RESUMEN
Objectives: The emergence of SARS-CoV-2 has triggered a global pandemic with profound implications for public health. Rapid changes in the pandemic landscape and limitations in in vitro diagnostics led to the introduction of numerous diagnostic devices with variable performance. In this study, we evaluated three commercial serological assays in Brazil for detecting anti-SARS-CoV-2 antibodies. Methods: We collected 90 serum samples from SARS-CoV-2-negative blood donors and 352 from SARS-CoV-2-positive, unvaccinated patients, categorized by symptom onset. Subsequently, we assessed the diagnostic performance of three commercial enzyme immunoassays: GOLD ELISA (enzyme-linked immunosorbent assay) COVID-19 Ig (immunoglobulin) G + IgM, Anti-SARS-CoV-2 NCP IgM ELISA, and Anti-SARS-CoV-2 NCP IgG ELISA. Results: Our findings revealed that the GOLD ELISA COVID-19 IgG + IgM exhibited the highest sensitivity (57.7%) and diagnostic odds ratio, surpassing the manufacturer's reported sensitivity in most analyzed time frames while maintaining exceptional specificity (98.9%). Conversely, the Anti-SARS-CoV-2 NCP IgG ELISA demonstrated lower sensitivity but aligned with independent evaluations, boasting a specificity of 100%. However, the Anti-SARS-CoV-2 NCP IgM ELISA exhibited lower sensitivity than claimed, particularly in samples collected shortly after positive reverse transcription polymerase chain reaction results. Performance improved 15-21 days after symptom onset and beyond 22 days, but in the first week, both Anti-SARS-CoV-2 NCP IgM ELISA and Anti-SARS-CoV-2 NCP IgG ELISA struggled to differentiate positive and negative samples. Conclusions: Our study emphasizes the need for standardized validation protocols to address discrepancies between manufacturer-claimed and actual performance. These insights provide essential information for health care practitioners and policymakers regarding the diagnostic capabilities of these assays in various clinical scenarios.
RESUMEN
COVID-19 laboratory diagnosis primarily relies on molecular tests, highly sensitive during early infection stages with high viral loads. As the disease progresses, sensitivity decreases, requiring antibody detection. Since the beginning of the pandemic, serological tests have been developed and made available in Brazil, but their diagnostic performance varies. This study evaluated the IBMP ELISA IgA/IgM/IgG COVID-19 kit performance in detecting SARS-CoV-2 antibodies. A total of 90 samples, including 64 from COVID-19 patients and 26 pre-pandemic donors, were assessed based on time post symptom onset (0-7, 8-14, and 15-21 days). The kit showed 61% sensitivity, 100% specificity, and 72% accuracy overall. Sensitivity varied with time, being 25%, 57%, and 96% for 0-7, 8-14, and 15-21 days, respectively. Similar variations were noted in other commercial tests. The Gold ELISA COVID-19 (IgG/IgM) had sensitivities of 31%, 71%, and 100%, while the Anti-SARS-CoV-2 NCP ELISA (IgG) and Anti-SARS-CoV-2 NCP ELISA (IgM) showed varying sensitivities. The IBMP ELISA kit displayed high diagnostic capability, especially as the disease progressed, complementing COVID-19 diagnosis. Reproducibility assessment revealed minimal systematic and analytical errors. In conclusion, the IBMP ELISA IgA/IgM/IgG COVID-19 kit is a robust tool for detecting anti-SARS-CoV-2 antibodies, increasing in efficacy over the disease course, and minimizing false negatives in RT-PCR COVID-19 diagnosis.
