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Toxoplasma gondii SAG2, SAG3 and GRA6 alleles and single nucleotide polymorphism in congenital infections with known parasite load and clinical outcome SAG2 SAG GRA
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Targa, Lília Spaleta

; Santos, Emilly Henrique dos

; Yamamoto, Lidia

; Barreira, Gabriel Acca

; Rodrigues, Karen Alessandra

; Rocha, Mussya Cisotto

; Kanunfre, Kelly Aparecida

; Okay, Thelma Suely

Revista do Instituto de Medicina Tropical de São Paulo

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2023, Volume 65 elocation e8

Abstract: En | Text: En | PDF: En

ABSTRACT Amniotic fluid DNA samples were genotyped by multilocus-nested-PCR-RFLP, but only three of 11 markers amplified 113 of 122 (92.6%) samples, resulting in 12 untyped and 101 partial non-archetypal genotypes. The 101 typed samples were subdivided into four groups: G1 with 73 samples (5’and 3’ SAG2 allele I + SAG3 allele III + GRA6 allele III), 53 had parasite load ≤ 102 parasites/mL (43 asymptomatic, 10 mild infections), 17 had load > 102 and ≤ 103 (one mild, 13 moderate and three severe), and three had load > 103 parasites/mL (three severe); G2 with 22 samples (5’and 3’ SAG2 allele I + SAG3 allele III), all parasite load levels ≤ 102 parasites/mL (18 asymptomatic and four mild); G3 with five samples (5’ and 3’ SAG2 allele I + SAG3 allele II), parasite load ≤ 102 parasites/mL (three asymptomatic and two mild); G4 with one sample (5’ and 3’ SAG2 allele II + SAG3 allele II + GRA6 allele I), a parasite load < 102 parasites/mL in an asymptomatic infant. After DNA sequencing, restriction sites confirmed SAG2, SAG3 and GRA6 alleles in 98.7%, 100% and 100% of the cases, respectively, while single nucleotide polymorphisms confirmed 90% of 5’-SAG2 allele I; 98.7% of 3’-SAG2 allele I; 98% of SAG-3 allele III, but only 40% of GRA6 allele III results. For the moment, partial non-archetypal genotypes of parasites did not show any relationship with either parasite load in amniotic fluid samples or clinical outcome of infants at the age of 12 months. multilocusnestedPCRRFLP, multilocusnestedPCRRFLP multilocus nested PCR RFLP, RFLP multilocus-nested-PCR-RFLP 1 92.6% 926 92 6 (92.6% nonarchetypal non archetypal groups G 7 5and 5 3 SAG GRA , III) parasitesmL mL 43 (4 infections, infections infections) severe, severe severe) 2 18 (1 mild) (5 II, II) I, I) infant sequencing 987 98 100 cases respectively 90 5SAG2 5’-SAG 98.7 3SAG2 3’-SAG SAG- 40 results moment months 92.6 9 (92.6 4 ( 5SAG 98. 3SAG 92. (92. (92 (9

https://doi.org/10.1590/s1678-9946202365008

Coxsackievirus A6 strains causing an outbreak of hand-foot-and-mouth disease in Northeastern Brazil in 2018
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Luchs, Adriana

