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Esquistossomose é uma das doenças infecciosas mais prevalentes do mundo. As etapas de migração do helminto no organismo definem as fases da doença. Na fase aguda, a dispneia e tosse estão habitualmente associadas a opacidades em vidro fosco e consolidações nodulares. Na crônica, as manifestações pulmonares mais frequentes decorrem de hipertensão pulmonar e cor pulmonale. Relatamos um caso de esquistossomose pulmonar com apresentação nodular migratória.

Sarcoidose é uma doença sistêmica que pode acometer vários órgãos. Relatamos o caso de uma paciente com acometimento pulmonar nodular que é uma apresentação rara da sarcoidose pulmonar. Caracteriza-se por sintomas constitucionais associados ao achado de único ou múltiplos nódulos pulmonares. A presença de granulomas geralmente não caseosos na biópsia pulmonar corrobora o diagnóstico, juntamente com a exclusão de outras doenças granulomatosas. O prognóstico costuma ser favorável, com boa resposta ao tratamento com corticosteroide oral.

Paciente de 79 anos, masculino, com diagnóstico recente de mielofibrose, apresentou tosse persistente por uma semana. Durante investigação diagnóstica, tomografia computadorizada de tórax evidenciou micronódulos de distribuição randômica difusos em ambos os pulmões. Na suspeita de quadro infeccioso, o paciente foi submetido a broncoscopia, cuja biópsia confirmou processo granulomatoso crônico e, no entanto, as pesquisas de fungos e bacilo álcoolresistente foram negativas. O diagnóstico de histoplasmose pulmonar aguda foi firmado após positividade da banda M na sorologia para Histoplasma capsulatum. Iniciado tratamento com itraconazol, paciente evoluiu com completa resolução da doençaos sintomas.

A doença causada pelo coronavírus 2019 (COVID-19) pode variar de doença assintomática a doença grave decorrente da pneumonia viral. Em pacientes que evoluem com piora da hipoxemia, além de aumento da extensão do acometimento do parênquima pulmonar, devemos afastar complicações secundárias, como tromboembolismo pulmonar e infecção bacteriana sobreposta. Em alguns casos, no entanto, faz-se necessário ampliar os diagnósticos diferenciais. Descrevemos um caso de paciente com COVID-19 que cursou com piora da hipoxemia secundária a síndrome de platipneia e ortodeoxia associada a pneumomediastino.

O primeiro caso de COVID-19 foi identificado na China no final de 2019 e rapidamente foi declarada pandemia em consequência da elevada transmissibilidade e morbimortalidade do vírus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), seu agente etiológico. O espectro clínico é altamente variável, desde sintomas respiratórios e sistêmicos leves até quadros graves com sepse, síndrome do desconforto respiratório agudo (SDRA) e disfunção de múltiplos órgãos. Postula-se que a desproporcional resposta imune do hospedeiro humano ao vírus seja responsável pelas injúrias teciduais e hiperinflamação sistêmica. Os achados tomográficos principais incluem opacidades em vidro fosco e consolidações periféricas e podem variar ao longo do curso da doença, sendo, portanto, inespecíficos. Exames diagnósticos baseiam-se na detecção de proteínas do vírus e resposta imunológica à inflamação. Agentes antivirais e drogas imunomoduladoras estão sendo testados. Até o momento, o tratamento baseia-se em terapia de suporte, controle de sintomas clínicos e manejo de complicações.

Background: Surveillance of multidrug resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB) is essential to guide disease dissemination control measures. Brazil contributes to a significant fraction of tuberculosis (TB) cases worldwide, but only few reports addressed MDR/XDR-TB in the country. Methods: This cross-sectional, laboratory-based study describes the phenotypic resistance profiles of isolates obtained between January 2008 and December 2011 in Bahia, Brazil, and sociodemographic, epidemiological, and clinical characteristics (obtained from mandatory national registries) of the corresponding 204 MDR/XDR-TB patients. We analyzed the mycobacterial spoligotyping and variable number of tandem repeats of mycobacterial interspersed repetitive units in 12-loci profiles obtained from Salvador. Results: MDR/XDR-TB patients were predominantly male, had a median age of 43 years, belonged to black ethnicity, and failed treatment before MDR-TB diagnosis. Nearly one-third of the isolates had phenotypic resistance (evaluated by mycobacteria growth indicator tube assay) to second-line anti-TB drugs (64/204, 31%), of which 22% cases (14/64) were diagnosed as XDR-TB. Death was a frequent outcome among these individuals and was associated with resistance to second-line anti-TB drugs. Most isolates successfully genotyped belonged to the Latin-American Mediterranean (LAM) Family, with an unprecedented high proportion of LAM10-Cameroon subfamily bacilli. More than half of these isolates were assigned to a unique cluster by the genotyping methods performed. Large clusters of identical genotypes were also observed among LAM SIT42 and SIT376 strains. Conclusions: We highlight the need for strengthening local and national efforts to perform early detection of TB drug resistance and to prevent treatment discontinuation to limit the emergence of drug-resistant strains.