RESUMEN
BACKGROUND: In most cases, Zika virus (ZIKV) causes a self-limited acute illness in adults, characterized by mild clinical symptoms that resolve within a few days. Immune responses, both innate and adaptive, play a central role in controlling and eliminating virus-infected cells during the early stages of infection. AIM: To test the hypothesis that circulating T cells exhibit phenotypic and functional activation characteristics during the viremic phase of ZIKV infection. METHODS: A comprehensive analysis using mass cytometry was performed on peripheral blood mononuclear cells obtained from patients with acute ZIKV infection (as confirmed by RT-PCR) and compared with that from healthy donors (HD). The frequency of IFN-γ-producing T cells in response to peptide pools covering immunogenic regions of structural and nonstructural ZIKV proteins was quantified using an ELISpot assay. RESULTS: Circulating CD4+ and CD8+ T lymphocytes from ZIKV-infected patients expressed higher levels of IFN-γ and pSTAT-5, as well as cell surface markers associated with proliferation (Ki-67), activation ((HLA-DR, CD38) or exhaustion (PD1 and CTLA-4), compared to those from HD. Activation of CD4+ and CD8+ memory T cell subsets, including Transitional Memory T Cells (TTM), Effector Memory T cells (TEM), and Effector Memory T cells Re-expressing CD45RA (TEMRA), was prominent among CD4+ T cell subset of ZIKV-infected patients and was associated with increased levels of IFN-γ, pSTAT-5, Ki-67, CTLA-4, and PD1, as compared to HD. Additionally, approximately 30% of ZIKV-infected patients exhibited a T cell response primarily directed against the ZIKV NS5 protein. CONCLUSION: Circulating T lymphocytes spontaneously produce IFN-γ and express elevated levels of pSTAT-5 during the early phase of ZIKV infection whereas recognition of ZIKV antigen results in the generation of virus-specific IFN-γ-producing T cells.
Asunto(s)
Linfocitos T CD8-positivos , Interferón gamma , Infección por el Virus Zika , Virus Zika , Humanos , Infección por el Virus Zika/inmunología , Infección por el Virus Zika/epidemiología , Adulto , Virus Zika/inmunología , Femenino , Masculino , Interferón gamma/metabolismo , Interferón gamma/inmunología , Brasil/epidemiología , Linfocitos T CD8-positivos/inmunología , Linfocitos T CD4-Positivos/inmunología , Persona de Mediana Edad , Adulto Joven , Epidemias , Activación de Linfocitos/inmunología , Linfocitos T/inmunologíaRESUMEN
Objectives: This study evaluated the performance of recombinant receptor binding domain (RBD) protein-based enzyme-linked immunosorbent assays (RBD-ELISAs) for detecting anti-SARS-CoV-2 immunoglobulin (Ig) G and IgM antibodies. Methods: In this study, 705 sera from SARS-CoV-2-infected individuals and 315 sera from healthy individuals were analyzed. Results: The RBD-ELISA IgG exhibited high specificity (99.1%) and moderate sensitivity (48.0%), with an overall diagnostic accuracy of 73.5%. RBD-ELISA IgM demonstrated specificity at 94.6% and sensitivity at 51.1%, with an accuracy of 72.8%. Both assays displayed improved performance when analyzing samples collected 15-21 days post-symptom onset, achieving sensitivity and accuracy exceeding 88% and 90%, respectively. Combining RBD-ELISA IgG and IgM in parallel analysis enhanced sensitivity to 98.6% and accuracy to 96.2%. Comparing these RBD-ELISAs with commercially available tests, the study found overlapping sensitivity and similar specificity values. Notably, the combined RBD-ELISA IgG and IgM showed superior performance. Cross-reactivity analysis revealed low false-positive rates (4.4% for IgG, 3.7% for IgM), primarily with viral infections. Conclusion: This research underscores the potential of RBD-based ELISAs for COVID-19 diagnosis, especially when assessing samples collected 15-21 days post-symptom onset and utilizing a parallel testing approach. The RBD protein's immunogenicity and specificity make it a valuable tool for serodiagnosis, offering an alternative to polymerase chain reaction-based methods, particularly in resource-limited settings.
RESUMEN
OBJECTIVE: Genome sequencing has been proved to be an excellent tool to monitor the molecular epidemiology of the disease caused by severe acute respiratory syndrome coronavirus 2, i.e., coronavirus disease 2019. Some reports of infected, vaccinated individuals have aroused great interest because they are primarily being infected with circulating variants of concern. To investigate the cases of infected, vaccinated individuals in Salvador, Bahia, Brazil, we performed genomic monitoring to estimate the magnitude of the different variants of concern in these cases. METHODS: Nasopharyngeal swabs from infected (symptomatic and asymptomatic), vaccinated or unvaccinated individuals (n=29), and quantitative reverse transcription polymerase chain reaction cycle threshold value (Ct values) of ≤30 were subjected to viral sequencing using nanopore technology. RESULTS: Our analysis revealed that the Omicron variant was found in 99% of cases and the Delta variant was found in only one case. Infected, fully vaccinated patients have a favorable clinical prognosis; however, within the community, they become viral carriers with the aggravating factor of viral dissemination of variants of concern not neutralized by the currently available vaccines. CONCLUSION: It is important to acknowledge the limitations of these vaccines and to develop new vaccines to emergent variants of concern, as is the case of influenza vaccine; going through new doses of the same coronavirus vaccines is "more of the same."
