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Association between vitamin D serum levels and clinical, laboratory, and parasitological parameters in patients with malaria from an endemic area of the Amazon
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Setto, Janaina Maria

; Libonati, Rosana Maria Feio

; Ventura, Ana Maria Revoredo da Silva

; Chaves, Tânia do Socorro Souza

; Sequeira, Carina Guilhon

; Martins Filho, Arnaldo Jorge

; Machado, Ricardo Luiz Dantas

; Franceschin, Sylvia do Carmo Castro

; Barreto, Jéssica Thuanny Teixeira

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0077-2021

Abstract: En | Text: En | PDF: En

ABSTRACT Background: Some studies have suggested the importance of vitamin D [25(OH)D] in malaria clinical practice. The prevalence of 25(OH)D deficiency in the Amazon population is not well known, and there are few studies in patients with malaria. This study aimed to evaluate 25(OH)D serum levels in patients with malaria and determine their relationships with epidemiological, clinical, laboratory, and parasitemia data. Methods: An analytical cross-sectional study of 123 patients with malaria and 122 individuals without malaria was performed in Itaituba, Pará, Brazil, from January 2018 to October 2019, by evaluating sociodemographic, clinical-epidemiological, parasitological, and laboratory data and adopting a 5% significance level. Parametric tests (Student's t-test), non-parametric tests (Mann-Whitney U), and Spearman’s correlation ([rs], for non-parametric variables) were used according to the nature of the distribution of the variables. For the qualitative variables, Pearson's chi-square test, Fisher's exact test, and the G test were used. Spearman's correlation was used to compare the results of the 25(OH)D levels and blood counts performed among patients and the control group. Results: Malaria patients residing in a mining area had 25(OH)D serum levels that were significantly lower than those in the control group residing in the mining area, though both were within normal levels. Red blood cell counts had an inverse correlation with parasitemia (Plasmodium falciparum), and platelet levels had an inverse correlation with parasitemia (Plasmodium vivax). 25(OH)D deficiency was evidenced in Itaituba, in the state of Pará, which is an endemic area of malaria in the Amazon region.

https://doi.org/10.1590/0037-8682-0077-2021

Malária na fronteira do Brasil com a Guiana Francesa: a influência dos determinantes sociais e ambientais da saúde na permanência da doença
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Gomes, Margarete do Socorro Mendonça

; Menezes, Rubens Alex de Oliveira

; Vieira, José Luís Fernandez

; Mendes, Anapaula Martins

; Silva, Gutemberg de Vilhena

; Peiter, Paulo Cesar

; Suárez-Mutis, Martha Cecilia

; Franco, Vivian da Cruz

; Couto, Álvaro A. R. D’Almeida

; Machado, Ricardo Luiz Dantas

Saúde e Sociedade

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2020, Volume 29 N. 2 elocation e181046

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

Resumo O objetivo deste artigo é analisar a influência dos determinantes socioambientais da saúde na incidência de malária por Plasmodium vivax na fronteira franco-brasileira. O estudo foi realizado entre 2011 e 2015, no município de Oiapoque (AP), na Amazônia brasileira. Foram incluídos na amostra 253 indivíduos de ambos os sexos, de 10 a 60 anos de idade. Houve predominância de 63,64% (161/253) de casos de malária em adultos do sexo masculino. A faixa etária mais acometida foi de 20 a 29 anos, com 30% (76/253); 84,6% (214/253) dos pacientes não concluíram o ensino médio, e 29,6% (75/253) não concluíram o ensino primário. No aspecto ambiental, houve correlação negativa entre as precipitações pluviométricas e a incidência da malária por P. vivax (p=0,0026). Em termos de mobilidade, constatou-se considerável proporção de migrantes provenientes dos estados do Pará e do Maranhão (55,73%; 141/253). Por fim, os dados apontaram que 31,23% (79/253) dos casos de malária foram importados da Guiana Francesa. Em síntese, a transmissão da malária na fronteira franco-brasileira envolve fatores ecológico-ambientais, biológicos e sociais que se expressam na elevada vulnerabilidade social da população que vive e circula na zona fronteiriça, favorecendo a ocorrência de surtos e a permanência da enfermidade.

