Serum levels of high sensitive C reactive protein in healthy adults from southern Brazil.

BACKGROUND: With the emergence of more sensitive assay techniques, it has been shown that C reactive protein (CRP) is present at low levels in the serum of all the clinically healthy individuals. OBJECTIVE: To determine the interval values of high-sensitivity CRP (hs-CRP) in healthy adults. METHODS: Serum hs-CRP level was evaluated in 176 healthy blood donors. RESULTS: The serum hs-CRP level ranged from <0.175 to 48.7 mg/l (median 1.2 mg/l); 127 (72.2%) individuals exhibited values ≥0.175 and <3.0 mg/l and 31 (17.6%) showed values >3.0 and ≤10.0 mg. Higher hs-CRP level was observed among the female than male (P = 0.0001), and among the older than the younger individuals (P = 0.0180). Individuals with body mass index ≥25.0 kg/m(2) exhibited higher hs-CRP level than those with normal weight (18.5-24.9 kg/m(2) ; P < 0.0005). When the participants were stratified into gender and low (≤24.9 kg/m(2) ) and high (≥24.9 kg/m(2) ) body mass index (BMI) groups, the gender difference in hs-CRP levels remained (female with low BMI vs. male with low BMI, P = 0.0221; female with high BMI vs. male with high BMI, P = 0.0001). CONCLUSION: Gender, age, and BMI influence serum hs-CRP level in healthy individuals and these variables should be considered for the interpretation of hs-CRP values. The results reinforce the importance in evaluating whether these differences in hs-CRP levels could contribute to alter the cardiovascular risk criteria and clinical outcomes, and whether hs-CRP thresholds for cardiovascular risk assessment should be adjusted for different gender and body mass index groups.

Epidemiological, immunological and virological characteristics, and disease progression of HIV-1/HCV-co-infected patients from a southern Brazilian population.

A cross-sectional study was carried out in order to describe the epidemiological, immunological and virological characteristics, and the disease progression of hepatitis C virus (HCV)/human immunodeficiency virus type 1 (HIV-1)- co-infected patients from a southern Brazilian population. Of 778 HIV-1-infected individuals enrolled in the study from September 2001 to December 2003, and followed up until June 2004, 757 were tested for anti-HCV antibodies. Of these, 159 (21.0%) showed positive results for anti-HCV. Males, individuals in the 25 to 34 year age range, and individuals of lower economic levels were more likely to be seropositive for both viruses [prevalence rate (PR), 2.04; 95% confidence interval (95% CI), 1.43-2.92; p<0.001]. The anti-HCV reactivity was also associated with blood routes of transmission (PR, 2.20; 95% CI, 1.28-3.77; p<0.001), intravenous drug use (PR, 5.79; 95% CI, 4.74-7.07; p<0.001), self-reported previous sexually transmitted diseases (PR, 1.55; 95% CI, 1.18-2.04; p=0.002), VDRL positivity (PR, 2.87; 95% CI, 2.40-3.43; p<0.001), and anti-HTLV I/II reactivity (PR, 5.09; 95% CI, 4.16-6.23; p<0.001). In the follow-up period, the HCV/HIV-1-co-infected patients showed a trend toward lower CD4+ T-cell counts, higher HIV-1 RNA plasma viral load and faster disease progression than patients infected only with HIV-1, but significant differences were not observed. Although there were proportionately more deaths in the HCV/HIV-1-co-infected group, the use of highly active antiretroviral therapy (HAART) was a string predictor of increased CD4+ T-cell counts and decreased HIV-1 RNA plasma levels, suggesting that HAART is more important to the immunological and virological outcomes in HIV-1 infection than is HCV co-infection status.

Frequency of CCR5-Delta32 deletion in human immunodeficiency virus type 1 (HIV-1) in healthy blood donors, HIV-1-exposed seronegative and HIV-1-seropositive individuals of southern Brazilian population.

