To avoid the occurrence of tuberculosis reactivation in people living with HIV (PLHIV) who have latent tuberculosis infection (LTBI), the therapeutical indications to this population were expanded in Brazil in 2018, with the recommendation of treatment for those with CD4 T lymphocyte count less than or equal to 350 cells/mm3, regardless of the result of the tuberculin test (TT). To evaluate the practical application of this recommendation, we decided to determine the prevalence of LTBI in PLHIV followed in our outpatient clinic. Ninety-nine adolescents and young adults living with HIV accompanied in a Reference Service were evaluated for the occurrence of LTBI with TT and TCD4 cell count application. The prevalence of LTBI was estimated at 7.1% considering the result of TT, and 18% when considering patients with CD4 lymphocyte count less than or equal to 350 cells/mm3. This difference reinforces the idea that the detection of patients with TCD4 lymphocytes less than or equal to 350 cells/mm3 effectively expands the indication for treatment of LTBI. However, only 4 (22.2%) of 18 patients with TCD4 less than or equal to 350 cells/mm3 adhered to the therapeutic proposal. The rebellious aspect inherent to this population, the failure to attend consultations and the refusal to use another drug were some of the reasons for the low adherence to treatment.

Malaria is a tropical parasitic disease that triggers severe social and economic problems worldwide and causes thousands of deaths each year. Early diagnosis enables proper treatment. People from non-endemic areas who travel to areas of transmission are often exposed to late or incorrect diagnosis because healthcare professionals have great difficulty in conceiving malaria as a diagnostic hypothesis. In addition, technicians skilled in recognizing malaria etiologic agent are not abundant. This paper addresses the case of a child from a non-endemic malaria region in Brazil, with a prior hypothetic diagnosis of visceral leishmaniasis, however bone marrow aspirate revealed Plasmodium instead of Leishmania. A retrospective epidemiological investigation showed a history of a recent trip to a malaria area and the review of blood smears obtained on admission disclosed a large number of trophozoites and gametocytes of Plasmodium falciparum that had been unnoticed, suggesting that diagnosis could have been possible earlier. Malaria clinical picture is easily mistaken for other febrile infectious diseases, thus the possibility of its occurrence cannot be ruled out. There is a need to increasingly train the microscopy technicians, both in endemic and non-endemic areas, so as to minimize the false diagnoses and decrease morbidity and mortality of the disease.