Identification and characterisation of SARS-CoV-2 and Human alphaherpesvirus 1 from a productive coinfection in a fatal COVID-19 case.

BACKGROUND: During routine Coronavirus disease 2019 (COVID-19) diagnosis, an unusually high viral load was detected by reverse transcription real-time polymerase chain reaction (RT-qPCR) in a nasopharyngeal swab sample collected from a patient with respiratory and neurological symptoms who rapidly succumbed to the disease. Therefore we sought to characterise the infection. OBJECTIVES: We aimed to determine and characterise the etiological agent responsible for the poor outcome. METHODS: Classical virological methods, such as plaque assay and plaque reduction neutralisation test combined with amplicon-based sequencing, as well as a viral metagenomic approach, were performed to characterise the etiological agents of the infection. FINDINGS: Plaque assay revealed two distinct plaque phenotypes, suggesting either the presence of two severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains or a productive coinfection of two different species of virus. Amplicon-based sequencing did not support the presence of any SARS-CoV-2 genetic variants that would explain the high viral load and suggested the presence of a single SARS-CoV-2 strain. Nonetheless, the viral metagenomic analysis revealed that Coronaviridae and Herpesviridae were the predominant virus families within the sample. This finding was confirmed by a plaque reduction neutralisation test and PCR. MAIN CONCLUSIONS: We characterised a productive coinfection of SARS-CoV-2 and Herpes simplex virus 1 (HSV-1) in a patient with severe symptoms that succumbed to the disease. Although we cannot establish the causal relationship between the coinfection and the severity of the clinical case, this work serves as a warning for future studies focused on the interplay between SARS-CoV-2 and HSV-1 coinfection and COVID-19 severity.

Treatment dropout after pregnancy: a study of women living with HIV in Rio de Janeiro.

Despite the investment in prevention of mother-to-child transmission of HIV, there is still little data about the proportion of women that are retained in treatment after pregnancy in Brazil. Research worldwide shows that a significant proportion of women drop out of treatment after pregnancy. The aim of this study was to identify factors associated with treatment dropout of women that received prenatal care at a federal hospital in Rio de Janeiro between 2016 and 2017 and abandoned treatment after pregnancy. This was a retrospective cohort study using data on prescription refills and hospital medical records. Cross-sectional analysis of data from 454 women showed that 18% were not on cART after pregnancy. Illicit drug use during pregnancy, being less than 35 years old, and being aware of HIV diagnosis before conceiving but not taking cART were factors associated with treatment interruption postpartum. The high prevalence of interruption of HIV treatment after pregnancy suggests that there is a need for better post-natal care to increase adherence in this population.

Identification and characterisation of SARS-CoV-2 and Human alphaherpesvirus 1 from a productive coinfection in a fatal COVID-19 case

BACKGROUND During routine Coronavirus disease 2019 (COVID-19) diagnosis, an unusually high viral load was detected by reverse transcription real-time polymerase chain reaction (RT-qPCR) in a nasopharyngeal swab sample collected from a patient with respiratory and neurological symptoms who rapidly succumbed to the disease. Therefore we sought to characterise the infection. OBJECTIVES We aimed to determine and characterise the etiological agent responsible for the poor outcome. METHODS Classical virological methods, such as plaque assay and plaque reduction neutralisation test combined with amplicon-based sequencing, as well as a viral metagenomic approach, were performed to characterise the etiological agents of the infection. FINDINGS Plaque assay revealed two distinct plaque phenotypes, suggesting either the presence of two severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains or a productive coinfection of two different species of virus. Amplicon-based sequencing did not support the presence of any SARS-CoV-2 genetic variants that would explain the high viral load and suggested the presence of a single SARS-CoV-2 strain. Nonetheless, the viral metagenomic analysis revealed that Coronaviridae and Herpesviridae were the predominant virus families within the sample. This finding was confirmed by a plaque reduction neutralisation test and PCR. MAIN CONCLUSIONS We characterised a productive coinfection of SARS-CoV-2 and Herpes simplex virus 1 (HSV-1) in a patient with severe symptoms that succumbed to the disease. Although we cannot establish the causal relationship between the coinfection and the severity of the clinical case, this work serves as a warning for future studies focused on the interplay between SARS-CoV-2 and HSV-1 coinfection and COVID-19 severity.

