RESUMO
From 2012 to 2013, 300 adults under investigation of tuberculous meningitis (TBM) were tested with polymerase chain reaction (PCR) in central spinal fluid (CSF), followed by TBM score calculation. There were 33(11%) confirmed TBM cases based on clinical findings, CSF-culture; biopsy/necropsy exams and clinical improvement after tuberculosis specific treatment. Other 267 adults were classified as non-TBM. Based on the original score there were 143 possible cases (6≤score≤11) and 20(60.6%) out of 33 TBM; among 27 probable TBM (score≥12) there were 13/33 (39.4%) confirmed cases. The CSF-PCR detected 48% (16/33) of TBM. Based on these findings, a new cut-off point was proposed to differentiate probable (score≥10) from possible (6≤score≤9) TBM. After score adjustment, there were 61 probable TBM with 26/33 (78.8%) TBM, and among the 109 possible TBM there were 7/33(21.2%) confirmed cases. In both systems, there were 130 non-TBM (score≤5) and no confirmed TBM. The association of adjusted score (≥10) and CSF-PCR showed high sensitivity (90.9%) and specificity (86.9%), positive and negative predictive value of 46.2% and 98.9%, respectively. The combination of CSF-PCR and TBM score is a useful tool for the management of adults under investigation of TBM, but the best cut-off point may need local/regional adjustments.
Assuntos
DNA Bacteriano/genética , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Reação em Cadeia da Polimerase , Tuberculose Meníngea/diagnóstico , Adulto , Brasil , Estudos Transversais , DNA Bacteriano/líquido cefalorraquidiano , DNA Bacteriano/isolamento & purificação , Humanos , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Tuberculose Meníngea/líquido cefalorraquidiano , Adulto JovemRESUMO
BACKGROUND: Maxadilan (Max) is a salivary component in the sandfly Lutzomyia longipalpis (Lutz & Neiva 1912), a vector of visceral leishmaniasis. Max has a powerful vasodilatory effect and is a candidate vaccine that has been tested in experimental leishmaniasis. Nyssomyia neivai (Pinto 1926) is a vector of the pathogen responsible for American tegumentary leishmaniasis (ATL) in Brazil. OBJECTIVE: We searched for Max expression in Ny. neivai and for antibodies against Max in ATL patients. METHODS: cDNA and protein were extracted from the cephalic segment, including salivary glands, of Ny. neivai and analysed by polymerase chain reaction, DNA sequencing, and blotting assays. The results were compared with data obtained from Lu. longipalpis samples. We quantified antibodies against Max in serum samples from 41 patients with ATL (31 and 10 with the cutaneous and mucocutaneous forms, respectively) and 63 controls from the endemic northeastern region of São Paulo state, using enzyme-linked immunosorbent assay. FINDINGS: Recognition of a Max-simile peptide by specific antibodies confirmed expression of a Max sequence in Ny. neivai (GenBank EF601123.1). Compared to controls, patients with ATL presented higher levels of antibodies against Max (p = 0.004); 24.4% of the patients with ATL and 3.2% of the controls presented anti-Max levels above the cutoff index (p = 0.014). The anti-Max levels were not associated with the specific clinical form of ATL, leishmanin skin test response, absence or presence of amastigotes in histopathologic exam, results of indirect immunofluorescence testing for leishmaniasis, or duration of cutaneous form disease. MAIN CONCLUSION: High serum anti-Max levels did not protect patients against ATL, but confirmed previous natural exposure to Ny. neivai bites in this ATL endemic region.
Assuntos
Anticorpos/sangue , Proteínas de Insetos/análise , Insetos Vetores/química , Leishmaniose Cutânea/sangue , Psychodidae/química , Animais , Anticorpos/imunologia , Brasil , Estudos de Casos e Controles , Doenças Endêmicas , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Immunoblotting , Proteínas de Insetos/imunologia , Insetos Vetores/classificação , Leishmaniose Cutânea/imunologia , Masculino , Reação em Cadeia da Polimerase , Psychodidae/classificação , Coelhos , Análise de Sequência de DNARESUMO
BACKGROUND Maxadilan (Max) is a salivary component in the sandfly Lutzomyia longipalpis (Lutz & Neiva 1912), a vector of visceral leishmaniasis. Max has a powerful vasodilatory effect and is a candidate vaccine that has been tested in experimental leishmaniasis. Nyssomyia neivai (Pinto 1926) is a vector of the pathogen responsible for American tegumentary leishmaniasis (ATL) in Brazil. OBJECTIVE We searched for Max expression in Ny. neivai and for antibodies against Max in ATL patients. METHODS cDNA and protein were extracted from the cephalic segment, including salivary glands, of Ny. neivai and analysed by polymerase chain reaction, DNA sequencing, and blotting assays. The results were compared with data obtained from Lu. longipalpis samples. We quantified antibodies against Max in serum samples from 41 patients with ATL (31 and 10 with the cutaneous and mucocutaneous forms, respectively) and 63 controls from the endemic northeastern region of São Paulo state, using enzyme-linked immunosorbent assay. FINDINGS Recognition of a Max-simile peptide by specific antibodies confirmed expression of a Max sequence in Ny. neivai (GenBank EF601123.1). Compared to controls, patients with ATL presented higher levels of antibodies against Max (p = 0.004); 24.4% of the patients with ATL and 3.2% of the controls presented anti-Max levels above the cutoff index (p = 0.014). The anti-Max levels were not associated with the specific clinical form of ATL, leishmanin skin test response, absence or presence of amastigotes in histopathologic exam, results of indirect immunofluorescence testing for leishmaniasis, or duration of cutaneous form disease. MAIN CONCLUSION High serum anti-Max levels did not protect patients against ATL, but confirmed previous natural exposure to Ny. neivai bites in this ATL endemic region.
