Characterization of Cryptococcus neoformans isolated from urban environmental sources in Goiânia, Goiás State, Brazil

Cryptococcus neoformans is an opportunistic fungal pathogen that causes meningoencephalitis as the most frequent clinical presentation in immunocompromised patients, mainly in people infected by HIV. This fungus is an environmental encapsulated yeast, commonly found in soil enriched with avian droppings and plant material. A total of 290 samples of pigeon and the other avian droppings, soil, ornamental trees and vegetable material associated with Eucalyptus trees were collected to study environmental sources of Cryptococcus species in Goiania, Goiás State. The determination of varieties, serotypes and the susceptibility in vitro to fluconazole, itraconazole and amphotericin B of C. neoformans isolates were performed. C. neoformans var. grubii (serotype A) was found in 20.3% (36/177) of pigeon dropping samples and in 14.3% (5/35) of samples of Eucalyptus. None of the environmental isolates of C. neoformans showed in vitro resistance to three antifungal agents. The knowledge of major route for human cryptococcal infection (inhalation of infectious particles from saprophytic sources) and a total of 60 C. neoformans isolates obtained from AIDS patients with cryptococcal meningitis between October 2001 and April 2002 justify the study of the habitats of these yeasts as probable sources of cryptococcosis in this city.     

Antifungal susceptibilities of clinical and environmental isolates of Cryptococcus neoformans in Goiânia city, Goiás, Brazil

We evaluated the antifungal activities of amphotericin B, fluconazole, itraconazole and voriconazole in 70 Cryptococcus neoformans strains obtained from cerebrospinal fluid from AIDS patients and 40 C. neoformans strains isolated from the environment. Four clinical isolates were identified as C. neoformans var. gattii. The susceptibility test was done using a broth microdilution method according to NCCLS M27-A2. Range minimal inhibitory concentrations (MICs) for C. neoformans clinical isolates were 0.06-1.0 microg/mL for amphotericin B, 0.125-8 microg/mL for fluconazole, 0.03-0.5 microg/mL for itraconazole and 0.03-0.25 microg/mL for voriconazole. C. neoformans environmental isolates showed range MICs 0.015-0.125 microg/mL, 0.25-2.0 microg/mL, 0.007-0.125 microg/mL and 0.03-0.25 microg/mL for amphotericin B, fluconazole, itraconazole and voriconazole respectively. The MICs results obtained from clinical and environmental isolates showed similar pattern of susceptibility and no resistance has been found in our isolates.     

Intra-familial and extra-familial risk factors associated with Cryptosporidium parvum infection among children hospitalized for diarrhea in Goiânia,Goiás,Brazil

A cross-sectional study was conducted for assessing the prevalence of and risk factors associated with Cryptosporidium parvum in diarrheic children who were hospitalized in Goiania, capital of Goiás State in Brazil. A crude prevalence of 14.4% (64 of 445) was observed using a direct immunfluorescent assay (DFA), but the true prevalence was 18.7% (83 of 445) when a gold standard of immunomagnetic separation was used in combination with the DFA. Infection was more predominant in children less than 24 months old (odds ratio [OR] = 0.50, 90% confidence interval [CI] = 0.36-0.68, P = 0.0001), and males were 2.2 times more at risk for infection when compared with females (OR = 2.2. 90% CI = 0.13-3.8, P = 0.01). The socioeconomic, intra-familial, and environmental factors associated with cryptosporidiosis were day care attendance, household children with diarrhea up to 30 days prior to the interview, contact with surface water within past 30 days prior to the interview, dwelling distance from a body of water, and the late rainy season (P < 0.10). C. parvum was not associated with the parent's occupation, household sleeping arrangements, number of caregivers, breast-fed children, diet and type of food hygiene, source and type of treatment of drinking water, presence of sewage, and animal exposure (P > 0.10). Although weight was not found to be associated with infection, children infected with C parvum weighed on average 2.0% less than children not infected with C. parvum (P > 0.10). Thus, C. parvum is an important etiologic agent of childhood diarrhea and should be identified in routine parasitologic tests of diarrheal stool samples.     

