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
8 resultados
Resultados de Busca
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- AIDS-related cytomegalovirus encephalitis in the late ART era: A retrospective cohort study at a referral center in Brazil(2023) LUCAS JUNIOR, Rodovaldo M.; BOGONI, Giuliane; SCHNEIDER, Gustavo A. Reis; SOUZA, Nidyanara F. Castanheira de; CARVALHO, Maria Kassab; VIDAL, Jose ErnestoBackground AIDS-related cytomegalovirus (CMV) encephalitis has declined in the combined antiretroviral therapy (ART) era in high-income countries. However, there is scarce information on CMV encephalitis in low- and middle-income countries. The objectives of this study were to identify the prevalence of AIDS-related CMV encephalitis and describe its main features. Methods This was a retrospective cohort study carried out at a referral center in Sao Paulo, Brazil. We included adult people living with HIV/AIDS (PLWHA), hospitalized in 2019, with a CD4 cell count <= 100/mm(3) and quantitation CMV DNA results in plasma. Cases with compatible neurological manifestations and detection of CMV DNA by polymerase chain reaction (PCR) in cerebrospinal fluid samples were defined as CMV encephalitis. Results Among 761 PLWHA hospitalized, 248 (32.5%) cases were included in this study. Prevalence of CMV encephalitis was 2.4% (6/248) among all included cases and 7.7% (6/78) among individuals with neurological opportunistic diseases. The six patients with CMV encephalitis were males and had CD4 cell count <50/mm(3). Five (83%) cases had CMV encephalitis as AIDS-defining disease and showed CMV DNA detection by PCR >500,000 UI/mL plasma. All six cases received anti-CMV therapy (ganciclovir, n = 4; ganciclovir plus foscarnet, n = 2) and five were discharged to home. CMV encephalitis was not uncommon among hospitalized PLWHA with neurological opportunistic diseases. Conclusions The epidemiological and immunological profile of individuals with CMV encephalitis was similar to that described in the pre-ART era, but in contrast, most cases were treated and discharged from the hospital.
- Hemorrhagic brain lesions in a newly diagnosed HIV-1 infected patient(2019) PELLEGRINO, D.; LIMA, Patricia Picciarelli de; OLIVEIRA, Augusto Cesar Penalva de; VIDAL, Jose E.We report the case of a previously healthy 29-year-old man who has sex with men who was admitted with sub-acute onset of headache, seizures and altered mental status. Physical examination revealed oral thrush, mental confusion and right hemiparesis. An unenhanced computed tomography of the brain revealed multiple rounded hemorrhages associated with perilesional edema and no enhancement was seen after contrast infusion. A rapid test for HIV-1 was positive and the CD4 T-lymphocyte count was 120 cells/mm(3). Pyrimethamine, sulfadiazine plus folinic acid and dexamethasome were started. After two weeks of treatment, the clinical condition and neuroimaging of the patient remained unaltered. A stereotactic brain biopsy was performed and the histopathologic examination confirmed the diagnosis of hemorrhagic toxoplasmosis. After a longer course of anti-Toxoplasma treatment due to an incomplete clinical and radiological response, the patient was discharged home. Hemorrhagic toxoplasmosis is a rare presentation of cerebral toxoplasmosis and should be considered in the differential diagnosis of hemorrhagic cerebral lesions in HIV-infected patients in order to initiate specific treatment promptly.
- First case report of eosinophilic meningitis associated with cerebral toxoplasmosis in an HIV-positive patient(2020) VIDAL, Jose E.; CUNHA, Mirella Alves; KASSAB, Maria J.; DAUAR, Rafi F.; VASCONCELOS, Dewton de MoraesCerebral toxoplasmosis is the most common cause of focal brain lesion in people living with HIV (PLWH) and usually causes multifocal encephalitis with little or no meningeal involvement. Classically, only subtle cerebrospinal fluid (CSF) abnormalities are described. There are no prior case reports in the literature on eosinophilic meningitis associated with cerebral toxoplasmosis in PLWH. We report on an HIV-positive man from Brazil who presented to the emergency department with headache, nausea, vomiting, and hemiparesis. He had a T-CD4+ lymphocyte count of 145 cells/mm(3), and antiretroviral failure was identified. Brain computed tomography showed a contrast-enhancing lesion with mild mass effect and trimethoprim-sulfamethoxazole and dexamethasone were started. Examination of CSF showed 194 cells/mm(3) (74% eosinophils, 18% lymphocytes, 4% monocytes, and 2% neutrophils), protein = 83 mg/dL, and glucose = 49 mg/dL. Detection of Toxoplasma gondii on CSF by polymerase chain reaction confirmed the diagnosis of cerebral toxoplasmosis. An exhaustive laboratorial investigation excluded other possible etiologies. After 14 days, the patient showed complete resolution of neurological and CSF alterations and substantial improvement in the brain lesion and was discharged home. We suggest that eosinophilic meningitis should be included in the spectrum of manifestations of HIV-related cerebral toxoplasmosis, especially in countries with high prevalence of toxoplasmosis in the general population.
