Navegando por Autor "Vechi, Hareton Teixeira"

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Brazilian older people hospitalized by COVID-19: characteristics and prognostic factors in a retrospective cohort study
(SAGE Publications, 2021-01-06) Santos, Marquiony M.; Lucena, Eudes Euler Souza; Bonfada, Diego; Santos, Aramis Costa; Vechi, Hareton Teixeira; Lima, Kenio Costa de
Objective: analyzing the survival of older people hospitalized due to COVID-19 in Brazil and identifying its main predictive factors for death. Method: this is a retrospective, multicenter cohort study, based on 20,831 records of hospitalizations of older people due to SARS-CoV-2 in Brazil. The observation period was from February 28 to May 18, 2020. Results: there was a reduced overall survival time of 47.70% (95% confidence interval [CI] = [46.72%, 48.67%]) in 10 days. The variables age, race, education, intensive care unit (ICU), region, day of hospitalization, time elapsed between the first symptom and hospitalization, and the municipality that provided assistance showed increased risk of death using the multiple Cox proportional-hazards model. Conclusion: these results emphasize the relevance of inequality and access to health services as determinants for the death of older people with COVID-19
Case report: combination therapy with liposomal amphotericin B, n-methyl meglumine antimoniate, and pentamidine isethionate for disseminated visceral leishmaniasis in a splenectomized adult patient
(American Society of Tropical Medicine and Hygiene, 2020-02-05) Vechi, Hareton Teixeira; Sousa, Ana Solange Vasconcelos de; Cunha, Mirella Alves da; Shaw, Jeffrey Jon; Luz, Kleber Giovanni
In immunocompromised patients, visceral leishmaniasis (VL) can present with atypical clinical symptoms that include poorresponse to treatment.Nooptimal therapeuticregimen is available for such cases. In a splenectomizedmale patient, we observed a disseminated form of the disease in the liver, bone marrow, lymph nodes, and gastrointestinal tract. Therewas an apparent clinical improvementwhenhewas initiallytreatedwith liposomal amphotericin B (L-AmB), butthiswas followed by a relapse involving severe clinical symptoms. He was finally treated successfully with a combination of L-AmB, meglumine antimoniate, and pentamidine isethionate. It is important to include asplenia as an immunosuppressive condition that induces exotic VL pathologies. In such cases, combination anti-Leishmania drug therapy should be considered
Chronic cavitary pneumonia by Rhodococcus equi in a highly prevalent tuberculosis country: a diagnosis challenge
(Universidade de São Paulo, 2018-11-14) Vechi, Hareton Teixeira; Oliveira, Eduardo Teodoro Gurgel de; Freitas, Marise Reis de; Rossi, Flávia; Britto, Maria Helena Marques Fonseca de; Alves, Manoella do Monte
Rhodococcus equi is a facultative aerobic, intracellular, non-motile, non-spore-forming, Gram-positive, weakly acid-fast coccobacillus belonging to the group of nocardioform actinomycetes. R. equi infections are rare opportunistic illnesses in patients with Acquired Immunodeficiency Syndrome (AIDS), associated with a high mortality rate. The most common clinical presentation of R. equi infections is a chronic cavitary pneumonia. Due to its acid-fastness, R. equi can be mistaken for others acid-fast organisms, as Mycobacterium tuberculosis. In turn, R. equi is also a gram-positive pleomorphic bacteria and can be mistaken for diphtheroids or Micrococcus organisms, being accidentally disregarded as oral contaminants in sputum cultures. Therefore, in Brazil, a highly prevalent tuberculosis (TB) country, pulmonary infections caused by R. equi may mimic pulmonary TB and represent a diagnostic challenge. Here, we report on a case of chronic cavitary pneumonia by R. equi in a Human Immunodeficiency Virus (HIV)-infected patient, focusing on diagnostic aspects.