Prevalence and associated risk factors for Giardia lamblia infection among children hospitalized for diarrhea in Goiânia, Goiás State, Brazil

The objective of this study was to determine the prevalence and to identify risk factors associated with Giardia lamblia infection in diarrheic children hospitalized for diarrhea in Goiania, State of Goiás, Brazil. A cross-sectional study was conducted and a comprehensive questionnaire was administered to the child's primary custodian. Fixed effects logistic regression was used to determine the association between infection status for G. lamblia and host, sociodemographic, environmental and zoonotic risk factors. A total of 445 fecal samples were collected and processed by the DFA methodology, and G. lamblia cysts were present in the feces of 44 diarrheic children (9.9%). A variety of factors were found to be associated with giardiasis in these population: age of children (OR, 1.18; 90% CI, 1.0 - 1.36; p = 0.052), number of children in the household (OR 1.45; 90% CI, 1.13 - 1.86; p = 0.015), number of cats in the household (OR, 1.26; 90% CI, 1.03 -1.53; p = 0.059), food hygiene (OR, 2.9; 90% CI, 1.34 - 6.43; p = 0.024), day-care centers attendance (OR, 2.3; 90% CI, 1.20 - 4.36; p = 0.034), living on a rural farm within the past six months prior hospitalization (OR, 5.4; CI 90%, 1.5 - 20.1; p = 0.03) and the number of household adults (OR, 0.59; 90% CI, 0.42 - 0.83; p = 0.012). Such factors appropriately managed may help to reduce the annual incidence of this protozoal infection in the studied population.     

Seroprevalence of hepatitis B virus infection in individuals with clinical evidence of hepatitis in Goiânia,Goiás. Detection of viral DNA and determination of subtypes

The presence of serological markers for hepatitis B virus (HBsAg, anti-HBc IgM and Anti-HBc total) was investigated in the serum of 1,396 individuals who had clinical suspect of hepatitis. It was observed that 50.7% of the individuals were positive and, from the total of the studied individuals, 14.5% were positive for HBsAg. From these, 8.5% were also positive for anti-HBc IgM. The analysis in relation to gender showed a higher seroprevalence index among male individuals (p < 0.0001). It was observed the occurrence of subtypes adw2 (62.7%), ayw3 (23.5%), ayw2 (9.8%) and adw4 (3.9%). The viral DNA was detected in 61 (33.9%) HBsAg positive samples and in one sample positive only for anti-HBc total. These results indicate an important incidence of the HBV infection in this population, and reinforce previous studies regarding this virus in the central west region of Brazil.     

Human vaccinia-like virus outbreaks in São Paulo and Goiás States, Brazil: virus detection, isolation and identification

Since October 2001, the Adolfo Lutz Institute has been receiving vesicular fluids and scab specimens of patients from Paraíba Valley region in the S?o Paulo and Minas Gerais States and from S?o Patricio Valley, in the Goiás State. Epidemiological data suggested that the outbreaks were caused by Cowpox virus or Vaccinia virus. Most of the patients are dairy milkers that had vesiculo-pustular lesions on the hands, arms, forearms, and some of them, on the face. Virus particles with orthopoxvirus morphology were detected by direct electron microscopy (DEM) in samples of 49 (66.21%) patients of a total of 74 analyzed. Viruses were isolated in Vero cell culture and on chorioallantoic membrane (CAM) of embryonated chicken eggs. Among 21 samples submitted to PCR using primers for hemagglutinin (HA) gene, 19 were positive. Restriction digestion with TaqI resulted in four characteristic Vaccinia virus fragments. HA nucleotide sequences showed 99.9% similarity with Cantagalo virus, described as a strain of Vaccinia virus. The only difference observed was the substitution of one nucleotide in the position 616 leading to change in one amino acid of the protein in the position 206. The phylogenetic analysis showed that the isolates clustered together with Cantagalo virus, other Vaccinia strains and Rabbitpox virus.     

