ObjectiveTo describe and analyze transmitted drug resistance (TDR) between 2014 and 2019 in newly infected patients with HIV-1 in Portugal and to characterize its transmission networks.MethodsClinical, socioepidemiological, and risk behavior data were collected from 820 newly diagnosed patients in Portugal between September 2014 and December 2019. The sequences obtained from drug resistance testing were used for subtyping, TDR determination, and transmission cluster (TC) analyses.ResultsIn Portugal, the overall prevalence of TDR between 2014 and 2019 was 11.0%. TDR presented a decreasing trend from 16.7% in 2014 to 9.2% in 2016 (pfor–trend = 0.114). Multivariate analysis indicated that TDR was significantly associated with transmission route (MSM presented a lower probability of presenting TDR when compared to heterosexual contact) and with subtype (subtype C presented significantly more TDR when compared to subtype B). TC analysis corroborated that the heterosexual risk group presented a higher proportion of TDR in TCs when compared to MSMs. Among subtype A1, TDR reached 16.6% in heterosexuals, followed by 14.2% in patients infected with subtype B and 9.4% in patients infected with subtype G.ConclusionOur molecular epidemiology approach indicates that the HIV-1 epidemic in Portugal is changing among risk group populations, with heterosexuals showing increasing levels of HIV-1 transmission and TDR. Prevention measures for this subpopulation should be reinforced.

A encefalopatia/encefalite ligeira com lesão reversível do corpo caloso é uma entidade clínico-radiológica benigna rara, caracterizada por sintomas neurológicos inespecíficos associados a achados imagiológicos, em ressonância magnética, e lesão do corpo caloso. De etiopatogénese desconhecida, têm sido sugeridos vários desencadeadores (infeções, alterações metabólicas, fármacos, entre outros). Apresenta-se o caso de um homem de 44 anos, previamente saudável,  admitido na urgência com quadro súbito de cefaleias, ataxia, mioclonias da face e disartria, em contexto de síndrome gripal. Após diagnóstico presuntivo de encefalite vírica iniciou aciclovir empiricamente, suspenso após ressonância magnética revelando lesões no corpo caloso. O doente evoluiu favoravelmente sem terapêutica dirigida, com resolução clínica em menos de uma semana e controlo imagiológico, aos dois meses, normal. Esta entidade, que exige diagnóstico diferencial entre condições benignas e outras, de pior prognóstico, é habitualmente diagnosticada por exclusão, não exige terapêutica dirigida e apresenta, quase universalmente, um desfecho favorável.

Pasteurella multocida is the most common cause of soft tissue infection in humans following bites caused by dogs and (particularly) cats. Transmission may also occur after scratches inflicted by these animals. The authors present the case of a 78-year-old immunocompromised male who presented to the emergency department with fever and inflammatory signs on his right hand following a cat scratch. He was started on empirical intravenous antibiotics which, after isolation of Pasteurella spp. on a swab sample, was subsequently directed. A total of 3 weeks of antibiotics were administered, the patient improved and was discharged. Ten days after he returned to the hospital with septic shock secondary to recurrence of the cellulitis, and Pasteurella multocida was identified on blood cultures. After availability of the antibiotic sensitivity test, 6 weeks of levofloxacin and penicillin were administered. The patient recovered, despite being immunocompromised and Pasteurella spp. bacteremia having a relevant mortality rate.

Helcococcus kunzii is a Gram-positive anaerobic facultative coccus that colonises the skin. Human infection is rare, with very few cases being described in the literature. The authors present the case of a 17-year-old man, with a history of cholesteatoma, diagnosed with mastoiditis complicated by intracranial empyema. After urgent surgical drainage, Gram staining revealed a Gram-negative bacillus and a Gram-positive coccus. The latter exhibited fastidious growth, presented as small grey colonies in blood agar, and was afterwards identified as H. kunzii. The patient was started on intravenous antibiotics, switched to oral route after 8 weeks and fully recovered. To the best of our knowledge, this is the third case of an intracranial infection in which H. kunzii is involved, two of them occurring in patients with cholesteatoma.