Once rare, septic shock (SS) due to disseminated fungal infections has been increasingly reported due to a growing number of immunocompromised patients, but remains rare in non-immune-compromised individuals. In paracoccidioidomycosis, it has been described in only three patients with the severe, acute form of the disease. We describe the development of a refractory, fatal septic shock due to a severe disseminated chronic form of paracoccidioidomycosis in an older woman without any other microbial insults. A striking event in the evolution of her case was the severe depletion of lymphocytes from the peripheral blood and lymphoid organs. Lymphocyte depletion due to apoptosis is described in the late phase of sepsis and can contribute both to immunosuppression and the progression of SS. The possible mechanisms involved in the induction of SS in the chronic form of paracoccidioidomycosis are discussed.

Objetivos: demonstrar a série histórica de internamentos por sepse no Brasil, quais as capitais e regiões mais acometidas, bem como, se essas internações tiveram crescimento, em que proporção ocorreram e qual a relação com o Índice de Desenvolvimento Humano (IDH). Métodos: Foi realizado um estudo epidemiológico de série temporal com dados dos internamentos por septicemia nas capitais brasileiras de 1999 a 2016, obtidos do Sistema de Informações Hospitalares do Ministério da Saúde (SIH) e IDH das mesmas no período. Foram calculados os indicadores de internamentos para a metade de cada triênio do período obtido. Modelos de regressão linear e de Poisson foram realizados para verificar a tendência temporal e coeficientes de correlação de Pearson ou Spearman para correlação com o IDH. Resultados: houve aumento significativo de internamentos em algumas capitais, tais como: Boa Vista, Maceió, Porto Velho e Rio de Janeiro, e decréscimo em Campo Grande e Goiânia. A maior média de internamentos ocorreu em Porto Velho com 26.443,7 e a menor média em Teresina 171,3. Os coeficientes de correlação entre o total de internamentos e o IDH de cada capital registraram correlação positiva e significativa para Belo Horizonte, Boa Vista, São Paulo e Vitória. Conclusão: os internamentos por sepse tiveram mais acréscimos que decréscimos e a correlação com o IDH mostrou que quanto maior o IDH, maior fica o índice de internamentos, sugerindo que com taxas maiores desse IDH, torna-se possível fornecer uma estrutura adequada e um melhor desempenho no reconhecimento e desfecho da sepse.

This study aimed to evaluate the impact of invasive devices as risk factors for the development of neonatal sepsis in Neonatal Intensive Care Units. Hospital-based retrospective cohort study performed in two Neonatal Intensive Care Units in Ponta Grossa, Paraná, Brazil. Documentary data were collected through consultation of electronic medical charts of all patients admitted to two hospitals and of the patients with diagnosis of sepsis in another hospital. Health conditions at admission and outcomes were evaluated. Frequencies of the reasons for admission and the outcomes were calculated. In the association analysis, exposure variables were calculated with odds ratio and confidence intervals (95%). The frequency of sepsis was 39%, and 45.7% of the cases were of early-onset sepsis and 54.3% of late-onset sepsis. The mortality rate associated with sepsis was 9.9%. The use of invasive devices was observed to increase by 6 times the risk of neonatal sepsis. Peripherally inserted central catheter and phlebotomy were the devices causing higher risk. The high incidence of late-onset sepsis, its association with the use of invasive devices and the higher mortality rate among newborns with sepsis suggest the presence of fragilities in neonatal care and the need to seek alternatives of neonatal approach to avoid new cases of neonatal sepsis and consequent death.