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Paracoccidioidomycosis (PCM) is one of the main endemic systemic mycoses in Latin America, usually occurring in rural areas. When PCM occurs simultaneously with underlying immunosuppressive conditions, it can present as an opportunistic disease. Between 2000 and 2017, literature reported around 200 PCM cases in people living with HIV/AIDS (PLWHA). To address research gaps on this co-infection and to study its possible temporal changes in the last decade, we performed an active co-infection case search on the HIV/AIDS and PCM cohorts from a Brazilian reference center database from 1989 to 2019. We found 20 PLWHA among 684 PCM patients (2.92%), predominantly male (70.0%) and urban workers (80.0%). The median age of patients was higher in the 2010-2019 decade (p = 0.006). The occurrence of PCM in PLWHA was lower when compared with other fungal diseases. Although 50.0% of the patients had already been diagnosed with HIV infection and presented CD4+ T cell counts greater than 200/mm3 at the time of PCM diagnosis, the suspicion of immunosuppression in the context of atypical and more severe clinical forms of PCM revealed the diagnosis of HIV infection in 35.0% of the patients. Two (10.0%) patients had an evolution compatible with immune reconstitution inflammatory syndrome (IRIS) after starting antiretroviral therapy (ART).We highlight the importance of considering a PCM diagnosis in PLWHA to prevent a late-onset treatment and progression to severe manifestations and unfavorable outcomes. In addition, HIV investigation is recommended in PCM patients, especially those with atypical and more severe clinical presentations.

A Hanseníase é uma doença negligenciada com alto estigma e carga em países em desenvolvimento. Infecção crônica, granulomatosa, causada pelo M. leprae que afeta principalmente a pele e nervos periféricos. O Fenômeno de Lúcio (FL) é uma manifestação incomum com graves lesões cutâneas necróticas em pacientes com Hanseníase Lepromatosa. Dentre os fatores precipitantes, destacam-se infecções, uso de drogas e gravidez. JAFS, 17 anos, Nova Iguaçu, RJ, é admitida com lesões disseminadas, recebendo antibióticos sob suspeita de sepse cutânea. História pregressa de abortamento de 1º trimestre há 2 meses da internação; e Hanseníase com Poliquimioterapia (PQT-MB) por 1 ano com Rifampicina (RMP), Clofazimina (CFZ) e Dapsona. É transferida para serviço de referência após 7 dias, mantendo febre, taquicardia e astenia. Ao exame: regular estado, desidratada, com máculas hipercrômicas e purpúricas, placas eritematosas, bolhas serohemáticas e ulcerações necróticas nos membros, orelhas, nariz, palmas e plantas. Artrite do punho e 1º quirodáctilo esquerdos, além de amiotrofias, dor e espessamento dos nervos ulnares, parestesias em bota e em luva, bilaterais, mas assimétricas. Laboratório: Anemia (Hb 7.2 g/dL), trombocitose (624.000), leucocitose (28.040/mm3-0/0/3/5/17/59/12/4), e PCR elevada (29 mg/dL). Sorologias para HIV, Hepatites e Sífilis, hemoculturas para bactérias, fungos, e teste de gravidez foram negativos. Baciloscopia: BAAR e globias em todos os sítios (Índice Baciloscópico: 2.5+) e no aspirado das bolhas. A histopatologia da pele demonstrou inflamação superficial e profunda, perivascular, dermatite granulomatosa perianexial e depósitos fibrinoides vasculares. Com os achados clínicos, histopatológicos e baciloscópicos, foi feito o diagnóstico de Hanseníase Borderline-Lepromatosa em estado reacional - Fenômeno de Lúcio. Recebeu pulsoterapia com metilprednisolona por 3 dias, reduzindo as áreas hipercrômicas e maculares e resolvendo a febre, taquicardia e artrite. A PQT-MB foi reintroduzida com RMP, CFZ, Ofloxacino, Prednisona e Pentoxifilina. Teve alta hospitalar com acompanhamento mensal ambulatorial, com resolução das lesões após desbridamento cirúrgico do material necrótico em 3 meses de seguimento. O FL é raro e potencialmente fatal pela extensão e gravidade das lesões cutâneas, favorecendo complicações discrásicas ou infecciosas. A gravidez é descrita como deflagradora ou exacerbadora de quadros de Hanseníase devido às alterações hormonais e imunológicas.

Neuroparacoccidioidomycosis (NPCM) is a rare and severe clinical presentation of paracoccidioidomycosis (PCM). We performed a retrospective cohort study at the Evandro Chagas National Institute of Infectious Diseases (INI/Fiocruz), a reference center for PCM in the state of Rio de Janeiro, Brazil. All cases of PCM admitted to the INI/Fiocruz from January 2007 to December 2019 were reviewed. Eight (3.9%) among 207 patients met the diagnostic criteria for NPCM. The mean age was 44.6 years and the male:female ratio was 7:1. All cases presented multifocal disease, 5 (62.5%) the chronic form and 3 (37.5%) the acute/subacute form. All patients presented the pseudotumoral pattern and 6 (75.0%) had multiple lesions in the cerebral hemispheres. Seizures and motor symptoms were the most frequent clinical manifestations (50.0%, each). The treatment of choice was sulfamethoxazole/trimethoprim (SMZ-TMP) and fluconazole, in association (87.5%). Most patients responded well to the treatment. Sequela and death occurred in one (12.5%) patient, each.

