Validation of the Global Leadership Initiative on Malnutrition criteria for diagnosis of malnutrition and mortality prediction for people living with HIV or AIDS

OBJECTIVES

To validate the Global Leadership Initiative on Malnutrition (GLIM) criteria to diagnose malnutrition in hospitalized people living with HIV or AIDS (HA) considering different combinations, using the Subjective Global Assessment (SGA) as the semi-gold standard, and to assess the predictive effects of malnutrition according to the GLIM criteria on hospital length of stay and mortality.

METHODS

Retrospective observational study including hospitalized people living with HA aged >18 y. Forty GLIM combinations were obtained by combining the different phenotypic and etiologic criteria. The concurrent validity was assessed according to the sensitivity and specificity values, and the agreement with the SGA was tested using κ values. Multivariate logistic and Cox regression models were used to test the independent predictors for longer length of stay (LOS) and mortality, respectively.

RESULTS

The sample comprised 320 patients (mean age, 44.6 ± 12.1 y; 69.1% were men, and 68.4% were malnourished, according to the SGA). The prevalence of malnutrition, according to GLIM, varied from 10.3% to 69.1%. The combination of any phenotypic criteria with the etiologic criteria of low food intake and the combination of any phenotypic criteria with the etiologic criteria of disease severity were independent predictors for mortality (Hazard Ratio: 2.09 [95% CI, 1.15-3.77] and 2.09 [95% CI, 1.25-3.51], respectively). The combination of low body mass index and reduced absorption was independently associated with LOS higher than the median value (Oodds Ratio; 2.57; 95% CI, 1.21-5.45).

CONCLUSIONS

Nine GLIM combinations had satisfactory sensitivity and specificity values to determine concurrent validity, all of them including weight loss and low weight; two combinations were independent predictors of mortality (any phenotypic criteria and low food intake or opportunistic infections), and one combination predicted longer LOS. Combining any phenotypic criteria with low food intake resulted in adequate concurrent and predictive validity.

Disseminated Sporothrix brasiliensis infection with endocardial and ocular involvement in an HIV-infected patient

Disseminated sporotrichosis occurs in individuals with impaired cellular immunity, such as in cases of neoplasia, transplantation, diabetes, and especially, acquired immunodeficiency syndrome. This report presents a 32-year-old Brazilian human immunodeficiency virus (HIV)-infected patient who developed a protracted condition of disseminated sporotrichosis with endocarditis, bilateral endophthalmitis, and lymphatic involvement. He needed cardiac surgery to replace the mitral valve. Sporothrix brasiliensis isolates were recovered from cultures of subcutaneous nodules and mitral valve fragments. Species identification was based on classical and molecular methods. The patient received amphotericin B for 52 days and subsequently, oral itraconazole. He remains asymptomatic, and he is on maintenance therapy with itraconazole. Despite his positive clinical outcome, he developed bilateral blindness. To our knowledge, this case is the first report of endocarditis and endophthalmitis caused by S. brasiliensis.

Comparative study of survivor and nonsurvivor sepsis patients in a university hospital

To determine parameters associated with the evolution of sepsis, a five-year retrospective study was conducted in a university hospital. One hundred and four consecutive sepsis patients were evaluated, of whom 55.8% were men. The mortality was 68.3% and was associated with older age (p<0.05). Chronic comorbidities and infection site were not associated with prognosis. Gram-positive bacteria were more frequently identified in survivors (p<0.05), while non-detection of the germ was associated with mortality (p<0.01). Appropriate use of antibiotics (germ sensitive to at least one drug administered) was associated with survival (p<0.0001) while inappropriate use (p<0.05) or empirical use (p<0.01) were more frequent in nonsurvivors. Leukocytosis was the main abnormality (54.8%) detected on diagnosis, from the leukocyte count. During the evolution, normal leukocyte count was associated with survival (p<0.01) and leukocytosis with mortality (p<0.05). In conclusion, mortality was associated with nondetection of the pathogen, leukocytosis during the evolution of the sepsis and inappropriate or empirical use of antimicrobials. Evidence-based treatment that is directed towards modifiable risk factors might improve the prognosis for sepsis patients.

Cytokine serum levels in patients infected by human immunodeficiency virus with and without Trypanosoma cruzi coinfection

This study assessed the number of CD4 T lymphocytes, the parasitemia and serum levels of interferon gamma (IFN-gamma), tumor necrosis factor alpha (TNF-alpha), interleukin-1 (IL-1), IL-4 and IL-10 of patients infected by human immunodeficiency virus (HIV) and human immunodeficiency virus/Chagas' disease coinfection. CD4 T lymphocytes were low in the two groups of patients, although significantly lower in patients without Chagas' disease. Serum levels of IFN-gamma, IL-4 and TNF-alpha were significantly higher in patients with HIV/Chagas' disease. IL-4/IFN-gamma ratios were higher in patients with HIV/Chagas' disease, which showed a clear balance in favor of Th2-like cytokines in this group of patients. This Th2 balance was higher in patients with detectable parasitemia. We conclude that, although immunosuppression was observed, with CD4 T lymphocytes bellow 200/µm³, these patients did not display reactivation of T. cruzi infection and that a balance favorable to Th2 was associated with the presence of parasitemia.

