Resumo em Inglês:

The safety and efficacy of cefepime empiric monotherapy compared with standard broad-spectrum combination therapy for hospitalized adult patients with moderate to severe community-acquired bacterial infections were evaluated. In an open-label, multicenter study, 317 patients with an Acute Physiology and Chronic Health Evaluation (APACHE II) score ranging from >5 to =19 were enrolled with documented pneumonia (n=196), urinary tract infection (n=65), intra-abdominal infection (n=38), or sepsis (n=18). Patients were randomly assigned 1:1 to receive cefepime 1 to 2 g IV twice daily or three times a day or IV ampicillin, cephalothin, or ceftriaxone ± aminoglycoside therapy for 3 to 21 days. For both treatment groups, metronidazole, vancomycin, or macrolide therapy was added as deemed necessary. The primary efficacy variable was clinical response at the end of therapy. Two hundred ninety-six (93%) patients met evaluation criteria and were included in the efficacy analysis. Diagnoses included the following: 180 pneumonias (90 cefepime, 90 comparator), 62 urinary tract infections (29 cefepime, 33 comparator), 37 intra-abdominal infections (19 cefepime, 18 comparator), and 17 sepses (8 cefepime, 9 comparator). At the end of therapy, overall clinical success rates were 131/146 (90%) for patients treated with cefepime vs 125/150 (83%) for those treated with comparator (95% confidence interval [CI]: - 2.6% to 16.3%). The clinical success rate for patients with community-acquired pneumonia, the most frequent infection, was 86% for both treatment groups. Among the patients clinically evaluated, 162 pathogens were isolated and identified before therapy. The most commonly isolated pathogens were Escherichia coli (n=49), Streptococcus pneumoniae (n=29), Haemophilus influenzae (n=14), and Staphylococcus aureus (n=11). Bacteriologic eradication/presumed eradication was 97% for cefepime vs 94% for comparator-treated patients. Drug-related adverse events were reported in 16% of cefepime patients and 19% of comparator patients. In conclusion, cefepime had higher cure rates compared with broad-spectrum combination therapy as an initial empiric treatment for hospitalized patients with moderate to severe community-acquired infections, including urinary tract infections, intra-abdominal infections, and sepsis.

Resumo em Inglês:

There is increasing interest in the identification of factors associated with liver disease progression in patients infected with hepatitis C virus (HCV). We assessed host-related factors associated with a histologically advanced stage of this disease and determined the rate of liver fibrosis progression in HCV-infected patients. We included patients submitted to liver biopsy, who were anti-HCV and HCV RNA positive, who showed a parenteral risk factor (blood transfusion or intravenous drug use), and who gave information about alcohol consumption.Patients were divided into two groups for analysis: group 1 - grades 0 to 2; group 2 - grades 3 to 4. The groups were compared in terms of sex, age at the time of infection, estimated duration of infection and alcoholism. The rate of fibrosis progression (index of fibrosis) was determined based on the relationship between disease stage and duration of infection (years). Logistic regression analysis revealed that age at the time of infection (P<0.01; 95% CI 1.06-1.22) and the duration of infection (P<0.01; 95% CI 1.06-1.32) were independently associated with a more advanced stage of hepatitis C. The median index of fibrosis was 0.14 for the group as a whole. A significant difference in the index of fibrosis was observed between patients aged < 40 years at infection (median = 0.11) and patients aged > or = 40 years (median = 0.47). The main factors associated with a more rapid fibrosis progression were age at the time of infection and the estimated duration of infection. Patients who acquired HCV after 40 years of age showed a higher rate of fibrosis progression.

Resumo em Inglês:

The high incidence of Hepatitis A and B in institutionalized patients with Down Syndrome (DS) is not fully understood. Under poor hygienic conditions, immunological alterations might predispose individuals to these infections. Sixty three DS children between 1 and 12 years old living at home with their families were examined for anti-HAV and compared to age-matched controls (64 healthy children). This cross-sectional study was carried out from May, 1999, to April, 2000, at the Hospital de Clínicas of Porto Alegre, southern Brazil. Groups were compared in terms of age, sex, skin color, and family income (> R$ 500 and < R$ 500/ month) by the chi-square test, with Yates' correction and for the prevalence of anti-HAV (Fisher's exact test). In the DS group (n=63), the mean age was 4.4 ± 3.3 years, 94% of the patients were white and 51% were female. Family income was <= R$ 500/month in 40 cases (63%). In the control group (n=64), the mean age was 4.8 ± 2.7 years, 81% of the patients were white and 56% were female. Family income was <= R$ 500 in 20 patients (31%). DS children's families had a significantly lower income (P<0.0005). In the DS group there were 6 positive (9.5%) anti-HAV cases, and all came from low-income families (less than R$ 500/ month). In the control group, 3 cases (4.7%) were positive for anti-HAV (two were from a low-income family and one was from a higher income family). These differences were not significant. Our data indicate that Hepatitis A is not a special risk for mentally retarded DS outpatients, even in a developing country like Brazil.

Resumo em Inglês:

OBJECTIVES: Estimate the prevalence of immunity to poliomyelitis (anti-polio antibodies) in the city of São Paulo/Brazil through a population-based survey. METHODS: A quantitative and inductive method was used to draw a representative sample of the population. Randomization and stratification (based on sex, age and residence region) was done, and 1,059 individuals were studied on a home-visit basis (structured questionnaires and blood samples). A microneutralization test was performed to detect anti-polio antibodies against serotypes 1, 2 and 3. RESULTS: The estimated prevalence of immunity to poliomyelitis was high, with 94.6% prevalence of anti-polio 1 antibodies, 98.8% anti-polio 2 and 91.9% anti-polio 3. Despite this high prevalence, there were significantly lower prevalence levels in some groups, specially among age and residence region groups. DISCUSSION: Routine child immunization and NIDs with OPV have provided excellent levels of serological immunity to poliomyelitis in the population of the city of São Paulo, Brazil. However, there may be specific groups with a lower prevalence of immunity. Estimations of the prevalence of immunity to poliomyelitis were made in a population-based survey, which could be used as an auxiliary tool for supporting the polio eradication program.

