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Tendências e distribuição espacial da hepatite D no Norte do Brasil, 2009-2018: um estudo ecológico
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Yamada, Adriano Benício Fernandes

; Freitas, Polyanne Lopes de

; Silva, Rafael Fernandes da

; Souto, Francisco José Dutra

Epidemiologia e Serviços de Saúde

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2021, Volume 30 N. 4 elocation e2020867

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

Resumo Objetivo: Analisar a incidência anual de hepatite D no Brasil e na região Norte, no período 2009-2018. Métodos: Estudo ecológico de casos de hepatite D notificados no Sistema de Informação de Agravos de Notificação (Sinan), analisados por sexo, idade e estados do Norte. Realizou-se análise de tendência temporal pelo método de Prais-Winsten, para estimar a variação percentual anual (VPA) das taxas de incidência. Resultados: No período, foram reportados 2.710 casos no Brasil, 74,5% na região Norte e 71,5% somente no Amazonas, Acre e Rondônia. Houve tendência de queda da VPA no país (-21,6% - IC95% -3,8;-36,2%), região Norte (-28,5% - IC95% -5,2;-46,1%,), Amazonas (-34,1% - IC95% -0,8;-56,2%) e Acre (-37,6% - IC95% -18,0;-52,6%). Verificou-se diminuição de casos nos estratos etários abaixo de 40 anos. Conclusão: Houve tendência de queda da incidência de hepatite D na Amazônia Ocidental, que impactou na incidência no país. Essa redução foi puxada pelos mais jovens, provavelmente resultado da vacinação para hepatite B.

Abstract Objective: To analyze the annual incidence of hepatitis D cases in both Brazil and the Brazilian Northern region between 2009 and 2018. Methods: This was an ecological study of hepatitis cases notified on the Notifiable Health Conditions Information System (SINAN), analyzed by sex, age groups, and Northern region states. Temporal trend analysis was performed using the Prais-Winsten method to estimate incident rate annual percent change (APC). Results: In the period studied, 2,710 cases were reported in Brazil, 74.5% of them in the Northern region and 71.5% in Amazonas, Acre and Rondonia alone. APC showed a downward trend in Brazil as a whole (-21.6% - 95%CI -3.8;-36.2%), in the Northern region (-28.5% - 95%CI -5.2;-46.1%,), in Amazonas (-34.1% - 95%CI -0.8;-56.2%) and in Acre (-37.6% - 95%CI -18.0;-52.6%). Cases decreased in age groups below 40 years old. Conclusion: There was a downward trend in incidence in the Western Amazon, impacting incidence in Brazil as a whole. This fall was led by younger people, probably due to hepatitis B vaccination.

Resumen Objetivo: Evaluar la incidencia anual de casos de hepatitis D en Brasil y en la Región Norte, entre 2009-2018. Métodos: En este estudio ecológico, se utilizaron casos notificados al Sistema Nacional de Agravamiento de de Enfermedades (Sinan), analizados por sexo, edad y estados del Norte. Se utilizó la regresión de Prais-Winsten para análisis de la tendencia temporal y el cálculo de la variación porcentual anual (VPA) de tasas de incidencia. Resultados: En el periodo, se notificaron 2.710 casos, siendo 74,5% en el Norte e 71,5% en Amazonas, Acre y Rondônia. Hubo tendencia a disminución de la VPA en Brasil (-21,6% - IC95% -3,8;-36,2%), región Norte (-28,5% - IC95% -5,2;-46,1%,), Amazonas (-34,1% - IC95% -0,8;-56,2%) y Acre (-37,6% - IC95% -18,0;-52,6%). Hubo disminución de casos entre los menores de 40 años. Conclusión: Hubo tendencia a la disminución de la incidencia en la Amazonía Occidental, impactando en la incidencia en Brasil. Esta baja está relacionada con los más jóvenes, probablemente debido a la vacunación contra la hepatitis B.

https://doi.org/10.1590/s1679-49742021000400014 45 downloads

Tendências e distribuição espacial da hepatite D no Norte do Brasil, 2009-2018: um estudo ecológico
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Yamada, Adriano Benício Fernandes