; Azevedo, Lais Sampaio de

; Souza, Ellen Viana de

; Medeiros, Roberta Salzone

; Souza, Yasmin França Viana Pires de

; Teixeira, Dalane Loudal Florentino

; Carneiro, Thiago Franco de Oliveira

; Alencar, Gabriela Maria Fernandes de

; Morais, Fernanda Lúcia de Sousa Leite

; Pinto, Diana de Fátima Alves

; Okay, Thelma Suely

; Yamamoto, Lidia

; Morais, Vanessa dos Santos

; Araújo, Emerson Luiz Lima

; Leal, Elcio

; Costa, Antonio Charlys da

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e16

Abstract: En | Text: En | PDF: En

ABSTRACT Hand-foot-and-mouth disease (HFMD) is a highly contagious viral disease commonly associated to Enteroviruses (EV). During 2018, Brazil faced massive HFMD outbreaks spread across the country. This study aimed to characterize the EV responsible for the HFMD outbreak that occurred in Paraiba State, Brazilian Northeastern region, in 2018, followed by a phylogenetic analysis to detail information on its genetic diversity. A total of 49 serum samples (one from each patient) collected from children ≤ 15 years old, clinically diagnosed with HFMD were tested for EV using conventional RT-PCR and RT-qPCR. EV infection was confirmed in 71.4% (35/49) of samples. The mean and median ages were 1.83 years and one year old, respectively. Twenty-two EV-positive samples were successfully sequenced and classified as EV-A species; 13 samples were also identified with the CV-A6 genotype. The phylogenetic analysis (VP1 region) of three samples revealed that the detected CV-A6 strains belonged to sub-lineage D3. The CV-A6 strains detected here clustered with strains from South America, Europe and West Asia strains that were also involved in HFMD cases during the 2017-2018 seasons, in addition to the previously detected Brazilian CV-A6 strains from 2012 to 2017, suggesting a global co-circulation of a set of different CV-A6 strains introduced in the country at different times. The growing circulation of the emerging CV-A6 associated with HFMD, together with the detection of more severe cases worldwide, suggests the need for a more intense surveillance system of HFMD in Brazil. In addition, this investigation was performed exclusively on serum samples, and the analysis of whole blood samples should be considered and could have shown advantages when employed in the diagnosis of enteroviral HFMD outbreaks.

https://doi.org/10.1590/s1678-9946202264016

SARS-CoV-2 and rhinovirus infections: are there differences in clinical presentation, laboratory abnormalities, and outcomes in the pediatric population?
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Pereira, Maria Fernanda Bádue

; Suguita, Priscila

; Litvinov, Nadia

; Farhat, Sylvia Costa Lima

; Paula, Camila Sanson Yoshino de

; Lázari, Carolina dos Santos

; Bedê, Pedro Vale

; Framil, Juliana Valeria de Souza

; Bueno, Catarina

; Branas, Priscila Cristina Abduch Adas

; Guimarães, Irina Monteiro da Costa

; Leite, Marcia Marques

; Navega, Ana Carolina Barsaglini

; Nanbu, Danilo Yamamoto

; Schvartsman, Claudio

; Pinho, João Renato Rebello

; Silva, Clovis Artur Almeida

; Marques, Heloisa Helena de Sousa

; Eisencraft, Adriana Pasmanik

; Rossi Jr, Alfio

; Delgado, Artur Figueiredo

; Leal, Gabriela Nunes

; Gibelli, Maria Augusta Cicaroni

; Palmeira, Patricia

; Sakita, Neusa Keico

; Santos, Emilly Henrique dos

; Rocha, Mussya Cisotto

; Kanunfre, Kelly Aparecida

; Okay, Thelma Suely

; Carneiro-Sampaio, Magda

; Carvalho, Werther Brunow de

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e34

Abstract: En | Text: En | PDF: En

ABSTRACT This study aims to assess COVID-19 and other respiratory viruses in pediatric patients. Between April 17 and September 30, 2020, we collected 1,566 respiratory samples from 1,044 symptomatic patients who were younger than 18 years old to assess SARS-CoV-2 infection. Of these, 919 were analyzed for other respiratory pathogens (ORP). Patients with laboratory-confirmed COVID-19 or ORP were included. We evaluated 76 pediatric COVID-19 infections and 157 other respiratory virus infections. Rhinovirus occurred in 132/157 (84%). COVID-19 patients who were significantly older, had more fevers, headaches and pneumonia than those with ORP. The median white blood cell count was lower in patients with SARS-CoV-2 than in those with ORP (6,470 versus 8,170; p=0.02). COVID-19 patients had significantly worse symptoms than those with ORP.

https://doi.org/10.1590/s1678-9946202264034

Silent circulation of Chikungunya virus among pregnant women and newborns in the Western Brazilian Amazon before the first outbreak of chikungunya fever
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Kanunfre, Kelly Aparecida

; Rocha, Mussya Cisotto

; Malta, Maíra Barreto

; Souza, Rodrigo Medeiros de

; Castro, Marcia Caldas

; Boscardin, Silvia Beatriz

; Souza, Higo Fernando Santos

; Witkin, Steven S.