The frequency of CCR5-Delta32 allele in human immunodeficiency virus type 1 (HIV-1) infection in the southern Brazilian population was determined in a cross-sectional study carried out from October 2001 to June 2004. Genomic DNA was extracted from peripheral blood cells of 134 healthy blood donors, 145 HIV-1-exposed seronegative individuals, 152 HIV-1-seropositive asymptomatic individuals, and 478 HIV-1-seropositive individuals with AIDS. A fragment with 225 base-pairs of the CCR5 gene was amplified by polymerase chain reaction. The CCR5-Delta32 homozygous deletion was observed in 2 (1.5%) blood donors and in 1 (0.7%) individual HIV-1-exposed seronegative, and was absent among all the HIV-1-seropositive individuals (Fisher's exact test, p=0.0242). The frequency of the homozygous CCR5-Delta32 deletion in the HIV-1-exposed did not differ when compared with that observed in the HIV-1 seronegative blood donors (Fisher's exact test, p=0.6093; OR: 2.18, 95% CI: 0.11-129.6). The wild-type genotype CCR5/CCR5 frequency was higher among the HIV-1-seropositive with AIDS compared to HIV-1 seropositive asymptomatic individuals (Chi-square test, p=0.0263; OR: 2.02, 95% CI: 1.03-3.97). The absence of the homozygous deletion of CCR5-Delta32 among HIV-1-seropositive individuals underscored that this genotype is an important genetic factor associated with the decreased susceptibility to HIV-1 infection. The higher frequency of heterozygosity for the CCR5-Delta32 and the CCR5-Delta32 allele in HIV-1 seropositive asymptomatic compared to HIV-seropositive with AIDS individuals also underscored that this deletion could be associated with the delay of the HIV-1 disease progression in this population. However, the low frequency of CCR5-Delta32 homozygosity observed among HIV-1-exposed seronegative individuals shows that the allele could not explain, by itself, the natural resistance to HIV-1 infection and different mechanisms of protection against HIV-1 infection that must be involved in this population.

Multivariate analysis of the factors associated with the risk of pneumonia in intensive care units.

Pneumonia is the most frequent hospital infection in patients admitted to intensive care units (ICU) and is also responsible for the highest lethality rates, as well as an increase in both the duration and costs of hospitalization. The objective of this study was to identify predisposing factors for pneumonia. A prospective cohort study was carried out between June 1996 and June 1997, and included 540 patients admitted consecutively for periods greater than 24 hours to the adult ICU of the Londrina State University's Teaching Hospital. Of these, 83 (15.4%) developed pneumonia. All patients were analyzed with respect to various risk factors for hospital-acquired pneumonia. Univariate analysis identified the following factors: decreased level of consciousness, craniotomy, prior use of antibiotics, mechanical ventilation, nasogastric tube feeding, enteral feeding, aspiration of gastric contents, central venous catheter and the time spent in the ICU. Multivariate analysis identified four risk factors for pneumonia in the ICU: tracheotomy (RR = 1.09; 95%CI = 1.04-1.17), nasogastric tube feeding (RR = 1.11; 95%CI = 1.05-1.18), H2-blocker use (RR = 1.09; 95%CI = 1.05-1.14) and decreased level of consciousness (RR = 2.67; 95%CI = 1.43-5.04). In 56.6% of patients, pneumonia occurred within the first four days following ICU admission. The risk factors identified were all necessary for the treatment of the patient except for decreased level of consciousness, either present at admission or occurring during hospitalization due to deterioration in the clinical condition of the patient or to the use of sedatives.

The effect of stromal cell-derived factor 1 (SDF1/CXCL12) genetic polymorphism on HIV-1 disease progression.

The human immunodeficiency virus type 1 (HIV-1) epidemic is increasing in Brazil, and little information has been reported about the genetic host factors related to HIV-1 infection in the Brazilian population. A polymorphism in the conserved 3' untranslated region of the stromal cell-derived factor 1 (SDF1/CXCL12) gene has been related either to resistance to HIV-1 infection and delayed progression to AIDS or to rapid disease progression and death. A longitudinal study was conducted to evaluate the association of the SDF1 polymorphism and the progression of HIV-1 infection in 161 asymptomatic patients infected with HIV-1 (ASYMPT) and 617 patients with AIDS (SYMPT) from Londrina and the surrounding region, southern Brazil. The endpoints used were the development of AIDS, death, and the slopes of the CD4+ T cell counts and HIV-1 RNA plasma levels. Among the 161 ASYMPT patients, all of the 7 patients (4.3%) homozygous for the mutation remained asymptomatic (p=0.1906); 6 of them had not initiated antiretroviral therapy. Among the 617 patients with AIDS, 40 (6.5%) progressed to death. Of these, 33/388 (8.5%) did not have the SDF1-3'A allele, 6/196 (3.1%) were heterozygous and 1/33 (3.0%) was homozygous for the SDF1-3'A allele (p=0.029). The SDF1 genotypes were not associated with the surrogate markers of HIV-1 disease progression such as the CD4+ T cell decline and plasma HIV-1 RNA levels. The results observed in this study support the hypothesis that the mutation of SDF1-3'A could have a possible late-stage protective effect on HIV-1 disease progression in the Brazilian population.

