JOSE ERNESTO VIDAL BERMUDEZ
Projetos de Pesquisa
Unidades Organizacionais
P ICHC, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina - Líder
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- Reply to Banno et al and Padhi et al(2022) V, Adrian Hernandez; ROMAN, Yuani M.; BURELA, Paula A.; PASUPULETI, Vinay; PISCOYA, Alejandro; VIDAL, Jose E.
- Diagnostic and therapeutic approach to chronic meningitis in Brazil: a narrative review(2022) SILVA, Guilherme Diogo; GUEDES, Bruno Fukelmann; JUNQUEIRA, Iori Rodrigues; GOMES, Helio Rodrigues; VIDAL, Jose ErnestoBackground Chronic meningitis (CM) is characterized by neurological symptoms associated with the evidence of cerebrospinal fluid pleocytosis lasting > 4 weeks. Studies on the management of CM in Brazil are scarce.Objective To critically review the literature on CM and propose a rational approach in the Brazilian scenario.Methods Narrative literature review discussing the epidemiology, clinical evaluation, basic and advanced diagnostic testing, and empirical and targeted therapy for the most relevant causes of CM. The present review was contextualized with the local experience of the authors. In addition, we propose an algorithm for the management of CM in Brazil.Results In Brazil, tuberculosis and cryptococcosis are endemic and should always be considered in CM patients. In addition to these diseases, neurosyphilis and other endemic conditions should be included in the differential diagnosis, including neurocysticercosis, Baggio-Yoshinari syndrome, and endemic mycosis. After infectious etiologies, meningeal carcinomatosis and autoimmune diseases should be considered. Unbiased and targeted methods should be used based on availability and clinical and epidemiological data.Conclusion We propose a rational approach to CM in Brazil, considering the epidemiological scenario, systematizing the etiological investigation, and evaluating the timely use of empirical therapies.
- Early clinical and microbiological predictors of outcome in hospitalized patients with cryptococcal meningitis(2022) OLIVEIRA, Lidiane de; MELHEM, Marcia de Souza Carvalho; BUCCHERI, Renata; CHAGAS, Oscar Jose; VIDAL, Jose Ernesto; DIAZ-QUIJANO, Fredi AlexanderBackground Cryptococcal meningitis causes high mortality in immunocompromised and immunocompetent patients. The objective of this study was to identify early predictors of clinical outcome, available at the first days of hospitalization, in patients with cryptococcal meningitis in a tertiary center in Brazil. Methods Ninety-six cases of cryptococcal meningitis with clinical, epidemiological and laboratory data, and identification and antifungal susceptibility of the strains were analyzed. Quantitative CSF yeast counts were performed by direct microscopic exam with a Fuchs-Rosenthal cell counting chamber using an institutional protocol. Univariable and multiple analyses using logistic regression were performed to identify predictors, available at the beginning of hospitalization, of in-hospital mortality. Moreover, we performed a secondary analysis for a composite outcome defined by hospital mortality and intensive care unit transfer. Results The species and the antifungal susceptibility were not associated with the outcomes evaluated. The variables significantly associated with the mortality were age (OR = 1.08, 95% CI 1.02-1.15), the cerebrospinal fluid (CSF) yeasts count (OR = 1.65, 95% CI 1.20-2.27), systemic arterial hypertension (OR = 22.63, 95% CI 1.64-312.91) and neurological impairment identified by computed tomography (OR = 41.73, 95% CI 3.10-561.65). At the secondary analysis, CSF yeast count was also associated with the composite outcome, in addition to the culture of Cryptococcus spp. from bloodstream and cerebral toxoplasmosis. The associations were consistent with survival models evaluated. Conclusions Age and CSF yeast count were independently associated with in-hospital mortality of patients with cryptococcal meningitis but Cryptococcus species identification and antifungal susceptibility were not associated with the outcomes. Quantitative CSF yeast counts used in this study can be evaluated and implemented in other low and middle-income settings.
- Chronic disseminated cryptococcosis without meningeal involvement in a severely immunosuppressed HIV-infected patient successfully treated with fluconazole(2022) YONEKURA, Tatiane da Silveira; MACEDO, Soraya Devi; MOYA, Fernanda Gonsalves; VIDAL, Jose ErnestoA 43-year-old female with advanced HIV infection presented with two chronic skin lesions. Cutaneous crypto-coccosis was confirmed and pulmonary cryptococcosis was suspected. The patient was neurologically asymp-tomatic and the cerebrospinal fluid cryptococcal antigen lateral flow assay was negative. She received oral fluconazole and had resolution of the skin lesions and significant improvement of the lung lesions. We report a person with AIDS with chronic disseminated cryptococcosis without meningeal involvement successfully treated with oral fluconazole.
- Clinical outcomes of HIV-syphilis coinfection among patients with no neurological symptoms: a retrospective cohort study(2022) HENRIQUES, Barbara L.; CORTEZ, Andre L.; NUNES, Nathalia N.; VIDAL, Jose E.; I, Vivian Avelino-SilvaObjective Our objective was to describe and compare the occurrence of neurological outcomes and neurosyphilis in people living with HIV with incident syphilis and no neurological symptoms who underwent early screening for asymptomatic neurosyphilis (ANS) or regular clinical management without a lumbar puncture. Methods This was a retrospective cohort study in a single referral centre of Sao Paulo, Brazil. Patients with incident syphilis diagnosed between January 2000 and August 2016 and meeting the adapted criteria for ANS investigation suggested by Marra et al. (CD4(+) T-cell counts <= 350 cells/mm(3) and/or venereal disease research laboratory test results >= 1:16) were identified. Those with no neurological symptoms and immediately referred for lumbar puncture were categorized as group 1, and those not referred for cerebrospinal fluid collection were categorized as group 2. We compared the occurrence of neurological symptoms and neurosyphilis diagnoses between the groups using incidence rates and Kaplan-Meier curves. Results We included 425 participants with a median follow-up of 6 years. The incidence rate of neurological symptoms was 36.5/1000 person-years in group 1 and 40.6/1000 person-years in group 2 (incidence rate ratio [IRR] 0.90; 95% confidence interval [CI] 0.57-1.39; p = 0.62). The incidence rate of neurosyphilis was 15.0 cases/1000 person-years in group 1 and 6.7 cases/1000 person-years in group 2 (IRR 2.26; 95% CI 0.93-5.68; p = 0.05). Conclusions We found no statistically significant differences between groups in the incidence rates of neurological symptoms and neurosyphilis. Our findings support the current guidelines, which suggest a less invasive approach regarding ANS investigation among people living with HIV with incident syphilis.