Assuntos
Animais , Masculino , Feminino , Coelhos , Leishmaniose Cutânea/imunologia , Leishmaniose Cutânea/sangue , Proteínas de Insetos/imunologia , Insetos Vetores/classificação , Anticorpos/imunologia , Anticorpos/sangue , Psychodidae/química , Brasil , Ensaio de Imunoadsorção Enzimática , Immunoblotting , Estudos de Casos e Controles , Reação em Cadeia da Polimerase , Proteínas de Insetos/análise , Doenças EndêmicasRESUMO
INTRODUCTION: Hepatitis B and C viral infections remain an important cause of global morbidity and mortality. Studies have been conducted in population groups of large cities, leaving gaps in the knowledge regarding the situation in small municipalities. We aimed to measure the prevalence of hepatitis B and C markers and presence of infection-associated factors. METHODS: All inhabitants of Cássia dos Coqueiros aged ≥18 years who agreed to participate in the research were included. We collected blood as well as information via a questionnaire between March 2011 and December 2013. Univariate and multivariate analyses were conducted. RESULTS: Among the 1,001 participants, 41 (4.1%) participants had a serological profile of hepatitis B viral exposure, and only one (0.1%) participant was considered a virus carrier. The frequency of isolated antibody to hepatitis B virus surface antigen (anti-HBs) markers was 17.8% for the overall population. In the multivariate analysis, hepatitis B virus (HBV) infection was associated with age, birth outside the State of São Paulo, history of hepatitis, ≥2 sexual partners in the last 6 months, and tattoos. Four (0.4%) participants had a serological profile of hepatitis C viral exposure. However, after confirmation using viral ribonucleic acid (RNA) evaluation, only one (0.1%) individual remained positive. CONCLUSIONS: The positivity rates for hepatitis B and C were low, despite greater sexual freedom and the recent emergence of illicit drugs, as observed by the health personnel working in Cássia dos Coqueiros.
Assuntos
Hepatite B/epidemiologia , Hepatite C/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Anticorpos Anti-Hepatite B/sangue , Antígenos do Núcleo do Vírus da Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/imunologia , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , População Rural , Fatores Socioeconômicos , População Urbana , Adulto JovemRESUMO
Abstract: INTRODUCTION: Hepatitis B and C viral infections remain an important cause of global morbidity and mortality. Studies have been conducted in population groups of large cities, leaving gaps in the knowledge regarding the situation in small municipalities. We aimed to measure the prevalence of hepatitis B and C markers and presence of infection-associated factors. METHODS: All inhabitants of Cássia dos Coqueiros aged ≥18 years who agreed to participate in the research were included. We collected blood as well as information via a questionnaire between March 2011 and December 2013. Univariate and multivariate analyses were conducted. RESULTS: Among the 1,001 participants, 41 (4.1%) participants had a serological profile of hepatitis B viral exposure, and only one (0.1%) participant was considered a virus carrier. The frequency of isolated antibody to hepatitis B virus surface antigen (anti-HBs) markers was 17.8% for the overall population. In the multivariate analysis, hepatitis B virus (HBV) infection was associated with age, birth outside the State of São Paulo, history of hepatitis, ≥2 sexual partners in the last 6 months, and tattoos. Four (0.4%) participants had a serological profile of hepatitis C viral exposure. However, after confirmation using viral ribonucleic acid (RNA) evaluation, only one (0.1%) individual remained positive. CONCLUSIONS: The positivity rates for hepatitis B and C were low, despite greater sexual freedom and the recent emergence of illicit drugs, as observed by the health personnel working in Cássia dos Coqueiros.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Brasil/epidemiologia , Métodos Epidemiológicos , Anticorpos Anti-Hepatite B/sangue , Antígenos do Núcleo do Vírus da Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/imunologia , Anticorpos Anti-Hepatite C/sangue , População Rural , Fatores Socioeconômicos , População UrbanaRESUMO
INTRODUCTION: Although deaf people are exposed to hepatitis B and C risk factors, epidemiological studies regarding these diseases in deaf people are lacking. METHODS: After watching an explanatory digital versatile disc (DVD) in Brazilian Sign Language, 88 deaf people were interviewed and tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), hepatitis B core antibody (anti-HBc), and hepatitis C virus antibody (anti-HCV). RESULTS: The prevalence of hepatitis B markers was 8%; they were associated with incarceration and being born outside the State of São Paulo. No cases of hepatitis C were identified. CONCLUSIONS: Participants showed a substantial lack of knowledge regarding viral hepatitis, indicating a need for public policies that consider linguistic and cultural profiles.