Seroprevalence for hepatitis E virus (HEV) infection among volunteer blood donors of the Regional Blood Bank of Londrina, State of Paraná , Brazil.

A cross-sectional study was carried out among 996 volunteer blood donors enrolled from May 1999 to December 1999 to determine the seroprevalence of hepatitis E virus (HEV) infection among volunteer blood donors of the Regional Blood Bank of Londrina, State of Paraná, Brazil, and to evaluate whether the rate of seroprevalence of IgG anti-HEV antibodies is associated with sociodemographic variables and with seropositivity for hepatitis A virus (HAV) infection. All participants answered the questionnaire regarding the sociodemographic characteristics. Serum samples were tested for IgG antibodies to HEV (anti-HEV) by an enzyme linked immunoassay (ELISA). All serum samples positive for anti-HEV IgG and 237 serum samples negative for anti-HEV were also assayed for IgG anti-HAV antibodies by ELISA. Anti-HEV IgG was confirmed in 23/996 samples, resulting in a seroprevalence of 2.3% for HEV infection, similar to previous results obtained in developed countries. No significant association was found between the presence of anti-HEV IgG antibodies and the sociodemographic variables including gender, age, educational level, rural or urban areas, source of water, and sewer system (p > 0.05). Also, no association with seropositivity for anti-HAV IgG antibodies was observed (p > 0.05). Although this study revealed a low seroprevalence of HEV infection in the population evaluated, the results showed that this virus is circulating among the population from Londrina, South Brazil, and point out the need of further studies to define the clinical and epidemiological importance of HEV infection and to identify additional risk factors involved in the epidemiology and pathogenesis of this infection in this population.

The epidemiologic profile and prevalence of cardiopathy in Trypanosoma cruzi infected blood donor candidates, Londrina, Paraná, Brazil.

To describe the epidemiologic profile and prevalence of cardiopathy in 163 Trypanosoma cruzi serum positive blood donor candidates, a descriptive study was carried out between August, 1996 and November, 1997 at the Londrina State University Chagas Disease Outpatient Clinic. The profile found was: young, average age 42.95 +/- 8.62 years; male (65%); Caucasian (84%); low level of schooling; low family income; agricultural worker (26%); born in the state of Paraná (67%); from rural areas (85%); migrated to the city (85%); and the vector as the main mechanism of transmission. During the clinical characterization a chronic cardiac form was found in 38% of the patients and classified as cardiac suggestive form in 21% and little suggestive of Chagas disease in 17%. No significant difference was found among age group distribution, sex and the presence of cardiac symptoms in patients with or without cardiopathy. This study emphasizes the importance of expanding medical services to areas with a greater prevalence of infected individuals, in a hierarchical manner and aiming at decentralization.

Socio-demographic and epidemiological characteristics associated with human immunodeficiency virus type I (HIV-1) infection in HIV-1-exposed but uninfected individuals, and in HIV-1-infected patients from a southern Brazilian population.

The ability to control human immunodeficiency virus type 1 (HIV-1) infection and progression of the disease is regulated by host and viral factors. This cross-sectional study describes the socio-demographic and epidemiological characteristics associated with HIV-1 infection in 1,061 subjects attended in Londrina and region, south of Brazil: 136 healthy individuals (Group 1), 147 HIV-1-exposed but uninfected individuals (Group 2), 161 HIV-1-infected asymptomatic patients (Group 3), and 617 patients with AIDS (Group 4). Data were obtained by a standardized questionnaire and serological tests. The age of the individuals ranged from 15.1 to 79.5 years, 54.0% and 56.1% of the Groups 3 and 4 patients, respectively, were men. The major features of groups 2, 3, and 4 were a predominance of education level up to secondary school (55.8%, 60.2% and 62.4%, respectively), sexual route of exposure (88.4%, 87.0% and 82.0%, respectively), heterosexual behavior (91.8%, 75.2% and 83.7%, respectively), and previous sexually transmitted diseases (20.4%, 32.5%, and 38.1%, respectively). The patients with AIDS showed the highest rates of seropositivity for syphilis (25.6%), of anti-HCV (22.3%), and anti-HTLV I/II obtained by two serological screening tests (6.2% and 6.8%, respectively). The results documenting the predominant characteristics for HIV-1 infection among residents of Londrina and region, could be useful for the improvement of current HIV-1 prevention, monitoring and therapeutic programs targeted at this population.

