the lesions, and reduce transmission.

A resistência a carbapenemases em bacilos gram-negativas (BGN) tornou-se um problema mundial, elevando a taxa de morbidade e mortalidade. O método automatizado foi utilizado para identificação e suscetibilidade dos isolados. E o método molecular foi aplicado na detecção de bacilos gram-negativas (BGN) produtoras de carbapenemase. Um total de 205 BGN foram recuperados a partir de diferentes amostras clínicas, resistentes a carbapenemases. Os genes de resistência blaKPC (57,5%), blaVIM (30,2%), blaGES (17%), blaNDM (15%) e blaSPM (2,4%) foram recuperados a partir de isolados clínicos. O gene blaIMP não foi detectado em nenhum dos isolados. É preocupante que Pseudomonas aeruginosa e Acinetobacter baumannii representem a maioria dos isolados (61,6%) recuperados de infecções de diferentes sítios, com alta resistência a carbapenêmicos, carregando simultaneamente os genes blaKPC, blaGES e blaVIM, assim como encontrados também em Enterobactericeae. A carbapenemase mais prevalente foi blaKPC e blaVIM, seguida de blaNDM dentre os isolados multidroga resistentes. Esses resultados são um ameaça à saúde pública, configurando altas taxas de resistência, limitando as opções terapêuticas.

As infecções por Clostridioides difficile (CDI) aumentaram em gravidade e incidência durante a última década. O câncer predispõe os pacientes à CDI, devido à maior exposição aos fatores de risco. O presente estudo teve como objetivo determinar a prevalência, resposta clínica, desfecho, descrever os fatores de risco estabelecidos na literatura em pacientes oncológicos com CDI. O estudo foi realizado em dois serviços de referência em oncologia de Recife/PE e envolveu pessoas com idade ≥18 anos, que apresentaram o quadro de diarreia após 48horas da admissão hospitalar, no período de novembro/2017 a agosto/2019. Para o diagnóstico de CDI foi utilizado o exame Reação em Cadeia da Polimerase em Tempo Real (qRT-PCR). Um total de 156 pacientes foram incluídos, a CDI foi identificada em 7,05% (11/156) dos pacientes estudados, todos isolados foram rastreados e amplificados por qRT-PCR quanto à presença dos genes que codificam as toxinas A e B (tcdA e tcdB), toxina binária (cdtA) e triose fosfato isomerase (tpi). O câncer de mama 27,3% (3/11) e a leucemia linfóide aguda 18,2% (2/11) foram os cânceres mais frequentes; 90,9% (10/11) fizeram uso de antibióticos e 63,6% (7/11) dos casos evoluíram para óbito. Apesar de utilizar a técnica qRT-PCR, que é a mais sensível e específica, a prevalência de CDI foi baixa 7,05% (11/156), não houve registros de casos de CDI graves, sendo a maioria dos casos leves, o que sugere uma circulação de cepas com baixa virulência que determinam menor morbidade e mortalidade.

Background: Kaposi's sarcoma continues to be the most common human immunodeficiency virus - associated neoplasm with considerable morbidity and mortality. Objective: To describe the clinical and laboratory characteristics, initial staging, and outcomes of aids patients with Kaposi's sarcoma at an university hospital of Recife, Pernambuco. Methods: This is a descriptive study with analytic character, retrospective, of a case series between 2004 and 2014. Results: Of the 22 patients included in the study, 20 were aged