- Should we perform the serum cryptococcal antigen test in people living with HIV hospitalized due to a community-acquired pneumonia episode?(2020) SILVA, Adriana Paulino; ZENATTI, Carolina Toniolo; FIGUEIREDO-MELLO, Claudia; NEGRA, Marinella Della; LEVIN, Anna S.; BOULWARE, David R.; VIDAL, Jose ErnestoCommunity-acquired pneumonia (CAP) is a common cause of hospitalization among people living with human immunodeficiency virus (PLWH), particularly those with severe immunosuppression. Pulmonary disease due to cryptococcosis is uncommonly reported and likely under-diagnosed. There is scarce information about cryptococcal antigen (CrAg) prevalence in PLWH with CAP. The objectives of this study were to identify among PLWH who were hospitalized with CAP: (i) the prevalence of serum CrAg positivity, (ii) the proportion with asymptomatic vs. symptomatic cryptococcosis; and (iii) the prevalence of serum CrAg positivity in CD4+ T-cell count <100 cells/mm(3). We performed a sub-analysis of a prospective cohort of hospitalized adults enrolled into a randomized clinical trial testing therapy for CAP. We included 202 participants who had serum CrAg testing performed. We found a 3.5% prevalence of serum CrAg-positivity overall, being higher (5.7%) in CD4+ T-cell count <100 cells/mm(3). Overall, asymptomatic and symptomatic cryptococcosis were present in 2.0% and 1.5%, respectively. This study identifies a target population for CrAg testing: PLWH hospitalized with diagnosis of CAP, particularly those with CD4+ T-cell count <100 cells/mm(3) where the number needed to test was 18 to detect 1 CrAg-positive person. This approach may facilitate the detection of asymptomatic cryptococcal infection and allow a timely diagnosis of symptomatic cryptococcal disease.
- Cytomegalovirus retinitis in hospitalized people living with HIV in the late antiretroviral therapy era in Sao Paulo, Brazil(2023) BOGONI, Giuliane; LUCAS JUNIOR, Rodovaldo M.; SCHNEIDER, Gustavo Arthur Reis; SOUZA, Nidyanara F. Castanheira de; CARVALHO, Maria Kassab; MARCUSSO, Rosa Maria; VIDAL, Jose ErnestoBackground There is scarce information on AIDS-related cytomegalovirus (CMV) retinitis in middle-income countries. The objectives of this study were to identify the prevalence of active CMV retinitis in severely immunosuppressed people living with HIV (PLWHIV) and to describe its main features. Methods This retrospective cohort study was carried out at a tertiary center in Sao Paulo, Brazil. We included hospitalized adults PLWHIV with CD4 count <= 100 cells/mu L, >= one quantitation of CMV DNA in plasma, and indirect ophthalmoscopy evaluation. Results Thirty-eight (21.6%) of 176 participants had at least an ophthalmoscopy diagnosis and only 3 (1.7%) individuals presented active CMV retinitis. All these participants were male, and retinitis was asymptomatic in 2 cases. Two participants had extraocular end-organ CMV disease and detectable CMV DNA in plasma. Conclusions These results show a low prevalence of active CMV retinitis in the evaluated population. However, 2 of 3 participants had asymptomatic active CMV retinitis and a fifth of participants had at least one ophthalmoscopy diagnosis, suggesting the need for routine ophthalmologic evaluation in hospitalized severely immunosuppressed PLWHIV. The profile of participants with active CMV retinitis was similar to that described in the pre-ART era and quantitation of CMV DNA in plasma was variable.