Asunto(s)
COVID-19 , Vacunas , Humanos , Brasil/epidemiología , SARS-CoV-2/genética , Prevalencia , COVID-19/epidemiología , COVID-19/prevención & control , GenómicaRESUMEN
SUMMARY OBJECTIVE: Genome sequencing has been proved to be an excellent tool to monitor the molecular epidemiology of the disease caused by severe acute respiratory syndrome coronavirus 2, i.e., coronavirus disease 2019. Some reports of infected, vaccinated individuals have aroused great interest because they are primarily being infected with circulating variants of concern. To investigate the cases of infected, vaccinated individuals in Salvador, Bahia, Brazil, we performed genomic monitoring to estimate the magnitude of the different variants of concern in these cases. METHODS: Nasopharyngeal swabs from infected (symptomatic and asymptomatic), vaccinated or unvaccinated individuals (n=29), and quantitative reverse transcription polymerase chain reaction cycle threshold value (Ct values) of ≤30 were subjected to viral sequencing using nanopore technology. RESULTS: Our analysis revealed that the Omicron variant was found in 99% of cases and the Delta variant was found in only one case. Infected, fully vaccinated patients have a favorable clinical prognosis; however, within the community, they become viral carriers with the aggravating factor of viral dissemination of variants of concern not neutralized by the currently available vaccines. CONCLUSION: It is important to acknowledge the limitations of these vaccines and to develop new vaccines to emergent variants of concern, as is the case of influenza vaccine; going through new doses of the same coronavirus vaccines is "more of the same."
RESUMEN
Background: From late 2016 to early 2021, cases of Haff disease, a rare cause of rhabdomyolysis, possibly due to poisoning by palytoxin-like compounds in seafood, were detected in Salvador, Brazil. Surveillance was established to detect additional cases aiming at describing the clinical characteristics of the cases, identifying associated factors, estimating disease attack rate, and investigating the presence of biotoxins and trace metals in selected fish specimens obtained from cases. Method: Between December/2016-January/2021, surveillance investigated Haff disease suspected cases, and obtained clinical and fish samples to test. Findings: Of 65 cases investigated during the 2016-2017 outbreak, 43 (66%) had high creatine phosphokinase (CPK) levels. Among those with laboratory-confirmed rhabdomyolysis, 38 (88%) were hospitalized, 11 (26%) required intensive care, and three (7%) dialysis. Ingestion of marine fish 24h before disease onset was reported by 74% of the cases with elevated CPK and by 41% of those without CPK measurement (P=0·02). Attack rate for individuals who ate fish related to the outbreak was 55%. Following this outbreak, surveillance identified 12 suspected cases between 2017-2019, and a second outbreak in 2020-2021, with 16 laboratory-confirmed rhabdomyolysis patients (five required intensive care; one died). No traces of ciguatoxins and metals were detected in fish specimens obtained in 2016, found to be Seriola rivoliana. Some fish samples from 2020 were screened for palytoxin (PlTX)-like compounds and contained detectable levels of molecule fragments characteristics of isobaric PlTX, ovatoxin-a (OVTX-a), OVTX-b and OVTX-d. Interpretation: These findings support the hypothesis that compounds related to PlTX accumulated in marine fish may be the toxic agent causing the disease. Haff disease is a life-threatening condition, requiring clinical suspicion for patients with sudden-onset myalgia following fish ingestion. Suspected cases should be reported to health authorities for investigation.