Background Some antiretrovirals (ARVs) cause muscle toxicity and their use has been attributed to beginning of respiratory and peripheral muscle weakness in people living with HIV/AIDS (PLWHA) on treatment. Dolutegravir (DTG) has been adopted by Brazil as a first-line regimen with Tenofovir/Lamivudine (TDF/3TC) since 2017, with low toxicity profile. Due to the short use of this regimen, we have not found data in the literature regarding its effects in the respiratory and peripheral muscles in PLWHA. The aim of this study was to compare respiratory and peripheral muscle strength before and after start of this new combined ART (TDF/3TC/DTG).Methods Descriptive, longitudinal and prospective study, observational and analytical with 41 PLWHA evaluated before the initiation of antiretroviral therapy (ART) (T0) which of these, 28 were reevaluated after more than 50 days of treatment (T1).The assessments of maximum functional capacity (six-minute walk test distance), maximal inspiratory (MIP) and expiratory (MEP) pressures and handgrip strength (HGS) were performed using standardized methods. In addition, laboratory data (CD4, CD4/CD8 ratio and viral load-VL) were collected. Shapiro-Wilk test was applied for normality while Fisher's exact test and t-test or Wilcoxon test were used for comparisons of categorical and continuous variables, respectively. Pearson or Spearman correlations were used according to data normality and p-value < 0.05 were considered significant for all analyzes.Results The frequency of peripheral muscle weakness in patients evaluated at T0 was 97.6%, while 31.7% had inspiratory and / or expiratory muscle weakness. HGS was positively correlated with CD4 (p = 0.027) and negatively correlated with VL (p = 0.046). Both MIP (p = 0.0176) and HGS (p = 0.0018) showed improvement in T1.Conclusion ART combined with TDF / 3TC / DTG increased MIP and HGS after more than 50 days of treatment. Cohort studies are needed to better understand the action of these medications on PLWHA musculature under treatment.

16S rRNA methylases confer high-level resistance to aminoglycosides which are used to treat serious infections caused by gram-negative bacteria, such as Acinetobacter spp. Some genes encoding these enzymes are disseminated worldwide, while others were detected in only some countries. The objective was to characterize the susceptibility profile to aminoglycosides (amikacin and gentamicin) of clinical isolates of Acinetobacter spp. from an oncological hospital in Recife, and given the resistance to both antimicrobials, to characterize minimal inhibitory concentrations (MICs) of amikacin, gentamicin and tobramycin, the occurrence of 16S rRNA methylase genes (armA, rmtB, rmtC and rmtD) and of s-lactamase gene (blaKPC) and the clonal profile. Isolates resistant to both antimicrobials, amikacin and gentamicin, were selected by disk diffusion technique in Mueller–Hinton agar and identified. Broth microdilution was conducted to determine MICs of amikacin, gentamicin, and tobramycin. These isolates were subjected to polymerase chain reaction and pulsed-field gel electrophoresis. Among 23 analyzed isolates, 12 (52.2%) were resistant to gentamicin and amikacin and identified as Acinetobacter baumannii. Among these, 11 (91.7%), 12 (100%), and 9 (75%) isolates showed respectively MICs > 256 µg/mL of amikacin, > 64 µg/mL of gentamicin, and > 64 µg/mL of tobramycin. The armA gene was found in 12 (100%) isolates and 6 (50%) showed coexistence of armA, rmtB, and rmtC genes. The rmtD and blaKPC genes were not detected. These isolates showed high genetic similarity (92%) and were classified as clone A. Elaboration and fulfillment of measures are thus essential to prevent the spread of this resistance mechanism.

Emergent fungal infections are uncommon conditions which frequently lead to death. To our knowledge, only a few cases of invasive infection by Cystobasidium minutum (previously known as Rhodotorula minuta) have been reported. Moreover, several factors are responsible for deep site infections, such as catheter-related fungemia. This report describes the first case report of Cystobasidium minutum causing fungemia in Brazil. The pathogens fungemia was demonstrated by catheter and blood culture-proven, and both yeasts were identified by sequences of D1/D2 rDNA region. After the end of antifungal therapy and catheter removal, a second blood culture was found to be negative and the clinical signs and symptoms of the patient improved.

Systemic infections due to Candida tropicalis are conditions which can frequently lead to death. The aim of this report is to describe the features of C. tropicalis biofilm in a patient with catheter-associated fungemia.

Coccidioidomycosis is a fungal infection caused by Coccidioides immitis or Coccidioides posadasii. These fungi are known to thrive in desert climate. Fungi produce infectious arthroconidia in soil, they are aerosolized in the air and when inhaled by humans, usually cause infections such as pneumonia. The first cases of coccidioidomycosis in Brazil were reported in 1978. Since then, there have been other reports mainly from desert regions of Northeastern Brazil. The present report describes three cases of coccidioidomycosis on male farmers from Serra Talhada county, Pernambuco State, who developed pneumonia and were subsequently diagnosed with pulmonary coccidioidomycosis. These three farmers were successfully treated with oral fluconazole. They reported having hunted armadillos in a rural and arid area of Pernambuco State. Armadillos are known to be carriers of Coccidioides. This is the first report of infection caused by Coccidioides in Pernambuco State, Brazil.