Assuntos
Biomarcadores/sangue , Hepacivirus/imunologia , Vírus da Hepatite B/imunologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Pessoas com Deficiência Auditiva/estatística & dados numéricos , Adulto , Idoso , Brasil/epidemiologia , Feminino , Hepatite B/diagnóstico , Anticorpos Anti-Hepatite B/sangue , Antígenos do Núcleo do Vírus da Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Hepatite C/diagnóstico , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Adulto JovemRESUMO
INTRODUCTION: Pseudomonas aeruginosa isolates related to nosocomial infections are often resistant to multiple antibacterial agents. In this study, antimicrobial combinations were evaluated to detect in vitro synergy against clinical isolates of P. aeruginosa. METHODS: Four clinical P. aeruginosa isolates were selected at random among other isolates from inpatients treated at the public University hospital in Ribeirão Preto, SP, Brazil. Two isolates were susceptible to imipenem (IPM-S) and several other antimicrobials, while the other two isolates were imipenem and multidrug resistant (IPM-R). The checkerboard method was used to assess the interactions between antimicrobials. RESULTS: Combinations of imipenem or other anti-Pseudomonas drugs with complementary antibiotics, such as aminoglycosides, fosfomycin and rifampin, reached synergy rates of 20.8%, 50%, 62.5% and 50% for the two IPM-S and two IPM-R Pseudomonas isolates, respectively. Imipenem, piperacillin-tazobactam and ceftazidime yielded a greater synergy rate than cefepime or ciprofloxacin. Synergist combinations were more commonly observed when the complementary drug was tobramycin (65%) or fosfomycin (57%). CONCLUSIONS: Some antibacterial combinations led to significant reductions of the minimum inhibitory concentrations of both drugs, suggesting that they could be clinically applied to control infections caused by multidrug-resistant P. aeruginosa.
Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla , Pseudomonas aeruginosa/efeitos dos fármacos , Sinergismo Farmacológico , Quimioterapia Combinada/métodos , Testes de Sensibilidade MicrobianaRESUMO
Introduction Pseudomonas aeruginosa isolates related to nosocomial infections are often resistant to multiple antibacterial agents. In this study, antimicrobial combinations were evaluated to detect in vitro synergy against clinical isolates of P. aeruginosa. Methods Four clinical P. aeruginosa isolates were selected at random among other isolates from inpatients treated at the public University hospital in Ribeirão Preto, SP, Brazil. Two isolates were susceptible to imipenem (IPM-S) and several other antimicrobials, while the other two isolates were imipenem and multidrug resistant (IPM-R). The checkerboard method was used to assess the interactions between antimicrobials. Results Combinations of imipenem or other anti-Pseudomonas drugs with complementary antibiotics, such as aminoglycosides, fosfomycin and rifampin, reached synergy rates of 20.8%, 50%, 62.5% and 50% for the two IPM-S and two IPM-R Pseudomonas isolates, respectively. Imipenem, piperacillin-tazobactam and ceftazidime yielded a greater synergy rate than cefepime or ciprofloxacin. Synergist combinations were more commonly observed when the complementary drug was tobramycin (65%) or fosfomycin (57%). Conclusions Some antibacterial combinations led to significant reductions of the minimum inhibitory concentrations of both drugs, suggesting that they could be clinically applied to control infections caused by multidrug-resistant P. aeruginosa. .
Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla , Pseudomonas aeruginosa/efeitos dos fármacos , Sinergismo Farmacológico , Quimioterapia Combinada/métodos , Testes de Sensibilidade MicrobianaRESUMO
UNLABELLED: BACKGROUND - Multibacillary (MB) leprosy may be manifested with antiphospholipid antibodies (aPL), among which anti-beta2GP1 (beta2-glycoprotein 1). High titers of aPL are associated with APS (Antiphospholipid Syndrome), characterized by thrombosis. The mutation Val247Leu in the domain V of beta2GP1 exposes hidden epitopes with consequent development of anti-beta2GP1 antibodies. OBJECTIVE: To evaluate the Val247Leu polymorphism of beta2GP1 gene and its correlation with anti-beta2GP1 antibodies in leprosy patients. METHODS: The Val247Leu polymorphism was performed by PCR-RFLP and anti-beta2GP1 antibodies were measured by ELISA. RESULTS: The genotypic Val/Val was more prevalent in the leprosy group, compared to controls. Regarding the 7 MB patients with APS, four presented heterozygosis and three, Val/Val homozygosis. Although higher titrations of anti-beta2GP1 IgM antibodies were seen in MB leprosy group with Val/Leu and Val/Val genotypes, there was no statistical difference when compared to Leu/Leu genotype. CONCLUSION: The prevalence of Val/Val homozygosis in leprosy group can partially justify the presence of anti-beta2GP1 IgM antibodies in MB leprosy. The description of heterozygosis and Val/Val homozygosis in 7 patients with MB leprosy and thrombosis corroborates the implication of anomalous phenotype expression of beta2GP1 and development of anti-beta2GP1 antibodies, with consequent thrombosis and APS.