Fatores associados à susceptibilidade aos vírus das hepatites A e B entre homens que fazem sexo com homens usuários de profilaxia pré-exposição ao HIV no Rio Grande do Norte
(Universidade Federal do Rio Grande do Norte, 2024-04-03) Vechi, Hareton Teixeira; Lima, Kenio Costa de; https://orcid.org/0000-0002-5668-4398; http://lattes.cnpq.br/5835673385014578; https://orcid.org/0000-0001-7845-3921; http://lattes.cnpq.br/9160109948661718; Freitas, Marise Reis de; http://lattes.cnpq.br/9028554205811163; Perdigão Neto, Lauro Vieira
Homens que fazem sexo com homens (HSH) são desproporcionalmente mais afetados por infecções pelos vírus das hepatites A e B (HAV e HBV, respectivamente) e as práticas sexuais têm sido implicadas como importantes modos de transmissão nesta população. Conforme recomendações do Ministério da Saúde, usuários de profilaxia pré-exposição ao HIV (PrEP HIV), dos quais 80-90% são HSH, devem se submeter à avaliação do status imune para HAV e HBV por testes sorológicos, para tomada de decisões clínicas individuais e coletivas relativas ao controle e prevenção destas infecções. Este estudo visa avaliar a prevalência e os fatores associados à susceptibilidade ao HAV e HBV entre HSH usuários de PrEP HIV no Rio Grande do Norte, Nordeste do Brasil. Trata-se de um estudo transversal, conduzido entre setembro de 2021 e junho de 2023, em que os participantes foram entrevistados com questionário estruturado para coleta de dados sociodemográficos e clínicos. Amostras de sangue também foram coletadas para triagem de infecções sexualmente transmissíveis (IST) e testagem sorológica para HAV e HBV. Um total de 287 HSH foram incluídos no estudo. Susceptibilidade ao HAV foi encontrada em 106/282 (37,6%) participantes. Os fatores associados à suscetibilidade ao HAV foram: idade < 30 anos (razão de prevalência [RP]: 2,02; intervalo de confiança de 95% [IC 95%]: 1,61-2,53), ter plano de saúde (RP: 1,39; IC 95%: 1,19-1,64) , sexo apenas com homens cisgêneros (RP: 1,52; IC 95%: 1,23-1,89), parceria sexual não-fixa (RP: 1,20; IC 95%: 1,01-1,43) e ausência de IST ao longo da vida (RP: 1,25; 95% IC: 1,03-1,53). Suscetibilidade ao HBV foi encontrada em 58/286 (20,3%) indivíduos. A suscetibilidade ao HBV esteve significativamente associada a: renda mensal ≤ 5 salários mínimos (RP: 2,02; IC 95%: 1,01-4,05), não ter vacinação completa contra hepatite B (RP: 4,52; IC 95%: 2,89-7,06), início de PrEP HIV (RP: 2,18; IC 95%: 1,21-3,94), duração de seis meses de PrEP HIV (RP: 2,16; IC 95%: 1,19-3,91), ausência de tatuagens (RP: 1,55; IC 95%: 1,00-2,40) e ausência de história médica de IST (RP: 1,65; IC 95%: 1,07-2,54). Observa-se significativa proporção de suscetibilidade ao HAV e HBV entre HSH em uso de PrEP HIV no Estado do Rio Grande do Norte. Fatores socioeconômicos, status de vacinação, e questões de saúde sexual desempenharam papéis críticos na determinação desta suscetibilidade. A integração do rastreio e da vacinação das hepatites A e B aos serviços de PrEP HIV é fundamental para identificar e abordar a problemática da susceptibilidade. As intervenções que aumentem a cobertura vacinal e promovam práticas sexuais mais seguras são essenciais para mitigar o impacto destas infecções nesta população.
Favorable outcome of COVID-19 in a young woman with severe Crohn’s disease on regular use of adalimumab and prednisone: a case report
(Universidade de São Paulo (USP), 2020) Vechi, Hareton Teixeira; Maia, Lucas Rodrigues; Alves, Manoela do Monte; Rodrigues-Neto, João Firmino
COVID-19 is a viral disease caused by SARS-CoV-2 that compromises the host immune response in severe cases, promoting a hyperinflammation that results in acute lung injury and multiple organs failure. In this context, patients presenting with immune-related diseases, such as Crohn’s disease, affected by COVID-19, may have an uncertain prognosis. We report on a case of a young female patient with a severe Crohn’s disease that presented with COVID-19 pneumonia and a favorable outcome even maintaining the use of adalimumab, TNF - alpha inhibitor and prednisone. This case raises the hypothesis that aside from prednisone, TNF-α inhibitors such as adalimumab could be used to stop the progression to COVID-19 complications by blocking the TNF-alpha-driven inflammatory process that occurs in severe COVID-19
Invasive fungal infection by Cryptococcus neoformans var. grubii with bone marrow and meningeal involvement in a HIV infected patient: a case report
(BMC, 2019-03) Vechi, Hareton Teixeira; Theodoro, Raquel Cordeiro; Oliveira, Andrea Lima de; Gomes, Ronald Muryellison Oliveira da Silva; Soares, Rodolfo Daniel de Almeida; Freire, Munya Gandour; Bay, Mônica Baumgardt