Trends in epidemiology and antifungal susceptibility of Candida species in Brazil between 2019–2020 are reported. A total of 22 isolates diagnosed from candidemia episodes were analyzed. Candida species were identified by specie specific primer and/or sequencing of 28S rDNA. Antifungal susceptibility was determined by CLSI method. C. tropicalis accounted for 11 (50%) cases followed by C. albicans (n=5, 22.73%), C. parapsilosis (n=4, 18.19%), Issatchenkia orientalis (n= 1, 4.54%), and Saccharomyces cerevisiae (n= 1, 4.54%). All Candida isolates were susceptible to amphotericin B and micafungin, and one was dose-dependent to anidulafungin. Eight of 20 Candida isolates were resistant to fluconazole and four sensitive doses dependent. Sixteen of 20 Candida isolates were resistant to voriconazole, and one resistant and one sensitive dose-dependent on caspofungin. Besides, the respective MIC50 and MIC90 values ​​were calculated with fluconazole (MIC50 and MIC90 of 4 and 64µg/mL, respectively) and voriconazole (MIC50 and MIC90 of 16µg/mL) showing the lowest potencies. The spread of fluconazole-resistant in one of major concerns, especially to C. tropicalis. The high use of antifungal drug may be a possible cause related to this scenario. Thus, the susceptibility profile test may be used to know the best way to introduce appropriateness empirical antibiotics therapy. Changing trends in incidence and antifungal susceptibility patterns of six Candida species causing candidemia in Kuwait between 2006–2017 are reported. A total of 2075 isolates obtained from 1448 patients were analyzed. Identity of Candida species isolates was determined by phenotypic methods and confirmed by PCR amplification/PCR-sequencing of rDNA and/or MALDI-TOF MS. Antifungal susceptibility was determined by Etest. C. albicans accounted for 539 (37.22%) cases followed by C. parapsilosis (n = 502, 34.67%), C. tropicalis (n = 210, 14.5%), C. glabrata (n = 148, 10.22%), C. krusei (n = 27, 1.81%) and C. dubliniensis (n = 22, 1.5%). The comparative percent distribution of Candida species causing candidemia between 2006–2011 and 2012–2017 was as follows: C. albicans 41.8% and 33.1%, C. parapsilosis complex 32.01% and 37.04%, C. tropicalis 13.59% and 15.31%, and C. glabrata 8.77% and 11.51%, C. krusei 2.0% and 1.7%, and C. dubliniensis 1.75 and 1.3%, respectively. Three of 371 C. albicans isolates during 2006–2011 and five of 363 during 2012–2017 were resistant to fluconazole. Among C. parapsilosis isolates, one of 310 during 2006–2011 and 21 of 446 during 2012–2017 were resistant to this drug. Furthermore, at an epidemiologic cutoff value (ECV) of ≤0.5 μg/ml, 70.1% C. albicans isolates were wild-type for fluconazole during 2006–2011 as compared to 58.1% during 2012–2017. Likewise, at an ECV of ≤2 μg/ml, 98.0% of C. parapsilosis isolates were wild-type during 2006–2011 as compared to 93.4% during 2012–2017. Clonal spread of fluconazole-resistant C. parapsilosis in one major hospital was documented. An 8.8% shift in favor of non-albicans Candida species with concomitant increase in MICs between the two periods preludes emergence of fluconazole-resistant candidemia cases in Kuwait.Changing trends in incidence and antifungal susceptibility patterns of six Candida species causing candidemia in Kuwait between 2006–2017 are reported. A total of 2075 isolates obtained from 1448 patients were analyzed. Identity of Candida species isolates was determined by phenotypic methods and confirmed by PCR amplification/PCR-sequencing of rDNA and/or MALDI-TOF MS. Antifungal susceptibility was determined by Etest. C. albicans accounted for 539 (37.22%) cases followed by C. parapsilosis (n = 502, 34.67%), C. tropicalis (n = 210, 14.5%), C. glabrata (n = 148, 10.22%), C. krusei (n = 27, 1.81%) and C. dubliniensis (n = 22, 1.5%). The comparative percent distribution of Candida species causing candidemia between 2006–2011 and 2012–2017 was as follows: C. albicans 41.8% and 33.1%, C. parapsilosis complex 32.01% and 37.04%, C. tropicalis 13.59% and 15.31%, and C. glabrata 8.77% and 11.51%, C. krusei 2.0% and 1.7%, and C. dubliniensis 1.75 and 1.3%, respectively. Three of 371 C. albicans isolates during 2006–2011 and five of 363 during 2012–2017 were resistant to fluconazole. Among C. parapsilosis isolates, one of 310 during 2006–2011 and 21 of 446 during 2012–2017 were resistant to this drug. Furthermore, at an epidemiologic cutoff value (ECV) of ≤0.5 μg/ml, 70.1% C. albicans isolates were wild-type for fluconazole during 2006–2011 as compared to 58.1% during 2012–2017. Likewise, at an ECV of ≤2 μg/ml, 98.0% of C. parapsilosis isolates were wild-type during 2006–2011 as compared to 93.4% during 2012–2017. Clonal spread of fluconazole-resistant C. parapsilosis in one major hospital was documented. An 8.8% shift in favor of non-albicans Candida species with concomitant increase in MICs between the two periods preludes emergence of fluconazole-resistant candidemia cases in Kuwait. Se informan las tendencias epidemiológicas y de susceptibilidad antifúngica de especies de Candida en Brasil, entre 2019-2020. Se analizaron un total de 22 aislamientos diagnosticados de episodios de candidemia. Las especies de Candida se identificaron mediante cebador específico y/o secuenciación del dominio D1/D2, región 28S del rDNA. La susceptibilidad antifúngica se determinó mediante el método CLSI. Candida tropicalis fue responsable de 11 (50%) casos, seguida de C. albicans (n=5, 22,73%), C. parapsilosis (n=4, 18,19%), Issatchenkia orientalis (n=1, 4,54 %) y Saccharomyces cerevisiae (n=1, 4,54%). Todos los aislados de Candida fueron sensibles a la anfotericina B y la micafungina, y uno fue sensible dosis dependiente a la anidulafungina. Ocho de los 20 aislados de Candida fueron resistentes al fluconazol y cuatro sensibles dosis dependiente. Dieciséis de los 20 aislados de Candida fueron resistentes al voriconazol, uno resistente y uno sensible dosis dependiente a la caspofungina. Además, se calcularon los valores respectivos de MIC50 y MIC90 con fluconazol (MIC50 y MIC90 de 4 y 64 µg/mL, respectivamente) y voriconazol (MIC50 y MIC90 de 16 µg/mL) que presentaron las potencias más bajas. La propagación de especies resistentes al fluconazol es una preocupación importante, especialmente para C. tropicalis. El uso indiscriminado de antifúngicos puede ser una posible causa relacionada con este escenario. Por lo tanto, la prueba del perfil de susceptibilidad se puede utilizar para encontrar la mejor manera de introducir una terapia antibiótica empírica adecuada. Tendências epidemiológicas e de susceptibilidade antifúngica de espécies de Candida no Brasil, entre 2019-2020, são relatadas. Um total de 22 isolados diagnosticados a partir de episódios de candidemia foram analisados. As espécies de Candida foram identificadas por meio de primer específico e/ou sequenciamento do domínio D1/D2, região 28S do rDNA. A susceptibilidade antifúngica foi determinada pelo método do CLSI. Candida tropicalis foi responsável por 11 (50%) casos, seguido por C. albicans (n=5, 22,73%), C. parapsilosis (n=4, 18,19%), Issatchenkia orientalis (n=1, 4,54%) e Saccharomyces cerevisiae (n=1, 4,54%). Todos os isolados de Candida foram susceptíveis à anfotericina B e micafungina, e um foi dose-dependente à anidulafungina. Oito dos 20 isolados de Candida foram resistentes ao fluconazol e quatro susceptível dose dependente. Dezesseis dos 20 isolados de Candida foram resistentes ao voriconazol, um resistente e um susceptível dose-dependente a caspofungina. Além disso, os respectivos valores de MIC50 e MIC90 foram calculados com fluconazol (MIC50 e MIC90 de 4 e 64µg/mL, respectivamente) e voriconazol (MIC50 e MIC90 de 16µg/mL) que apresentaram as potências mais baixas. A disseminação de espécies resistentes ao fluconazol é uma das principais preocupações, especialmente para C. tropicalis. O uso indiscriminado do antifúngico pode ser uma possível causa relacionada a esse cenário. Assim, a testagem do perfil de susceptibilidade pode ser usado para saber a melhor maneira de introduzir a terapia antibiótica empírica adequada.