Isospora belli Infection: Observation of Unicellular Cysts in Mesenteric Lymphoid Tissues of a Brazilian Patient with AIDS and Animal Inoculation

We describe the finding of unizoic cysts of Isospora belli in lymphoid tissues of a Brazilian patient with AIDS, and discuss the possibilities of their drug resistance, they being the cause of relapses, and of being an indication for the existence of intermediary or paratenic animal hosts.

[Extraintestinal finding of Isospora belli unizoic cysts in a patient with AIDS: case report]

This report describes the presence of Isospora belli unizoic cysts in mesenteric lymph nodes and of gametocytes in the gallbladder epitelium of a 26 year-old Brazilian male patient with Acquired Immune Deficiency Syndrome. This patient had received treatment for several times with sulfamethoxazole-trimethoprim. It is discussed the significance of I. belli tissue cysts as possible foci of resistance of the parasite and their association with the infection relapse even post-treatment with anticoccidian medication.

Hantavirus pulmonary syndrome in Uberaba, Minas Gerais, Brazil

This report describes the epidemiological and clinical-evolutive characteristics of eight patients with hantavirus pulmonary syndrome (HPS) in Uberaba, Minas Gerais, Brazil. A positive history of contact with rodents was present in 100% of the cases. The time between the onset of symptoms and hospital care was, on average, 3.6 days. All patients showed clinical and laboratory findings suggestive of HPS. Elevated urea and creatinine levels were observed in 6 (75%) cases, PO2 was < 60 mmHg in 100% of the cases, and a chest X-ray demonstrated a bilateral interstitial-alveolar infiltrate. The diagnosis was confirmed by the detection of IgM antibodies against Sin Nombre virus by ELISA. Three patients died as a direct consequence of HPS.

Report of the second satellite symposium on ultrasound in schistosomiasis

A group of experts on schistosomiasis and ultrasonography discussed the experiences and results obtained with the Niamey-Belo Horizonte Protocol on Ultrasonography in Schistosomiasis. A series of recommendations about qualitative and quantitative data obtained by ultrasound in studies performed in Africa and Brazil are presented. Immunological, genetic and epidemiological studies must rely on ultrasound for the identification of patients with periportal thickening/fibrosis.

[Brain abscess caused by Nocardia sp in immunosuppressed patient]

Patient with autoimmune haemolytic anaemia and thrombocytopenic purpura (Evans Syndrome), treated with immunosuppressive therapy (prednisone and azathioprine) developed brain abscess unresponsive to antimicrobial therapy, in spite of its 23 days duration. Diagnosis could be possible after recover secretion of peribulbar abscess and maintenance of this material over seven days in incubation.

Abdominal ultrasound in acute schistosomiasis mansoni

Reports on abdominal ultrasound studies in patients with acute schistosomiasis are still scarce and limited data are available on structural changes of the liver parenchyma in this stage of the disease. 26 patients with acute schistosomiasis mansoni were submitted to clinical and ultrasound examination. For ultrasound comparison, each acute patient was paired by age, gender, weight and height to a non-infected individual. Ultrasound showed a non-specific homogeneous size increase of the liver, and spleen in all acute patients, and easily identified intraabdominal lymph nodes in the periportal region in most cases. Three out of the five patients with periportal thickening underwent percutaneous liver biopsy. Periportal thickening disappeared 6 months after treatment for schistosomiasis. 24 months after successful treatment there was involution of the liver and spleen; lymph nodes, although reduced in size, were still easily recognized. Liver biopsy showed dense inflammatory infiltration of neutrophils, macrophages and eosinophils in the portal tracts associated with discrete fibrous tissue formation.

Influence of Schistosoma mansoni infection on the reproductive capacity of albino mice

This paper reports reduction on the reproductive capacity of female mice infected with Schistosoma mansoni, either in the acute phase or in the chronic one of the disease. This decrease in the reproductive capacity was highly significant (93.3% and 86.7%, for the acute and chronic phases, respectively).

Acute schistosomiasis: report on five singular cases

The cases of five patients with unusual manifestations of acute schistosomiasis mansoni are described in this paper. One patient developed skin lesions, three displayed diverse lung involvement, and one presented pyogenic liver abscesses caused by Staphylococcus aureus.