; Cardoso, Marly Augusto

; Okay, Thelma Suely

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e25

Abstract: En | Text: En | PDF: En

ABSTRACT The prevalence of immunity to Chikungunya virus (CHIKV) in pregnant women and newborns in the Western Brazilian Amazon was assessed at a time when previous studies did not report chikungunya fever in the area. In 435 asymptomatic pregnant women and 642 healthy unrelated newborns, the presence of IgM and IgG antibodies to CHIKV were determined by a commercial ELISA. All participants were negative to IgM anti-CHIKV. Anti-CHIKV IgG was identified in 41 (9.4%) pregnant women and 66 (10.3%) newborns. The presence of anti-CHIKV IgG was positively associated with the lowest socioeconomic status in pregnant women (OR 2.54, 95% CI 1.15-5.62, p=0.021) and in the newborns’ mothers (OR 5.10, 95% CI 2.15-12.09, p< 0.001). Anti-CHIKV IgG was also associated with maternal age in both, the pregnant women (OR 1.06, 95% CI 1.00-1.11, p=0.037) and the newborns’mothers (OR 1.08, 95% CI 1.03-1.12, p=0.001). Pregnancy outcomes in which the mother or the newborn was anti-CHIKV IgG positive proceeded normally. Negative CHIKV serology was associated with being positive for DENV antibodies and having had malaria during pregnancy. These findings showed that there was already a silent circulation of CHIKV in this Amazon region before the first outbreak of chikungunya fever. Furthermore, seropositivity for CHIKV was surprisingly frequent (10%) in both, pregnant women and newborns, affecting mainly low-income women.

https://doi.org/10.1590/s1678-9946202264025

Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital
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Marques, Heloisa Helena de Sousa

