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Papers by Juliana Gerhardt

Research paper thumbnail of Role of quantitative CSF microscopy to predict culture status and outcome in HIV-associated cryptococcal meningitis in a Brazilian cohort

Objectives-To evaluate clinical, laboratory, and quantitative cerebrospinal fluid (CSF) cryptococ... more Objectives-To evaluate clinical, laboratory, and quantitative cerebrospinal fluid (CSF) cryptococcal cell counts for associations with in-hospital outcomes of HIV-infected patients with cryptococcal meningitis.

Research paper thumbnail of Ring enhancing intracranial lesion responding to antituberculous treatment in an HIV-infected patient

Ring enhancing intracranial lesion responding to antituberculous treatment in an HIV-infected patient

Revista do Departamento de Psicologia. UFF, 2010

Cerebral tuberculomas constitute a major differential diagnosis of cerebral toxoplasmosis in huma... more Cerebral tuberculomas constitute a major differential diagnosis of cerebral toxoplasmosis in human immunodeficiency virus (HIV)-infected patients in developing countries. We report the case of a 34-year old woman co-infected with HIV and possible disseminated tuberculosis (hepatitis, lymphadenopathy, and pleural effusion) who presented a large and solitary intracranial mass lesion. Despite extensive diagnostic efforts, including brain, ganglionar, and liver biopsies, no definitive diagnosis was reached. However, a trial with first-line antituberculous drugs led to a significant clinical and radiological improvement. Atypical presentations of cerebral tuberculomas should always be considered in the differential diagnosis of intracranial mass lesions in HIV-infected patients and a trial with antituberculous drugs is a valuable strategy to infer the diagnosis in a subset of patients.

Research paper thumbnail of Role of quantitative CSF microscopy to predict culture status and outcome in HIV-associated cryptococcal meningitis in a Brazilian cohort

Diagnostic Microbiology and Infectious Disease, 2012

Objectives-To evaluate clinical, laboratory, and quantitative cerebrospinal fluid (CSF) cryptococ... more Objectives-To evaluate clinical, laboratory, and quantitative cerebrospinal fluid (CSF) cryptococcal cell counts for associations with in-hospital outcomes of HIV-infected patients with cryptococcal meningitis. Methods-98 HIV-infected adult patients with CSF culture-proven cryptococcal meningitis admitted between January 2006 and June 2008 at a referral center in Sao Paulo, Brazil. Results-Cryptococcal meningitis was the first AIDS-defining illness in 69% of whom 97% (95/98) had known prior HIV-infection. The median CD4+ T cell count was 39 cells/mcL (IQR: 17-87 cells/mcL). Prior antiretroviral therapy (ART) was reported in 50%. Failure to sterilize the CSF by 7-14 days was associated with baseline fungal burden of ≥10 yeasts/mcL by quantitative CSF microscopy (OR=15.3, 95% CI: 4.1-56.7;P<.001) and positive blood cultures (OR=11.5, 95% CI:1.2-109;P=.034). At 7-14 days, ≥10 yeasts/mcL CSF was associated with positive CSF cultures in 98% vs. 36% when <10 yeasts/mcL CSF (P<.001). In-hospital mortality was 30% and associated with symptoms duration for >14 days, altered mental status (P<.001), CSF WBC counts <5 cells/mcL (P=.027), intracranial hypertension (P=.011), viral loads >50,000 copies/mL (P=. 036), ≥10 yeasts/mcL CSF at 7-14 days (P=.038), and intracranial pressure >50 cmH 2 0 at 7-14 days (P=.007).

Research paper thumbnail of CASE REPORT: PARACOCCIDIOIDOMYCOSIS AS A CAUSE OF RESPIRATORY FAILURE IN AN AIDS PATIENT

CASE REPORT: PARACOCCIDIOIDOMYCOSIS AS A CAUSE OF RESPIRATORY FAILURE IN AN AIDS PATIENT

Critical Care Medicine, 2006

A 40 years old heterosexual male, born in rural area from Paraná State (endemic area for paracocc... more A 40 years old heterosexual male, born in rural area from Paraná State (endemic area for paracoccidioidomycosis) sought medical care in University Hospital, due cough with abundant sputum and weight loss (6kg) in the last 4 months. He had a previous diagnosis ...

Research paper thumbnail of Incidence of diarrhea by Clostridium difficile in hematologic patients and hematopoietic stem cell transplantation patients: risk factors for severe forms and death

Revista do Instituto de Medicina Tropical de São Paulo

We describe the rate of incidence of Clostridium difficile-associated diarrhea (CDAD) in hematolo... more We describe the rate of incidence of Clostridium difficile-associated diarrhea (CDAD) in hematologic and patients undergone stem cell transplant (HSCT) at HC-FMUSP, from January 2007 to June 2011, using two denominators 1,000 patient and 1,000 days of neutropenia and the risk factors associated with the severe form of the disease and death. The ELISA method (Ridascreen-Biopharm, Germany) for the detections of toxins A/B was used to identify C. difficile. A multivariate analysis was performed to evaluate potential factors associated with severe CDAD and death within 14 days after the diagnosis of CDAD, using multiple logistic regression. Sixty-six episodes were identified in 64 patients among 439 patients with diarrhea during the study period. CDA rate of incidence varied from 0.78 to 5.45 per 1,000 days of neutropenia and from 0.65 to 5.45 per 1,000 patient-days. The most common underlying disease was acute myeloid leukemia 30/64 (44%), 32/64 (46%) patients were neutropenic, 31/64 (...

