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1.
Rev Inst Med Trop Sao Paulo ; 43(3): 125-31, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11452319

RESUMO

The respiratory viruses are recognized as the most frequent lower respiratory tract pathogens for infants and young children in developed countries but less is known for developing populations. The authors conducted a prospective study to evaluate the occurrence, clinical patterns, and seasonal trends of viral infections among hospitalized children with lower respiratory tract disease (Group A). The presence of respiratory viruses in children's nasopharyngeal was assessed at admission in a pediatric ward. Cell cultures and immunofluorescence assays were used for viral identification. Complementary tests included blood and pleural cultures conducted for bacterial investigation. Clinical data and radiological exams were recorded at admission and throughout the hospitalization period. To better evaluate the results, a non- respiratory group of patients (Group B) was also constituted for comparison. Starting in February 1995, during a period of 18 months, 414 children were included- 239 in Group A and 175 in Group B. In Group A, 111 children (46.4%) had 114 viruses detected while only 5 children (2.9%) presented viruses in Group B. Respiratory Syncytial Virus was detected in 100 children from Group A (41.8%), Adenovirus in 11 (4.6%), Influenza A virus in 2 (0.8%), and Parainfluenza virus in one child (0.4%). In Group A, aerobic bacteria were found in 14 cases (5.8%). Respiratory Syncytial Virus was associated to other viruses and/or bacteria in six cases. There were two seasonal trends for Respiratory Syncytial Virus cases, which peaked in May and June. All children affected by the virus were younger than 3 years of age, mostly less than one year old. Episodic diffuse bronchial commitment and/or focal alveolar condensation were the clinical patterns more often associated to Respiratory Syncytial Virus cases. All children from Group A survived. In conclusion, it was observed that Respiratory Syncytial Virus was the most frequent pathogen found in hospitalized children admitted for severe respiratory diseases. Affected children were predominantly infants and boys presenting bronchiolitis and focal pneumonias. Similarly to what occurs in other subtropical regions, the virus outbreaks peak in the fall and their occurrence extends to the winter, which parallels an increase in hospital admissions due to respiratory diseases.


Assuntos
Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções Respiratórias/virologia , Estações do Ano , Adolescente , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Infecções por Vírus Respiratório Sincicial/virologia , Infecções Respiratórias/epidemiologia , Índice de Gravidade de Doença , Estatísticas não Paramétricas
2.
Transfusion ; 40(6): 708-11, 2000 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10864993

RESUMO

BACKGROUND: Porcine clotting factor has been used for more than 15 years to treat severe bleeding episodes in persons with hemophilia who have antibodies to human clotting factor. In 1996, QC procedures revealed for the first time the presence of porcine parvovirus (PPV) in the product. This report describes an investigation to determine the extent of product contamination and to evaluate past recipients of porcine clotting factor (Hyate:C, Speywood Biopharm) for evidence of PPV infection. STUDY DESIGN AND METHODS: Stored specimens from 22 lots of previously released Hyate:C were tested for the presence of PPV DNA by PCR and nested PCR assays. Serum specimens from 98 recipients of Hyate:C and 24 controls who did not receive Hyate:C were tested for PPV antibodies by an immunofluorescence assay. RESULTS: PPV DNA was detected in product from 21 of the 22 lots of Hyate:C, primarily by nested PCR testing. In contrast, none of the serum specimens from the 98 Hyate:C recipients tested positive for PPV IgG antibodies. CONCLUSION: The risk of human disease from percutaneous exposure to low levels of PPV seems to be low. Nevertheless, the theoretical risk of human infection with PPV has led to manufacturing changes, including PCR screening of all porcine plasma, which are designed to eliminate this risk.