Assuntos
Síndrome Antifosfolipídica/genética , Síndrome Antifosfolipídica/imunologia , Autoanticorpos/biossíntese , Hanseníase Multibacilar/genética , Hanseníase Multibacilar/imunologia , Mutação , Polimorfismo Genético , beta 2-Glicoproteína I/genética , beta 2-Glicoproteína I/imunologia , Síndrome Antifosfolipídica/sangue , Feminino , Humanos , Hanseníase Multibacilar/sangue , Masculino , Pessoa de Meia-IdadeRESUMO
FUNDAMENTOS - Anticorpos antifosfolípides (AAF), como antiβ2GP1 (β2-glicoproteína 1), são descritos na hanseníase multibacilar (MB) sem, contudo, caracterizar a síndrome do anticorpo antifosfolípide (SAF), constituída por fenômenos tromboembólicos (FTE). A mutação Val247Leu no V domínio da β2GP1 - substituição da leucina por valina - expõe epítopos crípticos com consequente formação de anticorpos antiβ2GP1. OBJETIVO: Avaliar a associação do polimorfismo Val247Leu do gene β2GP1 com títulos de anticorpos antiβ2GP1 na hanseníase. MÉTODO: O polimorfismo Val247Leu foi detectado por PCR-RFLP, e os títulos de anticorpos antiβ2GP1, por Elisa. RESULTADOS: O genótipo Val/Val estatisticamente predominou no grupo de hansênicos, em relação ao controle. Embora maiores títulos de anticorpos antiβ2GP1 IgM estivessem alocados no grupo MB com genótipos Val/Val e Val/Leu, não houve diferença estatística em relação ao genótipo Leu/Leu. Dos sete pacientes MB com FTE, quatro apresentaram heterozigose, e três Val/Val homozigose. CONCLUSÃO: A prevalência do genótipo Val/Val no grupo de hansênicos pode justificar parcialmente a presença de anticorpos antiβ2GP1 na forma MB. A heterozigose ou homozigose Val/Val nos sete pacientes com hanseníase MB e FTE corroboram a implicação de expressão fenotípica anômala da β2GPl e formação de anticorpos antiβ2GPl, com consequente FTE e SAF.
BACKGROUND - Multibacillary (MB) leprosy may be manifested with antiphospholipid antibodies (aPL), among which anti-β2GP1 (β2-glycoprotein 1). High titers of aPL are associated with APS (Antiphospholipid Syndrome), characterized by thrombosis. The mutation Val247Leu in the domain V of β2GP1 exposes hidden epitopes with consequent development of anti-β2GP1 antibodies. OBJECTIVE: To evaluate the Val247Leu polymorphism of β2GP1 gene and its correlation with anti-β2GP1 antibodies in leprosy patients. METHODS: The Val247Leu polymorphism was performed by PCR-RFLP and anti-β2GP1 antibodies were measured by ELISA. RESULTS: The genotypic Val/Val was more prevalent in the leprosy group, compared to controls. Regarding the 7 MB patients with APS, four presented heterozygosis and three, Val/Val homozygosis. Although higher titrations of anti-β2GP1 IgM antibodies were seen in MB leprosy group with Val/Leu and Val/Val genotypes, there was no statistical difference when compared to Leu/Leu genotype. CONCLUSION: The prevalence of Val/Val homozygosis in leprosy group can partially justify the presence of anti-β2GP1 IgM antibodies in MB leprosy. The description of heterozygosis and Val/Val homozygosis in 7 patients with MB leprosy and thrombosis corroborates the implication of anomalous phenotype expression of β2GP1 and development of anti-β2GP1 antibodies, with consequent thrombosis and APS.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Antifosfolipídica/genética , Síndrome Antifosfolipídica/imunologia , Autoanticorpos/biossíntese , Hanseníase Multibacilar/genética , Hanseníase Multibacilar/imunologia , Mutação , Polimorfismo Genético , /genética , /imunologia , Síndrome Antifosfolipídica/sangue , Hanseníase Multibacilar/sangueRESUMO
This study was performed with the purpose of testing the hypothesis that the high prevalence of hepatitis C among former athletes is associated with their past use of injectable stimulants. The study involved the participation of 208 former professional and amateur soccer and basketball players from the region of Ribeirão Preto, Brazil, who answered a questionnaire regarding their exposure to risk factors, including the use of injectable stimulants in the time they were engaged in sporting activities. ELISA tests were used to detect infection by the hepatitis C virus, and confirmed with PCR and genotyping for the positive cases. It was observed that the former use of injectable stimulants was a practice disseminated among the participants (24.5 percent), reaching 50.8 percent in the professionals. The overall prevalence for hepatitis C was 7.2 percent, with values of 11 percent among professionals and 5.5 percent among amateurs. In both categories, the presence of infection was markedly higher among those who admitted past use of injectable stimulants when compared to those who denied such practice (36 percent and 0.8 percent among amateurs; 21.9 percent and 0 percent among professionals, respectively). Multivariate analysis showed that the use of those substances was the only variable associated with the risk of hepatitis C. This confirms previous observations, performed with reduced sample sizes and without comparison groups, which indicated that the use of injectable vitamins was a risk factor of hepatitis C among former athletes.