Association of tumor necrosis factor ß genetic polymorphism and sepsis susceptibility.

The association of the tumor necrosis factor ß (TNF-ß) Nco1 genetic polymorphism with susceptibility to sepsis was evaluated in 60 consecutive patients diagnosed with sepsis and in 148 healthy blood donors. Genomic DNA was extracted from peripheral blood cells and a 782 base-pair fragment of the TNF-ß gene was amplified by PCR. The PCR products were subjected to Nco1 restriction digestion and analysed by restriction fragment length polymorphism analysis. Tumor necrosis factor α (TNF-α) and the C-reactive protein (CRP) serum levels were also determined by ELISA and nephelometry, respectively. Among the septic patients, the allelic frequencies of TNFB1 and TNFB2 were 0.2833 and 0.7166, respectively, and they differed from those observed in the blood donors (p=0.0282). The TNFB2 allele frequency was higher in the septic patients than in the blood donors [odds ratio=1.65 (CI 95% 1.02-2.69), p=0.0315]. The TNF-α and CRP serum levels and the APACHE II and SOFA clinical scores did not differ in the patients with the TNFB1 or TNFB2 alleles (p>0.05). The results suggest that the TNFB2 allele is associated with susceptibility to sepsis, but it was not found to be associated with the immunological and clinical biomarkers of the disease.

Frequency and diversity of human immunodeficiency virus type 1 mutations associated with antiretroviral resistance among patients from Southern Brazil failing highly active antiretroviral therapy (HAART).

The human immunodeficiency virus type 1 (HIV-1) epidemic in Brazil is spreading to small municipalities as well as the innermost parts of the country and scarce information has been reported on the frequency of HIV-1 resistance-associated mutations in these areas. To determine the frequency and diversity of the HIV-1 antiretroviral resistance-associated mutations among patients failing highly active antiretroviral therapy from Londrina in Southern Brazil, 127 HIV-1 genotyping tests that were assayed during January 2000 to July 2008 from 108 patients were evaluated. Sixty-nine patients (63.9%) were male and 39 (36.1%) were female and the age ranged from 10 to 68 years (mean, 40.8+/-9.2). All of them showed at least one HIV-1 antiretroviral resistance-associated mutation and in 72 (56.7%) genotyping tests, mutations for the three antiretroviral classes were detected simultaneously. Mutations associated with resistance to protease inhibitor (PI) were detected in 124 tests (97.6%), the main ones were L90M in 28 (22.0%), V82A in 27 (21.2%), M46I in 26 (20.5%), and I54V in 23 (18.1%). The main mutations associated with nucleoside reverse transcriptase inhibitor (NRTI) resistance were M184V in 82 (64.6%), and the thymidine analog mutations were D67N in 51 (40.1%) tests, K70R in 45 (35.4%), T215Y in 40 (31.5%), and M41L in 38 (30.0%). The most frequent major mutations associated with resistance to non-nucleoside RT inhibitors (NNRTI) were K103N in 47 (37.0%), G190A in 11 (8.7%), and G190S in 2 (2.6%) tests. Mutations associated with reduced susceptibility to NRTI and IP simultaneously were observed in 46 (36.2%) tests. The results obtained may contribute to the improvement of the treatment strategies and the management of the antiretroviral drug therapy of HIV-1-infected patients from this Brazilian region, reducing public costs for antiretroviral drugs which have not been efficient in therapy.