Abstract This study analyzes the influence of socio-environmental health determinants on the maintenance of Plasmodium vivax malaria at the borders between French Guiana and Brazil. This study was carried out between 2011 and 2015 in the city of Oiapoque, Amapá, situated in the Brazilian Amazon region. The sample included 253 individuals of both sexes aged between 10 and 60 years. The disease was predominant in 63.64% (161/253) adult males. The most affected age group was 20 to 29 years old, with 30% (76/253). About 84.6% did not complete high school, while 29.6% (75/253) of the cases had not finished the first degree. Concerning the environmental aspect, negative correlation was observed between rainfall and the incidence of P. vivax malaria (p=0.0026). In terms of mobility, there was a considerable influx of migrants from the states of Pará and Maranhão, with 55.73% (141/253). Lastly, the data indicated that 31.23% (79/253) of malaria cases were imported from French Guiana. In summary, the transmission of malaria in these particular borders involved ecological, environmental, biological and social factors, which are expressed in the high social vulnerability of the population living and circulating in the border zone, favoring the occurrence of outbreaks and the maintenance of the disease.

https://doi.org/10.1590/s0104-12902020181046 1426 downloads

Malária na fronteira do Brasil com a Guiana Francesa: a influência dos determinantes sociais e ambientais da saúde na permanência da doença
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Gomes, Margarete do Socorro Mendonça

; Menezes, Rubens Alex de Oliveira

; Vieira, José Luís Fernandez

; Mendes, Anapaula Martins

; Silva, Gutemberg de Vilhena

; Peiter, Paulo Cesar

; Suárez-Mutis, Martha Cecilia

; Franco, Vivian da Cruz

; Couto, Álvaro A. R. D’Almeida

; Machado, Ricardo Luiz Dantas

Saúde e Sociedade

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2020, Volume 29 N. 2 elocation e181046

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

https://doi.org/10.1590/s0104-12902020181046

Chloroquine and mefloquine resistance profiles are not related to the circumsporozoite protein (CSP) VK210 subtypes in field isolates of Plasmodium vivax from Manaus, Brazilian Amazon
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Pratt-Riccio, Lilian Rose

; Baptista, Bárbara de Oliveira

; Torres, Vanessa Rodrigues

; Bianco-Junior, Cesare

; Perce-Da-Silva, Daiana de Souza

; Riccio, Evelyn Kety Pratt

; Lima-Junior, Josué da Costa

; Totino, Paulo Renato Rivas

; Cassiano, Gustavo Capatti

; Storti-Melo, Luciane Moreno

; Machado, Ricardo Luiz Dantas

; de Oliveira-Ferreira, Joseli

; Banic, Dalma Maria

; Carvalho, Leonardo José de Moura

; Daniel-Ribeiro, Cláudio Tadeu

Memórias do Instituto Oswaldo Cruz

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2019, Volume 114 elocation e190054

Abstract: En | Text: En | PDF: En

BACKGROUND The central repetitive region (CRR) of the Plasmodium vivax circumsporozoite surface protein (CSP) is composed of a repetitive sequence that is characterised by three variants: VK210, VK247 and P. vivax-like. The most important challenge in the treatment of P. vivax infection is the possibility of differential response based on the parasite genotype. OBJECTIVES To characterise the CSP variants in P. vivax isolates from individuals residing in a malaria-endemic region in Brazil and to profile these variants based on sensitivity to chloroquine and mefloquine. METHODS The CSP variants were determined by sequencing and the sensitivity of the P. vivax isolates to chloroquine and mefloquine was determined by Deli-test. FINDINGS Although five different allele sizes were amplified, the sequencing results showed that all of the isolates belonged to the VK210 variant. However, we observed substantial genetic diversity in the CRR, resulting in the identification of 10 different VK210 subtypes. The frequency of isolates that were resistant to chloroquine and mefloquine was 11.8 and 23.8%, respectively. However, we did not observe any difference in the frequency of the resistant isolates belonging to the VK210 subtypes. MAIN CONCLUSION The VK210 variant is the most frequently observed in the studied region and there is significant genetic variability in the CRR of the P. vivax CSP. Moreover, the antimalarial drug sensitivity profiles of the isolates does not seem to be related to the VK210 subtypes.

https://doi.org/10.1590/0074-02760190054 912 downloads

Plasmodium falciparum malarial parasites from Brazil lack artemisinin resistance-associated mutations in the kelch13 gene
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Chapadense, Francesca

; Machado, Ricardo Luiz Dantas

; Ventura, Ana Maria Revorêdo da Silva

; Áreas, André

; Machado, Renato Beilner

; Viana, Giselle Rachid

; Zalis, Mariano Gustavo

; Castro, Ana Maria de

; Cravo, Pedro

Revista da Sociedade Brasileira de Medicina Tropical

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2019, Volume 52 elocation e20180225

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION Mutations in the propeller domain of the Plasmodium falciparum kelch13 (k13) gene are associated with artemisinin resistance. METHODS: We developed a PCR protocol to sequence the pfk13 gene and determined its sequence in a batch of 50 samples collected from 2003 to 2016 in Brazil. RESULTS: We identified 1 K189T substitution located outside the propeller domain of the PfK13 protein in 36% of samples. CONCLUSIONS: Although the sample size is relatively small, these results suggest that P. falciparum artemisinin-resistant mutants do not exist in Brazil, thereby supporting the continuation of current treatment programs based on artemisinin-based combination therapy.