Postmalaria neurological syndrome: a case report.

Described here is a case of postmalaria neurological syndrome in a patient who presented infection by Plasmodium falciparum two months earlier. The patient received empiric use of acyclovir for herpetic meningoencephalitis, but neuropsychiatric symptoms improved only after administration of methylprednisolone.

Postmalaria neurological syndrome: a case report / Síndrome neurológica pós-malária: relato de um caso

Described here is a case of postmalaria neurological syndrome in a patient who presented infection by Plasmodium falciparum two months earlier. The patient received empiric use of acyclovir for herpetic meningoencephalitis, but neuropsychiatric symptoms improved only after administration of methylprednisolone.

Descrição de um caso de síndrome neurológica pós-malária em paciente que apresentou infecção por Plasmodium falciparum dois meses antes. O paciente fez uso empírico de aciclovir para meningoencefalite herpética, mas a melhora dos sintomas neuropsiquiátricos só ocorreu após administração de metilprednisolona.

Streptococcus do Grupo B em gestantes infectadas pelo HIV: políticas Institucionais e taxas de infecção na América Latina e estudo da colonização, sorotipos e perfil de susceptibilidade antimicrobiana em uma coorte de gestantes no Rio de Janeiro

Introdução: A prevenção da doença estreptocócica neonatal ainda não está efetivamente implementada em muitos centros no Brasil e na América Latina, e pouco se conhece da epidemiologia das infecções estreptocócicas em gestantes infectadas pelo HIV. Objetivos: O objetivo desse estudo foi avaliar a prevalência e fatores de risco associados à colonização pelo Estreptococo do Grupo B (EGB), em gestantes infectadas pelo HIV, identificar os sorotipos e o perfil de susceptibilidade antimicrobiana e, adicionalmente, descrever as políticas institucionais de prevenção à doença estreptocócica invasiva precoce em neonatos em centros de prevenção da transmissão vertical do HIV da América Latina. Métodos: A primeira etapa do projeto consistiu de um estudo seccional prospectivo em uma coorte de gestantes infectadas pelo HIV e seus recém-natos no Hospital Federal dos Servidores do Estado (HFSE) \2013 Rio de Janeiro, e a segunda etapa compreendeu um inquérito epidemiológico das práticas e políticas de prevenção da doença neonatal estreptocócica em 12 Centros de prevenção da transmissão vertical do HIV da América Latina Resultados: A taxa global de colonização anovaginal nas gestantes da coorte do HFSE foi 31%; os sorotipos predominantes foram Ib e Ia e todas as amostras positivas para EGB foram sensíveis à penicilina. No inquérito epidemiológico realizado nos Centros da América Latina, nove apresentaram políticas de prevenção para doença estreptocócica neonatal e sete centros realizavam o rastreio para EGB rotineiramente nas gestantes, com uma taxa de colonização anovaginal de 8,3%. Conclusão: A taxa de colonização pelo EGB no HFSE foi alta e o sorotipo Ib foi o mais freqüente. Esforços para implementar políticas de prevenção da doença estreptocócica e vigilância continuada se fazem necessários para compreender melhor o impacto da colonização pelo EGB em gestantes infectadas pelo HIV e seus recém-natos na América Latina.