Human bertiellosis in Goiás,Brazil: a case report on human infection by Bertiella sp. (Cestoda: Anoplocephalidae)

The authors report on a new case of human Bertiellosis in a 2-year old female patient who was born in Goiania-Goiás (Brazil) and has had history of permanent dwelling in an area frequently visited by simians in Mato Grosso (Brazil). At the time of diagnosis the patient showed inappetence, abdominal pain, and loss of weight. Eggs and proglottids were found in her stool and were identified as Bertiella sp. The objective of this report is to register the third case of human Bertiellosis in Brazil, characterizing one more case of helminthic zoonosis.     

Manejo perioperatorio y periprocedimiento del tratamiento antitrombótico: documento de consenso de SEC,SEDAR, SEACV,SECTCV, AEC,SECPRE, SEPD,SEGO, SEHH,SETH, SEMERGEN,SEMFYC, SEMG,SEMICYUC, SEMI,SEMES, SEPAR,SENEC, SEO,SEPA, SERVEI,SECOT y AEU

During the last few years, the number of patients receiving anticoagulant and antiplatelet therapy has increased worldwide. Since this is a chronic treatment, patients receiving it can be expected to need some kind of surgery or intervention during their lifetime that may require treatment discontinuation. The decision to withdraw antithrombotic therapy depends on the patient's thrombotic risk versus hemorrhagic risk. Assessment of both factors will show the precise management of anticoagulant and antiplatelet therapy in these scenarios. The aim of this consensus document, coordinated by the Cardiovascular Thrombosis Working Group of the Spanish Society of Cardiology, and endorsed by most of the Spanish scientific societies of clinical specialities that may play a role in the patient-health care process during the perioperative or periprocedural period, is to recommend some simple and practical guidelines with a view to homogenizing daily clinical practice.Full English text available from: www.revespcardiol.org/en     

腹痛,腹泻,便血,脱发,指甲萎缩,胃肠息肉

患者女,67岁。2个月前始,无明显原因及诱因出现上腹及脐周痛,伴腹胀、纳差,腹泻与便秘交替出现。胃镜检查发现胃粘膜皱襞粗大,呈脑回状,胃体前壁及大弯侧可见弥漫性息肉样粘膜增生、糜烂。大便OB(++)。按“糜烂性胃炎”口服洛赛克、西沙必利等10天,症状无好转。近半月,患者腹痛、腹泻加重,大便呈水样或稀糊状,带大量粘液,每日7～10次。1周前,反复便血3次,每次50～100ml,且头发、眉毛大量脱落,双手、足指(趾)甲进行性萎缩,皮肤干燥,下肢浮肿。家族中无类似疾病患者。该患者有糖尿病史6年。入院查体:T36.5℃,P70次/min,R20次/min,Bp17/8kPa。皮肤粗糙、脱屑,面部及双眼睑轻度浮肿,毛发稀疏。口腔粘膜无溃疡,舌质红,无苔。心肺正常。腹部轻度膨隆,无肠型及蠕动波,全腹轻度压痛,无反跳痛,未扪及肿块,肝脾不大,移动性浊音阴性,肠鸣音活跃。双下肢轻度凹陷性浮肿,内踝以上皮面有较密集的黑褐斑。双手、足指(趾)甲萎缩明显,左手无名指、食指及右手小指、双足小趾甲床裸露。外周血:RBC5.46×     

上腹疼痛,饱胀,纳差,恶心,呕吐

上腹疼痛、饱胀、纳差、恶心、呕吐济南市中心医院（２５００１３）田淑杰张书元盛文化病历摘要患者女，３８岁。反复发作上腹疼痛、饱胀、纳差、恶心呕吐３年，伴明显消瘦１年入院。曾在当地医院行钡餐检查示胃下垂、十二指肠球部变形，经常规治疗后症状减轻。１年后因精...     