; Pereira, Maria Fernanda Badue

; Santos, Angélica Carreira dos

; Fink, Thais Toledo

; Paula, Camila Sanson Yoshino de

; Litvinov, Nadia

; Schvartsman, Claudio

; Delgado, Artur Figueiredo

; Gibelli, Maria Augusta Bento Cicaroni

; Carvalho, Werther Brunow de

; Odone Filho, Vicente

; Tannuri, Uenis

; Carneiro-Sampaio, Magda

; Grisi, Sandra

; Duarte, Alberto José da Silva

; Antonangelo, Leila

; Francisco, Rossana Pucineli Vieira

; Okay, Thelma Suely

; Batisttella, Linamara Rizzo

; Carvalho, Carlos Roberto Ribeiro de

; Brentani, Alexandra Valéria Maria

; Silva, Clovis Artur

; Eisencraft, Adriana Pasmanik

; Rossi Junior, Alfio

; Fante, Alice Lima

; Cora, Aline Pivetta

; Reis, Amelia Gorete A. de Costa

; Ferrer, Ana Paula Scoleze

; Andrade, Anarella Penha Meirelles de

; Watanabe, Andreia

; Gonçalves, Angelina Maria Freire

; Waetge, Aurora Rosaria Pagliara

; Silva, Camila Altenfelder

; Ceneviva, Carina

; Lazari, Carolina dos Santos

; Abellan, Deipara Monteiro

; Santos, Emilly Henrique dos

; Sabino, Ester Cerdeira

; Bianchini, Fabíola Roberta Marim

; Alcantara, Flávio Ferraz de Paes

; Ramos, Gabriel Frizzo

; Leal, Gabriela Nunes

; Rodriguez, Isadora Souza

; Pinho, João Renato Rebello

; Carneiro, Jorge David Avaizoglou

; Paz, Jose Albino

; Ferreira, Juliana Carvalho

; Ferranti, Juliana Ferreira

; Ferreira, Juliana de Oliveira Achili

; Framil, Juliana Valéria de Souza

; Silva, Katia Regina da

; Kanunfre, Kelly Aparecida

; Bastos, Karina Lucio de Medeiros

; Galleti, Karine Vusberg

; Cristofani, Lilian Maria

; Suzuki, Lisa

; Campos, Lucia Maria Arruda

; Perondi, Maria Beatriz de Moliterno

; Diniz, Maria de Fatima Rodrigues

; Fonseca, Maria Fernanda Mota

; Cordon, Mariana Nutti de Almeida

; Pissolato, Mariana

; Peres, Marina Silva

; Garanito, Marlene Pereira

; Imamura, Marta

; Dorna, Mayra de Barros

; Luglio, Michele

; Rocha, Mussya Cisotto

; Aikawa, Nadia Emi

; Degaspare, Natalia Viu

; Sakita, Neusa Keico

; Udsen, Nicole Lee

; Scudeller, Paula Gobi

; Gaiolla, Paula Vieira de Vincenzi

; Severini, Rafael da Silva Giannasi

; Rodrigues, Regina Maria

; Toma, Ricardo Katsuya

; Paula, Ricardo Iunis Citrangulo de

; Palmeira, Patricia

; Forsait, Silvana

; Farhat, Sylvia Costa Lima

; Sakano, Tânia Miyuki Shimoda

; Koch, Vera Hermina Kalika

; Cobello Junior, Vilson

Clinics

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2021, Volume 76 elocation e3488

Abstract: En | Text: En | PDF: En

OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.

https://doi.org/10.6061/clinics/2021/e3488

SARS-CoV-2 and the COVID-19 disease: a mini review on diagnostic methods
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Oliveira, Beatriz Araujo

; Oliveira, Lea Campos de

; Sabino, Ester Cerdeira

; Okay, Thelma Suely

Revista do Instituto de Medicina Tropical de São Paulo

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2020, Volume 62 elocation e44

Abstract: En | Text: En | PDF: En

ABSTRACT Coronavirus disease 2019 (COVID-19) is an infectious disease initially reported in China and currently worldwide dispersed caused by a new coronavirus (SARS-CoV-2 or 2019-nCoV) affecting more than seven million people around the world causing more than 400 thousand deaths (on June 8th, 2020). The diagnosis of COVID-19 is based on the clinical and epidemiological history of the patient. However, the gold standard for COVID-19 diagnosis is the viral detection through the amplification of nucleic acids. Although the quantitative Reverse-Transcription Polymerase Chain Reaction (RT-PCR) has been described as the gold standard for diagnosing COVID-19, there are several difficulties involving its use. Here we comment on RT-PCR and describe alternative tests developed for the diagnosis of COVID-19.

https://doi.org/10.1590/s1678-9946202062044 9069 downloads

Saliva: an important alternative for screening and monitoring of COVID-19 in children
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Santos, Catielma Nascimento

; Rezende, Karla Mayra

; Oliveira Neto, Nilson Ferreira de

; Okay, Thelma Suely

; Braz-Silva, Paulo Henrique

; Bönecker, Marcelo

Brazilian Oral Research

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2020, Volume 34 elocation e0125

Abstract: En | Text: En | PDF: En

Abstract: The increasing number of cases of COVID-19 worldwide poses challenges to healthcare systems not only in effectively identifying individuals positive for SARS-CoV-2, but also in isolating cases to minimise contagion in early diagnosing more severe cases that will need hospitalization. Less-invasive collection methods are indispensable in a pandemic scenario as large-scale tests are necessary to understand the actual evolution of contagion in different populations, thus enabling decision-making based on scientific evidence. Saliva has been shown to be an alternative for diagnosing viral infections as this biological fluid can be easily and quickly collected without using specific devices and causing less discomfort during collection, which is an important factor for use in children. Despite the smaller percentage of severe cases of COVID-19 among children, they seem to play an important role in the contagion as they have the same potential of transmission as that of adults. Knowing the evolution of COVID-19 pandemic in children is extremely important, mainly regarding the changing in rules of social distancing, such as re-opening schools and recreational activities spaces. In addition, countless cases of a severe multi-systemic inflammatory syndrome that shares clinical and laboratory features with Kawasaki's disease have been recently related to SARS-CoV-2 infections in children, adolescents and young adults. In view of this scenario, the aim of this study was to present saliva as an alternative for seeking diagnostic and prognostic markers of COVID-19 in children, including adequate sample collection techniques for different age groups.

https://doi.org/10.1590/1807-3107bor-2020.vol34.0125 3169 downloads

SARS-CoV-2 infections with emphasis on pediatric patients: a narrative review
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Yamamoto, Lidia