Assuntos
Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Basquetebol/estatística & dados numéricos , Estimulantes do Sistema Nervoso Central/administração & dosagem , Hepatite C/transmissão , Futebol/estatística & dados numéricos , Brasil/epidemiologia , Ensaio de Imunoadsorção Enzimática , Hepacivirus/genética , Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/sangue , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Injeções Intravenosas/efeitos adversos , Reação em Cadeia da Polimerase , Prevalência , Fatores de RiscoRESUMO
AIMS: The use of hemodialysis temporary dual-lumen catheters is often complicated by infections, which may be a significant cause of death among patients with end stage renal disease (ESRD). The aim of this study was to assess the incidence of bacteremia and bacterial colonization related to non-tunneled, non-cuffed, dual-lumen temporary catheters in patients with ESRD submitted to hemodialysis. METHODS: This study included 29 patients with ESRD. After catheter implantation, patients were monitored throughout the period of catheter permanence by means of blood samples collected weekly from a peripheral vein. Bacteria were isolated and identified according to CLSI recommendations. When catheters were removed for any reason, their tips were evaluated microbiologically. RESULTS: A total of 194 blood samples from the 29 patients implanted with 55 catheters were analyzed. Of these, 15.5% (30 samples) demonstrated bacterial growth, principally Staphylococcus epidermidis (64.5%). Twenty patients (68.9%) presented at least one positive blood culture during follow-up. The median time for catheter colonization was 18.5 days (95% CI: 16.8-30.3). Of the 55 catheters implanted, 28 (50.9%) showed bacterial colonization, corresponding to 23.4 episodes/1000 catheter/days and 9.2 episodes of bacteremia /1000 catheter/days. Fifteen of 28 catheter tips analyzed showed bacterial growth (53.5%). In 14 of these (93.3%), there was agreement between the isolates from the catheter tip and blood cultures. Of 24 episodes of positive blood cultures from 20 different patients in 17 episodes (70.8%), the patients showed no clinical signs or symptoms of bacteremia. CONCLUSIONS: The high incidence of catheter colonization, the correlation between blood and catheter tip cultures, and the occurrence of frequent cases of asymptomatic bacteremia justify the proposal of routine peripheral blood collections to monitor patients undergoing hemodialysis with temporary dual-lumen catheters.
Assuntos
Derivação Arteriovenosa Cirúrgica , Bactérias/crescimento & desenvolvimento , Cateteres de Demora/microbiologia , Diálise Renal/instrumentação , Adulto , Bacteriemia/etiologia , Cateteres de Demora/efeitos adversos , Contagem de Colônia Microbiana , Contaminação de Equipamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
This study was performed with the purpose of testing the hypothesis that the high prevalence of hepatitis C among former athletes is associated with their past use of injectable stimulants. The study involved the participation of 208 former professional and amateur soccer and basketball players from the region of Ribeirão Preto, Brazil, who answered a questionnaire regarding their exposure to risk factors, including the use of injectable stimulants in the time they were engaged in sporting activities. ELISA tests were used to detect infection by the hepatitis C virus, and confirmed with PCR and genotyping for the positive cases. It was observed that the former use of injectable stimulants was a practice disseminated among the participants (24.5%), reaching 50.8% in the professionals. The overall prevalence for hepatitis C was 7.2%, with values of 11% among professionals and 5.5% among amateurs. In both categories, the presence of infection was markedly higher among those who admitted past use of injectable stimulants when compared to those who denied such practice (36% and 0.8% among amateurs; 21.9% and 0% among professionals, respectively). Multivariate analysis showed that the use of those substances was the only variable associated with the risk of hepatitis C. This confirms previous observations, performed with reduced sample sizes and without comparison groups, which indicated that the use of injectable vitamins was a risk factor of hepatitis C among former athletes.