Corynebacterium striatum is a potentially pathogenic microorganism with the ability to produce outbreaks of nosocomial infections. Here, we document a nosocomial outbreak caused by multidrug-resistant (MDR) C. striatum in Rio de Janeiro, Brazil. C. striatum identification was confirmed by 16S rRNA and rpoB gene sequencing. Fifteen C. striatum strains were isolated from adults (half of whom were 50 years of age and older). C. striatum was mostly isolated in pure culture from tracheal aspirates of patients undergoing endotracheal intubation procedures. The analysis by pulsed-field gel electrophoresis (PFGE) indicated the presence of four PFGE profiles, including two related clones of MDR strains (PFGE I and II). The data demonstrated the predominance of PFGE type I, comprising 11 MDR isolates that were mostly isolated from intensive care units and surgical wards. A potential causal link between death and MDR C. striatum (PFGE types I and II) infection was observed in five cases.

Paracoccidioidomycosis (PCM) is one of the main endemic systemic mycoses in Latin America, usually occurring in rural areas. When PCM occurs simultaneously with underlying immunosuppressive conditions, it can present as an opportunistic disease. Between 2000 and 2017, literature reported around 200 PCM cases in people living with HIV/AIDS (PLWHA). To address research gaps on this co-infection and to study its possible temporal changes in the last decade, we performed an active co-infection case search on the HIV/AIDS and PCM cohorts from a Brazilian reference center database from 1989 to 2019. We found 20 PLWHA among 684 PCM patients (2.92%), predominantly male (70.0%) and urban workers (80.0%). The median age of patients was higher in the 2010–2019 decade (p = 0.006). The occurrence of PCM in PLWHA was lower when compared with other fungal diseases. Although 50.0% of the patients had already been diagnosed with HIV infection and presented CD4+ T cell counts greater than 200/mm3 at the time of PCM diagnosis, the suspicion of immunosuppression in the context of atypical and more severe clinical forms of PCM revealed the diagnosis of HIV infection in 35.0% of the patients. Two (10.0%) patients had an evolution compatible with immune reconstitution inflammatory syndrome (IRIS) after starting antiretroviral therapy (ART).We highlight the importance of considering a PCM diagnosis in PLWHA to prevent a late-onset treatment and progression to severe manifestations and unfavorable outcomes. In addition, HIV investigation is recommended in PCM patients, especially those with atypical and more severe clinical presentations. Author summary: Paracoccidioidomycosis (PCM) is a severe systemic mycosis caused by inhalation of fungi belonging to the genus Paracoccidioides present in the soil of endemic areas in Latin America. However, it is still a neglected disease, affecting vulnerable populations such as rural workers. In the last decade, there was an increase of acute PCM cases in young people living in urban areas of the endemic area of Rio de Janeiro, Brazil. This could increase the occurrence of PCM in people living HIV/AIDS (PLWHA) because they are more concentrated in these regions. When PCM and immunosuppression due to AIDS occur simultaneously, PCM can present as an opportunistic disease, with more severe, invasive, and atypical presentations. In these cases, late diagnosis and treatment can lead to higher risk of complications, sequelae, and deaths. PCM occurrence in PLWHA is scarcely reported in the literature. This study aims to describe the clinical profile of patients diagnosed with PCM and HIV co-infection from a 30-year historical cohort followed at a Brazilian reference center for infectious diseases. Our results revealed that the suspicion of this co-infection in patients with more severe clinical forms of PCM as well as routine HIV testing in PCM patients could help to prevent late-onset treatment and progression to unfavorable outcomes. [ABSTRACT FROM AUTHOR]

Neuroparacoccidioidomycosis (NPCM) is a rare and severe clinical presentation of paracoccidioidomycosis (PCM). We performed a retrospective cohort study at the Evandro Chagas National Institute of Infectious Diseases (INI/Fiocruz), a reference center for PCM in the state of Rio de Janeiro, Brazil. All cases of PCM admitted to the INI/Fiocruz from January 2007 to December 2019 were reviewed. Eight (3.9%) among 207 patients met the diagnostic criteria for NPCM. The mean age was 44.6 years and the male:female ratio was 7:1. All cases presented multifocal disease, 5 (62.5%) the chronic form and 3 (37.5%) the acute/subacute form. All patients presented the pseudotumoral pattern and 6 (75.0%) had multiple lesions in the cerebral hemispheres. Seizures and motor symptoms were the most frequent clinical manifestations (50.0%, each). The treatment of choice was sulfamethoxazole/trimethoprim (SMZ-TMP) and fluconazole, in association (87.5%). Most patients responded well to the treatment. Sequela and death occurred in one (12.5%) patient, each. [ABSTRACT FROM AUTHOR]