- Long-term virological effectiveness with darunavir/ritonavir-based salvage therapy in people living with HIV/AIDS from Sao Paulo, Brazil(2020) SANTOS, Ariane Melare Ramos dos; MARTINS, Amaury Pachione; JULIATO, Denise; MIRANDA, Erique Jose Farias Peixoto de; LOPES, Giselle Ibette Silva Lopez; BRIGIDO, Luis Fernando de Macedo; VIDAL, Jose ErnestoEven though darunavir/ritonavir (DRV/r) has high potency and a greater genetic barrier, there are few studies on the long-term effectiveness of DRV/r-based salvage therapy in people living with HIV (PLWH) in low and middle-income countries. This retrospective cohort study, from Sao Paulo, Brazil, included ART-experienced PLWH aged >= 18 years with virological failure (VF) who had started DRV/r plus an optimized background regimen (OBR) between 2008 and 2012. The proportion of patients with viral load (VL) <50 copies/mL, the improved mean CD4+ T cell count and the factors associated with VF during the 144-week follow-up were assessed. The study included 173 patients with the following characteristics [median (interquartile range)]: age 48 (42 -53) years; CD4+ T cell count, 229 (89 -376) cells/mm3; VL, 4.26 (3.70 -4.74) log10; 6 (4 -7) previous regimens; and 100 (38 -156) months of VF. After 144 weeks, 129 (75%) patients had VL< 50 copies/mL and a mean increase in the CD4+ T cell count of 190 cells/mm3. VL>100,000 copies/mL and poor adherence were associated with VF. DRV/r plus an OBR showed high long-term virological suppression and immunological recovery. VL>100,000 copies/mL and poor adherence were associated with VF at 144 weeks.
- Efficacy and safety of trimethoprim-sulfamethoxazole in HIV-infected patients with cerebral toxoplasmosis in Brazil: a single-arm open-label clinical trial(2019) PELLEGRINO, Daniela; GRYSCHEK, Ronaldo; OLIVEIRA, Augusto Cesar Penalva de; MARCUSSO, Rosa; CORREIA, Ademir; VIDAL, Jose E.Cerebral toxoplasmosis continues to cause high morbidity and mortality in developing countries. The association of sulfadiazine and pyrimethamine is considered the standard therapy; however, it has potential disadvantages. This single-arm open-label clinical trial was carried out in a tertiary hospital in Sao Paulo, Brazil. We included patients of at least 18 years of age, whose HIV infection was confirmed, and clinical and brain computed tomography (CT) findings were compatible with cerebral toxoplasmosis upon admission. Patients received trimethoprim (TMP) 10 mg/kg/day sulfamethoxazole (SMX) 50 mg/kg/day, in two divided doses. Brain CT was performed at study entry and after two weeks. The endpoints of the study were: (i) the proportion of patients with clinical and radiological response after two weeks of TMP-SMX and (ii) the proportion of patients who discontinued TMP-SMX due to adverse events. Forty-six patients were included (23 males, median age 35 years). The main clinical manifestations were headache, hemiparesis and altered mental status. The proportion of patients who obtained clinical and radiological response after two weeks of anti-toxoplasma treatment was 85% (n = 39). Overall, TMP-SMX was safe, with only 2 (4%) discontinuations due to adverse events. In this study, TMP-SMX was effective and safe in the treatment of HIV-related cerebral toxoplasmosis.
- AIDS-related gastrointestinal cytomegalovirus end-organ disease: A retrospective cohort study at a tertiary center in Sao Paulo, Brazil(2024) SCHNEIDER, Gustavo Arthur Reis; BOGONI, Giuliane; CASTANHEIRA, Nidyanara Francine; LUCAS JUNIOR, Rodovaldo Moraes; VIDAL, Jose ErnestoBackground: Current information about AIDS-related gastrointestinal cytomegalovirus end-organ disease (CMV-EOD) is scarce. The objectives of this study were to identify the prevalence and main features of gastrointestinal CMV-EOD in patients with advanced HIV disease. Methods: Retrospective cohort study carried-out at a tertiary-care center in Sao Paulo, Brazil, from January to December 2019. We included hospitalized people living with HIV with gastrointestinal CMV-EOD, CD4 + count =100 cells/mu L, and = one quantitative detection of CMV DNA in plasma. Results: Ten (3.8%) of 261 cases had gastrointestinal CMV-EOD. Nine (90%) cases were men, age median (IQR) was 44 (38-54) years, and CD4 + cell count median (IQR) was 6 (7-39) cells/mu L. The 10 cases had positive quantitative detection of CMV DNA in plasma with median (IQR) of 572 (103-2 981) IU/mL. The main presenting condition was esophagitis (n = 7, 2.7% cases). Eight (80%) cases received anti-CMV treatment, and one case died due to nosocomial pneumonia. Conclusions: The prevalence of gastrointestinal CMV-EOD was 3.8%, similar to described in pre-combined antiretroviral therapy studies. Among cases with gastrointestinal CMV-EOD, all had positive quantitative detection of CMV-DNA in plasma but the values varied; esophagitis was the most common presentation, and all but one were discharged from the hospital.