In trials evaluating the immune responses to Bacille of Calmette-Guérin (BCG), the genetic background and the nutritional status are host-related factors that could affect the heterogeneity in these parameters. The IFNG+874 A/T (rs 62559044) polymorphism has been reported to influence the IFN-γ production by BCG-vaccinated individuals challenged in vitro with mycobacterial antigens. The body mass index (BMI) is a proxy for the nutritional status and has been associated both with the susceptibility to tuberculosis and with the IFN-γ response. We show that although the IFNG+874 A/T polymorphism was not associated with the heterogeneity of IFN-γ production in a randomized controlled trial that evaluated long-term immune responses to BCG revaccination previously conducted in Salvador, Bahia, Brazil, the effect of this polymorphism on the observed increase in IFN-γ production among revaccinated subjects was adjusted in individuals with a low BMI.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-06-15T13:46:35Z No. of bitstreams: 1 Santos Darci. 2014 et al.pdf: 184108 bytes, checksum: efe395c3ae5f3394885f78dd6758071d (MD5) Made available in DSpace on 2015-06-15T13:46:35Z (GMT). No. of bitstreams: 1 Santos Darci. 2014 et al.pdf: 184108 bytes, checksum: efe395c3ae5f3394885f78dd6758071d (MD5) Previous issue date: 2014 INTRODUCTION: Despite the availability of treatment and a vaccine, tuberculosis continues to be a public health problem worldwide. Mental disorders might contribute to the burden of the disease. OBJECTIVE: The objective of this study was to investigate the association between common mental disorders and tuberculosis. METHODS: A matched case-control study was conducted. The study population included symptomatic respiratory patients who attended three referral hospitals and six community clinics in the city of Salvador, Brazil. A doctor's diagnosis defined potential cases and controls. Cases were newly diagnosed tuberculosis cases, and controls were symptomatic respiratory patients for whom tuberculosis was excluded as a diagnosis by the attending physician. Cases and controls were ascertained in the same clinic. Data collection occurred between August 2008 and April 2010. The study instruments included a structured interview, a self-reporting questionnaire for the identification of common mental disorders, and a questionnaire for alcoholism. An univariate analysis included descriptive procedures (with chi-square statistics), and a multivariate analysis used conditional logistic regression. RESULTS: The mean age of the cases was 38 years, and 61% of the cases were males. After adjusting for potential confounders, the odds of tuberculosis were significantly higher in patients diagnosed with a common mental disorder (OR: 1.34; 95% CI 1.05-1.70). CONCLUSION: There appears to be a positive and independent association between common mental disorders and tuberculosis; further epidemiological studies are required to increase our understanding of the possible biological and social mechanisms responsible for this association. Independent of the direction of the association, this finding has implications for the provision of care for mental disorders and for tuberculosis. San Francisco

The Bacille Calmette-Guérin (BCG) vaccine is the only vaccine currently available for tuberculosis, and it demonstrates variable efficacy against the disease. The assessment of new vaccine strategies is hindered by the small annual probability that an infected individual will develop tuberculosis, and the lack of simple and reliable surrogate markers of protection. The frequency of cytokine-producing T cells as well as the production of IFN-γ have been disputed as surrogate markers of protection. We evaluated the evolution of these immune parameters in a population from a high burden city where BCG revaccination has been shown to result in mild protection. We found that individuals whose in vitro IFN-γ responses to mycobacterial antigens had increased by more than 3.3-fold were more likely to maintain higher responses after 1 year and to show increased expansion of IFN-γ-producing T lymphocytes than those with lower or null increase of IFN-γ.