O início precoce do suporte nutricional como fator prognóstico para pacientes com sepse grave e choque séptico / Early initiation of nutritional support as a prognostic factor for patients with severe sepsis

O objetivo deste estudo é analisar a evolução de pacientes críticos que tiveram diagnóstico de sepse grave e utilizaram suporte nutricional precoce durante o período que permaneceram na UTI. Foi realizado estudo observacional prospectivo dos pacientes com diagnóstico de sepse grave admitidos naUTI do Hospital Universitário no período de estudo. Foi utilizada a ficha clínica do Banco de Dados do CTI do HU-UEL para a obtenção das variáveis analisadas. Com este estudo, observou-se que o suporte nutricional foi iniciado precocemente em metade dos pacientes com diagnóstico de sepse grave ouchoque séptico no período de estudo e o início precoce do suporte nutricional resultou em redução do tempo de internação na UTI. Não foi observada diferença na ocorrência de disfunções orgânicas ou na mortalidade associadas com início precoce do suporte nutricional.

The aim of this study was to analyze the evolution of critical patients diagnosed with severe sepsis who used early nutritional support during the period that stayed in the ICU. Prospective observational study was conducted of patients with severe sepsis who were admitted to the ICU of University Hospital during the study period. The clinical database of the HU-UEL ICU was used to obtain the variables. In this study, we observed that early nutritional support was initiated in half of patients with severe sepsis or septic shock during the study period and the beginning of early nutritional support resulted in reduced duration of hospitalization in the ICU. We could not detect difference in the occurrence oforgan dysfunction or mortality associated with early initiation of nutritional support.

Intradermal vaccination of adults with three low doses (2 micrograms) of recombinant hepatitis B vaccine. II. Persistence of immunity and induction of immunologic memory.

Of the 110 dentists who had presented seroconversion 50 days after the intradermal application of three 2 micrograms doses of the Belgian recombinant vaccine against hepatitis B (HB), administered eight years before at an interval of one month between the 1st and 2nd doses and of five months between the 2nd and 3rd doses, 51 were included for the assessment of the persistence of immunity. None of the dentists had hepatitis or had received HB vaccine during this period. All subjects were submitted to serological tests for the detection of the following markers of hepatitis B virus (HBV) infection: HBsAg, anti-HBc, HBeAg, anti-HBe, and anti-HBs, with no HBsAg, anti-HBc, HBeAg or anti-HBe being detected. A microparticle enzyme immunoassay (MEIA) revealed the presence of anti-HBs at protective titers (> or = 10 mIU/ml) in 42 dentists (82.4%), with the anti-HBs titer being higher than 100 mIU/ml in 36 of them (70.6%) (good responders), between 10 and 100 mIU/ml in 6 (11.8%) (poor responders), and lower than 10 mIU/ml in 9 (17.6%) (non-responders). According to clinical data and serological tests, none of the dentists had presented disease or latent HBV infection during the eight years following the first vaccination. A 2 micrograms booster dose was administered intradermally to eight dentists with anti-HBs titers lower than 10 mIU/ml (non-responders) and to six dentists with titers ranging from 10 to 100 mIU/ml (poor responders); the determination of anti-HBs one month later demonstrated the occurrence of seroconversion in the eight non-responders and an increase in anti-HBs titer in the six poor responders. In summary, the present results demonstrated the prolonged persistence of protection against HBV infection and the development of immunologic memory provided by vaccination against HB--with intradermal application of three 2 micrograms doses of the Belgian recombinant vaccine at 0, 1, and 6 months--carried out eight years before in 51 dentists.

Diagnóstico precoce e progressão da tuberculose em contatos / Early diagnosis and progression of tuberculosis in contacts

O objetivo deste trabalho é o de estimar o rendimento do exame radiológico pulmonar, como recurso de diagnóstico precoce de tuberculose nos contatos, e o risco de casos secundários entre contatos de casos-indices. Realizou-se uma análise retrospectiva de uma coorte de 3.091 contatos de 879 prontuários de casos de tuberculose atendidos no Ambulatório de Pneumologia Sanitária de Londrina, Município do Estado do Paraná, Brasil. A associação entre alteração radiológica inicial e a ocorrência posterior de tuberculose nos contatos foi avaliada pela estimativa de risco relativo, confirmada em 13,7 por cento. O resultado do exame radiológico pulmonar, realizado em contatos quando da inscrição dos casos-índice, foi avaliado comodiagnóstico precoce da doença; 4,3 por cento dos contatos (73/1.698) foram classificados como suspeitos. O adoecimento nos contatos foi estimado pela curva de Kaplan-Meyer; e seu risco de adoecimento, pela incidência acumulada e densidade de incidência. O risco de adoecimento nos contatos com exame radiológico suspeito foi 6,13 vezes maior, comparativamente ao dos contatos com exame normal. A probabilidade de ocorrência da doença nos contatos, em cinco anos, foi de aproximadamente 2 por cento. Conclui-se que o exame radiológico é importante na triagem dos contatos; porém, seu rendimento foi insuficiente no diagnóstico precoce, persistindo o risco da doença durante o período de cinco anos...