RESUMEN
Zika virus (ZIKV) is a mosquito-borne flavivirus that has emerged as a global concern because of its impact on human health. ZIKV infection during pregnancy can cause microcephaly and other severe brain defects in the developing fetus and there have been reports of the occurrence of Guillain-Barré syndrome in areas affected by ZIKV. NK cells are activated during acute viral infections and their activity contributes to a first line of defense because of their ability to rapidly recognize and kill virus-infected cells. To provide insight into NK cell function during ZIKV infection, we have profiled, using mass cytometry, the NK cell receptor-ligand repertoire in a cohort of acute ZIKV-infected female patients. Freshly isolated NK cells from these patients contained distinct, activated, and terminally differentiated, subsets expressing higher levels of CD57, NKG2C, and KIR3DL1 as compared with those from healthy donors. Moreover, KIR3DL1+ NK cells from these patients produced high levels of IFN-γ and TNF-α, in the absence of direct cytotoxicity, in response to in vitro stimulation with autologous, ZIKV-infected, monocyte-derived dendritic cells. In ZIKV-infected patients, overproduction of IFN-γ correlated with STAT-5 activation (r = 0.6643; p = 0.0085) and was mediated following the recognition of MHC class 1-related chain A and chain B molecules expressed by ZIKV-infected monocyte-derived dendritic cells, in synergy with IL-12 production by the latter cells. Together, these findings suggest that NK cells contribute to the generation of an efficacious adaptive anti-ZIKV immune response that could potentially affect the outcome of the disease and/or the development of persistent symptoms.
Asunto(s)
Células Asesinas Naturales/inmunología , Infección por el Virus Zika/inmunología , Virus Zika/fisiología , Enfermedad Aguda , Células Cultivadas , Estudios de Cohortes , Femenino , Humanos , Interferón gamma/metabolismo , Interleucina-12/metabolismo , Activación de Linfocitos , Embarazo , Receptores KIR3DL1/metabolismo , Factor de Transcripción STAT5/metabolismo , Factor de Necrosis Tumoral alfa/metabolismoRESUMEN
Congenital Zika virus syndrome (CZS) is associated with damage to neural progenitor cells by ZIKA virus infection. There are no accurate statistics on the percentage of pregnant mothers who have had babies affected by the syndrome. Few cases of discordant twins have been described in the literature and, therefore, we hypothesize that the genetic background of the progeny and/or mother may play a role in the fate of the syndrome. We performed a complete exome sequencing in a set of dizygotic individuals and their parents. After that, we selected discordant variants on the MTOR gene between the affected and unaffected twin and we observed a mutation (rs2295079), placed in a region restricted to proximal 5'-UTR, as a strong possible causal variant. In addition, in most brain tissues (including fetal brain) evaluated for expression quantitative trait loci (eQTL), this locus is strongly correlated with post-translational modifications of histones (promoter and enhancer marks) and hypersensitivity to DNAse I (open chromatin mark). Taken together, our data suggest that changes in the MTOR gene may be related to CZS. Additional functional studies should be carried out to prove how and why a MTOR mutation can predispose the fetus to the syndrome.
RESUMEN
Identificada inicialmente em Wuhan, na China, a Covid-19 causada pelo novo coronavírus da síndrome respiratória (SARS-CoV-2) provocou um alerta global. Diante desse cenário emergencial, o Brasil, assim como outros países, tem vivenciando grandes mudanças nas ações e serviços em saúde. Na Bahia, a velocidade de disseminação da doença ocasionou um aumento significativo na notificação de casos e óbitos, promovendo uma restruturação no processo de trabalho da vigilância epidemiológica estadual para atuar de forma oportuna na captação, investigação e classificação de casos, e publicação e recomendações de medidas sanitárias. Este trabalho objetiva descrever o processo de trabalho na vigilância epidemiológica de óbitos por Covid-19 no estado da Bahia. Trata-se de um relato de experiência do processo de trabalho de análise dos óbitos por Covid-19 no período de março a dezembro de 2020. A trajetória metodológica foi estruturada em análise documental, relatórios de investigação, ferramentas de notificação do Ministério da Saúde e outros sistemas oficiais, como o Formulário Eletrônico do SUS FormSUS, produzido pela Diretoria de Vigilância Epidemiológica para identificar os óbitos por Covid-19 nos hospitais da Bahia em tempo hábil, facilitando o processo de captação, investigação, análise e publicação de informação de mortalidade. Observou-se que a estruturação de um processo organizado e aplicado ao fluxo de trabalho possibilitou a qualificação e a fidedignidade das informações dos óbitos por Covid-19, garantindo mudanças incrementais no âmbito da vigilância e segurança das informações publicadas, essenciais para o planejamento das ações de prevenção e controle.