; Santos, Emilly Henrique dos

; Pinto, Lacyane Santos

; Rocha, Mussya Cisotto

; Kanunfre, Kelly Aparecida

; Vallada, Marcelo Genofre

; Okay, Thelma Suely

Revista do Instituto de Medicina Tropical de São Paulo

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2020, Volume 62 elocation e65

Abstract: En | Text: En | PDF: En

ABSTRACT This narrative review summarizes the main aspects underlying the new coronavirus SARS-CoV-2, its epidemiology, pathophysiology, pointing to differences of SARS-CoV-2 main receptors ACE2, in terms of expression and the amount of soluble ACE2 in the circulation of children, men and women, and also in those with risk factors such as the smokers and pregnant women or presenting with comorbidities (diabetes, obesity, hypertension and other cardiovascular diseases, renal and CNS pre-existing diseases). Clinical manifestations in adults and children were also described, emphasizing the particularities already seen in children, regarding signs, symptoms, viral excretion time and the involvement of all organs and systems. The COVID-19 in the pediatric population was divided into two sections: one dedicated to previously healthy children and adolescents with COVID-19, and the other to those who live with comorbidities and acquired COVID-19. A few paragraphs were reserved to the recently described severe multisystemic inflammatory syndrome associated with COVID-19 (MIS-C) that shares certain characteristics with Kawasaki disease. Some studies on the infection in pregnant and postpartum women, as well as neonates were shown. This review has also covered the laboratory diagnosis of COVID-19, passing through the imaging diagnosis made by the chest tomography revealing ground glass patching opacities, and results of non-specific exams such as the total blood with lymphopenia, the coagulation tests with increased prothrombin times, as well as marked increments of the D-dimer, troponin and proinflammatory cytokines. In the section devoted to the specific laboratory diagnosis of COVID-19, the most used RT-PCR protocols were described and some studies on the serological diagnosis with IgA, IgM and IgG detection were detailed, including the use of rapid immunochromatographic assays and discussing the ideal period after the onset of symptoms to perform each type of test. In the end, the management of pediatric patients with COVID-19 based mainly on supportive measures has been briefly commented.

https://doi.org/10.1590/s1678-9946202062065 2690 downloads

Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome
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Pereira, Maria Fernanda Badue

; Litvinov, Nadia

; Farhat, Sylvia Costa Lima

; Eisencraft, Adriana Pasmanik

; Gibelli, Maria Augusta Bento Cicaroni

; Carvalho, Werther Brunow de

; Fernandes, Vinicius Rodrigues

; Fink, Thais de Toledo

; Framil, Juliana Valéria de Souza

; Galleti, Karine Vusberg

; Fante, Alice Lima

; Fonseca, Maria Fernanda Mota

; Watanabe, Andreia

; Paula, Camila Sanson Yoshino de

; Palandri, Giovanna Gavros

; Leal, Gabriela Nunes

; Diniz, Maria de Fatima Rodrigues

; Pinho, João Renato Rebello

; Silva, Clovis Artur

; Marques, Heloisa Helena de Sousa

; Rossi Junior, Alfio

; Delgado, Artur Figueiredo

; Andrade, Anarella Penha Meirelles de

; Schvartsman, Claudio

; Sabino, Ester Cerdeira

; Rocha, Mussya Cisotto

; Kanunfre, Kelly Aparecida

; Okay, Thelma Suely

; Carneiro-Sampaio, Magda Maria Sales

; Jorge, Patricia Palmeira Daenekas

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2020, Volume 75 elocation e2209

Abstract: En | Text: En | PDF: En

OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p<0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p<0.001), vasoactive agent use (83% vs. 3%, p<0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p<0.001), and death (67% vs. 3%, p<0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p<0.001), aspirin therapy (50% vs. 0%, p<0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39-526.79; p<0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.

https://doi.org/10.6061/clinics/2020/e2209 2260 downloads

10.