发热,腰痛,腹痛,血尿

病历摘要患者男,２５岁,教师。患者因发热,咽痛于１９９７年７月１日住入外院,诊断急性扁桃体炎。该院给予静脉滴注青霉素８００万ｕ／ｄ,２ｄ后发热、咽痛缓解,但出现持续性腰痛、腹痛,呈阵发性加剧,伴有肉眼血尿。于１９９７年７月６日晚转来我院就诊。急诊室以尿路感染、尿路结石收入肾内科病房治疗。既住史：平素健康,无结核史。２月前出现尿频、尿急、尿痛等症状。入院体检：Ｔ３７．５°Ｃ,Ｒ２４次／ｍｉｎ,Ｐ１００次／ｍｉｎ,ＢＰ１６／１２ｋＰａ（１２０／９０ｍｍＨｇ）。神志清,急性痛苦病容,周身皮肤、粘膜未见…     

腹胀,黄疸,呕血,精神萎靡

腹胀、黄疸、呕血、精神萎靡山东省立医院（２５００２１）石军杨崇美朱菊人病历摘要患者女，３２岁。停经７个月，因纳差、恶心、呕吐１周，尿黄３天于１９９６年１２月１１月入院。入院１周前无明显诱因的出现恶心、呕吐，每日１０余次，多为胃内容物，伴上腹痛、纳差、...     

头痛,发热,恶心,呕吐

病历摘要患者女，３８岁。因头痛、发热伴恶心、呕吐半个月于１９９７年８月１６日入院。半个月前，患者无明显诱因出现持续性全头痛，伴非喷射性恶心呕吐，体温３７～３８℃。查体：Ｔ３７．７℃，Ｐ８０次／ｍｉｎ，Ｒ２０次／ｍｉｎ，Ｂｐ１７／１０ｋＰａ。神志清楚，...     

胸闷,心慌,全身无力,心脏骤停

第一次查房主任医师：本例因胸闷、心慌、全身无力入院,住院后出现心脏骤停,经抢救心脏已复跳,但尚未明确诊断。现对其临床资料进行分析讨论。先请汇报病历。住院医师：患者男,２８岁。因发热２天,胸闷、心慌及全身无力３小时入院。入院后询问病史时,患者突然意识丧失,跌倒在地,四肢抽搐。心电监护示室颤。立即给予电击复律,心律转复,静脉给予利多卡因,但心律难以维持,仍反复发生室速;经多次电复律和静注心律平后,心律维持为加速性交界性自身性节律,患者清醒。但此后不久,又反复出现室速、室颤和心跳停顿,给予反复电复律和…     

腹胀,腹痛,低热,血性腹水

第一次查房主任医师：这次讨论的是位老年患者,以发热、腹水、血沉快为特点,至今未明确诊断。先请简要汇报病历。实习医师：患者男,６５岁,因腹胀、腹痛、纳差、低热２周入院。体检：Ｔ３７．８℃。心肺（－）。腹壁静脉无怒张,腹肌略紧张,有柔韧感,全腹未触及包块...     

紫绀,憋喘,腹胀,水肿

病历摘要患者女,４６岁。发现心脏杂音４０余年,活动后心慌,气促伴口唇青紫６年多,因出现腹胀、纳差、憋喘伴双下肢水肿２个月而入院。无蹲踞史,无关节炎及结核病史。查体：Ｔ３６８℃,Ｐ９８次／ｍｉｎ,Ｒ２６次／ｍｉｎ,Ｂｐ１２／９ｋＰａ。身高１６３ｃｍ,体重３５ｋｇ。严重消瘦,呈恶病质,口唇紫绀,颈静脉怒张,杵状指（趾）。双肺呼吸音粗。心前区无隆起,未触及震颤,心尖搏动弥散,心界向双侧扩大,胸骨左缘第三、四肋间闻及Ⅱ／６级收缩期杂音,胸骨右缘第五肋间闻及Ⅱ／６级收缩期杂音,均柔和,Ｐ２消失。蛙状腹、…