Assuntos
Basquetebol/estatística & dados numéricos , Estimulantes do Sistema Nervoso Central/administração & dosagem , Hepatite C/transmissão , Futebol/estatística & dados numéricos , Adulto , Idoso , Brasil/epidemiologia , Ensaio de Imunoadsorção Enzimática , Hepacivirus/genética , Hepacivirus/imunologia , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Anticorpos Anti-Hepatite C/sangue , Humanos , Injeções Intravenosas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Prevalência , Fatores de RiscoRESUMO
OBJECTIVE: To estimate the prevalence of hepatitis B markers and to study the risk factors for this disease among female sex workers in the city of Ribeirão Preto, Brazil. METHODS: A questionnaire was given to 449 female sex workers in order to obtain information about demographic, socioeconomic and behavioral variables. Blood samples were collected and analyzed by immunoenzymatic techniques for detection of HBsAg, anti-HBs, anti-HBc and anti-HCV markers. RESULTS: The mean age of participants was 23 years, varying from 13 to 64 years. A high spatial mobility was observed, with 47.9 percent of participants residing in places out of the region of Ribeirão Preto or in other Brazilian states. Complete absence of previous vaccine against hepatitis B was referred by 98.2 percent. Overall, the presence of any hepatitis B marker was observed in 106 participants (prevalence of 23.6 percent; 95 percent CI: 19.7 27.5), with 84 positive for anti-HBs (18.7 percent), 100 for anti-HBc (22.3 percent), and only 3 for HBsAg (0.7 percent). The logistic regression analysis showed association between hepatitis B markers and the following co-variables: residence in Ribeirão Preto, age, low socioeconomic level, consumption of crack, intercourse with HIV-infected individuals, history of previous hepatitis, intercourse with a case of hepatitis, and positivity for hepatitis C. CONCLUSIONS: Ribeirão Preto's female sex workers present several risk factors for hepatitis B and almost absence of previous specific vaccination, making it necessary to emphasize this low-cost preventive measure, preferably through the use of a mobile team, taking the vaccine to their places of work.
OBJETIVOS: Estimar a prevalência de marcadores de hepatite B e estudar os fatores de risco para esta doença entre mulheres profissionais do sexo na cidade de Ribeirão Preto, Brasil. MÉTODOS: Foi aplicado um questionário a 449 mulheres profissionais do sexo, com a finalidade de levantar informações demográficas, socioeconômicas e comportamentais. Amostras de sangue das participantes foram analisadas através de técnicas imunoenzimáticas, para detecção dos marcadores HBsAg, anti-HBs e anti-HBc. RESULTADOS: A idade média das participantes foi 23 anos, variando de 13 a 64 anos. Uma elevada mobilidade espacial foi verificada, com 47,9 por cento delas residindo em locais fora da região de Ribeirão Preto ou em outros estados brasileiros. Completa ausência de vacinação prévia contra hepatite B foi referida por 98,2 por cento. No total, observou-se presença de qualquer marcador de hepatite B em 106 participantes (prevalência de 23,6 por cento; IC95 por cento: 19,7 27,5), com 84 positivos para anti-HBs (18,7 por cento), 100 para anti-HBc (22,3 por cento) e apenas 3 para HBsAg (0,7 por cento). A análise por regressão logística evidenciou associação entre marcadores de hepatite B e as seguintes co-variáveis: idade, baixo nível socioeconômico, consumo de crack, relações sexuais com indivíduos infectados pelo HIV, história de hepatite prévia, relações sexuais com pessoas portadoras de hepatite e positividade para hepatite C. CONCLUSÕES: As profissionais do sexo em Ribeirão Preto apresentam diversos fatores de risco para hepatite B e quase total ausência de vacinação prévia específica, tornando necessários esforços concentrados na aplicação dessa medida de baixo custo, preferencialmente através do uso de equipes móveis que levem a vacina até os seus locais de trabalho.
Assuntos
Hepatite B , Prevalência , Trabalho SexualRESUMO
The diagnosis of American cutaneous leishmaniasis (ACL) is frequently based on clinical and epidemiological data associated with the results of laboratory tests. Some laboratory methods are currently being applied for the diagnosis of ACL, among them the indirect immunofluorescence reaction (IIFR), the Montenegro skin test (MST), histopathological examination, and the polymerase chain reaction (PCR). The performance of these methods varies in a considerable proportion of patients. After the standardization of an immunoenzymatic test (ELISA) for the detection of IgG in the serum of patients with ACL using a crude Leishmania braziliensis antigen, the results obtained were compared to those of other tests routinely used for the diagnosis. The tests revealed the following sensitivity, when analyzed separately: 85% for ELISA IgG, 81% for PCR, 64.4% for MST, 58.1% for IIFR, and 34% for the presence of parasites in the biopsy. ELISA was positive in 75% of patients with ACL presenting a negative MST, in 84.8% of ACL patients with negative skin or mucous biopsies for the presence of the parasite, and in 100% of cases with a negative PCR. Thus, ELISA presented a higher sensitivity than the other tests and was useful as a complementary method for the diagnosis of ACL.