https://doi.org/10.1590/0037-8682-0225-2018 1502 downloads

Co-infection with arthropod-borne pathogens in domestic cats
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André, Marcos Rogério

; Filgueira, Kilder Dantas

; Calchi, Ana Cláudia

; Sousa, Keyla Carstens Marques de

; Gonçalves, Luiz Ricardo

; Medeiros, Vitor Brasil

; Ximenes, Poliana Araújo

; Lelis, Ivana Cristina Nunes Gadelha

; Meireles, Maria Vanuza Nunes de

; Machado, Rosangela Zacarias

Revista Brasileira de Parasitologia Veterinária

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dec 2017, Volume 26 N. 4 Pages 525 - 531

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

Resumo O papel de diversos patógenos felinos transmitidos por vetores (PFTV) como causa de enfermidades em gatos não tem sido claramente determinado. De fato, com exceção de Bartonella spp. e hemoplasmas, PFTV têm sido bem menos estudados no Brasil. O presente estudo objetivou investigar, utilizando métodos moleculares, a presença de PFTV em três gatos apresentando sinais clínicos inespecíficos e inclusões sugestivas de hemoparasitas em esfregaços sanguíneos. Cytauxzoon felis, ‘Candidatus Mycoplasma haemominutum’, Ehrlichia sp. filogeneticamente relacionada a Ehrlichia canis, e Anaplasma sp. filogeneticamente relacionado a Anaplasma phagocytophilum foram detectados em amostras de sangue de dois dos três gatos amostrados. Os dois gatos positivos para múltiplos PFTV não apresentaram alterações hematológicas e bioquímicas. O presente trabalho enfatiza a necessidade de confirmação molecular da infecção por múltiplos PFTV em gatos apresentando sinais clínicos inespecíficos e inclusões sugestivas de hemoparasitas em esfregaços sanguíneos.

Abstract The role of several feline vector-borne pathogens (FVBP) as a cause of disease in cats has not been clearly determined. In fact, with the exception of Bartonella spp. and hemoplasmas, FVBP in cats has not been clearly determined in Brazil yet. The present study aimed at identifying, by using molecular methods, the presence of FVBP in three cats showing non-specific clinical signs and inclusions suggestive of hemoparasites in blood smears. Cytauxzoon felis, ‘Candidatus Mycoplasma haemominutum’, Ehrlichia sp. closely related to Ehrlichia canis, and Anaplasma sp. closely related to Anaplasma phagocytophilum were detected in blood samples from two out of three sampled cats. Both cats positive for multiple FVBP did not show hematological and biochemical abnormalities. The present work emphasizes the need for molecular confirmation of co-infection by multiple FVBP in cats presenting non-specific clinical signs and inclusions resembling hemoparasites in blood smears.

https://doi.org/10.1590/s1984-29612017064 1531 downloads

Diretrizes para avaliação e validação do potencial doador de órgãos em morte encefálica
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Westphal, Glauco Adrieno

; Garcia, Valter Duro

; Souza, Rafael Lisboa de

; Franke, Cristiano Augusto

; Vieira, Kalinca Daberkow

; Birckholz, Viviane Renata Zaclikevis

; Machado, Miriam Cristine

; Almeida, Eliana Régia Barbosa de

; Machado, Fernando Osni

; Sardinha, Luiz Antônio da Costa

; Wanzuita, Raquel

; Silvado, Carlos Eduardo Soares

; Costa, Gerson

; Braatz, Vera

; Caldeira Filho, Milton

; Furtado, Rodrigo

; Tannous, Luana Alves

; Albuquerque, André Gustavo Neves de

; Abdala, Edson

; Gonçalves, Anderson Ricardo Roman

; Pacheco-Moreira, Lúcio Filgueiras

; Dias, Fernando Suparregui

; Fernandes, Rogério

; Giovanni, Frederico Di

; Carvalho, Frederico Bruzzi de

; Fiorelli, Alfredo

; Teixeira, Cassiano

; Feijó, Cristiano

; Camargo, Spencer Marcantonio

; Oliveira, Neymar Elias de

; David, André Ibrahim

; Prinz, Rafael Augusto Dantas

; Herranz, Laura Brasil

; Andrade, Joel de

Revista Brasileira de Terapia Intensiva

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sep 2016, Volume 28 N. 3 Pages 220 - 255

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

RESUMO O transplante de órgãos é a única alternativa para muitos pacientes portadores de algumas doenças terminais. Ao mesmo tempo, é preocupante a crescente desproporção entre a alta demanda por transplantes de órgãos e o baixo índice de transplantes efetivados. Dentre as diferentes causas que alimentam essa desproporção, estão os equívocos na identificação do potencial doador de órgãos e as contraindicações mal atribuídas pela equipe assistente. Assim, o presente documento pretende fornecer subsídios à equipe multiprofissional da terapia intensiva para o reconhecimento, a avaliação e a validação do potencial doador de órgãos.