Initially identified in Wuhan, China, Covid-19 caused by the respiratory syndrome coronavirus (SARS-CoV-2) has triggered a global alert. Faced with this emergency scenario, Brazil, like other countries, has been experiencing major changes in health actions and services. In the state of Bahia, the rapid spread of the disease increased significantly the notification of cases and deaths, promoting a restructuring in the work process of state epidemiological surveillance to act in a timely manner in capturing, investigating and classifying cases, publishing and recommending sanitary measures. This paper aims at describing the work process in the epidemiological surveillance of deaths by Covid-19 in the state of Bahia. This is an experience report of Covid-19 death analysis work process, from March to December 2020. The methodological trajectory was structured in document analysis, investigation reports, notification tools from the Ministry of Health and others official systems, and the SUS FormSUS Electronic Form, produced by the Epidemiological Surveillance Directorate (Divep) to identify deaths by Covid-19 by hospitals in Bahia in a timely manner, facilitating the process of capturing, investigating, analyzing and publishing information of mortality. It was observed that the structuring of an organized process and application to the workflow enabled the qualification and reliability of death information by Covid-19, ensuring incremental changes in the scope of surveillance and security in the published information, essential for planning prevention and control actions.
Inicialmente identificado en Wuhan, China, el covid-19 causante del síndrome respiratorio agudo grave (SARS-CoV-2) ha desencadenado una alerta global. Ante este escenario de emergencia, Brasil, al igual que otros países, ha venido experimentando importantes cambios en las acciones y servicios de salud. En Bahía, la velocidad de propagación de la enfermedad provocó un aumento significativo en la notificación de casos y defunciones, promoviendo una reestructuración en el proceso de trabajo de la vigilancia epidemiológica estadual para actuar de manera oportuna en la recopilación, investigación, clasificación de casos, publicación y recomendación de medidas preventivas. Este artículo tiene como objetivo describir el proceso de trabajo en la vigilancia epidemiológica de las muertes por covid-19 en el estado de Bahía. Es un informe de experiencia del proceso de trabajo de análisis de muertes por covid-19, de marzo a diciembre de 2020. La trayectoria metodológica se estructuró en análisis de documentos, informes de investigación, herramientas de notificación del Ministerio de Salud y otros sistemas oficiales, así como el Formulario Electrónico SUS FormSUS, elaborado por la Dirección de Vigilancia Epidemiológica (Divep) para identificar las muertes por covid-19 en los hospitales de Bahía de manera oportuna, lo que facilita el proceso de recopilación, investigación, análisis y publicación de información sobre mortalidad. Se observó que la estructuración de un proceso organizado y aplicado al flujo de trabajo permitió la calificación y confiabilidad de la información de muertes por covid-19, asegurando cambios incrementales en el alcance de la vigilancia y seguridad de la información publicada, fundamental para planificar la prevención y el control.
Asunto(s)
Mortalidad , Coronavirus , Muerte , Síndrome Respiratorio Agudo Grave , PandemiasRESUMEN
Abstract Several major epidemics of Zika fever, caused by the ZIKA virus (ZIKV), have emerged in Brazil since early 2015, eventually spreading to other countries on the South American continent. The present study describes the clinical manifestations and laboratory findings of patients with confirmed acute ZIKV infection during the first epidemic that occurred in Salvador, Brazil. All included patients were seen at the emergency room of a private tertiary hospital located in Salvador, Brazil from 2015 through 2017. Patients were considered eligible if signs of systemic viral febrile disease were present. All individuals were tested for ZIKV and Chikungunya infection using PCR, while rapid test was used to detect Dengue virus antibodies or, alternatively, the NS1 antigen. A diagnosis of acute ZIKV infection was confirmed in 78/434 (18%) individuals with systemic viral febrile illness. Positivity was mainly observed in blood, followed by saliva and urine. Coinfection with Chikungunya and/or Dengue virus was detected in 5% of the ZIKV-infected patients. The most frequent clinical findings were myalgia, arthralgia and low-grade fever. Laboratory analysis demonstrated normal levels of hematocrit, platelets and liver enzymes. In summary, in acute settings where molecular testing remains unavailable, clinicians face difficulties to confirm the diagnosis of ZIKV infection, as they rely only on clinical examinations and conventional laboratory tests.