Assessment and comparison of bacterial load levels determined by quantitative amplifications in blood culture-positive and negative neonatal sepsis
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Stranieri, Inês

; Kanunfre, Kelly Aparecida

; Rodrigues, Jonatas Cristian

; Yamamoto, Lidia

; Nadaf, Maria Isabel Valdomir

; Palmeira, Patricia

; Okay, Thelma Suely

Revista do Instituto de Medicina Tropical de São Paulo

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2018, Volume 60 elocation e61

Abstract: En | Text: En | PDF: En

ABSTRACT Bacterial sepsis remains a major cause of mortality and blood cultures are the gold standard of laboratory diagnosis even though they lack sensitivity in neonates. Culturenegative sepsis, also known as clinical sepsis, has long been considered a diagnosis in neonatal intensive care units because, as well as culture-positive infants, culture-negative neonates have worse prognosis in comparison with non-infected ones. Quantitative amplifications are used to detect bacterial infections in neonates but results are considered only in a qualitative way (positive or negative). The aim of the present study was to determine and compare bacterial load levels in blood culture-positive and culture-negative neonatal sepsis. Seventy neonates with clinical and laboratory evidence of infection admitted at three neonatal intensive care units were classified as blood culture-positive or culture-negative. Blood samples obtained at the same time of blood cultures had bacterial load levels assessed through a 16S rDNA qPCR. Blood cultures were positive in 29 cases (41.4%) and qPCR in 64 (91.4%). In the 29 culture-positive cases, 100% were also positive by qPCR, while in the 41 culture-negative cases, 35 (85.4%) were positive by qPCR. Bacterial load levels were in general < 50 CFU/mL, but were significantly higher in culture-positive cases (Mann-Whitney, p = 0.013), although clinical and laboratory findings were similar, excepting for deaths. In conclusion, the present study has shown that blood culture-negative neonates have lower bacteria load levels in their bloodstream when compared to blood culture-positive infants.

https://doi.org/10.1590/s1678-9946201860061 1528 downloads

11.

PRELIMINARY REPORT ON THE PUTATIVE ASSOCIATION OF IL10 -3575 T/A GENETIC POLYMORPHISM WITH MALARIA SYMPTOMS
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DOMINGUES, Wilson

; KANUNFRE, Kelly Aparecida

; RODRIGUES, Jonatas Cristian

; TEIXEIRA, Leandro Emidio

; YAMAMOTO, Lidia

; OKAY, Thelma Suely

Revista do Instituto de Medicina Tropical de São Paulo

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2016, Volume 58 elocation 30

Abstract: En | Text: En | PDF: En

Only a small percentage of individuals living in endemic areas develop severe malaria suggesting that host genetic factors may play a key role. This study has determined the frequency of single nucleotide polymorphisms (SNPs) in some pro and anti-inflammatory cytokine gene sequences: IL6 (-174; rs1800795), IL12p40 (+1188; rs3212227), IL4 (+33; rs2070874), IL10 (-3575; rs1800890) and TGFb1 (+869; rs1800470), by means of PCR-RFLP. Blood samples were collected from 104 symptomatic and 37 asymptomatic subjects. Laboratory diagnosis was assessed by the thick blood smear test and nested-PCR. No association was found between IL6 (-174), IL12p40 (+1188), IL4 (+33), IL10 (- 3575), TGFb1 (+869) SNPs and malaria symptoms. However, regarding the IL10 -3575 T/A SNP, there were significantly more AA and AT subjects, carrying the polymorphic allele A, in the symptomatic group (c2 = 4.54, p = 0.01, OR = 0.40 [95% CI - 0.17- 0.94]). When the analysis was performed by allele, the frequency of the polymorphic allele A was also significantly higher in the symptomatic group (c2 = 4.50, p = 0.01, OR = 0.45 [95% CI - 0.21-0.95]). In conclusion, this study has suggested the possibility that the IL10 - 3575 T/A SNP might be associated with the presence and maintenance of malaria symptoms in individuals living in endemic areas. Taking into account that this polymorphism is related to decreased IL10 production, a possible role of this SNP in the pathophysiology of malaria is also suggested, but replication studies with a higher number of patients and evaluation of IL10 levels are needed for confirmation.

https://doi.org/10.1590/s1678-9946201658030 1986 downloads

12.