Hospital infections associated with multidrug-resistant (MDR) Pseudomonas aeruginosa are a worldwide public health problem. Efflux systems and biofilm formation are mechanisms related to resistance to carbapenemics. In this study, quantum dots (QDs) were used to evaluate the effect of carbonyl cyanide-3-chlorophenylhydrazone (CCCP), an efflux pump system inhibitor, on biofilm formation and antimicrobial resistance profile of P. aeruginosa strains. For this, QDs were covalently conjugated to meropenem (MPM) and incubated with a P. aeruginosa resistant isolate (P118) or a control sensitive strain (ATCC Pa27853). P118 was also analyzed with conjugates after previous CCCP efflux inhibitor incubation. Fluorescence microscopy images showed that both sensitive and resistant bacteria were efficiently labeled. Nevertheless, P118 isolates presented fluorescent cell agglomerates, suggesting biofilm formation. The addition of the CCCP changed the labeling profile of the resistant isolate, and the absence of agglomerates was observed, indicating no biofilm formation. Genetic assays revealed the presence of MexA and MexE genes encoding channel proteins from efflux pump systems in both resistant and sensitive strains. Disk-diffusion and broth microdilution tests determined drug susceptibility profiles in the presence and absence of CCCP for P118 isolates. We verified that the CCCP efflux system inhibitor may contribute to P. aeruginosa resistant phenotype reduction for some antimicrobials. This study verified the efficiency of QD-MPM conjugates to trigger and study biofilm formation, or its inhibition, before and after CCCP addition. QDs conjugated to antimicrobials can be used as nanotools to investigate multidrug-resistant bacterial strains on biofilm formation.