The objective of this work is to evaluate the profitability of chest X-rays as a resource of premature diagnosis of tuberculosis and the risk of secondary cases among contacts of index-cases. A retrospective study was performed at 3,091 contacts of 879 tuberculosis index-cases admitted for treatment in the Sanitary Pulmonary Ambulatory in the Municipality of Londrina, State of Paraná, Brazil. The association between the initial X-ray abnormality and the subsequent occurrence of the disease in contacts was evaluated by the relative risk, and confirmed in 13.7% (10/73). The chest X-ray results, realized in contacts in the admission of the index-cases, were classified as a premature diagnosis for tuberculosis, and 4.3% of contacts (73/1,698) were classified as suspect cases. The progress of the disease in contacts was estimated by Kaplan-Meyer's curve, and its frequency by cumulative incidence and incidence density. The risk of getting ill in the contacts with suspected X-ray results was 6.13 times bigger than the risk in contacts with normal X-ray results. The probability of acquiring the disease in contacts, in five years, was approximately 2%. In conclusion, the chest X-ray exam is important when screening contacts. However, its profitability was considered low in the early diagnosis, and the risk of the disease, during a period of five years, still persists.

Multivariate analysis of the factors associated with the risk of pneumonia in intensive care units

Pneumonia is the most frequent hospital infection in patients admitted to intensive care units (ICU) and is also responsible for the highest lethality rates, as well as an increase in both the duration and costs of hospitalization. The objective of this study was to identify predisposing factors for pneumonia. A prospective cohort study was carried out between June 1996 and June 1997, and included 540 patients admitted consecutively for periods greater than 24 hours to the adult ICU of the Londrina State University's Teaching Hospital. Of these, 83 (15.4 percent) developed pneumonia. All patients were analyzed with respect to various risk factors for hospital-acquired pneumonia. Univariate analysis identified the following factors: decreased level of consciousness, craniotomy, prior use of antibiotics, mechanical ventilation, nasogastric tube feeding, enteral feeding, aspiration of gastric contents, central venous catheter and the time spent in the ICU. Multivariate analysis identified four risk factors for pneumonia in the ICU: tracheotomy (RR = 1.09; 95 percentCI = 1.04-1.17), nasogastric tube feeding (RR = 1.11; 95 percentCI = 1.05-1.18), H2-blocker use (RR = 1.09; 95 percentCI = 1.05-1.14) and decreased level of consciousness (RR = 2.67; 95 percentCI = 1.43-5.04). In 56.6 percent of patients, pneumonia occurred within the first four days following ICU admission. The risk factors identified were all necessary for the treatment of the patient except for decreased level of consciousness, either present at admission or occurring during hospitalization due to deterioration in the clinical condition of the patient or to the use of sedatives.

Seroprevalence for hepatitis E virus (HEV) infection among volunteer blood donors of the Regional Blood Bank of Londrina, State of Paraná, Brazil