ABSTRACT Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.

https://doi.org/10.5935/0103-507X.20160049 53556 downloads

Analysis of potential drug interactions and adverse reactions to nonsteroidal anti-inflammatory drugs among the elderly
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Lima, Tiago Aparecido Maschio de

; Furini, Adriana Antônia da Cruz

; Atique, Tábata Salum Calille

; Di Done, Patricia

; Machado, Ricardo Luiz Dantas

; Godoy, Moacir Fernandes de

Revista Brasileira de Geriatria e Gerontologia

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jun 2016, Volume 19 N. 3 Pages 533 - 544

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

Resumo Objetivo: Analisar potenciais interações medicamentosas e reações adversas a anti-inflamatórios não esteroides (AINEs) em idosos usuários de um serviço particular de distribuição de medicamentos. Método: Trata-se de um estudo prospectivo, exploratório e descritivo com abordagem quantitativa. Foram analisadas receitas e entrevistados idosos usuários de AINEs atendidos no serviço no período entre maio e setembro de 2014. A análise de interações medicamentosas foi realizada por meio de bases de dados informatizadas. Para a análise pós-comercialização das reações adversas foi utilizada a Escala de Probabilidade de Reação Adversa a Medicamentos. Para a análise estatística foram utilizados os testes Qui-quadrado e Exato de Fisher. Resultados: Foram incluídos 200 idosos com predomínio de mulheres (56,5%). A média de idade foi 65±10 anos. Os AINEs corresponderam a 38,7% dos medicamentos prescritos, entre eles: dipirona sódica (26,9%), nimesulida (22,8%) e cetoprofeno (16,3%); dos quais, 8,5% constavam na lista de medicamentos inapropriados para idosos. Foram identificadas 104 potenciais interações medicamentosas, sendo 24% de maior intensidade. Os AINEs com maior risco de interações foram cetoprofeno 46,2%, cetorolaco 14,4%, nimesulida 12,5% e diclofenaco 9,6%. No acompanhamento pós-comercialização, 30,5% dos idosos relataram sintomas indesejáveis após o uso de AINE, sendo desconforto estomacal (17%) o mais incidente. Conclusão: Conclui-se a importância do monitoramento do uso de AINEs em idosos devido ao aumento no risco de interações medicamentosas e reações adversas, associado à idade, doenças concomitantes, multiprescrição e polimedicação. A escolha de medicamentos apropriados para idosos, a reconciliação de todos os medicamentos em uso pelo paciente e a atenção farmacêutica efetiva são medidas que contribuem para o uso racional e seguro de AINEs.

Abstract Objective: The aim of the present study was to analyze potential drug interactions and adverse reactions to NSAIDs in elderly users of a private drug distribution service. Method: A prospective, exploratory and descriptive study with a quantitative approach was performed. The elderly users of NSAIDs attended by the service were interviewed and their prescriptions analyzed between May and September, 2014. Analysis of drug interactions was performed through computerized databases. The post-sales analysis of adverse reactions was performed using the Adverse Drug Reaction Probability Scale. Statistical analysis was performed with the Chi-squared and Fisher's Exact tests. Results: The study evaluated 200 elderly persons, among whom women predominated (56.5%). The average age was 65 years ±10. The NSAIDs accounted for 38.7% of prescription drugs used, and included dipyrone (26.9%), nimesulide (22.8%) and ketoprofen (16.3%). A total of 8.5% of such drugs were considered inappropriate medications for the elderly. A total of 104 potential drug interactions were identified, of which 24% were considered highly clinically significant. The NSAIDs with the greatest risk of interactions were ketoprofen 46.2%, ketorolac 14.4%, nimesulide 12.5% and diclofenac 9.6%. In post-sales monitoring 30.5% of the elderly persons reported undesirable symptoms after the use of NSAIDs, with stomach discomfort the most prevalent (17%). Conclusion: The present study confirmed the importance of monitoring the use of NSAIDs among the elderly due to the increased risk of drug interactions and adverse reactions associated with age, concomitant diseases, multi- prescriptions and polypharmacy. The choice of appropriate drugs for the elderly, the reconciliation of all the medications taken by the patient, and effective pharmaceutical care are measures that can contribute to the rational and safe use of NSAIDs.