Asunto(s)
Humanos , Virus Chikungunya , Dengue , Virus del Dengue , Epidemias , Fiebre Chikungunya , Virus Zika , Infección por el Virus Zika , Brasil/epidemiología , Dengue/epidemiología , Fiebre Chikungunya/epidemiología , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/epidemiologíaRESUMEN
Several major epidemics of Zika fever, caused by the ZIKA virus (ZIKV), have emerged in Brazil since early 2015, eventually spreading to other countries on the South American continent. The present study describes the clinical manifestations and laboratory findings of patients with confirmed acute ZIKV infection during the first epidemic that occurred in Salvador, Brazil. All included patients were seen at the emergency room of a private tertiary hospital located in Salvador, Brazil from 2015 through 2017. Patients were considered eligible if signs of systemic viral febrile disease were present. All individuals were tested for ZIKV and Chikungunya infection using PCR, while rapid test was used to detect Dengue virus antibodies or, alternatively, the NS1 antigen. A diagnosis of acute ZIKV infection was confirmed in 78/434 (18%) individuals with systemic viral febrile illness. Positivity was mainly observed in blood, followed by saliva and urine. Coinfection with Chikungunya and/or Dengue virus was detected in 5% of the ZIKV-infected patients. The most frequent clinical findings were myalgia, arthralgia and low-grade fever. Laboratory analysis demonstrated normal levels of hematocrit, platelets and liver enzymes. In summary, in acute settings where molecular testing remains unavailable, clinicians face difficulties to confirm the diagnosis of ZIKV infection, as they rely only on clinical examinations and conventional laboratory tests.
Asunto(s)
Fiebre Chikungunya , Virus Chikungunya , Virus del Dengue , Dengue , Epidemias , Infección por el Virus Zika , Virus Zika , Brasil/epidemiología , Fiebre Chikungunya/epidemiología , Dengue/epidemiología , Humanos , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/epidemiologíaRESUMEN
Zika virus (ZIKV) is considered to cause an acute self-limited infection in adults, and microcephaly in fetus. Presence of the virus for long periods has been detected in body fluids; however, persistent viremia in serum for more than 1 year has not yet been reported. We have investigated persistence of ZIKV in serum samples of 77 subjects who were infected by the virus between 18 months and 3 years before the start of this study. The subjects included children with microcephaly and their parents. Serum samples were subjected to routine RT-qPCR assay for ZIKV, Chikungunya virus, and Dengue virus. From the 77 subjects, five showed positive for the presence of ZIKV particles by RT-qPCR, including four members of the same family. Viral isolation in Vero cells and C6/36 cells confirmed the result and showed the viral particles were active. We have detected viremia in healthy carriers up to 3 years after symptom onset. Humans acting as potential viral reservoirs have major implication for the current understanding of ZIKV infection.
Asunto(s)
Reservorios de Enfermedades/virología , Viremia/diagnóstico , Infección por el Virus Zika/sangre , Virus Zika/aislamiento & purificación , Adulto , Animales , Niño , Chlorocebus aethiops , Familia , Femenino , Humanos , Recién Nacido , Masculino , Persona de Mediana Edad , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/virología , Células Vero , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/transmisiónRESUMEN
Oropouche virus (OROV) is a negative-sense, single-stranded RNA arbovirus transmitted to humans by the midge Culicoides paraenesis, causing Oropouche fever. Reports of its outbreak in Brazil have so far been restricted to the Central-Northern region of the country. However, its incidence is underestimated, mainly due to its clinical similarities with other arbovirus diseases, including dengue (DENV), chikungunya (CHIKV), and zika (ZIKV), and the lack of specific diagnostic tests. Here, we report for the first time, the detection of OROV in saliva and urine samples, and cases of autochthone OROV infections in Salvador Metropolitan region, Bahia, a Northeastern capital in the coast of Brazil. Serum, saliva, and urine samples negative for DENV, CHIKV, and ZIKV were tested for OROV using a reverse transcription nested polymerase chain reaction (RT-nested-PCR) protocol, and 2 serum, 2 saliva, and 1 urine samples were positive. This report shows the need for an efficient surveillance system for controlling the spread of this virus, and suggests the use of saliva and urine as alternative samples for OROV detection in the absence of serum samples.
Asunto(s)
Infecciones por Bunyaviridae/diagnóstico , Infecciones por Bunyaviridae/orina , Fiebre/virología , Orthobunyavirus/genética , Saliva/virología , Animales , Brasil/epidemiología , Infecciones por Bunyaviridae/epidemiología , Ceratopogonidae/virología , Brotes de Enfermedades , Humanos , Orthobunyavirus/aislamiento & purificación , ARN Viral/genéticaRESUMEN
Chikungunya virus (CHIKV) is an RNA virus transmitted by Aedes mosquitoes. The clinical manifestations include fever, arthralgia, rash, and other atypical clinical findings including ocular lesions. We report the case of a 57-year-old man with meningoencephalitis and anterior uveitis due to CHIKV. The patient had developed bilateral anterior uveitis with iris atrophy and a cotton wool spot on the left eye, and his serum, urine, saliva, and cerebrospinal fluid were positive for CHIKV by RT-PCR. The spectrum of the ophthalmologic manifestations and its pathophysiology in cases of CHIKV infections needs to be better understood. Additional studies examining the ocular lesions caused by CHIKV could improve the therapeutic goals of reducing the morbidity and sequels.