Assuntos
Antígenos de Protozoários , Ensaio de Imunoadsorção Enzimática , Leishmania braziliensis/imunologia , Leishmaniose Cutânea/diagnóstico , Animais , Anticorpos Antiprotozoários/sangue , Biópsia , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Imunoglobulina G/sangue , Reação em Cadeia da Polimerase , Sensibilidade e Especificidade , Testes CutâneosRESUMO
The diagnosis of American cutaneous leishmaniasis (ACL) is frequently based on clinical and epidemiological data associated with the results of laboratory tests. Some laboratory methods are currently being applied for the diagnosis of ACL, among them the indirect immunofluorescence reaction (IIFR), the Montenegro skin test (MST), histopathological examination, and the polymerase chain reaction (PCR). The performance of these methods varies in a considerable proportion of patients. After the standardization of an immunoenzymatic test (ELISA) for the detection of IgG in the serum of patients with ACL using a crude Leishmania braziliensis antigen, the results obtained were compared to those of other tests routinely used for the diagnosis. The tests revealed the following sensitivity, when analyzed separately: 85 percent for ELISA IgG, 81 percent for PCR, 64.4 percent for MST, 58.1 percent for IIFR, and 34 percent for the presence of parasites in the biopsy. ELISA was positive in 75 percent of patients with ACL presenting a negative MST, in 84.8 percent of ACL patients with negative skin or mucous biopsies for the presence of the parasite, and in 100 percent of cases with a negative PCR. Thus, ELISA presented a higher sensitivity than the other tests and was useful as a complementary method for the diagnosis of ACL.
O diagnóstico da Leishmaniose Tegumentar Americana (LTA) é feito com base nos dados clínicos e epidemiológicos e é confirmado por meio de diferentes métodos laboratoriais. Dentre estes, são utilizados, com desempenhos variáveis, a reação de imunofluorescência indireta (IFI), a reação intradérmica de Montenegro (IRM), a pesquisa de Leishmania em material de biópsia de pele ou mucosa e a reação em cadeia da polimerase (PCR). O objetivo do presente trabalho foi avaliar o desempenho de teste imunoenzimático (ELISA) como método alternativo de diagnóstico da LTA, comparando seus resultados com os obtidos por outros métodos tradicionais de diagnóstico dessa doença. Foi utilizado teste para pesquisa de IgG anti-Leishmania no soro, utilizando antígeno bruto de Leishmania braziliensis, com os seguintes resultados de sensibilidade: ELISA = 85 por cento; PCR = 81 por cento; IRM = 64.4 por cento; IFI = 58,1 por cento; presença de parasitas na biópsia = 34 por cento. Além disso, o teste ELISA foi positivo em parcela expressiva dos pacientes que apresentavam outros testes diagnósticos negativos (foi positivo em 100 por cento dos pacientes com PCR negativo; em 84,8 por cento dos casos com biópsias mostrando ausência de parasitas e em 75 por cento dos não reativos a IRM) mostrando-se útil como método alternativo de diagnóstico da LTA.
Assuntos
Humanos , Animais , Antígenos de Protozoários , Ensaio de Imunoadsorção Enzimática , Leishmania braziliensis/imunologia , Leishmaniose Cutânea/diagnóstico , Anticorpos Antiprotozoários/sangue , Biópsia , Técnica Indireta de Fluorescência para Anticorpo , Imunoglobulina G/sangue , Reação em Cadeia da Polimerase , Sensibilidade e Especificidade , Testes CutâneosAssuntos
Odontólogos , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Doenças Profissionais/epidemiologia , Exposição Ocupacional , Brasil/epidemiologia , Hepatite B/sangue , Hepatite B/psicologia , Anticorpos Anti-Hepatite B/sangue , Hepatite C/sangue , Hepatite C/psicologia , Anticorpos Anti-Hepatite C/sangue , Doenças Profissionais/imunologia , PrevalênciaRESUMO
FUNDAMENTOS: AA proteína MAX, componente salivar de Lutzomyia longipalpis, vetor do calazar ou leishmaniose sistêmica, tem sido empregada como vacina para leishmaniose tegumentar experimental, com funções de vasodilatação e imunomodulação. OBJETIVOS: Detectar anticorpos séricos antiMAX em pacientes com LTA e verificar a expressão de MAX em L. neivai, vetor da LTA na região em estudo. MÉTODOS: Anticorpos antiMAX foram detectados por Elisa em soro de 42 pacientes com LTA e 63 controles. A extração de proteínas e de DNA de L. longipalpis (controle positivo) e de L. neivai foi realizada pelo método Trizol e seguida pela detecção de proteínas por eletroforese e pela expressão gênica de MAX por PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) com as enzimas Hha I e Rsa I. RESULTADOS: Títulos maiores de anticorpos antiMAX foram observados na LTA (p=0,0132). A eletroforese de proteínas mostrou frações semelhantes para L. longipalpis e L. neivai, tendo-se observado para ambos fração protéica de peso molecular similar à proteína MAX. A expressão gênica de MAX em L. longipalpis e L. neivai foi confirmada por PCR-RFLP. CONCLUSÕES: A presença de antiMAX nos grupos em estudo tornou imprescindível a pesquisa de MAX no vetor de LTA da região, tendo sido registrada pela primeira vez expressão protéica e gênica de MAX em L. neivai. Detecção de antiMAX em controles confirma exposição a picadas de flebótomos. Títulos de anticorpos antiMAX maiores na LTA sugerem exposição prévia e natural à picada e, conseqüentemente, à proteína MAX, não protegendo da doença e desfavorecendo seu emprego em vacinação.