OBJETIVO: Analisar características relacionadas à adesão ao tratamento dos casos de tuberculose em serviços de referência para tuberculose. MÉTODOS: Trata-se de um estudo ecológico nas unidades de referência no tratamento dos casos de tuberculose dos distritos sanitários de Salvador, BA, em 2006. A amostra foi composta pelas unidades de saúde municipais que atenderam 67,2% dos 2.283 casos notificados de tuberculose no ano. Foram analisadas as variáveis: cura, abandono, exames realizados, equipe de saúde e benefícios aos pacientes. Para verificar associação entre as variáveis, foi utilizado o teste qui-quadrado ou exato de Fisher, sendo consideradas estatisticamente significantes as associações com p

To estimate the prevalence of obstructive sleep apnea syndrome (OSAS) in children and adolescents with sickle cell anemia (SCA); to investigate the possible correlation between mean annual hemoglobin level and total sleep time with SpO290%, as well as between mean annual hemoglobin level and total sleep time with SpO280%; and to investigate the possible correlation between apnea-hypopnea index (AHI) and painful crisis.The study involved 85 patients with SCA. The patients completed a questionnaire, were submitted to polysomnography and underwent clinical evaluation (by a pediatrician and an otolaryngologist). An AHI1 was considered indicative of a diagnosis of OSAS.The prevalence of OSAS was 10.6%. We found a negative correlation between mean annual hemoglobin level and total sleep time with SpO290% (r = micro0.343; p = 0.002), as well as between mean annual hemoglobin level and total sleep time with SpO280% (r = micro0.270; p = 0.016). There was no association between AHI and painful crisis.The prevalence of OSAS in this population was high (10.6%). Therefore, it is important to identify signs of OSAS as soon as possible and to determine the mean annual hemoglobin level because of the inverse correlation between that level and the total sleep time with SpO290% or80%.

To analyze characteristics related to adherence to tuberculosis treatment in tuberculosis outpatient clinics.An ecological study was conducted in outpatient clinics for the treatment of tuberculosis cases in the sanitary districts of Salvador, Northeastern Brazil, in 2006. The sample was composed of the municipal health units that assisted 67.2% of the 2,283 tuberculosis cases that were reported during the year. The following variables were analyzed: cure, dropout, tests, health team and benefits offered to the patients. Chi-square test or Fisher's exact test was used to verify the association between variables, and associations with p0.05 were considered to be statistically significant.Of the studied cases, 78.4% resulted in cure, 8.6% in dropout, 2.2% in death and 8.1% in transference. Adherence rates per health unit varied between 66.7% and 98.1%. The variables cure and dropout showed a statistically significant association with adherence in the comparison of proportions. All the units with high adherence rates had complete health teams.Adherence was an important factor for the outcomes cure and dropout, but the index of units that achieved the cure goals was low. The presence of a complete multidisciplinary team in the tuberculosis program may help the patient understand his/her illness and contribute to adherence to treatment.

Texto completo: acesso restrito. p.625-628 Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2013-09-11T13:41:21Z No. of bitstreams: 1 00126334-200512150-00018.pdf: 69775 bytes, checksum: 5de1e4fdf6c24dc3f33f6aa0c4f37689 (MD5) Approved for entry into archive by Rodrigo Meirelles (rodrigomei@ufba.br) on 2013-10-31T17:41:53Z (GMT) No. of bitstreams: 1 00126334-200512150-00018.pdf: 69775 bytes, checksum: 5de1e4fdf6c24dc3f33f6aa0c4f37689 (MD5) Made available in DSpace on 2013-10-31T17:41:53Z (GMT). No. of bitstreams: 1 00126334-200512150-00018.pdf: 69775 bytes, checksum: 5de1e4fdf6c24dc3f33f6aa0c4f37689 (MD5) Previous issue date: 2005 Objectives: To investigate whether infection with human T-lymphotropic virus type 1 (HTLV-1) increases the risk of tuberculosis. Design: A case-control study. Setting: City of Salvador, Brazil. Participants: A total of 375 patients with tuberculosis (cases) and 378 individuals without tuberculosis (controls), matched by age and sex. Main Outcome Measure: Tuberculosis of lung or lymph node. Main Exposure: Human HTLV-1 infection. Results: The prevalence of HTLV-1 infection was 4.27% (16/375) in patients with tuberculosis and 1.32% (5/378) in controls, resulting in a crude odds ratio of 3.31 (95% CI, 1.20-9.13) and an adjusted odds ratio of 3.01 (95% CI, 1.06-8.58). Conclusion: HTLV-1 infection is associated with a first diagnosis of tuberculosis. This may have implications for tuberculosis control in places with high prevalence of HTLV-1.