Asunto(s)
Fiebre Chikungunya/complicaciones , Encefalitis Viral/etiología , Infecciones Virales del Ojo/etiología , Uveítis Anterior/etiología , Enfermedad Aguda , Aedes/virología , Animales , Humor Acuoso/virología , Fiebre Chikungunya/transmisión , Fiebre Chikungunya/virología , Virus Chikungunya/genética , Encefalitis Viral/diagnóstico , Encefalitis Viral/virología , Infecciones Virales del Ojo/diagnóstico , Infecciones Virales del Ojo/virología , Humanos , Imagen por Resonancia Magnética , Masculino , Microscopía Acústica , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , ARN Viral/análisis , Tomografía de Coherencia Óptica , Uveítis Anterior/diagnóstico , Uveítis Anterior/virologíaRESUMEN
INTRODUCTION: The Brazilian HIV/AIDS management and treatment guideline (PCDT), published in 2013, recommends and standardizes the use of highly active antiretroviral therapy (HAART) in all adult patients, in spite of LTCD4 count. This study aimed to analyze the first year of HAART use in patients from a reference center on HIV/AIDS management in Fortaleza, Ceará. METHOD: This descriptive study reviewed all prescription forms of antiretroviral regimens initiation and changes from January to July 2014. All antiretroviral regimen changes that occurred during the first year of therapy were evaluated. Data were analyzed with SPSS version 20. Mean, standard deviation and frequency, Student's t and Mann-Whitney tests calculations were used, with significance at p<0.05. RESULTS: From 527 patients initiating HAART, 16.5% (n=87) had a regimen change in the first year. These patients were mostly male (59.8%; n=52), aged 20 to 39 years, with only one HAART change (72.4%; n=63). Efavirenz was the most often changed drug, followed by tenofovir, zidovudine and lopinavir/ritonavir. Mean time of HAART changes was 120 days, with adverse reactions as the most prevalent cause. HAART was effective in decreasing viral load since second month of treatment (p=0.003) and increasing LTCD4 lymphocytes since fifth month (p<0.001). CONCLUSION: The main cause of initial HAART changes was adverse reaction and most patients had only one change in the HAART regimen. HAART prescription was in accordance to the PCDT from 2013.
Asunto(s)
Fármacos Anti-VIH/efectos adversos , Terapia Antirretroviral Altamente Activa/efectos adversos , Sustitución de Medicamentos/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Adulto , Análisis de Varianza , Fármacos Anti-VIH/clasificación , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/clasificación , Terapia Antirretroviral Altamente Activa/estadística & datos numéricos , Brasil/epidemiología , Recuento de Linfocito CD4 , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Prevalencia , Factores Sexuales , Adulto JovenRESUMEN
Summary Introduction: The Brazilian HIV/AIDS management and treatment guideline (PCDT), published in 2013, recommends and standardizes the use of highly active antiretroviral therapy (HAART) in all adult patients, in spite of LTCD4 count. This study aimed to analyze the first year of HAART use in patients from a reference center on HIV/AIDS management in Fortaleza, Ceará. Method: This descriptive study reviewed all prescription forms of antiretroviral regimens initiation and changes from January to July 2014. All antiretroviral regimen changes that occurred during the first year of therapy were evaluated. Data were analyzed with SPSS version 20. Mean, standard deviation and frequency, Student's t and Mann-Whitney tests calculations were used, with significance at p<0.05. Results: From 527 patients initiating HAART, 16.5% (n=87) had a regimen change in the first year. These patients were mostly male (59.8%; n=52), aged 20 to 39 years, with only one HAART change (72.4%; n=63). Efavirenz was the most often changed drug, followed by tenofovir, zidovudine and lopinavir/ritonavir. Mean time of HAART changes was 120 days, with adverse reactions as the most prevalent cause. HAART was effective in decreasing viral load since second month of treatment (p=0.003) and increasing LTCD4 lymphocytes since fifth month (p<0.001). Conclusion: The main cause of initial HAART changes was adverse reaction and most patients had only one change in the HAART regimen. HAART prescription was in accordance to the PCDT from 2013.