- Ivermectin for the Treatment of Coronavirus Disease 2019: A Systematic Review and Meta-analysis of Randomized Controlled Trials(2022) ROMAN, Yuani M.; BURELA, Paula Alejandra; PASUPULETI, Vinay; PISCOYA, Alejandro; VIDAL, Jose E.; V, Adrian HernandezOur systematic review of randomized controlled trials showed that ivermectin (vs control) did not reduce all-cause mortality, hospital stays, or viral clearance in patients with mostly mild coronavirus disease 2019 (COVID-19). Ivermectin is not a viable treatment option for COVID-19. Background We systematically assessed benefits and harms of the use of ivermectin (IVM) in patients with coronavirus disease 2019 (COVID-19). Methods Published and preprint randomized controlled trials (RCTs) assessing the effects of IVM on adult patients with COVID-19 were searched until 22 March 2021 in 5 engines. Primary outcomes were all-cause mortality rate, length of hospital stay (LOS), and adverse events (AEs). Secondary outcomes included viral clearance and severe AEs (SAEs). The risk of bias (RoB) was evaluated using the Cochrane Risk of Bias 2.0 tool. Inverse variance random effect meta-analyses were performed, with quality of evidence (QoE) evaluated using GRADE methods. Results Ten RCTs (n = 1173) were included. The controls were the standard of care in 5 RCTs and placebo in 5. COVID-19 disease severity was mild in 8 RCTs, moderate in 1, and mild and moderate in 1. IVM did not reduce all-cause mortality rates compared with controls (relative risk [RR], 0.37 [95% confidence interval, .12-1.13]; very low QoE) or LOS compared with controls (mean difference, 0.72 days [95% confidence interval, -.86 to 2.29 days]; very low QoE). AEs, SAEs, and viral clearance were similar between IVM and control groups (low QoE for all outcomes). Subgroups by severity of COVID-19 or RoB were mostly consistent with main analyses; all-cause mortality rates in 3 RCTs at high RoB were reduced with IVM. Conclusions Compared with the standard of care or placebo, IVM did not reduce all-cause mortality, LOS, or viral clearance in RCTs in patients with mostly mild COVID-19. IVM did not have an effect on AEs or SAEs and is not a viable option to treat patients with COVID-19.
- Guillain-Barre syndrome spectrum as manifestation of HIV-related immune reconstitution inflammatory syndrome: case report and literature review(2022) VIDAL, Jose E.; GUEDES, Bruno F.; GOMES, Helio R.; MENDONCA, Rodrigo HolandaA 34-year-old man presented with a history of 21-days of gait unsteadiness and diplopia. Ten days before presentation, he developed limb weakness and in the last three days reduced consciousness. HIV infection was diagnosed three months ago (CD4+ = 160 cells/ mm(3); viral load HIV-1 = 144.000 copies/mL), and antiretroviral therapy was initiated. Impaired consciousness, ophthalmoplegia, limb weakness, ataxia, areflexia, and Babinsky's sign were noted. At that moment, CD4+ count was 372 cells/mm 3 and viral load HIV-1 <50 copies/mL. The clinical, laboratory and neurophysiological findings suggest overlapping Guillain-Barre syndrome (GBS) and Bickerstaff brainstem encephalitis as manifestation of HIV-related immune reconstitution inflammatory syndrome (IRIS). Here, we review and discuss 7 cases (including the present report) of GBS spectrum as manifestation of HIV-related IRIS. (C) 2022 Sociedade Brasileira de Infectologia.
- Case Report: Calcified Cerebral Toxoplasmosis Associated with Perilesional Edema in People Living with HIV/AIDS: Case Series of a Presentation Mimicking Neurocysticercosis(2022) VIDAL, Jose E.; RIVERO, Rene L. M.; SANTOS, Sigrid de Sousa dos; GUEDES, Bruno F.; GOMES, Helio R.; OLIVEIRA, Augusto C. Penalva de; GARCIA, Hector H.Perilesional edema, associated or not with neurological manifestations, is a well-characterized finding in cases of calcified neurocysticercosis. There are no previous reports of HIV-related calcified toxoplasmosis that mimics this presentation of neurocysticercosis. We report on five patients, four of them with new-onset neurological manifestations, who showed brain calcifications associated with perilesional edema. All cases had a history of HIV-related toxoplasmosis and current virological and immunological control of HIV infection. Similar to neurocysticercosis, brain calcified toxoplasmosis may cause perilesional edema and symptoms in people living with HIV/AIDS.
- Orbital Plasmacytoma in a Young Patient With HIV Presenting as Multiple Cranial Nerve Palsy(2022) FERNANDEZ, Paulo Eduardo Lahoz; KNAK, Caroline; FREIRE, Marcela Vieira; PEREIRA, Luisa de Oliveira; VIDAL, Jose Ernesto; OLIVEIRA, Augusto Cesar Penalva de