; Freitas, Polyanne Lopes de

; Silva, Rafael Fernandes da

; Souto, Francisco José Dutra

Epidemiologia e Serviços de Saúde

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2021, Volume 30 N. 4 elocation e2020867

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

https://doi.org/10.1590/s1679-49742021000400014

Vacinação universal contra hepatite A no Brasil: análise da cobertura vacinal e da incidência cinco anos após a implantação do programa
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Brito, Wagner Izidoro de

; Souto, Francisco José Dutra

Revista Brasileira de Epidemiologia

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2020, Volume 23 elocation e200073

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

RESUMO: Introdução: Em 2014, o Brasil introduziu programa de imunização universal contra o vírus da hepatite A (HAV) para crianças no segundo ano de vida, por meio de dose única da vacina de vírus inativado. Este estudo teve como objetivo avaliar a cobertura vacinal (CV) contra o HAV no Brasil, diante da incidência de casos notificados cinco anos após a implantação do programa. Metodologia: Dados secundários foram obtidos pesquisando-se sítios eletrônicos de acesso livre do Ministério da Saúde, Departamento de Informática do Sistema Único de Saúde (DATASUS), para análise de incidência e CV. Resultados: A CV variou entre 60,13 e 97,07%. A homogeneidade da CV contra hepatite A nos estados ficou aquém da meta estabelecida. Após 2015, houve queda da CV em todas as regiões do país. Apesar da cobertura insuficiente, houve redução concomitante da incidência da hepatite A em todo o Brasil. A taxa de incidência caiu de 3,29 para 0,80/100 mil entre 2014 e 2018. No entanto, ocorreu diminuição da velocidade de queda da incidência entre 2017 e 2018, o que pode ser consequência dos percentuais insuficientes de CV. Esse fenômeno parece acompanhar tendência geral de enfraquecimento do esforço vacinal no país, verificado também para outras vacinas, como poliomielite e tríplice viral. Conclusão: Esses números sugerem a necessidade de esforços para melhorar as taxas de CV da hepatite A no país.

ABSTRACT: Introduction: In 2014, Brazil introduced a universal immunization program against the hepatitis A virus (HAV) for children in the second year of life, using a single dose of inactivated virus vaccine. The objective of this study was to evaluate the vaccination coverage (VC) against HAV in Brazil, against the incidence of cases reported five years after the implementation of the program. Methodology: Secondary data were obtained by searching free access electronic sites of the Ministry of Health, Department of Informatics of the Unified Health System (Departamento de Informática do Sistema Único de Saúde - DATASUS), for incidence analysis and VC from 2014 to 2018. Results: VC ranged from 60.13 to 97.07%. The homogeneity of VC against hepatitis A did not reach the established goal throughout all states but for a few exceptions. After 2015, CV decreased in all regions of the country. Despite insufficient coverage, a concomitant reduction in the incidence of Hepatitis A took place throughout the country. The incidence rate fell from 3.29 to 0.80/100,000 between 2014 and 2018. However, there was an interruption in the pace of incidence fall between 2017 and 2018, which may be a consequence of insufficient VC. This phenomenon seems to be part of a widespread downward trend in vaccination effort across the country, also verified for other vaccines, such as poliomyelitis and measles, mumps and rubella vaccine. Conclusion: These figures suggest the need for implementing efforts to improve hepatitis A VC rates in the country.

https://doi.org/10.1590/1980-549720200073

Vacinação universal contra hepatite A no Brasil: análise da cobertura vacinal e da incidência cinco anos após a implantação do programa
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Brito, Wagner Izidoro de

; Souto, Francisco José Dutra

Revista Brasileira de Epidemiologia

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2020, Volume 23 elocation e200073

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

https://doi.org/10.1590/1980-549720200073 1793 downloads

Syphilis in pregnant women and congenital syphilis: spatial pattern and relationship with social determinants of health in Mato Grosso
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Oliveira, Leila Regina de

; Santos, Emerson Soares dos

; Souto, Francisco José Dutra

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volume 53 elocation e20200316