BACKGROUND: The protein MAX, salivary component of Lutzomyia longipalpis, vector of calazar or systemic leishmaniasis, has been used as vaccine for experimental tegumentar leishmaniasis, which vasodilatory and immunomodulatory functions are described. OBJECTIVES: Our purpose was to detect antibodies antiMAX in sera samples from patients with ATL and to verify the genetic and protein expression of MAX in L. neivai, phlebotomy vector of ATL in the area of study. METHODS: Antibodies antiMAX were detected by ELISA in sera from 42 patients with ATL and 63 controls. The extraction of proteins and of DNA from L. longipalpis (positive control) and L. neivai was accomplished by the method Trizol, following for the detection of proteins by electrophoresis, and genetic expression of MAX by PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) with the enzymes Hha I and Rsa I. RESULTS: Increased titles of antibodies antiMAX were observed in ATL, compared to controls (p=0,0132). Electrophoreses of proteins showed similar fractions for L. longipalpis and L. neivai, and for both a protein fraction with molecular weight similarity to MAX was observed. The genetic expression of MAX in L. longipalpis and L. neivai was confirmed by PCR-RFLP. CONCLUSIONS: The description of antibodies antiMAX in ATL patients and controls turned indispensable the research of MAX in the phlebotomy vector of ATL in the area of study. For the first time, it was registered protein and genetic expression of MAX in L. neivai. The antiMAX detection in controls confirms the previous exposition to prick of phlebotomies. Increased titles of antibodies antiMAX in ATL patients suggest previous and natural exposition to the bite and, consequently, to the protein MAX, not protecting them of disease and discouraging its employment in vaccination.
RESUMO
The objective of this investigation was to study the prevalence of hepatitis B virus infection in a sample of 406 adult patients with human immunodeficiency virus infection who attended at the public health care in the city of Belém, Pará, Brazil, as well as analyzing possible risk factors for hepatitis B virus infection. The overall prevalence of hepatitis B virus infection was 51% (CI: 46.1 - 55.8), with 7.9% (CI: 5.3 - 10.5) for HBsAg, 45.1% (CI: 40.3 - 49.9) for anti-HBc and 32.3% (CI: 27.5 - 36.8) for anti-HBs. After adjustment using logistic regression, hepatitis B serological markers were associated with the following variables: age, marital status and sexual preference. The frequency of hepatitis B markers was 28.7% in heterosexuals and 68.8% in homo/bisexuals (CI: 3.50 - 9.08; OR: 5.63; p=0.000). In married people the frequency was 31% and 58.7% in single people (CI: 1.29 - 3.63); OR: 2.16; p=0.003). Multivariate analysis showed no association between hepatitis B virus infection and illicit injectable drug use.
Assuntos
Infecções por HIV/complicações , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/imunologia , Hepatite B/epidemiologia , Adolescente , Adulto , Biomarcadores/sangue , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Hepatite B/complicações , Hepatite B/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The objective of this investigation was to study the prevalence of hepatitis C virus infection and to identify possible risk factors for its transmission, in 406 adult patients with HIV/AIDS who attended at public health services, in Belém city, Pará, Brazil. The anti-HCV was performed by third generation immunoenzymatic technique, and the HCV RNA by polymerase chain reaction. The overall prevalence of hepatitis C virus was 16% (CI: 12.4 - 19.6). Multivariate analysis showed association between virus C infection and age, with significant risk in the group about fifty years old or more (OR=9.75), blood transfusion (OR=4.74) and use of injecting drugs (OR=149.28). The hepatitis C virus infection was detected in 83.7% of intravenous drug users and 22.1% of transfused patients. These data indicate the efficient transmission of the virus through the percutaneous exposition and reaffirm the high risk to hepatitis C among injectable illicit drug user.