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Most of the patients with immunodeficiency virus infection (75%-85%) are coinfected with cytomegalovirus. It is estimated that cytomegalovirus disease develops in 45% of them, mainly those presenting low CD4 cell counts (< 100/mm3). Retinitis is the most common manifestation of reactivated cytomegalovirus disease (85%), followed by other extra ocular sites (central nervous system, lungs, gastrointestinal system, adrenal glands, etc.). The particularly high incidence of cytomegalovirus retinitis, the difficulties concerning its therapeutical approach and the relatively unsatisfactory results, justify this review, according to the new treatment options presented in recent literature.

Leishmaniasis is a disease caused by the intracellular protozoan parasite Leishmania and are known more than 20 species(1) harmful for men. A 74-year-old man, with sarcoidosis treated with methotrexate and corticoid, was assessed, in 2021, by an ENT specialist due to dysphagia, dysphonia, and odynophagia with a 5-year evolution and progressive worsening. A biopsy of the right vocal cord and epiglottis was performed, and the histology demonstrated the presence of amastigotes in the tissues coloured by Giemsa making the diagnosis of Leishmaniasis. The patient was referred to the Infectious Diseases Department, with the diagnosis of mucosal leishmaniasis, and hospitalized for treatment with Liposomal Amphotericin B. The dysphagia and odynophagia improved and was discharged to Infectious Diseases Day hospital to continue treatment. He completed a total of 10 days of treatment and continued follow up in Infectious Diseases, Pneumology and ENT departments. During this time the patient stopped treatment with methotrexate but maintained deflazacort 6 mg per day. In 2023, the patient presented with worsening dysphonia and dysphagia. A new biopsy of the epiglottis was performed in the ENT department. Leishmania DNA was detected, and histology was compatible with Leishmaniasis of the left larynx. He was hospitalized in Infectious Diseases department and started treatment with Liposomal Amphotericin B. The patient completed a total of 10 days of treatment, and, by this time, the medical team decided to maintain suppressive therapy once a month with Liposomal Amphotericin B, until the patient present with a CD4 leucocyte count superior to 350/mm³ . By the time of this article, the patient maintained follow up in the Infectious Disease department with monthly sessions of therapy., Competing Interests: The authors have no conflicts of interest., (© 2023 The Authors.)

Introduction: In Portugal, the prevalence of hepatitis A virus infection has decreased in the past decades, especially in young adults. The aim of this study was to detect the prevalence of antibody to hepatitis A virus in a population observed in our Travel Clinic., Material and Methods: Antibodies against hepatitis A, hepatitis B, hepatitis C and human immunodeficiency virus were tested using standard enzyme immunoassay in patients older than 18. The exclusion criteria were: prior vaccination for hepatitis A virus, previous diagnosis of infection with hepatitis B virus, hepatitis C virus and/or human immunodeficiency virus, foreign travelers and long-term expatriates. We applied an epidemiological survey and data was statistically analyzed with SPSS® 18.0., Results: In the 665 travelers studied, natural immunity to hepatitis A virus was present in 57.6% (n = 383). They were stratified into 8 age groups and for each one hepatitis A immunity was clarified: 5.0% (n = 1) in 18 - 25 years, 32.3% (n = 21) in 26 - 30 years, 40.9% (n = 47) in 31 - 35 years, 45.8% (n = 54) in 36 - 40 years, 68.7% (n = 79) in 41 - 45 years, 70.1% (n = 68) in 46 - 50 years, 80.8% (n = 63) in 51 - 55 years and 87.7% (n = 50) over 56 years old. In those who accepted further screening, positivity for hepatitis B core antibody was found in 0.6% (n = 3) travelers, hepatitis C virus infection in 1.1% (n = 6) and human immunodeficiency virus infection in 0.5% (n = 3) whose previous status was unknown. The most frequent travel destination was sub-Saharan Africa (72.6%; n = 483)., Discussion: We found 49.1% (n = 260) travelers under 50 years old susceptible to hepatitis A virus infection and for those between 40 and 50 years, 30.7% (n = 65) still need vaccine protection., Conclusion: Across age groups there is a trend towards lower prevalence of hepatitis A virus antibody, in particular among youngsters, when compared with older Portuguese studies.

Introduction: Brucellosis is an endemic zoonosis in Portugal. Brucellar spondylodiscitis is one of the most frequent focal manifestations which may cause severe sequelae despite appropriate therapy., Material and Methods: Retrospective study of patients with diagnosis of brucellar spondylodiscitis admitted to the Infectious Diseases Department of Centro Hospitalar e Universitário de Coimbra, over a 25-year period (1988-2012)., Results: We identified 54 patients, 55.6% male, mean age of 54.8 years. In 81.5% an epidemiological context was identified, mostly contact with sheep and goats. The duration of symptoms prior to diagnosis was 5.5 months. The most common signs and symptoms were pain (98.1%), fever (46.3%) and neurological deficits (25.9%). Spinal magnetic resonance imaging was the most used imaging method (77.8%) showing abscesses in 29.6% of patients. Lumbar location predominated (77.7%). Diagnosis was attained in 47 patients (87.0%): positive blood cultures (3 patients), positive serology (32 patients) or by both methods (12 patients). Combined regimens of doxycycline and rifampicin (64.8%), or streptomycin (24.1%) were most used, for an average duration of 4.4 months. A patient was referred for surgery for abscess drainage. Evolution was mostly favorable (92.6%), no deaths occurring., Discussion: Research of the epidemiologic context turned out to be a major key leading to the diagnosis. Treatment of osteoarticular brucellosis is still controversial., Conclusions: Brucellar spondylodiscitis should be considered in the differential diagnosis of patients with low back pain, even in the absence of fever, particularly in regions where the disease is endemic. Antibiotic regimen, its' duration and the need for surgery should be individualized to achieve a better prognosis. Cases have declined over the years, a fact related to better control of animal endemic.

The authors report a clinical case of an isolated oral histoplasmosis in a hemodialysis patient that presented with fever of unknown origin and had an unremarkable physical examination. During the investigation, a Gallium scan showed uptake in the oral cavity and soon after the oral cavity examination revealed a granulomatous lesion on the tooth 26. Histopathologic findings were compatible with histoplasmosis. The treatment regimen included liposomal amphotericin B followed by itraconazole consolidation therapy, and side effects did not occur. Both clinical evolution and outcome were favorable. Oral histoplasmosis in a non-immunosuppressed patient is extremely rare.

Most of the patients with immunodeficiency virus infection (75%-85%) are coinfected with cytomegalovirus. It is estimated that cytomegalovirus disease develops in 45% of them, mainly those presenting low CD4 cell counts (< 100/mm3). Retinitis is the most common manifestation of reactivated cytomegalovirus disease (85%), followed by other extra ocular sites (central nervous system, lungs, gastrointestinal system, adrenal glands, etc.). The particularly high incidence of cytomegalovirus retinitis, the difficulties concerning its therapeutical approach and the relatively unsatisfactory results, justify this review, according to the new treatment options presented in recent literature.