Bartonella henselae AS A PUTATIVE CAUSE OF CONGENITAL CHOLESTASIS
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VELHO, Paulo Eduardo Neves Ferreira

; BELLOMO-BRANDÃO, Maria Ângela

; DRUMMOND, Marina Rovani

; MAGALHÃES, Renata Ferreira

; HESSEL, Gabriel

; BARJAS-CASTRO, Maria de Lourdes

; ESCANHOELA, Cecília Amélia Fazzio

; DEL NEGRO, Gilda Maria Barbaro

; OKAY, Thelma Suely

Revista do Instituto de Medicina Tropical de São Paulo

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2016, Volume 58 elocation 56

Abstract: En | Text: En | PDF: En

SUMMARY Severe anemia and cholestatic hepatitis are associated with bartonella infections. A putative vertical Bartonella henselae infection was defined on the basis of ultrastructural and molecular analyses in a three-year-old child with anemia, jaundice and hepatosplenomegaly since birth. Physicians should consider bartonellosis in patients with anemia and hepatitis of unknown origin.

https://doi.org/10.1590/s1678-9946201658056 2207 downloads

13.

TRIBUTE TO PROF. CARLOS DA SILVA LACAZ
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OKAY, Thelma Suely

Revista do Instituto de Medicina Tropical de São Paulo

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sep 2015, Volume 57 Suppl. 19 Pages 1 - 1

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/S0036-46652015000700001 3719 downloads

14.

Accuracy of the QuantiFERON-TB Gold in Tube for diagnosing tuberculosis in a young pediatric population previously vaccinated with Bacille Calmette-Guérin
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Vallada, Marcelo Genofre

; Okay, Thelma Suely

; Negro, Gilda Maria B. Del

; Antonio, Claudio Amaral

; Yamamoto, Lidia

; Ramos, Sonia Regina T. S.

Revista Paulista de Pediatria

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mar 2014, Volume 32 N. 1 Pages 04 - 10

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Objetivo:Avaliar a acurácia de um teste de liberação de interferon-gama (QuantiFERON-TB Gold in Tube) para diagnosticar a infecção pelo Mycobacterium tuberculosisem uma população pediátrica.Métodos: Avaliaram-se 195 crianças previamente vacinadas com BCG, sendo 184 sadias, sem evidência clínica ou epidemiológica de infecção pelo M. tuberculosis, e 11 com infecção, definida de acordo com critérios clínicos, radiológicos e laboratoriais. Obteve-se uma amostra de sangue de cada criança, processada conforme as instruções do fabricante. Avaliou-se o desempenho do ensaio por meio de uma curva de características operacionais (curva Receiver Operating Characteristic - ROC).Resultados: No grupo de 184 crianças não infectadas, 130 (70,6%) eram menores de quatro anos (média de 35 meses). Nesse grupo, 177 crianças (96,2%) tiveram resultado negativo do teste, seis (3,2%) apresentaram resultado indeterminado e uma (0,5%) teve resultado positivo. No grupo de 11 crianças com infecção, a idade média era de 58,5 meses e duas (18%) apresentaram resultado negativo. A curva ROC determinou uma área sob a curva de 0,88 (IC95% 0,82-0,92; p<0,001), evidenciando um valor preditivo positivo de 81,8% para o teste (IC95% 46,3-97,4). A sensibilidade do teste foi de 81,8% (IC95% 48,2-97,2) e a especificidade, de 98,8% (IC95% 96-99,8).Conclusões: No presente estudo, o desempenho do QuantiFERON-TB Gold in Tubepara o diagnóstico da infecção pelo M. tuberculosis foi adequado quando utilizado em uma população pediátrica jovem.

Objective:To evaluate the accuracy of an interferongamma release assay (QuantiFERON-TB Gold in Tube) for diagnosing Mycobacterium tuberculosis infection in a young pediatric population.Methods: 195 children previously vaccinated with BCG were evaluated, being 184 healthy individuals with no clinical or epidemiological evidence of mycobacterial infection, and 11 with Mycobacterium tuberculosis infection, according to clinical, radiological, and laboratory parameters. A blood sample was obtained from each child and processed according to the manufacturer's instructions. The assay performance was evaluated by a Receiver Operating Characteristic (ROC) curve.Results: In the group of 184 non-infected children, 130 (70.6%) were under the age of four years (mean age of 35 months). In this group, 177 children (96.2%) had negative test results, six (3.2%) had indeterminate results, and one (0.5%) had a positive result. In the group of 11 infected children, the mean age was 58.5 months, and two of them (18%) had negative results. The ROC curve had an area under the curve of 0.88 (95%CI 0.82-0.92; p<0.001), disclosing a predictive positive value of 81.8% for the test (95%CI 46.3-97.4). The assay sensitivity was 81.8% (95%CI 48.2-97.2) and the specificity was 98.8% (95%CI 96-99.8).Conclusions: In the present study, the QuantiFERON-TB Gold in Tube performance for diagnosing M. tuberculosis infection was appropriate in a young pediatric population.