Resumo em Inglês:

Salmonella strains isolated from 1,138 samples representing 28,199 biological materials (stool, urine, blood and other fluids), collected between January 1985 and January 1999 at a reference University Hospital in Ribeirão Preto, São Paulo, Brazil, were studied. The most frequently detected serotypes were Salmonella enterica subspecies enterica serotype4,5,12:i:- (S. I 4,5,12:i:) (21.2%), S. agona (15.8%) and S. enteritidis (11.3%). A changing pattern of Salmonella serotypes was observed between 1985-1999. S. agona, which represented 27% of Salmonella serotypes isolated from 1985-1989, declined to 4% during the period from 1995 to 1999. S. enteritidis isolation remained below 1% until 1989; rose to 5.9% between 1990 and 1994, and increased to 32.3% between 1995-1999. S. I 4,5,12:i:-; S. Enteritidis; S. Typhimurium; S. dublin and S. infantis, showed low to moderate resistance profiles to most antimicrobial drugs. Nalidixic acid and tetracycline were the most and the least effective drugs, respectively, in the disk diffusion tests. We encountered changes in salmonellosis epidemiology in this geographical region.

Resumo em Inglês:

OBJECTIVE: Evaluate the incidence of mycobacterial disease and the colonization of the respiratory and gastrointestinal tracts by Mycobacterium avium complex (MAC) bacteria in AIDS patients. METHODS: Inclusion criteria: HIV-positive individuals with at least one CD4+ count < 100 cells/mm³. Exclusion criteria: Mycobacterial disease and MAC prophylaxis. Stool, sputum, and blood cultures were prospectively obtained every month from September, 1997, to December, 1999. The incidence was calculated using Poisson regression. Survival was estimated by the Kaplan Meier method and the Cox proportional hazard model. RESULTS: We followed-up 79 patients during a median period of 428 days. Blood cultures (n = 742) were negative for all mycobacteria. Positive cultures (25 samples) were obtained from non-sterile sites: Stools (19/703 specimens = 2.7%) and sputum (14/742 specimens = 1.9%). MAC was isolated in 7/703 stool samples (1%) and 1/32 sputum specimens (0.1%). The incidence of patient colonization with MAC was 0.09 /year (CI=0.05 - 0.18). CD4 counts in patients colonized with MAC were below 100 cells/mm³ in only 2 out of 8 cases. Restoration of CD4+ counts >100 cells/mm³ (HR = 0.18; CI = 0.05 - 0.70) predicted a lower risk of death (P<0.05) but was not protective for MAC colonization (HR=0.52;CI =0.62 - 4.35, P=0.55). CONCLUSION: The absence of DMAC infection in colonized individuals argues in favor of a HAART protective effect against; DMAC; however, restoration of CD4 counts did not protect patients against MAC colonization.

Resumo em Inglês:

The expansion of <FONT FACE=Symbol>gd </font>T cells in patients with active cutaneous leishmaniasis, with or without glucantime therapy, was investigated. Twenty patients with local cutaneous leishmaniasis including glucantime-treated (n=10) and untreated (n=10) patients were selected. The controls were healthy individuals (n=10) living in endemic areas. Whole blood was obtained and the T cell subpopulations were analyzed by flow cytometry. Significantly more <FONT FACE=Symbol>gd</FONT> CD3+ T cells were observed in untreated patients (15.9% ± 5.9), when compared with glucantime-treated patients (4.6% ± 1.4) and controls (5.3% ± 2.3). On the other hand, when the percentages of ab CD3+ T-cells were analyzed different results were obtained. A significant increase in <FONT FACE=Symbol>ab</FONT> T cells was seen in glucantime-treated patients (62.4% ± 7.6), when compared to the untreated patients (55.7% ± 5.5) and controls (55.1% ± 9.6). The percentage of total CD3+ T cells was statistically greater in both glucantime-treated (68.8% ± 7.4) and untreated patients (73.4% ± 5.9) when compared to the controls (61% ± 10.3). These results are consistent with previous results on the expansion of <FONT FACE=Symbol>gd</FONT>T cells during the course of cutaneous leishmaniasis. They also indicate that glucantime therapy can reverse the expansion of <FONT FACE=Symbol>gd</FONT>T cells and as a result increase the percentages of <FONT FACE=Symbol>ab</FONT> CD3+ T cells.

Resumo em Inglês:

Plasmodium falciparum and Plasmodium vivax malaria are endemic infections in India and are commonly associated with mild hematological abnormalities. Severe thrombocytopenia is common in isolated falciparum and mixed falciparum/vivax malaria, but is very rare in isolated P.vivax infection. We hereby report a case of severe thrombocytopenia (platelet count of 8x10(9)/L) in a case of vivax malaria. This is only the second case ever reported in the literature of such profound thrombocytopenia in a case of isolated P.vivax malaria.

Resumo em Inglês:

Bacterial infection is a common complication in cirrhotic patients. The portal hypertension as well as the immune depression observed in these patients can explain this high incidence of bacterial infection. Because of the high probability of cirrhotic patients to develop infections, antibiotic prophylaxis is warranted in some conditions, such as upper gastrointestinal bleeding or after spontaneous bacterial peritonitis. Nevertheless, antibiotic prophylaxis is not widely recommended for cirrhotic patients.