Os objetivos do estudo foram determinar a soroprevalência da infecção pelo vírus da hepatite E (VHE) em candidatos a doadores de sangue voluntários do Hemocentro Regional de Londrina, Paraná, e avaliar se essa soroprevalência está associada com variáveis socio-demográficas e com o índice de soropositividade para hepatite por vírus A (VHA). Foi realizado estudo transversal para determinar a taxa de soroprevalência da infecção pelo VHE em 996 candidatos a doadores de sangue. Todos os participantes responderam um questionário sobre características sociodemográficas. A pesquisa de anticorpos específicos IgG anti-VHE foi realizada por método de enzimaimunoensaio (ELISA). Todas as amostras soropositivas para IgG anti-VHE e 237 amostras soronegativas para IgG anti-VHE foram submetidas também à pesquisa de IgG anti-VHA por ELISA. Entre as 996 amostras de soro analisadas, anticorpos IgG anti-VHE foram detectados em 23 amostras, resultando em uma soroprevalência de 2,3% (IC 95%: 1,5 - 3,5), semelhante aos resultados de estudos realizados em países desenvolvidos. Não houve associação entre o índice de soropositividade de IgG anti-VHE e as variáveis sociodemográficas (sexo, idade, escolaridade, procedência, fonte de água e origem dos dejetos); também não se detectou associação entre soropositividade para IgG anti-VHE com soropositividade para IgG anti-VHA. Os resultados obtidos sugerem que, embora tenha se observado uma baixa prevalência da infecção pelo VHE na população analisada, verificou-se que existe circulação do VHE no município de Londrina e que estudos posteriores são necessários para definir a importância clínica e epidemiológica da infecção pelo VHE nesse município bem como identificar outros possíveis fatores de risco envolvidos na epidemiologia da infecção pelo VHE.

Soroprevalência da infecção pelo vírus da imunodeficiência humana em pacientes com tuberculose, em Londrina, Paraná / Human immunodeficiency virus seroprevalence in patients with tuberculosis in the city of Londrina, in the state of Paraná, Brazil

OBJETIVO: Estimar a prevalência da soropositividade da infecção pelo vírus da imunodeficiência humana em pacientes com tuberculose ativa, atendidos no serviço de Pneumologia Sanitária da 17ª Regional de Saúde do Estado do Paraná, em Londrina, e comparar os pacientes co-infectados com aqueles que apresentavam somente tuberculose, em relação à baciloscopia de escarro, exame radiológico de tórax, e forma clínica e esquema terapêutico para tratamento da tuberculose. MÉTODOS: Estudo transversal com 188 pacientes com tuberculose ativa. Os diagnósticos de tuberculose e de infecção pelo vírus da imunodeficiência humana foram realizados de acordo com os critérios adotados pelo Ministério da Saúde. Para a obtenção de informações clínicas e epidemiológicas, aplicou-se um questionário, além dos dados das fichas individuais de investigação de tuberculose. RESULTADOS: A prevalência de soropositividade da infecção pelo vírus da imunodeficiência humana nos pacientes com tuberculose foi de 14,9 por cento. O índice de positividade da baciloscopia de escarro foi maior no grupo sem a co-infecção (p = 0,0275) e a proporção de pacientes tratados com esquema alternativo foi significativamente maior no grupo com co-infecção (p = 0042). Em 32,1 por cento dos pacientes co-infectados, realizou-se teste sorológico para diagnóstico de infecção pelo vírus da imunodeficiência humana simultaneamente ou depois do diagnóstico de tuberculose. CONCLUSÃO: Os resultados ressaltam a importância da realização rotineira do teste para detecção de anticorpos contra o vírus da imunodeficiência humana em todos os pacientes com tuberculose.

The epidemiologic profile and prevalence of cardiopathy in Trypanosoma cruzi infected blood donor candidates, Londrina, Paraná, Brazil

Objetivando-se traçar o perfil epidemiológico e a prevalência de cardiopatia, realizou-se estudo descritivo em 163 candidatos a doador de sangue infectados por Trypanosoma cruzi, atendidos no período de agosto de 1996 a novembro de 1997 no ambulatório de doença de Chagas do Hospital de Clínicas da Universidade Estadual de Londrina. O perfil epidemiológico foi de paciente jovem, média de idade de 42,95 ± 8,62 anos, sexo masculino (65%), raça branca (84%), baixa escolaridade, baixa renda familiar, agricultor (26%), natural do estado do Paraná (67%), de zona rural (85%), residindo atualmente em zona urbana (85%), sendo o vetorial o principal mecanismo de transmissão. A forma crônica cardíaca, encontrada em 38% foi classificada em forma cardíaca sugestiva de doença de Chagas em 21% e pouco sugestiva em 17% dos pacientes. Não houve diferença significativa na distribuição da faixa etária, sexo e presença de sintomas cardíacos em relação aos pacientes com ou sem cardiopatia. O estudo ressalta a importância da expansão de serviços de atendimento em regiões de maior ocorrência de indivíduos infectados e manutenção de serviços de referência, para oferecer atendimento de forma descentralizada e hierarquizada.

