The objective of the present study was to evaluate the contribution of the shared epitope (SE), the rheumatoid arthritis (RA) protection model, and the occurrence of anti-cyclic citrullinated peptide (anti-CCP) antibodies in RA patients from a genetically diverse population. One hundred and forty Brazilian RA patients and 161 matched controls were typed for HLA-DRB1 alleles using amplified DNA hybridized with sequence-specific oligonucleotide probes or primers. Patients were stratified according to the presence or absence of SE (DRB1*0401, *0404, *0405, *0101, *1001, and *1402), of the DERAA alleles (DRB1*0103, *0402, *1102, *1103, *1301, *1302, and *1304), and X (all other alleles). Anti-CCP antibodies were measured by ELISA. The combined frequency of SE-positive alleles was significantly greater (76.4 vs 23.6%, P < 0.0001) than the controls. The SE/SE and SE/X genotypes were over-represented (P < 0.0001, OR = 6.02) and DERAA/X was under-represented in RA patients (P < 0.001, OR = 0.49), whereas the frequencies of the SE/DERAA, X/X and X/DERAA genotypes were not significantly different from controls. The frequency of anti-CCP antibodies was higher in SE-positive patients than in SE-negative patients (64.6 vs 44.7%, P = 0.03; OR = 2.25). Although the Brazilian population is highly miscegenated, the results of this study support the findings observed in most genetically homogeneous populations with RA; however, they are not mutually exclusive but rather complementary. The participation of DRB1-DERAA alleles in protection against RA was also observed (OR = 0.4; 95%CI = 0.23-0.68).

OBJETIVO: O isolamento de leveduras na urina não indica necessariamente infecção, porém a infecção do trato urinário por Candida constitui um problema hospitalar crescente. Neste estudo, o significado clínico da candidúria foi investigado em hospital universitário brasileiro. MÉTODOS: Em 1998, Candida spp. foi isolada na urina de 166 pacientes internados no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-SP. Os prontuários médicos de 100 destes pacientes, com candidúria detectada depois de três ou mais dias de hospitalização, foram revisados sobre aspectos microbiológicos, epidemiológicos e clínicos referentes a esse episódio. RESULTADOS: C. tropicalis foi isolada em 53% e C. albicans em 36% dos casos. Em 76% do doentes, a urocultura mostrou mais de 20.000 colônias de leveduras/mL. Doenças subjacentes crônicas, como neuropatias, cardiopatias e outras neoplasias e trauma foram freqüentes. Dos pacientes, 25% tinham diabetes mellitus. Os principais fatores predisponentes associados com candidúria foram: antibioticoterapia prévia (93%), sonda vesical de demora (83%), cirurgia nos últimos 60 dias (48%), insuficiência renal (32%), infecção bacteriana simultânea (28%) e uso de corticosteróides (20%) ou imunossupressores (10%). Apenas 43/100 pacientes foram tratados, 42 com fluconazol ou anfotericina B. No período de 60 dias após o episódio de candidúria, 40% dos doentes faleceram. CONCLUSÕES: Na presente casuística, as espécies não-albicans de Candida foram os principais agentes de candidúria, sendo considerados patógenos emergentes do trato urinário em pacientes gravemente enfermos. Foram, ainda, observadas doenças subjacentes, fatores de risco e alta mortalidade comumente associados com a candidíase do trato urinário.

BACKGROUND: Isolation of a yeast in urine does not necessarily indicate infection, but Candida urinary tract infection is an increasing nosocomial problem. In this study the clinical significance of candiduria was investigated in a Brazilian university hospital. METHODS: Between January and December 1998 species of Candida were isolated in the urine of 166 patients admitted to a tertiary-care general hospital at Ribeirão Preto, SP, Brazil. The data of 100 of these patients were retrospectivelly reviewed concerning microbiological, epidemiological, and clinical aspects of candiduria. RESULTS: C. tropicalis was found in 53% of the patients and C. albicans in 36%. Urine cultures yielded more than 20.000 yeast colonies/ml in 76% of cases. Neurological, cardiac and other chronic diseases, cancer, and trauma were frequent underlying illnesses. Diabetes mellitus was present in 25% of patients. The major predisposing factors associated with candiduria were previous antibiotic therapy (93%) indwelling urinary catheter (83%), surgery in the last 60 days (48%), renal failure (32%), concomitant bacterial infections (28%), use of corticosteroids (20%), and use of other immunosuppressive drugs (10%). Therapy for candiduria, fluconazole or amphotericin B with one exception, was given only to 43/100 patients. The overall mortality in the 60 days after the candiduria episode was 40%. CONCLUSIONS: The non-albicans species of Candida were the major agents of candiduria and are emergent pathogens of the urinary tract in critically ill patients. The underlying illnesses, risk factors and high mortality commonly associated with Candida urinary tract infection were also observed in a Brazilian university hospital.