Browsing by Author "Marques, T."
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- Imported African histoplasmosis by Histoplasma capsulatum var. duboisii in an HIV-2 infected patientPublication . Toscano, C.; Batista, J.; Carvalho, R.; Espírito-Santo, C.E.; Marcos, R.; Sabino, R.; Verissimo, C.; Viana, I.; Marques, T.Objectives: African histoplasmosis caused by the fungus Histoplasma capsulatum var. duboisii, is a rare endemic mycosis occuring in western and central regions of sub-Saharian Africa. For unknown reasons, although HIV infection and H. capsulatum var. duboisii coexist in Africa, this coinfection remains rare. In Europe, diagnosed cases of African histoplasmosis are all imported. We describe a case of African histoplasmosis on a Portuguese war veteran co-infected with HIV-2 who fought in Guiné-Bissau in 1963-65 and Angola in 1972. Methods: We report a case of a 76-year-old man, diagnosed with HIV-2 infection in the previous year (under combined antiretroviral therapy) presenting an ulcerated skin lesion on the right tight (image 1), just above the knee. He was diagnosed pulmonary tuberculosis the year before and was finishing one year treatment. The solitary skin lesion begun as a small non-pruriginous eritematous papule, evolving in 6 month to a painless 3-4cm ulcer with raised borders surrounded by a hiperpigmented halo. There were no adenopathies or bone lesions. Respiratory samples and blood cultures were systematically negative for Histoplasma capsulatum. He was treated with IV liposomal Amphotericin-B for one month, followed by oral itraconazol (now on the first month), with a favourable clinical outcome. Results: Histopathology of skin biopsy revealed a superficial ulceration with underlying granulomatous infiltrate with many giant cells, where numerous round mononucleated yeasts measuring 7-8µm were evident and highlighted with PAS and Grocott stain (image 2, left side). Skin biopsy was observed on a wet mount with KOH and revealed numerous round yeasts that were also seen on Gram stain, measuring 7-8µm. Culture of skin biopsy on two Sabouraud dextrose agar (with and without cicloheximide) showed growth of a filamentous fungus compatible with Histoplasma capsulatum (image 2, right side), with large thick-walled spherical macroconidia with finger-like projections (tuberculate conidia) that arise from short conidiophores, and small oval microconidia arising on short stalks from undifferentiated hyphae. Reversion to the yeast fase has not been succeed yet. Identification was further confirmed by sequencing of genomic DNA fragments using the universal fungal primers ITS1 and ITS4. The sequences obtained were compared with sequences deposited in the GenBank and the result was: Histoplasma capsulatum var. duboisii (99% homology). Conclusion: With banalization of business or leisure trips, endemic mycosis are becoming frequently diagnosed in countries outside their natural geographic endemic areas and only a high index of suspicion makes the diagnosis possible. Apart from trips, nowadays in Portugal 4% of the resident population is immigrant, mostly from Brasil (25.5%) but also from Angola and Guiné-Bissau (9.2%), being the former an endemic country of American histoplasmosis and the later of both American and African histoplasmosis. We consider histoplasmosis a probable underdiagnosed disease that should be suspected mainly in immunodeficient HIV positive individuals with a past history of travel or residence in an endemic area.
- Improving influenza surveillance in Portuguese preschool children by parents' reportPublication . Paixão, P.; Piedade, C.; Papoila, A.; Caires, I.; Pedro, C.; Santos, M.; Silvestre, M.J.; Brum, L.; Nunes, Baltazar; Guiomar, R.; Curran, M.D.; Carvalho, A.; Marques, T.; Neuparth, N.Influenza surveillance is usually based on nationally organized sentinel networks of physicians and on hospital reports. This study aimed to test a different report system, based on parents’ phone contact to the research team and in home collection of samples by a dedicated team. The identification of influenza and other respiratory viruses in children who attended a Hospital Emergency Department was also recorded. Real-time PCR and reverse transcription PCR were performed for influenza A and B, parainfluenza 1-4, adenovirus, human metapneumovirus, respiratory syncytial virus A and B, rhinovirus, enterovirus, group 1 coronaviruses, group 2 coronaviruses, and human bocavirus. One hundred children were included, 64 from the day care centers and 36 from the Hospital. Overall, 79 samples were positive for at least one respiratory virus. Influenza A (H3) was the virus most frequently detected: 25 cases, 20 of these in children under 5 years of age (ten from day care centers and ten who went to the hospital) which was higher than those reported by the National Influenza Surveillance Programme for this age. Conclusion: The results obtained in this study suggest that a surveillance system based on parents’ reports could complement the implanted system of the National Influenza Surveillance Programme.
- A large community outbreak of Legionnaires’ disease in Vila Franca de Xira, Portugal, October to November 2014Publication . Shivaji, T.; Sousa Pinto, C.; San-Bento, A.; Oliveira Serra, L.A.; Valente, J.; Machado, J.; Marques, T.; Carvalho, L.; Nogueira, P.J.; Nunes, Baltazar; Vasconcelos, P.An outbreak of Legionnaires’ disease with 334 confirmed cases was identified on 7 November 2014 in Vila Franca de Xira, Portugal and declared controlled by 21 November. Epidemiological, environmental and microbiological analysis identified industrial wet cooling systems to be the probable source of infection. Preliminary results from sequence-based typing of clinical specimens and environmental isolates confirmed this link. A series of meteorological phenomena are likely to have contributed to the scale of this outbreak.
- The typical presentation of an atypical pathogen during an outbreak of Legionnaires’ disease in Vila Franca de Xira, Portugal, 2014Publication . Dias, A.; Cysneiros, A.; Lopes, F.T.; von Amann, B.; Costa, C.; Dionísio, P.; Carvalho, J.; Durão, V.; Carvalho, G.; Paula, F.; Serrado, M.; Nunes, B.; Marques, T.; Froes, F.; Bárbara, C.Background: An outbreak of Legionella pneumophila serogroup 1, with 403 cases was identified on the 7th November 2014 in Vila Franca de Xira, Portugal. Outbreak source was the wet cooling system of a local factory. Hospital Pulido Valente was one of the hospitals receiving patients with Legionnaires’ disease (LD). Methods: We describe the clinical findings and diagnostic methods used among the 43 confirmed or probable cases admitted to our department. Results: 60.5% were male, mean age was 56.1 ± 13.5 years and tobacco smoking was the most frequent risk factor (76.7%). All patients had fever, 62.8% ≥39.5 ◦C, 72.1% had chills and myalgia/arthralgia and 62.8% had dry cough. Extra pulmonary symptoms were frequent: confusion and headache occurred in 34.9% and gastrointestinal symptoms in 20.9%. High C-Reactive Protein (55.8% ≥30 mg/dL) and hyponatremia (62.8%) were the laboratorial abnormalities most commonly found. Hypoxemia occurred in 55.8% and hypocapnia in 93%. Urinary Antigen Test (UAT) was positive in 83.7% of the cases. Conclusions: Although not specific, a combination of risk factors, symptoms and laboratory findings can be highly suggestive of LD, even in an outbreak. This should prompt diagnosis