Common in four continents, visceral leishmaniasis (VL) is an important but neglected disease. Human immunodeficiency virus (HIV) infection increases the risk of developing VL in people from leishmaniasis-endemic areas, with worse prognosis when there is coinfection. We conducted a cross-sectional study to determine the prevalence of HIV/VL coinfection in patients admitted in three referral hospitals for HIV/acquired immunodeficiency syndrome (AIDS) in Pernambuco, Brazil, and to compare epidemiological, clinical, and laboratory characteristics among HIV/VL coinfected and HIV mono-infected individuals. The sample consisted of HIV patients aged 18 years or more, in a period of data collection of 6 months. We performed four Leishmania tests-polymerase chain reaction (PCR), direct agglutination test, rK39, and latex agglutination test-and individuals with at least one positive test were considered coinfected. The HIV/VL coinfection prevalence we found was 16.9%. We observed large variation in prevalence according to the Leishmania test used, with low coincidence of positive tests. The most frequent symptoms found were weight loss (75.6%), fever (67.6%), and cough (55.3%). When we compared HIV/VL coinfected and HIV mono-infected groups we did not observe statistically significant differences. Low educational level (P = 0.004) and pallor (P = 0.009) were more frequent in the coinfected group. Serum albumin level was higher in coinfected individuals (P = 0.009). It is important to follow-up these individuals to understand the dynamics of VL in people living with HIV. New tests are necessary, ideally differentiating active from latent infection. Testing for VL in people with HIV is important and should be considered as part of the initial investigation in these individuals.

Objective To establish clinical and laboratory data of individuals presenting chyluria in endemic areas. Results 75 individuals were studied. The majority were females with an average age of 45 years residing in the Metropolitan Region of Recife. The mean time between the beginning of the presentation of chyluria and the first care service in the Serviço de Referencia Nacional em Filarioses was approximately 5 years. The most frequent urinalysis changes were hematuria (27.6%), leukocytes (21.9%) and proteinuria (10.5%). The Addis test showed mean values of 155.43 E/min/mL of cylinders, 52,892 E/min/mL of erythrocytes and 291,660 E/min/mL of leukocytes. Among recorded cases, proteinuria had a mean value of 1372.80 mg/dL in 24 h, and the presence of lymphocytes in the urine was positive in 68.3%. Among lymphatic filariasis tests, immunochromatography was positive in 16.7%, there was circulating filarial antigen determined by detection of OG4C3 antibodies in 7.7% and microfilaremia in only 1/55.