Resumo Introdução: O Protocolo Clínico e Diretrizes Terapêuticas para manejo da infecção pelo HIV em adultos (PCDT) de 2013 recomenda e normatiza início de terapia antirretroviral (TARV) em pacientes com qualquer contagem de LTCD4. O objetivo do estudo foi analisar o primeiro ano de TARV de pacientes em acompanhamento em um centro de referência em HIV/AIDS de Fortaleza, Ceará. Método: O estudo descritivo revisou formulários de solicitação de início e modificação de TARV em pacientes que iniciaram tratamento entre janeiro e julho de 2014. Foram avaliadas todas as mudanças que ocorreram durante o primeiro ano de terapia. Os dados foram analisados no programa Statistical Package for the Social Sciences (SPSS) versão 20. Foram calculados médias, desvios padrão, frequências, testes t Student e Mann-Whitney, com significância de p<0,05. Resultados: Dos 527 pacientes que iniciaram TARV, 16,5% (n=87) realizaram troca no primeiro ano. A maioria era do sexo masculino (59,8%; n=52), de 20 a 39 anos, com apenas uma mudança da TARV (72,4%; n=63). Efavirenz foi o fármaco mais substituído, seguido por tenofovir, zidovudina e lopinavir/ritonavir. O tempo médio de ocorrência das modificações da TARV foi de 120 dias, tendo reações adversas como causas principais. TARV foi efetiva na queda da carga viral desde o 2ºmês de tratamento (p=0,003) e na elevação de LTCD4 desde o 5º mês (p<0,001). Conclusão: Os principais fatores envolvidos em modificações de TARV inicial foram reações adversas, com apenas uma mudança de esquema na maioria dos pacientes. O manejo da TARV estava de acordo com o PCDT de 2013.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adulto Joven , Infecciones por VIH/tratamiento farmacológico , Fármacos Anti-VIH/efectos adversos , Terapia Antirretroviral Altamente Activa/efectos adversos , Sustitución de Medicamentos/estadística & datos numéricos , Brasil/epidemiología , Infecciones por VIH/epidemiología , Factores Sexuales , Prevalencia , Análisis de Varianza , Recuento de Linfocito CD4 , Fármacos Anti-VIH/clasificación , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/clasificación , Terapia Antirretroviral Altamente Activa/estadística & datos numéricosRESUMEN
Chikungunya virus (CHIKV) has never been detected in human breast milk. This is a brief report of CHIKV infection in a breastfeeding woman of a 3-month-old baby. The mother's CHIKV-RT PCR was positive in serum, urine and milk. The baby's CHIKV serology and reverse transcription polimerase chain reaction (RT-PCR) were negative. The detection of CHIKV in milk raises clinical and epidemiologic questions.
Asunto(s)
Fiebre Chikungunya , Virus Chikungunya , Leche Humana/virología , Adulto , Anticuerpos Antivirales/sangre , Lactancia Materna , Fiebre Chikungunya/diagnóstico , Fiebre Chikungunya/virología , Virus Chikungunya/genética , Virus Chikungunya/aislamiento & purificación , Femenino , Humanos , Lactante , Masculino , ARN Viral/análisis , ARN Viral/genética , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
We report the presence of Chikungunya (CHIKV) RNA in the blood, urine and semen during the acute phase of the disease in an adult with a dual infection with Dengue virus type 3. The patient, a 25 yr-old man from Salvador, Brazil, reported a 6-day duration of high fever, arthralgia, myalgia, headache and photophobia.Blood and semen specimens were positive for CHIKV in the first collected samples; semen and urine specimens were positive for CHIKV after 30 days of symptoms onset. DENV-3 RNA was positive in blood specimen when first collected 6 days after the initiation of symptoms.We describe for the first time the presence of CHIKV RNA in urine and semen for an extended period of time and we address the possible implications of these findings for diagnosis and transmission dynamics.
RESUMEN
We describe a 32-yr old woman with AIDS and cryptococcal meningitis that developed cardiomyopathy after 17 days of treatment with Deoxycholate Amphotericin-B (D-Amb) with reversal of the symptoms and transthoracic echocardiogram (TTE) findings after the drug had been stopped and switched to Fluconazole.