https://doi.org/10.1590/1809-98232016019.150062 20957 downloads

EVALUATION OF CIRCUMSPOROZOITE PROTEIN OF Plasmodium vivax TO ESTIMATE ITS PREVALENCE IN OIAPOQUE , AMAPÁ STATE, BRAZIL, BORDERING FRENCH GUIANA
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GOMES, Margarete do Socorro Mendonça

; VIEIRA, José Luiz Fernandes

; CASSIANO, Gustavo Capatti

; MUSSET, Lise

; LEGRAND, Eric

; NACHER, Mathieu

; COUTO, Vanja Suely Calvosa D'Almeida

; MACHADO, Ricardo Luiz Dantas

; COUTO, Álvaro Augusto Ribeiro D'Almeida

Revista do Instituto de Medicina Tropical de São Paulo

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2016, Volume 58 elocation 72

Abstract: En | Text: En | PDF: En

SUMMARY Malaria is a major health problem for people who live on the border between Brazil and French Guiana. Here we discuss Plasmodium vivax distribution pattern in the town of Oiapoque, Amapá State using the circumsporozoite (CS) gene as a marker. Ninety-one peripheral blood samples from P. vivax patients have been studied. Of these, 64 individuals were from the municipality of Oiapoque (Amapá State, Brazil) and 27 patients from French Guiana (August to December 2011). DNA extraction was performed, and a fragment of the P. vivax CS gene was subsequently analyzed using PCR/RFLP. The VK210 genotype was the most common in both countries (48.36% in Brazil and 14.28% in French Guiana), followed by the P. vivax-like (1.10% in both Brazil and French Guiana) and VK247 (1.10% only in Brazil) in single infections. We were able to detect all three CS genotypes simultaneously in mixed infections. There were no statistically significant differences either regarding infection site or parasitaemia among individuals with different genotypes. These results suggest that the same genotypes circulating in French Guiana are found in the municipality of Oiapoque in Brazil. These findings suggest that there may be a dispersion of parasitic populations occurring between the two countries. Most likely, this distribution is associated with prolonged and/or more complex transmission patterns of these genotypes in Brazil, bordering French Guiana.

https://doi.org/10.1590/S1678-9946201658072 1088 downloads

10.

Basic sanitation, socioeconomic conditions, and degree of risk for the presence and maintenance of malaria in a low-transmission area in the Brazilian Amazon
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Monteiro, Thais Hetierre Abreu

; Chaves, Tânia do Socorro Souza

; Matos, Haroldo José de

; Sofffiatti, Nelson Fernando de Lisboa

; Guimarães, Ricardo José de Paula Souza e

; Guimarães, Luis Henrique Rocha

; Ventura, Ana Maria Revoredo

; Machado, Ricardo Luiz Dantas

Revista da Sociedade Brasileira de Medicina Tropical

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oct 2015, Volume 48 N. 5 Pages 573 - 579

Abstract: En | Text: En | PDF: En

ABSTRACTINTRODUCTION:This study aimed to evaluate basic sanitation and socioeconomic indicators, reported cases of malaria, and risk of contracting malaria in the Ananindeua municipality, State of Pará.METHODS:Data on basic sanitation and socioeconomic dimensions were taken from the Brazilian Institute of Geography and Statistics [ Instituto Brasileiro de Geografia e Estatística (IBGE)] 2010 census. Epidemiological malaria information was taken from the Epidemiological Malaria Surveillance Information System [ Sistema de Informação de Vigilância Epidemiológica de Malária (SIVEP/Malaria)], between 2003 and 2013 of the Ministry of Health and from the SIVEP/Malaria forms of the municipality's Endemic Diseases Unit for 2,013 cases.RESULTS:Our data do not confirm the correlation among indicators of basic sanitation, socioeconomic conditions, and water supply with malaria cases. Of the 1,557 cases evaluated, most were caused by Plasmodium vivax , with rare cases of Plasmodium falciparum and mixed infections. There were 756 notifications in 2003. The number of reported cases was sharply reduced between 2006 and 2012, but a 142-case outbreak occurred in 2013. Ananindeua municipality's Annual Parasite Index indicated low risk in 2003 and no risk in other years, and the 2,013 cases were predominantly male individuals aged ≥40 years.CONCLUSIONS:Our data confirm the non-endemicity of malaria in the Ananindeua municipality, as the Annual Parasite Indices described for the years 2004-2013 classify it as a risk-free area. However, the 2013 outbreak indicates the need to strengthen prevention, surveillance, and control activities to reduce the risk of new outbreaks and consequent economic and social impacts on the population.

https://doi.org/10.1590/0037-8682-0118-2015 2385 downloads

11.