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: The increasing incidence of syphilis among pregnant women (PS) and congenital syphilis (CS) has negatively affected maternal-child health in Brazil. The spatial approach to diseases with social indicators improves knowledge of health situations. Herein, we aimed to evaluate the spatiotemporal distribution of incidences, identify the priority areas for infection control actions, and analyze the relationship of PS and CS clusters with social determinants of health in Mato Grosso. METHODS: This is an ecological study with data from different health information systems. After data procedure linkage, we analyzed the Bayesian incidences of triennial infections during specific periods. We performed SATSCAN screenings to identify spatiotemporal clusters. Further, we verified the differences between the clusters and indicators using Pearson’s chi-square test. RESULTS: The variations in PS incidence were 0.9-20.5/1,000 live births (LB), 0.6-46.3/1,000 LB, and 2.1-23.2/1,000 LB in the first, second, and last triennium, respectively; for CS, the variations were 0-7.1/1,000 LB, 0-7.5/1,000 LB, and 0.3-10.8/1,000 LB in the first, second, and last triennium, respectively. Three clusters each were identified for PS (RR=2.02; RR=0.30; RR=21.45, p<0.0001) and CS (RR=3.55; RR=0.10; RR=0.26, p<0.0001). The high-risk clusters overlapped in time-space; CS incidence was associated with municipalities with a higher proportion of LB mothers of race/non-white color and with poor sanitary conditions, lower proportion of pregnant teenagers, and under 8 years of schooling. CONCLUSIONS: The increase in the spatiotemporal evolution of PS and CS incidences and the extension of areas with persistent infections indicate the need for monitoring, especially of priority areas in the state.

https://doi.org/10.1590/0037-8682-0316-2020 456 downloads

Prevalence of hepatitis B and D virus infection in a district of Mato Grosso, bordering Amazonas and Rondônia states
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Antonio Ferreira-Junior, Paulo

; de-Oliveira, Elaine Cristina

; Martin, Thamires Oliveira Gasquez

; Rodrigues Alves-Junior, Eduardo

; Silva, Lucas José da

; Mello, Francisco Campello do Amaral

; Fontes, Cor Jesus Fernandes

; Souto, Francisco José Dutra

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volume 53 elocation e20190559

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: Brazil’s western Amazon basin has the highest prevalence of hepatitis B virus (HBV) infection in the country. Coinfection with hepatitis D virus (HDV) is also endemic. To estimate the prevalence of HBV and HDV markers in a population inhabiting the northwest portion of Mato Grosso state in the western Amazon. METHODS: We performed a cross-sectional study of the seroprevalence of antibodies against HBV core antigen (anti-HBc) in the Três Fronteiras District northwest of Mato Grosso. Anti-HBc-positive subjects were tested for HBV surface antigen (HBsAg). Those positive for this marker were tested for HDV antibodies. Anti-HBc-negative participants were tested for anti-HBsAg. All tests were performed by EIA. RESULTS: A total of 623 individuals in the community were assessed; the majority (67.6%) were male, with a mean age of 30.8 ± 15.4 years. Two hundred and fourteen individuals (34.3%) were anti-HBc-positive, and 47 (7.5%) were HBsAg carriers. Only one individual was anti-HDV-positive. Among the 409 individuals without HBV infection, 18.3% were anti-HBsAg-positive. There was no association between HBV infection and known risk factors. CONCLUSIONS: The study area had intermediate-to-high endemicity for HBV infection, but a low prevalence of HDV. Our serological results suggesting low vaccination-induced protection indicate a need for reinforced immunization programs in the populations of northwest Mato Grosso.

https://doi.org/10.1590/0037-8682-0559-2019 319 downloads

Expression of annexin-A1 in blood and tissue leukocytes of leprosy patients
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Ribeiro, Afonso Bezerra

; Caloi, Caroline Marques

; Pimenta, Silvia Thais Sá

; Seshayyan, Sudha

; Govindarajulu, Srinivas

; Souto, Francisco José Dutra

; Damazo, Amílcar Sabino

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volume 53 elocation e20200277