Objetivo: Evaluar la precisión de una prueba de liberación de interferón gama (QuantiFERON-TB Gold in Tube) para el diagnóstico de la infección por el Mycobacterium tuberculosis en una población pediátrica.Métodos: Se evaluaron 195 niños previamente vacunados con BCG, siendo 184 niños sanos sin evidencia clínica o epidemiológica de infección por el M. tuberculosis, y 11 niños con infección, definida conforme a criterios clínicos, radiológicos y laboratoriales. Se obtuvo una muestra de sangre de cada niño, que fue procesada conforme a las instrucciones del fabricante. El desempeño del ensayo fue evaluado mediante una curva de características operacionales (curva ROC).Resultados: En el grupo de 184 niños no infectados, 130 (70,6%) tenían menos que cuatro años (promedio de 35 meses). En este grupo control, 177 niños (96,2%) tuvieron un resultado negativo de la prueba, mientras que 6 niños (3,2%) presentaron resultado indeterminado, y un niño (0,5%) tuvo un resultado positivo. En el grupo de 11 niños con infección, el promedio de edad era de 58,5 meses, y 2 niños (18%) presentaron resultado negativo. La curva ROC determinó un área bajo la curva de 0,876 (95%IC 0,82-0,92; p<0,001), evidenciando un valor predictivo positivo del 81,8% para la prueba (95%IC 46,3-97,4). La sensibilidad de la prueba fue de 81,8% (95%IC, 48,2-97,2) y la especificidad de 98,8% (95%IC, 96-99,8).Conclusión: En el presente estudio, el desempeño del QuantiFERON-TB Gold in Tube para el diagnóstico de la infección por el M. tuberculosis fue adecuado cuando utilizado en una población pediátrica joven.

https://doi.org/10.1590/S0103-05822014000100002 6186 downloads Cited 1 time in SciELO

15.

USEFULNESS OF kDNA PCR IN THE DIAGNOSIS OF VISCERAL LEISHMANIASIS REACTIVATION IN CO-INFECTED PATIENTS
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Nicodemo, Antonio Carlos

; Amato, Valdir Sabbaga

; Tuon, Felipe Francisco

; Souza, Regina Maia de

; Okay, Thelma Suely

; Braz, Lúcia Maria Almeida

Revista do Instituto de Medicina Tropical de São Paulo

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dec 2013, Volume 55 N. 6 Pages 429 - 431

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMOÉ importante a pesquisa de novos métodos laboratoriais para o diagnóstico de recidivas em casos de co-infecção leishmaniose visceral (LV) e vírus da imunodeficiência humana (HIV), que permitam o diagnóstico precoce das recidivas, utilizando métodos menos invasivos. Descrevemos aqui, o caso de paciente co-infectada que apresentou recidivas após o tratamento da LV e onde a PCR qualitativa demonstrou bom desempenho. A kDNA PCR parece ser ferramenta útil para o diagnóstico de recidivas de LV após o tratamento em pacientes co-infectados com sintomas clínicos da doença.

SUMMARYIt is important to develop new methods for diagnosing relapses in the co-infection of visceral leishmaniasis (VL) and HIV to enable earlier detection using less invasive methods. We report a case of a co-infected patient who had relapses after VL treatment, where the qualitative kDNA PCR showed a good performance. The kDNA PCR seems to be a useful tool for diagnosing VL and may be a good marker for predicting VL relapses after treatment of co-infected patients with clinical symptoms of the disease.

https://doi.org/10.1590/S0036-46652013000600011 2712 downloads

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