Opportunistic infections among individuals with HIV-1/AIDS in the highly active antiretroviral therapy era at a Quaternary Level Care Teaching Hospital
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Galisteu, Katia Jaira

; Cardoso, Luciana Ventura

; Furini, Adriana Antônia da Cruz

; Schiesari Júnior, Arlindo

; Cesarino, Claudia Bernardi

; Franco, Célia

; Baptista, Andrea Regina de Souza

; Machado, Ricardo Luiz Dantas

Revista da Sociedade Brasileira de Medicina Tropical

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apr 2015, Volume 48 N. 2 Pages 149 - 156

Abstract: En | Text: En | PDF: En

INTRODUCTION : In this study, clinical-laboratory and epidemiological characteristics are described for a group of 700 individuals with HIV (human immunodeficiency virus)/AIDS (acquired immunodeficiency syndrome) in the ART (antiretroviral therapy) era at a teaching hospital that provides a quaternary level of care, with an emphasis on opportunistic infections (OIs), co-infections and immune profile. METHODS : A retrospective cross-sectional study of AIDS cases was conducted from 1998 to 2008 by reviewing medical records from the Base Hospital/FUNFARME (Fundação Faculdade Regional de Medicina), São José do Rio Preto, São Paulo, Brazil. RESULTS: The individuals were 14 to 75 years of age, and 458 were males. Heterosexuals accounted for 31.1% of all patients. Eighty-three percent were on ART, and 33.8% of those presented difficulties with treatment adherence. OIs were analyzed from medical records, and Pneumocystis jiroveci pneumonia was the most prevalent, regardless of the LTCD4+ (TCD4+ Lymphocytes) levels. Individuals whose viral loads were ≥10,000 showed a 90% greater chance of neurotoxoplasmosis. For P. jiroveci pneumonia, neurotoxoplasmosis, esophageal candidiasis, pulmonary tuberculosis and neurocryptococcosis, the chances of infection were higher among patients with LTCD4+ levels below 200 cells/mm3. HIV/hepatitis C virus (HCV) and HIV/hepatitis B virus (HBV) co-infections were significantly associated with death. CONCLUSIONS : OIs remain frequent in the ART era even in populations where the access to medical care is considered satisfactory.

https://doi.org/10.1590/0037-8682-0299-2014 12298 downloads

12.

Clinical and epidemiological profiles of individuals with drug-resistant tuberculosis
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Pedro, Heloisa da Silveira Paro

; Nardi, Susilene Maria Tonelli

; Pereira, Maria Izabel Ferreira

; Oliveira, Rosângela Siqueira

; Suffys, Philip Noel

; Gomes, Harrison Magdinier

; Finardi, Amanda Juliane

; Moraes, Eloise Brasil de

; Baptista, Ida Maria Foschiani Dias

; Machado, Ricardo Luiz Dantas

; Castiglioni, Lilian

Memórias do Instituto Oswaldo Cruz

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apr 2015, Volume 110 N. 2 Pages 235 - 248

Abstract: En | Text: En | PDF: En

Drug-resistant tuberculosis (TB) is a growing global threat. Approximately 450,000 people developed multidrug-resistant TB worldwide in 2012 and an estimated 170,000 people died from the disease. This paper describes the sociodemographic, clinical-epidemiological and bacteriological aspects of TB and correlates these features with the distribution of anti-TB drug resistance. Mycobacterium tuberculosis (MT) cultures and drug susceptibility testing were performed according to the BACTEC MGIT 960 method. The results demonstrated that MT strains from individuals who received treatment for TB and people who were infected with human immunodeficiency virus were more resistant to TB drugs compared to other individuals (p < 0.05). Approximately half of the individuals received supervised treatment, but most drug-resistant cases were positive for pulmonary TB and exhibited positive acid-fast bacilli smears, which are complicating factors for TB control programs. Primary healthcare is the ideal level for early disease detection, but tertiary healthcare is the most common entry point for patients into the system. These factors require special attention from healthcare managers and professionals to effectively control and monitor the spread of TB drug-resistant cases.

https://doi.org/10.1590/0074-02760140316 2214 downloads

13.