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION In leprosy, immune system mediators that regulate the infectious process act in a complex manner and can lead to several clinical outcomes. To understand the behavior of these mediators we quantified the expression of annexin-A1 (ANXA1) in the peripheral blood and plasma as well as tissue leukocytes in all clinical forms of leprosy and compared with healthy controls. METHODS Seventy healthy controls and 70 patients with leprosy, tuberculoid (TT) (n = 13), borderline tuberculoid (BT) (n = 15), borderline borderline (BB) (n = 13), borderline lepromatous (BL) (n = 15), and lepromatous leprosy (LL) (n = 14), were selected. Phenotyping of the lymphocyte cells and the intracellular expression of ANXA1 in leukocytes was performed by immunofluorescence. Plasma protein levels were determined by enzyme-linked immunosorbent assay. RESULTS Histiocytes and CD4+ and CD8+ T cells in the skin of BL and LL patients had higher ANXA1 expression. ANXA1 expression was also high in circulating polymorphonuclear, monocytes, and CD4+ and CD8+ T cells in the blood of LL patients compared to those of TT, BT, BB, and BL patients, and these levels were similar to those in healthy controls. Plasma ANXA1 levels indicate an increase in paracrine release in patients with LL. CONCLUSIONS The data indicate that ANXA1 expression is enhanced in the leukocytes and plasma of patients with LL, and may contribute to the inhibition of leukocyte action, leading to inadequate functioning of the immune system and thus contributing to the spread of M. leprae infection.

https://doi.org/10.1590/0037-8682-0277-2020 295 downloads

Hepatitis C disease burden and strategies for elimination by 2030 in Brazil. A mathematical modeling approach
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Benzaken, Adele Schwartz

; Girade, Renato

; Catapan, Elisa

; Pereira, Gerson Fernando Mendes

; Almeida, Elton Carlos de

; Vivaldini, Simone

; Fernandes, Neide

; Razavi, Homie

; Schmelzer, Jonathan

; Ferraz, Maria Lucia

; Ferreira, Paulo Roberto Abrão

; Pessoa, Mario Guimarães

; Martinelli, Ana

; Souto, Francisco José Dutra

; Walsh, Nick

; Mendes-Correa, Maria Cassia

Brazilian Journal of Infectious Diseases

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jun 2019, Volume 23 N. 3 Pages 182 - 190

Abstract: En | Text: En | PDF: En

ABSTRACT Introduction and aim: Hepatitis C is a key challenge to public health in Brazil. The objective of this paper was to describe the Brazilian strategy for hepatitis C to meet the 2030 elimination goal proposed by World Health Organization (WHO). Methods: A mathematical modeling approach was used to estimate the current HCV-infected Brazilian population, and to evaluate the relative costs of two different scenarios to address HCV disease burden in Brazil: (1) if no further changes are made to the HCV treatment program in Brazil; (2) where the WHO targets for 2030 elimination are met through diagnosis and treatment efforts peaking before 2024. Results: An anti-HCV prevalence of 0.53% was calculated for the total population. It was estimated that the number of HCV-RNA+ individuals in Brazil in 2017 was 632,000 (0.31% of the population). Scale-up of treatment and diagnosis over time will be necessary in order to achieve WHO targets beginning in 2018. Direct costs (diagnostic, treatment and healthcare costs) are projected to increase significantly during the scale-up of treatment and diagnosis in the initial years of the intervention scenario, but then fall below the base case on an annual basis by 2025-2036, once HCV is eliminated, due to health sectors savings from the prevention of HCV liver-related morbidity and mortality. Conclusion: Achieving the WHO targets is technically feasible in Brazil with a scale-up of treatment and diagnosis over time, beginning in 2018. However, elimination of hepatitis C requires policy changes to substantially scale-up prevention, screening and treatment of HCV, together with public health advocacy to raise awareness among affected populations and healthcare providers.

https://doi.org/10.1016/j.bjid.2019.04.010 994 downloads

Cerebral and mediastinal abscesses caused by Nocardia asiatica in an hiv-infected patient
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Azevedo, Francisco Kennedy Scofoni Faleiros de

; Dutra, Valéria

; Souto, Francisco José Dutra

Revista da Sociedade Brasileira de Medicina Tropical

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2019, Volume 52 elocation e20180485

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0037-8682-0485-2018 755 downloads

10.

