Background Visceral leishmaniasis (VL) in HIV-positive individuals is a global health problem. HIV-Leishmania coinfection worsens prognosis and mortality risk, and HIV-Leishmania coinfected individuals are more susceptible to VL relapses. Early initiation of antiretroviral therapy can protect against Leishmania infection in individuals living in VL-endemic areas, and regular use of antiretrovirals might prevent VL relapses in these individuals. We conducted a cross-sectional study in Petrolina, Brazil, an VL-endemic area, to estimate the prevalence of asymptomatic Leishmania cases among HIV-positive outpatients. Methods We invited any HIV-positive patients, aged ≥ 18-years-old, under antiretroviral therapy, and who were asymptomatic for VL. Patients were tested for Leishmania with enzyme-linked immunosorbent assays (ELISA)-rK39, immunochromatographic test (ICT)-rK39, direct agglutination test (DAT), latex agglutination test (KAtex), and conventional polymerase chain reaction (PCR). HIV-Leishmania coinfection was diagnosed when at least one VL test was positive. Results A total of 483 patients were included. The sample was predominantly composed of single, < 48-years-old, black/pardo, heterosexual males, with fewer than 8 years of schooling. The prevalence of asymptomatic HIV-Leishmania coinfection was 9.11% (44/483). HIV mono-infected and HIV-Leishmania coinfected groups differed statistically significantly in terms of race (p = 0.045), marital status (p = 0.030), and HIV viral load (p = 0.046). Black/pardo patients, married patients, and those with an HIV viral load up to 100,000 copies/ml presented higher odds for HIV-Leishmania coinfection. Conclusions A considerable number of asymptomatic Leishmania cases were observed among HIV-positive individuals in a VL-endemic area. Given the potential impact on transmission and health costs, as well as the impact on these coinfected individuals, studies of asymptomatic Leishmania carriers can be useful for guiding public health policies in VL-endemic areas aiming to control and eliminate the disease.

As infecções hospitalares são aquelas adquiridas 48 horas após a admissão hospitalar ou que se manifestam até 3 dias após a alta e que estejam associadas a cuidados em saúde. Este trabalho teve como objetivo analisar o perfil bacteriano de uroculturas coletadas em pacientes internados em um Hospital Universitário. Trata-se de um estudo retrospectivo, descritivo e documental, realizado a partir de planilhas disponibilizadas pelo Laboratório de Análises Clínicas/Setor Microbiologia do Hospital Universitário, provenientes de resultados dos exames realizados no período de janeiro de 2017 a dezembro de 2018. No primeiro ano foram coletadas 242 uroculturas, destas, 12% apresentaram crescimento bacteriano. Em 2018 foram 256, com 15% de positividade. As bactérias mais isoladas foram: Klebsiella pneumoniae, Enterococcus sp., Pseudomonas aeruginosa, Escherichia coli e Acinetobacter baumannii. Klebsiella pneumoniae apresentou resistência a amicacina, imipenem, piperacilia + tazobactam, sendo sensível a linezolida.  O Enterococcus sp. em 2017, foi resistente à ampicilina, ciprofloxacino, vancomicina e nitrofurantoína, porém em 2018 foram sensíveis a estes. A P. aeruginosa foi resistente à ceftazidima, cefepime, imipenem, piperacilina + tazobactam, quinolonas e amicacina e sensível a colistina. A E. coli foi resistente a ampicilina + sulbactam, as quinolonas e sulfametoxazol + trimetoprima, sendo sensível a amoxicilina + clavulonato, nitrofurantoina e piperacilina + tazobactam, cefalosporinas de 2ª geração, aminoglicosídeos e carbapenêmicos. O A. baumannii apresentou resistência para amicacina, gentamicina, imipenem, meropenem, piperacilina + tazobactam e colistina, não apresentando 100% de sensibilidade a nenhum dos antibióticos testados. O conhecimento do perfil bacteriano nas uroculturas é de grande importância, pois poderá nortear o tratamento medicamentoso, contribuindo na desaceleração da seleção de bactérias resistentes.

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We report a case of visceral leishmaniasis (VL)/HIV coinfection in a patient undergoing regular antiretroviral therapy and treatment with thalidomide for erythema nodosum leprosum. He presented at a health service with high fever, chills, asthenia, pale skin, lower limb edema, hepatomegaly, and splenomegaly. Visceral leishmaniasis was confirmed by direct examination, and serological and molecular tests. Serum levels of Th1/Th2 cytokines were measured. The patient began treatment with liposomal amphotericin B, with good clinical response; however, VL recurred 6 months later. Treatment was reinitiated, maintaining secondary prophylaxis with liposomal amphotericin B. The patient showed clinical improvement with important recovery of CD4 + T-lymphocyte count.

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