Anti-HIV-1 seroreactivity and HIV transmission route[R1]

Background: antibody binding assays carried out by our group have consistently indicated a higher reactivity of sera from male HIV-1 infected individuals. This study was carried out in order to analyze the importance of gender, route of transmission, disease progression and HIV-1 genotype in seroreactivity assays. Study design: specificity of antibody binding was studied in plasma of 247 HIV-1 seropositive individuals belonging to patient groups of pregnant women, injecting drug users (IDUs) and recent seroconvertors, resident in Rio de Janeiro, RJ. Recognition of synthetic peptides corresponding to antigenically important epitopes in the envelope of HIV-1 (gp41 immunodominant epitope, V3 loop, V2 loop and gp41 735­752 epitope) was determined. Results: the immunodominant gp41 peptide (amino acids 594­613, HIV-1 MN sequence) was recognized by 85% of all plasma tested. Reactivity with the gp41 735­752 peptide and gp120 V2 loop peptides was low but quite variable, being generally more often specific to a Brazilian V2 peptide used than to the HIV-1 MN derived V2 peptide. The overall recognition of the different V3 peptides tested varied from 41 to 76%. Patients with more advanced disease showed a more frequent reactivity with the peptides studied than did asymptomatic patients. Statistically significant differences in peptide recognition were observed by multiple logistic analyses comparing plasma derived from individuals infected by blood or sexual HIV transmission, adjusting for disease progression and gender. Plasma from individuals infected by sexual transmission showed lower peptide recognition than did plasma from individuals infected through HIV positive blood. Association attempts between seroreactivity and genotype indicated that plasma derived from patients infected with HIV-1 of the F subtype showed highest recognition of heterologous V3 peptides, as well as a slightly more frequent recognition of the non-V3 peptides tested. Recognition of homologous peptides was generally higher than recognition of heterologous peptides. Differences were most pronounced between the prototypical HIV-1 B subtype and the Brazilian B'' variant of this subtype but almost non-existent between the HIV-1 B and F subtypes. Conclusions: individual gender was shown to be a confounder when investigating the relationships of peptide reaction to HIV-1 route of transmission through multivariate statistical methods: patients infected by blood transmission (IDU) present higher frequency of peptide recognition than individuals infected by sexual HIV-1 transmission. Plasma from individuals infected with the B'' variant (GWG) of B subtype HIV-1 showed lower heterologous peptide recognition than that from HIV-1 B (GPG) or F infected individuals.

Calazar: relato de três pacientes adultos internados no HSE-INAMPS (RJ); consideraçöes sobre esta endemia de grande importância em nosso território / Kala-zar: report of 3 adult patients hospitalized in HSE - INAMPS (RJ); considerations on this endemia of large importance in our territory

Com a apresentaçäo de tres casos clínicos de Calazar em pacientes adultos internados no HSE-INAMPS-RJ e provenientes de diferentes regiöes reconhecidamente endêmicas desta moléstia, discute-se de forma geral a sua temática, fazendo-se uma atualizaçäo sobre a mesma em nosso país. Por outro lado, vale esta apresentaçäo como advertência à clínica geral e mesmo a algumas especializaçöes, no sentido de lembrar-lhes a necessidade de pensar com maior freqüência sobre esta doença que se encontra em franco processo de expansäo em nosso território, a despeito dos enormes esforços feitos pela Superintendência de Campanhas de Saúde Pública (SUCAM) para seu controle. Diversos fatores ambientais, sociais e econômicos, as correntes migratórias internas desordenadas, a quebra de equilíbrios ecológicos e a escassez de recursos humanos e financeiros seräo seguramente os principais fatos responsáveis pelas notáveis alteraçöes por que tem passado esta zooantroponose entre nós

Hemoptise/s e síndrome de angústia respiratória aguda como expressöes clínicas dominantes no curso da leptospirose / Massive hemoptysis and adult respiratory distress syndrome like clinical manifestations in leptospirosis

Säo apresentados, a guisa de exemplos, três casos de leptospirose com manifestaçöes clínicas respiratórias e alteraçöes radiográficas e gasométricas compatíveis com envolvimento pulmonar importante. Em dois casos, episódios de hemoptises francas foram assinalados, fato näo raramente detectado na leptospirose e que confunde com freqüência o diagnóstico. Como a doença é endêmica, com elevada prevalência em nosso meio, decidimos mostrar algumas características, clínicas do envolvimento do aparelho respiratório, fazendo uma revisäo de alguns trabalhos sobre o tema