Background: Cryptococcosis is a common opportunistic infection in patients infected by Human Immunodeficiency Virus (HIV) and is the second leading cause of mortality in Acquired Immunodeficiency Syndrome (AIDS) patients worldwide. The most frequent presentation of cryptococcal infection is subacute meningitis, especially in patients with a CD4+ T Lymphocytes count below 100 cells/μL. However, in severely immunosuppressed individuals Cryptococcus neoformans can infect virtually any human organ, including the bone marrow, which is a rare presentation of cryptococcosis. Case presentation: A 45-year-old HIV-infected male patient with a CD4+ T lymphocyte count of 26 cells/μL who presented to the emergency department with fever and pancytopenia. Throughout the diagnostic evaluation, the bone marrow aspirate culture yielded encapsulated yeasts in budding, identified as Cryptococcus sp. The bone marrow biopsy revealed a hypocellularity for age and absence of fibrosis. It was observed presence of loosely formed granuloma composed of multinucleated giant cells encompassing rounded yeast like organisms stained with mucicarmine, compatible with Cryptococcus sp. Then, the patient underwent a lumbar puncture to investigate meningitis, although he had no neurological symptoms and neurological examination was normal. The cerebrospinal fluid culture yielded Cryptococcus sp. The species and genotype identification step showed the infection was caused by Cryptococcus neoformans var. grubii (genotype VNI). The patient was initially treated with amphotericin B deoxycholate plus fluconazole for disseminated cryptococcosis, according to guideline recommendations. However, the patient developed acute kidney injury and the treatment was switched for fluconazole monotherapy. The symptoms disappeared completely with recovery of white blood cells and platelets counts. Cerebrospinal fluid cultures for fungi at one and two-weeks of treatment were negative. Conclusions: Bone marrow infection caused by Cryptococcus neoformans is a rare presentation of cryptococcosis. The cryptococcal infection should be included for differential diagnosis in HIV-infected patients with fever and cytopenias, especially when CD4+ T lymphocytes count is below 100 cells/μL.
Late acute pulmonary embolism after mild Coronavirus Disease 2019 (COVID-19): a case series
(Universidade de São Paulo, 2020-08) Vechi, Hareton Teixeira; Maia, Lucas Rodrigues; Alves, Manoella do Monte
In late 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged as the cause of a cluster of pneumonia cases in China, and the corresponding disease was designated as Coronavirus Disease 2019 (COVID-19), spreading quickly around the world resulting in a pandemic. COVID-19 is associated with a set of coagulation abnormalities that increase the risk of thromboembolic events, especially in patients with severe/critical disease. We describe a series of five cases of mild COVID-19, treated in an outpatient clinic, which, after an apparent clinical improvement, developed acute pulmonary embolism (APE) between the third and the fourth week after the onset of symptoms, when they are mostly related to acute illness disappearance. Thromboembolic events are also a potential complication of mild COVID-19 and can manifest later in the disease course. This finding raises discussion about the prevention of thromboembolic events in selected group of patients with mild COVID-19.
Mycobacterium marinum infection simulating chromomycosis: a case report
(Universidade de São Paulo (USP), 2020) Bezerra, Guilherme Holanda; Honório, Monica Larissa Padilha; Costa, Vivianne Lira da Camara; Vechi, Hareton Teixeira; Alves, Manoella do Monte; Britto, Maria Helena Marques Fonseca de; Rocha, Keyla Borges Ferreira; Carvalho, Luciana Distásio de
Skins infections caused by Mycobacterium marinum occur only rarely. We report one case of chronic and extensive M. marinum cutaneous infection simulating chromoblastomycosis and review the pertinent literature. A 52-year-old farmer reported a 32-year chronic skin problem on his right lower limb, resulting from contact with cacti. It consisted of skin lesion presenting with dyschromic atrophic center plate and verrucous borders with hematic crusts, extending from the knee anteriorly to the inferior third of the right leg. Mycobacterium marinum infection was detected by histopathological examination of a skin fragment, culture for mycobacteria and genetic mapping of the culture material. The patient was successfully treated with Ethambutol, Rifampicin and Trimethoprim-Sulfamethoxazole. The clinical and histopathological findings of M. marinum infection is nonspecific showing clinical polymorphism and bacilli are rarely evident on histopathological examination. Given these difficulties, it is essential to perform tissue culture in a suspicious case and it is important keep this infection in mind in patients with long-lasting indolent verrucous lesions and a history of exposure to sea water, freshwater, aquaria or fish

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Navegando por Autor "Vechi, Hareton Teixeira"