ENTEROPATHOGENS DETECTED IN A DAYCARE CENTER, SOUTHEASTERN BRAZIL: BACTERIA, VIRUS, AND PARASITE RESEARCH
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Castro, Edna Donizetti Rossi

; Germini, Marcela Cristina Braga Yassaka

; Mascarenhas, Joana D'Arc Pereira

; Gabbay, Yvone Benchimol

; Lima, Ian Carlos Gomes de

; Lobo, Patrícia dos Santos

; Fraga, Valéria Daltibari

; Conceição, Luciana Moran

; Machado, Ricardo Luiz Dantas

; Rossit, Andréa Regina Baptista

Revista do Instituto de Medicina Tropical de São Paulo

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feb 2015, Volume 57 N. 1 Pages 27 - 32

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

Introdução: O objetivo deste estudo foi determinar a prevalência e o perfil etiológico de enteropatógenos em crianças de uma creche. Métodos: No período de outubro de 2010 a fevereiro de 2011 foram coletadas e analisadas amostras de fezes de 100 crianças matriculadas em creche do governo no município de São José do Rio Preto, Estado de São Paulo. Resultados: Um total de 246 bactérias foram isoladas em 99% das amostras de fezes; 129 eram diarreicas e 117 não-diarreicas. Foram isoladas setenta e três cepas de Escherichia coli, 19 de Enterobacter, uma de Alcaligenes e uma de Proteus. Foram detectados 14 casos de colonização mista com Enterobacter e de E. coli. Norovírus e Astrovirus foram detectados em crianças com sinais clínicos sugestivos de diarréia. Estes vírus foram detectados exclusivamente entre as crianças residentes em áreas urbanas. Todas as amostras fecais foram negativas para a presença das espécies de rotavírus A e C. Foi observada a presença de Giardia lamblia, Entamoeba coli, Endolimax nana e ancilostomídeos. Foi encontrada associação significativa entre o consumo de alimentos fora do centro da casa e creche e a presença de parasitos intestinais. Conclusões: Para as crianças desta creche, a infecção intestinal por patógenos não parece ter contribuido para a ocorrência de diarreia ou outros sintomas intestinais. As diferenças observadas podem ser atribuídas à grande diversidade de características geográficas, sociais e econômicas e o clima do Brasil, as quais tem sido relatadas como fatores críticos para a modulação da frequência de diferentes enteropatógenos

Introduction: The objective of this study was to determine the prevalence and etiological profile of enteropathogens in children from a daycare center. Methods: From October 2010 to February 2011 stool samples from 100 children enrolled in a government daycare center in the municipality of São José do Rio Preto, in the state of São Paulo, were collected and analyzed. Results: A total of 246 bacteria were isolated in 99% of the fecal samples; 129 were in the diarrheal group and 117 in the non-diarrheal group. Seventy-three strains of Escherichia coli were isolated, 19 of Enterobacter, one of Alcaligenes and one of Proteus. There were 14 cases of mixed colonization with Enterobacter and E. coli. Norovirus and Astrovirus were detected in children with clinical signs suggestive of diarrhea. These viruses were detected exclusively among children residing in urban areas. All fecal samples were negative for the presence of the rotavirus species A and C. The presence of Giardia lamblia, Entamoeba coli, Endolimax nana and hookworm was observed. A significant association was found between food consumption outside home and daycare center and the presence of intestinal parasites. Conclusions: For children of this daycare center, intestinal infection due to pathogens does not seem to have contributed to the occurrence of diarrhea or other intestinal symptoms. The observed differences may be due to the wide diversity of geographical, social and economic characteristics and the climate of Brazil, all of which have been reported as critical factors in the modulation of the frequency of different enteropathogens.

https://doi.org/10.1590/S0036-46652015000100004 3351 downloads

14.

Study on coinfecting vector-borne pathogens in dogs and ticks in Rio Grande do Norte, Brazil
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Gonçalves, Luiz Ricardo

; Filgueira, Kilder Dantas

; Ahid, Silvia Maria Mendes

; Pereira, Josivânia Soares

; Vale, André Mendes do

; Machado, Rosangela Zacarias

; André, Marcos Rogério

Revista Brasileira de Parasitologia Veterinária

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sep 2014, Volume 23 N. 3 Pages 407 - 412

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

Cães que apresentam diversas doenças transmitidas por vetores podem mostrar nenhum ou alguns sinais clínicos inespecíficos. Dependendo da fase da infecção, a confirmação dos agentes envolvidos é necessária. O presente estudo teve como objetivo detectar a presença de Babesia spp., Ehrlichia spp., Anaplasma spp., Hepatozoon spp. e Leishmania spp. em amostras de sangue e carrapatos, coletados em dois cães do Rio Grande do Norte. Esses animais apresentavam sinais clínicos sugestivos de doenças transmitidas por carrapatos, quando foram usadas técnicas moleculares. DNA de E. canis, H. canis e L. infantum foram detectados em amostras de sangue e carrapatos R. sanguineus coletados dos cães. Entre todas as amostras analisadas, duas mostraram a presença de infecções múltiplas por E. canis, H. canis e L. infantum chagasi. Destaca-se a necessidade de um diagnóstico molecular diferencial em cães com sinais clínicos inespecíficos.

