HIV-1 subtype frequency in Northeast Brazil: A systematic review and meta-analysis.

Information on human immunodeficiency virus (HIV) molecular epidemiology is required to verify HIV/AIDS (acquired immune deficiency syndrome) epidemic dynamics in different regions, as well as provide support for response to antiretroviral therapy, transmission of resistance mutations, disease progression, and viral spread. The aim of this study was to conduct a systematic review and meta-analysis of the frequency of HIV-1 subtypes in Northeast Brazil. Seventy-six articles that refer to HIV-1 and its subtypes in the Northeast Brazil and published between 1 January 1999 and 31 August 2019 were identified. We included 27 articles for the qualitative synthesis, thus analyzing results from 4466 patients and 4298 genomic sequences. The results showed that subtypes B, F, and C and recombinant BF were responsible for 76% (IC95%: 71-80), 8% (IC95%: 5-11), 2% (IC95%: 2-3), and 7% (IC95%: 4-12) infections, respectively. The highest proportion of subtype B infections (82.2%) was observed in Piauí, while the subtype F had a high frequency in Pernambuco (23.4%). Bahia presented 11.6% of the proportion of recombinant BF. In addition, several recombinants such as AG, BC, BCF, and BD have been identified in the region. This is the first systematic review and meta-analysis on the HIV-1 subtype distribution in Northeast Brazil and has shown a high circulating viral diversity. Although subtype B is predominant in Brazil, a large frequency of non-B subtypes has also been found, which may have consequences for response to antiretroviral therapy, disease progression, and transmission. Thus, HIV molecular epidemiological data are essential for epidemic prevention and control strategies.

Occult hepatitis B virus infection in patients with leprosy.

Leprosy patients may present with immune system impairment and have a higher hepatitis B virus (HBV) seroprevalence, justifying the investigation of occult HBV infection in these individuals. The aim of this study was to verify the frequency and the clinical factors associated with occult HBV infection in leprosy patients. Between 2015 and 2016, leprosy patients from a reference center in Brazil were interviewed to assess clinical data. Blood samples were collected for the screening of HBV serological markers using enzyme-linked immunosorbent assay. Patients with negative hepatitis B surface antigen (HBsAg) that had positive anti-HBc and/or anti-HBs were selected for HBV DNA detection using real-time polymerase chain reaction. SPSS was used for data analysis. Among 114 selected patients, six were identified with occult infection (5.3%) and five of them with multibacillary leprosy. Three patients with occult infection had a history of a type 2 reaction (P = 0.072; OR, 4.97; 95% CI, 0.87-28.52). Only two patients with occult infection had isolated anti-HBc, while three had isolated anti-HBs, including those with the highest HBV DNA titers. In conclusion, in leprosy patients with negative HBsAg and positive anti-HBc and/or anti-HBs, occult HBV infection occurs in 5.3% and can be found even in patients with isolated anti-HBs.

First detection of metallo-β-lactamases in nosocomial isolates of Pseudomonas aeruginosa in Alagoas, Brazil / Primeira detecção de metalobetalactamases em isolados nosocomiais de Pseudomonas aeruginosa em Alagoas, Brasil

ABSTRACTIntroduction:Pseudomonas aeruginosa is a leading cause of opportunistic infections in humans, and the choice of effective antimicrobial agents to control this bacterium has been limited, mainly due to its ability to produce metallo-β-lactamases (MβL), enzymes capable of inactivating many antimicrobials through hydrolysis.Objective:This study aimed to detect the presence of multidrug-resistant (MDR) P. aeruginosa strains and the MβL-encoding genes (blaSPM, blaIMP and blaVIM) in nosocomial isolates in Maceió (AL).Methods:The isolates were collected from four public institutions/hospitals in Maceió, and cultures were identified by conventional methods. Antibiotic susceptibility was determined by the disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI), and polymerase chain reaction (PCR) was used to identify the presence of the MβL-encoding genes blaSPM, blaIMP and blaVIM.RESULTS:Forty-three strains of P. aeruginosa were MDR among 85 identified nosocomial isolates (50.6%), 79.1% and 20% of which were resistant to carbapenem (imipenem and meropenem) and aztreonam, respectively. PCR was performed in susceptible or resistant isolates and we identified nine (20.9%) MDR strains with blaSPM gene, whereas only one strain had blaIMP and none blaVIM positive was found.Conclusion:Production of MβL is an important mechanism of resistance to carbapenems and other β-lactams among P. aeruginosa strains in the evaluated samples. We reported the first identification of MβL-encoding genes in P. aeruginosa from nosocomial environments in Maceió, a new insight for the epidemiology of MβL in the Northeastern region of Brazil.

RESUMOIntrodução:Pseudomonas aeruginosa é a principal causa de infecções oportunistas em seres humanos, e a escolha de agentes antimicrobianos eficazes para controlar essa bactéria tem sido limitada, principalmente devido à sua capacidade de produzir metalobetalactamases (MβL), enzimas capazes de inativar muitos antimicrobianos por meio de hidrólise.Objetivo:Este estudo objetivou detectar a presença de cepas de P. aeruginosa multirresistentes e os genes codificadores de MβL (blaSPM, blaIMP e blaVIM) em isolados nosocomiais em Maceió (AL).Métodos:Os isolados foram coletados de quatro instituições públicas/hospitais em Maceió, e as culturas foram identificadas por métodos convencionais. A sensibilidade aos antibióticos foi determinada pelo método de disco-difusão de acordo com o Clinical and Laboratory Standards Institute (CLSI), e a reação em cadeia da polimerase (PCR) utilizada para identificar a presença de genes que codificam MβL - blaSPM, blaIMP e blaVIM.ResultadosQuarenta e três cepas de P. aeruginosa foram multirresistentes entre os 85 isolados nosocomiais identificados (50,6%); destes, 79,1% e 20% foram resistentes aos carbapenêmicos (imipenem e meropenen) e ao aztreonam, respectivamente. A PCR foi realizada em isolados suscetíveis ou resistentes, e nós identificamos nove (20,9%) cepas multirresistentes com gene blaSPM, enquanto apenas uma possuía blaIMP e nenhuma blaVIM positiva foi encontrada.CONCLUSÃO:A produção de MβL é um importante mecanismo de resistência aos carbapenêmicos e a outros betalactâmicos entre cepas de P. aeruginosa nas amostras avaliadas. Relatamos a primeira identificação de genes codificadores de MβL em P. aeruginosa de ambiente hospitalar de Maceió, uma nova visão para a epidemiologia de MβL na região Nordeste do Brasil.