Research paper thumbnail of Role of quantitative CSF microscopy to predict culture status and outcome in HIV-associated cryptococcal meningitis in a Brazilian cohort

Objectives-To evaluate clinical, laboratory, and quantitative cerebrospinal fluid (CSF) cryptococ... more Objectives-To evaluate clinical, laboratory, and quantitative cerebrospinal fluid (CSF) cryptococcal cell counts for associations with in-hospital outcomes of HIV-infected patients with cryptococcal meningitis.

Research paper thumbnail of Ring enhancing intracranial lesion responding to antituberculous treatment in an HIV-infected patient

Ring enhancing intracranial lesion responding to antituberculous treatment in an HIV-infected patient

Revista do Departamento de Psicologia. UFF, 2010

Cerebral tuberculomas constitute a major differential diagnosis of cerebral toxoplasmosis in huma... more Cerebral tuberculomas constitute a major differential diagnosis of cerebral toxoplasmosis in human immunodeficiency virus (HIV)-infected patients in developing countries. We report the case of a 34-year old woman co-infected with HIV and possible disseminated tuberculosis (hepatitis, lymphadenopathy, and pleural effusion) who presented a large and solitary intracranial mass lesion. Despite extensive diagnostic efforts, including brain, ganglionar, and liver biopsies, no definitive diagnosis was reached. However, a trial with first-line antituberculous drugs led to a significant clinical and radiological improvement. Atypical presentations of cerebral tuberculomas should always be considered in the differential diagnosis of intracranial mass lesions in HIV-infected patients and a trial with antituberculous drugs is a valuable strategy to infer the diagnosis in a subset of patients.

Research paper thumbnail of Role of quantitative CSF microscopy to predict culture status and outcome in HIV-associated cryptococcal meningitis in a Brazilian cohort

Diagnostic Microbiology and Infectious Disease, 2012

Objectives-To evaluate clinical, laboratory, and quantitative cerebrospinal fluid (CSF) cryptococ... more Objectives-To evaluate clinical, laboratory, and quantitative cerebrospinal fluid (CSF) cryptococcal cell counts for associations with in-hospital outcomes of HIV-infected patients with cryptococcal meningitis. Methods-98 HIV-infected adult patients with CSF culture-proven cryptococcal meningitis admitted between January 2006 and June 2008 at a referral center in Sao Paulo, Brazil. Results-Cryptococcal meningitis was the first AIDS-defining illness in 69% of whom 97% (95/98) had known prior HIV-infection. The median CD4+ T cell count was 39 cells/mcL (IQR: 17-87 cells/mcL). Prior antiretroviral therapy (ART) was reported in 50%. Failure to sterilize the CSF by 7-14 days was associated with baseline fungal burden of ≥10 yeasts/mcL by quantitative CSF microscopy (OR=15.3, 95% CI: 4.1-56.7;P<.001) and positive blood cultures (OR=11.5, 95% CI:1.2-109;P=.034). At 7-14 days, ≥10 yeasts/mcL CSF was associated with positive CSF cultures in 98% vs. 36% when <10 yeasts/mcL CSF (P<.001). In-hospital mortality was 30% and associated with symptoms duration for >14 days, altered mental status (P<.001), CSF WBC counts <5 cells/mcL (P=.027), intracranial hypertension (P=.011), viral loads >50,000 copies/mL (P=. 036), ≥10 yeasts/mcL CSF at 7-14 days (P=.038), and intracranial pressure >50 cmH 2 0 at 7-14 days (P=.007).

Research paper thumbnail of CASE REPORT: PARACOCCIDIOIDOMYCOSIS AS A CAUSE OF RESPIRATORY FAILURE IN AN AIDS PATIENT

CASE REPORT: PARACOCCIDIOIDOMYCOSIS AS A CAUSE OF RESPIRATORY FAILURE IN AN AIDS PATIENT

Critical Care Medicine, 2006

A 40 years old heterosexual male, born in rural area from Paraná State (endemic area for paracocc... more A 40 years old heterosexual male, born in rural area from Paraná State (endemic area for paracoccidioidomycosis) sought medical care in University Hospital, due cough with abundant sputum and weight loss (6kg) in the last 4 months. He had a previous diagnosis ...

Research paper thumbnail of Incidence of diarrhea by Clostridium difficile in hematologic patients and hematopoietic stem cell transplantation patients: risk factors for severe forms and death

Revista do Instituto de Medicina Tropical de São Paulo

We describe the rate of incidence of Clostridium difficile-associated diarrhea (CDAD) in hematolo... more We describe the rate of incidence of Clostridium difficile-associated diarrhea (CDAD) in hematologic and patients undergone stem cell transplant (HSCT) at HC-FMUSP, from January 2007 to June 2011, using two denominators 1,000 patient and 1,000 days of neutropenia and the risk factors associated with the severe form of the disease and death. The ELISA method (Ridascreen-Biopharm, Germany) for the detections of toxins A/B was used to identify C. difficile. A multivariate analysis was performed to evaluate potential factors associated with severe CDAD and death within 14 days after the diagnosis of CDAD, using multiple logistic regression. Sixty-six episodes were identified in 64 patients among 439 patients with diarrhea during the study period. CDA rate of incidence varied from 0.78 to 5.45 per 1,000 days of neutropenia and from 0.65 to 5.45 per 1,000 patient-days. The most common underlying disease was acute myeloid leukemia 30/64 (44%), 32/64 (46%) patients were neutropenic, 31/64 (...