Since dogs presenting several vector borne diseases can show none or nonspecific clinical signs depending on the phase of infection, the assessment of the particular agents involved is mandatory. The present study aimed to investigate the presence of Babesia spp., Ehrlichia spp., Anaplasma spp., Hepatozoon spp. and Leishmania spp. in blood samples and ticks, collected from two dogs from Rio Grande do Norte showing suggestive tick-borne disease by using molecular techniques. DNA of E. canis, H. canis and L. infantum were detected in blood samples and R. sanguineus ticks collected from dogs. Among all samples analyzed, two showed the presence of multiple infections with E. canis, H. canis and L. infantum chagasi. Here we highlighted the need for molecular differential diagnosis in dogs showing nonspecific clinical signs.

https://doi.org/10.1590/S1984-29612014071 2890 downloads

15.

Detection of Mycobacterium tuberculosis complex by nested polymerase chain reaction in pulmonary and extrapulmonary specimens
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Furini, Adriana Antônia da Cruz

; Pedro, Heloisa da Silveira Paro

; Rodrigues, Jean Francisco

; Montenegro, Lilian Maria Lapa

; Machado, Ricardo Luiz Dantas

; Franco, Célia

; Schindler, Haiana Charifker

; Batista, Ida Maria Foschiani Dias

; Rossit, Andrea Regina Baptista

Jornal Brasileiro de Pneumologia

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dec 2013, Volume 39 N. 6 Pages 711 - 718

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

OBJETIVO: Comparar o desempenho da técnica nested polymerase chain reaction (NPCR) com aquele de culturas na detecção do complexo Mycobacterium tuberculosis em espécimes pulmonares e extrapulmonares.MÉTODOS: Analisamos 20 e 78 espécimes pulmonares e extrapulmonares, respectivamente, de 67 pacientes hospitalizados com suspeita de tuberculose. Um sistema automatizado foi utilizado na identificação de culturas de Mycobacterium spp., e M. tuberculosis IS6110 foi utilizada como sequência alvo na NPCR. A estatística kappa foi utilizada para verificar a concordância entre os resultados.RESULTADOS: Entre os 67 pacientes, 6 e 5, respectivamente foram diagnosticados com tuberculose pulmonar e extrapulmonar, e a NPCR foi positiva em todos os casos. Entre os 98 espécimes clínicos, a baciloscopia, cultura e NPCR foram positivas em 6,00%, 8,16% e 13,26%, respectivamente. Comparando-se os resultados da NPCR com aqueles da cultura (padrão ouro) nos espécimes pulmonares, a sensibilidade e a especificidade foram 100% e 83%, respectivamente, enquanto essas nos espécimes extrapulmonares foram 83% e 96% respectivamente, com boa concordância entre os testes (kappa, 0,50 e 0,6867, respectivamente).CONCLUSÕES: Embora a NPCR tenha se mostrado uma ferramenta muito útil na detecção do complexo M. tuberculosis, No entanto, os resultados positivos da NPCR devem ser associados à clínica, dados clínicos, epidemiológicos e outros dados laboratoriais devem também ser considerados no diagnóstico e tratamento da tuberculose pulmonar e extrapulmonar.

OBJECTIVE: To compare the performance of nested polymerase chain reaction (NPCR) with that of cultures in the detection of the Mycobacterium tuberculosis complex in pulmonary and extrapulmonary specimens.METHODS: We analyzed 20 and 78 pulmonary and extrapulmonary specimens, respectively, of 67 hospitalized patients suspected of having tuberculosis. An automated microbial system was used for the identification of Mycobacterium spp. cultures, and M. tuberculosis IS6110 was used as the target sequence in the NPCR. The kappa statistic was used in order to assess the level of agreement among the results.RESULTS: Among the 67 patients, 6 and 5, respectively, were diagnosed with pulmonary and extrapulmonary tuberculosis, and the NPCR was positive in all of the cases. Among the 98 clinical specimens, smear microscopy, culture, and NPCR were positive in 6.00%, 8.16%, and 13.26%, respectively. Comparing the results of NPCR with those of cultures (the gold standard), we found that NPCR had a sensitivity and specificity of 100% and 83%, respectively, in pulmonary specimens, compared with 83% and 96%, respectively, in extrapulmonary specimens, with good concordance between the tests (kappa, 0.50 and 0.6867, respectively).CONCLUSIONS: Although NPCR proved to be a very useful tool for the detection of M. tuberculosis complex, clinical, epidemiological, and other laboratory data should also be considered in the diagnosis and treatment of pulmonary and extrapulmonary tuberculosis.

https://doi.org/10.1590/S1806-37132013000600010 6685 downloads

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