After the emergence of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), the number of visceral leishmaniasis (VL)-HIV/AIDS coinfections has increased worldwide. Herein, we assessed the usefulness of an rK39-based immunochromatographic test (rK39 ICT) (DiaMed-IT LEISH(®); DiaMed AG, Cressier-sur-Morat, Switzerland) and a latex agglutination test (KAtex; Kalon Biological, Guildford, United Kingdom) for urinary antigen detection to diagnose VL in 15 HIV/AIDS patients from northeastern Brazil. VL diagnosis was based on clinical findings, cytology, serology, parasite DNA, and/or urinary antigen detection. VL was confirmed in seven out of 15 HIV/AIDS patients. Only three patients were positive in bone marrow cytology, three patients were conventional polymerase chain reaction (PCR) positive, while six were real-time PCR positive. All patients were direct agglutination test (DAT) (Royal Tropical Institute, Amsterdam, The Netherlands) positive; of these, four were positive by rK39 ICT and five by KAtex. Large-scale studies are needed to validate the use of the KAtex in the national public health laboratory network in Brazil, aiming at improving the diagnosis of VL in HIV/AIDS patients in this country.

Study design: case report. Case report: Man, 42 years old, diagnosed with aids two years ago, had developed enlarging in abdominal volume six months from admission. Computed tomography imaging showed free liquid in peritoneal cavity and increased retroperitoneal and mesenteric lymph nodes, besides splenomegaly. Ascitic fluid had milky appearance and high triglycerides levels. Hodgkin's lymphoma (mixed cellularity) was confirmed by histopathological analysis of a video-laparoscopic lymph node biopsy, Ann Arbor IIIS staging. Chemotherapy and continuation of highly active antiretroviral therapy resulted in weight gain and reduction of abdominal volume. Chylous ascites is a rare condition, which has a vast differential diagnosis. Discussion: In our review, the majority (15/18, 83%) of chylous ascites in HIV/aids-patients are due to infectious causes (mainly Mycobacterium avium complex and tuberculosis infection), in highly immunocompromised patients (mean TCD4=87cell/mL). To the best of our knowledge, this is the first case of chylous ascites secondary to Hodgkin’s lymphoma in a patient with aids.

La estrongiloidiasis es una parasitosis que representa un grave problema de salud pública, principalmente en países ubicados en regiones tropicales y subtropicales. A lo largo de los años, algunas condiciones, como por ejemplo, avances en el tratamiento con corticosteroides y enfermedades que evolucionan con inmunosupresión, han favorecido no solamente al aumento de casos de estrongiloidiasis, sino también al surgimiento de formas graves de la enfermedad y/u decesos. Por lo expuesto, el objetivo del presente estudio fue realizar un análisis crítico de la ocurrencia de la estrongiloidiasis en portadores de co-morbilidades, describiendo las características clínico-epidemiológicas de esa asociación que puedan resaltar la importancia de vigilar esta parasitosis en grupos considerados más susceptibles. The strongyloidiasis is a parasitic disease that poses as a serious public health problem, mainly in tropical and subtropical countries. Over the years, some conditions, such as advances in corticosteroid treatment and immunosuppressive diseases, have improved not only the increase in cases of strongyloidiasis, but also the emergence of severe forms of the disease and / or deaths. For these reasons, the objective of this study is to make a critical analysis of the occurrence of strongyloidiasis in patients with comorbidities, describing clinical and epidemiological characteristics associated with these diseases that can highlight the importance of monitoring this parasitosis in most susceptible groups. Fil: Regueira Fernandes, Amanda. Fundación Oswaldo Cruz; Brasil. Hospital Otávio de Freitas; Brasil Fil: Romero, Sebastián. Fundación Oswaldo Cruz; Brasil. Hospital Otávio de Freitas; Brasil Fil: Alcântara De Souza Melo, Paula Fernanda. Fundación Oswaldo Cruz; Brasil. Hospital Otávio de Freitas; Brasil Fil: Ramos Araújo, Paulo Sérgio. Hospital Otávio de Freitas; Brasil. Fundación Oswaldo Cruz; Brasil Fil: Bottasso, Oscar Adelmo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario. Instituto de Inmunología Clinica y Experimental de Rosario. Universidad Nacional de Rosario. Facultad de Ciencias Médicas. Instituto de Inmunología Clinica y Experimental de Rosario; Argentina Fil: Rocha, Abraham. Hospital Otávio de Freitas; Brasil. Fundación Oswaldo Cruz; Brasil Fil: Brandão, Eduardo. Fundación Oswaldo Cruz; Brasil. Hospital Otávio de Freitas; Brasil

Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. are three of the pathogens most frequently involved in infections of cancer patients, and the production of β -lactamases is a major mechanism of resistance due to its wide diversity of existing enzymes. Therefore, the aim of the present study was to investigate the microbiological profile and data related to patients and infections, and to search for β -lactamase genes in bacterial isolates from hospitalized cancer patients in a hospital in Recife, Pernambuco, Brazil. A total of 169 isolates were recovered between 2012 and 2014, of which 58 were P. aeruginosa, 36 were Acinetobacter spp. and 75 were Klebsiella spp. A high percentage of carbapenem resistance was observed in P. aeruginosa and Acinetobacter spp. Among the carbapenem-resistant bacteria, the blaSPM-1 gene was detected in P. aeruginosa (35.5 %) and Acinetobacter spp. (3.8 %), while blaKPC was detected in P. aeruginosa (25.8 %) only. Among the third- and fourth-generation cephalosporin-resistant strains, in Klebsiella spp. we detected the genes blaTEM (30.6 %), blaCTX-M (58.3 %) and blaKPC (5.6 %), and in Acinetobacter spp. only blaTEM (25.9 %). This the first report of an Acinetobacter baumannii blaSPM-1 gene carrier that has been isolated in Brazil. The most frequent cancer types were bowel tumour [14.8 %; 95 % confidence interval (CI95 %) 9.8-21.1 %], breast cancer (13.6 %; CI95 % 8.8-19.7 %) and prostate cancer (11.2%; CI95 % 6.9-17.0 %). These results therefore provide knowledge of susceptibility profile and resistance mechanisms and thus can contribute to the strategic formulation of hospital infection control plans and the rational use of antimicrobials, reducing mortality from infection levels in cancer patients.

Abscesso do musculo psoas e uma condicao rara de dificil diagnostico clinico, pois apresenta sinais e sintomas inespecificos. No presente relato de caso, ilustramos um exemplo de abscesso do musculo psoas associado ao Mycobacterium tuberculosis em paciente do sexo feminino, 48 anos, com diagnostico de Aids ha cinco anos. O exame fisico da paciente evidenciou massa palpavel em regiao lombar que foi confirmada pela ultrassonografia e tomografia computadorizada. A baciloscopia do liquido obtido da puncao do abscesso demonstrou a presenca de bacilos alcool-acido resistentes. Apos iniciado esquema terapeutico combinado, com drogas antituberculosas, a paciente evoluiu com melhora clinica. Apesar de raro, o abscesso de musculo psoas e uma enfermidade que tem sido mais frequentemente observada em pacientes imunocomprometidos, principalmente aqueles que apresentam a co-infeccao HIV-tuberculose. Neste caso, a identificacao do agente etiologico associado ao abscesso foi fundamental para garantir a conduta terapeutica adequada e consequentemente a boa evolucao do quadro clinico

RATIONALE Total absence of superior vena cava (ASVC) is a very rare anomaly, and the patient usually suffers from superior vena cava syndrome (SVCS) or conduction disturbances. PATIENT CONCERNS We report a 36-year-old white male, born and living in Brazil, without comorbidities presented to hematologist thrombotic episodes even under anticoagulant therapy. On his first hematologic appointment, he had no active complaints except by the fullness after meals, and his physical examination presented remarkable collateral circulation in the chest. DIAGNOSES Congenital ASVC associated with factor V Leiden mutation. OUTCOMES In his magnetic resonance angiography of the thorax, a great amount of collateral circulation and communication of the azygos and hemiazygos veins with inferior vena cava were evident, as well as the absence of the upper cava vein. Furthermore, heterozygous genetic mutation was found for Leiden factor V. LESSONS This case gives us the lesson that we need to include ASVC in the differential diagnosis of SVCS. The importance of the V-Leiden factor as a joint risk with this congenital defect for venous thromboembolism episodes was also highlighted.