New sequence types of Acinetobacter baumannii in two emergency hospitals in the Central-West region of Brazil
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Azevedo, Francisco Kennedy Scofoni Faleiros de

; Dutra, Valéria

; Nakazato, Luciano

; Pepato, Marco Andrey

; Sousa, Alessandra Tammy Hayakawa Ito de

; Azevedo, Cassius Clay Scofoni Faleiros de

; Souto, Francisco José Dutra

Revista da Sociedade Brasileira de Medicina Tropical

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2019, Volume 52 elocation e20190077

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0037-8682-0077-2019 770 downloads

11.

Initial evaluation of universal immunization with a single dose against hepatitis A virus in Central Brazil
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Brito, Wagner Izidoro de

; Alves-Junior, Eduardo Rodrigues

; Oliveira, Rode Martinho de

; Souto, Francisco José Dutra

Brazilian Journal of Infectious Diseases

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jun 2018, Volume 22 N. 3 Pages 166 - 170

Abstract: En | Text: En | PDF: En

ABSTRACT Vaccination against the hepatitis A virus (HAV) administered in two doses has been used effectively in universal child immunization programs in several countries. A single-dose vaccination was adopted in some low-income countries in an attempt to reduce costs without losing effectiveness. In 2014, single-dose universal vaccination was introduced in Brazil for children aged two years. Since such strategy is still not universally accepted, its efficacy should be compared to the two-dose strategy. To assess the humoral response after the single-dose HAV vaccination schedule, a cross-sectional study was conducted in Primavera do Leste, in Mato Grosso state, Central Brazil, including 265 children vaccinated through the National Immunization Program. Blood was collected by using a digital puncture and further applied to filter paper cards. Anti-HAV was detected in 218 out of 265 dried blood spots (DBS). Blood venous samples were collected from 34 out of 47 children who were not anti-HAV positive in DBS samples. Eighteen of them tested positive for anti-HAV, giving a final score of 93.6% (236/252) of seropositivity. In conclusion, this study demonstrated a high rate of anti-HAV positivity in the short term after single-dose hepatitis A vaccination in the population investigated. Moreover, the DBS was shown to be a reliable tool for detecting anti-HAV antibodies.

https://doi.org/10.1016/j.bjid.2018.04.001 490 downloads

12.

Effectiveness of first-wave protease inhibitors in hepatitis C virus genotype 1 infection: a multicenter study in Brazil
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Lobato, Cirley Maria de Oliveira

; Balassiano, Natalia

; Hyppolito, Elodie Bomfim

; Sanchez-Lermen, Rafaela Liz Pellegrim

; Signorelli, Izabelle Venturini

; Nicacio, Miguel Yasuo Tomita

; Firmino Filho, Alberto Pereira

; Andrade, Thais Guaraná de

; Lima, José Milton de Castro

; Arruda, Talita Amorim de

; Coutinho, Fernanda Schwanz

; Araujo, Everton Felipe do Vale

; Esmeraldo, Ticiana Mota

; Cortez, Erlon

; Capeli, Rafaela Lorenzon Aragão

; Matos, Melquior Brunno Mateus de

; Pessoa, Francisco Sérgio Rangel

; Oliveira, Hélder Cássio de

; Arruda, Érico Antônio Gomes de

; Gonçalves, Patrícia Lofêgo

; Araújo Filho, Antônio Haroldo

; Esberard, Eliane Bordalo Cathalá

; Souto, Francisco José Dutra

Revista da Sociedade Brasileira de Medicina Tropical

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feb 2018, Volume 51 N. 1 Pages 14 - 20