Socio-demographic and epidemiological characteristics associated with human immunodeficiency virus type I (HIV-1) infection in HIV-1-explosed but uninfected individuals, and in HIV-1-infected patients from a southern brasilian population

Este estudo transversal descreve as principais características sociodemográficas e epidemiológicas associadas com a infecção pelo HIV-1 em 1.061 indivíduos atendidos em Londrina e região, Sul do Brasil: 136 indivíduos saudáveis (Grupo 1), 147 indivíduos expostos ao HIV-1 mas não infectados (Grupo 2), 161 pacientes infectados pelo HIV-1 assintomáticos (Grupo 3) e 617 pacientes com aids (Grupo 4). Os dados foram obtidos pela aplicação de um questionário padronizado e realização de testes sorológicos. A idade dos indivíduos variou de 15,1 a 79,5 anos; 54,0% e 56,1% dos pacientes dos Grupos 3 e 4, respectivamente, eram homens. As principais características dos indivíduos dos Grupos 2, 3 e 4 foram o predomínio do nível educacional com até oito anos de escolaridade (58,8%, 60,2% e 62,4%, respectivamente), a via sexual de transmissão (88,4%, 87,0% e 82,0%, respectivamente), o comportamento heterossexual (91,8%, 75,2% e 83,7%, respectivamente) e antecedentes de doenças sexualmente transmissíveis (20,4%, 32,5% e 38,1%, respectivamente). Os pacientes com aids apresentaram os valores mais elevados de soropositividade para sífilis (25,6%), anti-HCV (22,3%) e anti-HTLV I/II em dois testes de triagem sorológica (6,2% e 6,8%, respectivamente). Os resultados documentando as características predominantes associadas com a infecção pelo HIV-1 observada nos indivíduos de Londrina e região, poderá ser útil na melhoria dos atuais programas de prevenção, monitoramento e de tratamento da infecção pelo HIV-1 dirigidos a esta população.

Surto de toxoplasmose aguda transmitida através da ingestäo de carne crua de gado ovino / Outbreak of acute toxoplasmosis transmitted by ingestion of raw mutton

The authors present 17 cases of symptomatic acute toxoplasmosis acquired by the ingestion of raw mutton offered during a party in September 1993. The incubation period carried from 6 to 13 days (10.9 +/- 7.0). Sixteen (94.5 per cent) patients presented fever, headache, myalgia, arthralgia, and adenopathy (cervical or cervical/axilar). Hepatomegaly was found in 6 patients, splenomegaly in 4 and rash in 2. One patient presented clinical picture of chorioretinitis confirmed by ophthalmological exam. All patients showed increased serum levels of specific antibodies (IgG and IgM) on indirect immunofuorescence assay evidencing acute phase of toxoplasmosis. The patients were treated with specific drugs for toxoplasmosis and presented satisfactory clinical and laboratory response.

Seroprevalence of Trypanosoma cruzi infection in students at the seven-fourteen age range, Londrina, PR, Brazil, in 1995

Seropositivity for Chagas disease was evaluated in 834 children aged between 7 and 14 from the Municipal Teaching System in the District of Londrina, State of Paraná. A seroprevalence rate of 0.1 per cent was found through the use of an indirect immunofluorescent test and an enzyne-linked immunosorbent assay. This low rate of seroprevalence provides evidence that the vectorial transmission of Chagas disease has been eliminated in Londrina. The main reason for the elimination of vectorial transmission of Trypanosoma cruzi infection, as evaluated by serological tests, may be a remarkable change in the economic structure of the northern region of Paraná in the 1960's. At that time coffee production was almost completely replaced by soy beans, wheat and grazing in the rural areas. This change deeply affected the rural ecology and caused an exodus of the population from rural to urban areas as well as a decrease in the total number of the population of that region. The measures introduced for controlling the disease through the Program of Chagas Disease Control established by the Fundaçäo Nacional de Saúde of the Brazilian Ministry of Health, certainly, had a positive impact on the reduction of American trypanosomiasis prevalence in the area under study. However, it does not seem that this was the most relevant factor responsable for the elimination of vectorial transmission of Chagas disease in Londrina.