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: In 2013, combination therapy using peginterferon, ribavirin, and boceprevir or telaprevir was introduced to treat hepatitis C virus genotype 1 infection in Brazil. The effectiveness of this therapy in four Brazilian regions was evaluated. METHODS: Clinical and virological data were obtained from patients of public health institutions in five cities, including sustained virological response (SVR) and side effects. Patients with advanced fibrosis (F3/4), moderate fibrosis (F2) for > 3 years, or extra-hepatic manifestations were treated according to Ministry of Health protocol. Treatment effectiveness was verified by using bivariate and multivariate analysis; p-values of < 0.05 were considered significant. RESULTS: Of 275 patients (64.7% men; average age, 57 years old), most (61.8%) were treatment-experienced; 53.9% had subgenotype 1a infection, 85.1% had advanced fibrosis, and 85.5% were treated with telaprevir. SVR was observed in 54.2%. Rapid virological response (RVR) was observed in 54.6% of patients (data available for 251 patients). Overall, 87.5% reported side effects and 42.5% did not complete treatment. Skin rash, severe infection, and death occurred in 17.8%, 2.5%, and death in 1.4% of cases, respectively. SVR was associated with treatment completion, RVR, and anemia. CONCLUSIONS: The effectiveness of hepatitis C virus triple therapy was lower than that reported in phase III clinical trials, possibly owing to the prioritized treatment of patients with advanced liver fibrosis. The high frequency of side effects and treatment interruptions observed supported the decision of the Brazilian authorities to suspend its use when safer and more effective drugs became available in 2015.

https://doi.org/10.1590/0037-8682-0279-2017 1312 downloads

13.

Distribution of hepatitis B infection in Brazil: the epidemiological situation at the beginning of the 21 st century
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Souto, Francisco José Dutra

Revista da Sociedade Brasileira de Medicina Tropical

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feb 2016, Volume 49 N. 1 Pages 11 - 23

Abstract: En | Text: En | PDF: En

Abstract Brazil was formerly considered a country with intermediate hepatitis B endemicity, with large heterogeneity between Brazilian regions and areas of high prevalence, especially in the Amazon basin. Systematic vaccination of children was initiated in 1998. Between 2004 and 2009, a large population-based study reported decreased prevalence in all regions of Brazil. This review analyzed the current hepatitis B epidemiological situation in Brazil through a systematic search of the scientific literature in MEDLINE, LILACS, and CAPES thesis database, as well as disease notifications to the Information System for Notifiable Diseases. The search strategy identified 87 articles and 13 theses, resulting in 100 total publications. The most recent results indicate reduced hepatitis B prevalence nationwide, classifying Brazil as having low endemicity. Most studies showed HBV carrier prevalence less than 1%. However, there are still isolated regions with increased prevalence, particularly the Amazon, as well as specific groups, such as homeless people in large cities and isolated Afro-descendant communities in the center of the country. This review alsao detected successful vaccination coverage reported in a few studies around the country. The prevalence of anti-HBs alone ranged from 50% to 90%. However, isolated and distant localities still have low coverage rates. This review reinforces the downward trend of hepatitis B prevalence in Brazil and the need to intensify vaccination strategies for young people and adults in specific regions with persisting higher HBV infection prevalence.

https://doi.org/10.1590/0037-8682-0176-2015 28738 downloads

14.

Observational descriptive study of cutaneous manifestations in patients from Mato Grosso with viral chronic hepatitis
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Rostey, Renato Roberto Liberato

; Souto, Francisco José Dutra

Anais Brasileiros de Dermatologia

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dec 2015, Volume 90 N. 6 Pages 828 - 835

Abstract: En | Text: En | PDF: En

Abstract: BACKGROUND: Extrahepatic manifestations are seen in association with chronic infection by hepatitis B or C virus including cutaneous disorders. The frequency of these findings seems to vary among different places and reports. There is a lack of information about this issue in Brazil. OBJECTIVES: To estimate the prevalence of cutaneous findings affecting HBV or HCV carriers from a reference outpatient unit in Mato Grosso. METHODS: A cross-sectional observational study. RESULTS: 108 patients were studied. 88.9% presented some cutaneous findings but must of them were nonrelated to chronic viral infection. Four patients had cutaneous or autoimmune syndromes that may be HBV or HCV related. CONCLUSION: In our study we found no statistical association between viral hepatitis and skin diseases.

https://doi.org/10.1590/abd1806-4841.20153851 1468 downloads

15.

SAINT LOUIS ENCEPHALITIS VIRUS IN MATO GROSSO, CENTRAL-WESTERN BRAZIL
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HEINEN, Letícia Borges da Silva

; ZUCHI, Nayara

; SERRA, Otacília Pereira

; CARDOSO, Belgath Fernandes

; GONDIM, Breno Herman Ferreira

; SANTOS, Marcelo Adriano Mendes dos

; SOUTO, Francisco José Dutra

; PAULA, Daphine Ariadne Jesus de

; DUTRA, Valéria

; DEZENGRINI-SLHESSARENKO, Renata

Revista do Instituto de Medicina Tropical de São Paulo

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jun 2015, Volume 57 N. 3 Pages 215 - 220

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

O vírus da dengue (DENV), frequentemente envolvido em epidemias de grande proporção, e o vírus da febre amarela (YFV), responsável por surtos silvestres esporádicos, são considerados os flavivírus circulantes mais importantes no Brasil. Por este motivo, o diagnóstico laboratorial de doença febril aguda indiferenciada durante períodos epidêmicos é frequentemente direcionado para dengue e febre amarela no país, dificultando a detecção de outros arbovírus possivelmente circulantes, incluindo o vírus da encefalite de Saint Louis (SLEV), que é amplamente disperso nas Américas. O objetivo deste estudo foi investigar molecularmente a presença de 11 flavivírus no soro de 604 pacientes durante grande epidemia de dengue no estado de Mato Grosso (MT), Centro-Oeste do Brasil, entre 2011- 2012. Concomitantemente, 3.433 fêmeas de Culex spp. capturadas com aspirador de Nasci na cidade de Cuiabá, MT e alocadas em 409 pools com 1-10 mosquitos em 2013 foram testadas por multiplex seminested RT-PCR para os mesmos flavivírus. O SLEV foi detectado em três pacientes co-infectados com o DENV-4 das cidades de Cuiabá e Várzea Grande, MT. Um dos pacientes apresentava tripla co-infecção com DENV-1. Nenhum paciente referiu histórico recente de viagem ou acesso a áreas rurais/silvestres. Um pool contendo uma fêmea de Culex quinquefasciatus foi positivo para o SLEV, apresentando taxa de infecção mínima (MIR) de 0,29 por 1000 espécimes desta espécie. A análise filogenética indica que ambas as amostras formam um cluster com isolados do genótipo V-A do SLEV obtidos de animais na região amazônica do estado do Pará. Este é o primeiro relato de identificação molecular do SLEV no MT.

The dengue virus (DENV), which is frequently involved in large epidemics, and the yellow fever virus (YFV), which is responsible for sporadic sylvatic outbreaks, are considered the most important flaviviruses circulating in Brazil. Because of that, laboratorial diagnosis of acute undifferentiated febrile illness during epidemic periods is frequently directed towards these viruses, which may eventually hinder the detection of other circulating flaviviruses, including the Saint Louis encephalitis virus (SLEV), which is widely dispersed across the Americas. The aim of this study was to conduct a molecular investigation of 11 flaviviruses using 604 serum samples obtained from patients during a large dengue fever outbreak in the state of Mato Grosso (MT) between 2011 and 2012. Simultaneously, 3,433 female Culex spp. collected with Nasci aspirators in the city of Cuiabá, MT, in 2013, and allocated to 409 pools containing 1-10 mosquitoes, were also tested by multiplex semi-nested reverse transcription PCR for the same flaviviruses. SLEV was detected in three patients co-infected with DENV-4 from the cities of Cuiabá and Várzea Grande. One of them was a triple co-infection with DENV-1. None of them mentioned recent travel or access to sylvatic/rural regions, indicating that transmission might have occurred within the metropolitan area. Regarding mosquito samples, one pool containing one Culex quinquefasciatus female was positive for SLEV, with a minimum infection rate (MIR) of 0.29 per 1000 specimens of this species. Phylogenetic analysis indicates both human and mosquito SLEV cluster, with isolates from genotype V-A obtained from animals in the Amazon region, in the state of Pará. This is the first report of SLEV molecular identification in MT.

https://doi.org/10.1590/S0036-46652015000300006 3169 downloads

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