Assuntos
Anticorpos Antivirais/sangue , DNA Viral/sangue , Contaminação de Medicamentos , Fator VIII/efeitos adversos , Hemofilia A/complicações , Infecções por Parvoviridae/veterinária , Parvoviridae/isolamento & purificação , Doenças dos Suínos/transmissão , Suínos/virologia , Adulto , Animais , Canadá/epidemiologia , Hemofilia A/terapia , Humanos , Masculino , Parvoviridae/genética , Parvoviridae/imunologia , Infecções por Parvoviridae/epidemiologia , Infecções por Parvoviridae/transmissão , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Estudos Soroepidemiológicos , Método Simples-Cego , Suínos/sangue , Estados Unidos/epidemiologia , Viremia/veterinária , Zoonoses
3.
Clin Infect Dis ; 29(1): 134-40, 1999 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10433576

RESUMO

To better define the contribution of human parainfluenza viruses (HPIVs) to lower respiratory tract infection in adults, we tested acute- and convalescent-phase serum specimens from hospitalized adults participating in a population-based prospective study of lower respiratory tract infection during 1991-1992. We tested all available specimens from the epidemic seasons for each virus and approximately 300 randomly selected specimens from the corresponding off-seasons for antibodies to HPIV-1, HPIV-2, or HPIV-3. During the respective epidemic season, HPIV-1 infection was detected in 18 (2.5%) of 721 and HPIV-3 infection in 22 (3.1%) of 705 patients with lower respiratory tract infection. Only 2 (0.2%) of 1,057 patients tested positive for HPIV-2 infection. No HPIV-1 infections and only 2 (0.7% of 281 patients tested) HPIV-3 infections were detected during the off-seasons. HPIV-1 and HPIV-3 were among the four most frequently identified infections associated with lower respiratory tract infection during their respective outbreak seasons.


Assuntos
Vírus da Parainfluenza 1 Humana , Vírus da Parainfluenza 2 Humana , Vírus da Parainfluenza 3 Humana , Infecções por Paramyxoviridae/virologia , Pneumonia Viral/virologia , Adulto , Surtos de Doenças , Feminino , Hospitalização , Humanos , Masculino , Vírus da Parainfluenza 1 Humana/imunologia , Vírus da Parainfluenza 2 Humana/imunologia , Vírus da Parainfluenza 3 Humana/imunologia , Infecções por Paramyxoviridae/epidemiologia , Infecções por Paramyxoviridae/imunologia , Alta do Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Estudos Prospectivos
4.
Neuroepidemiology ; 17(6): 303-9, 1998.
Artigo em Inglês | MEDLINE | ID: mdl-9778596

RESUMO

To examine trends in progressive multifocal leukoencephalopathy (PML) mortality in the United States, we analyzed PML death rates and deaths for 1979 through 1994, using US multiple cause-of-death data. During the 16-year study period 3,894 PML deaths were reported. The age-adjusted death rate increased more than 20-fold, from less than 0.2 per million persons before 1984 to 3.3 per million persons in 1994. The increase was attributable to infection with human immunodeficiency virus (HIV) which was recorded on 2,267 (89.0%) of 2.546 death records from 1991 through 1994. PML age-adjusted death rates increased abruptly for all males beginning in 1984 and for black females in 1990. Only a small increase was observed for white females. In 1994, PML was reported in 2.1% of white males who died with HIV-associated disease compared with 1.2% of white females and 1.0% of black males and females who died of similar causes. The epidemic of PML deaths is increasing in parallel with the AIDS epidemic. The increase in HIV-associated PML deaths, first noted among males, has also become apparent among females and probably reflects the increasing importance of drug use and heterosexual transmission of HIV. The reason for the higher prevalence of PML among white males with HIV infection is unknown.


Assuntos
Síndrome da Imunodeficiência Adquirida/mortalidade , Leucoencefalopatia Multifocal Progressiva/mortalidade , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Idoso , Causas de Morte , Etnicidade , Feminino , Humanos , Leucoencefalopatia Multifocal Progressiva/complicações , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Estados Unidos/epidemiologia
5.
Am J Hematol ; 56(4): 248-51, 1997 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9395187

RESUMO

To detect and characterize parvovirus B19 infection during the course of progressive immune deficiency from human immunodeficiency virus (HIV), ten subjects enrolled in the Multicenter Hemophilia Cohort Study were followed for 6.4 to 15 years from HIV seroconversion through extreme immune deficiency. Four to five sera or plasma samples from each subject, collected at predetermined CD4+ lymphocyte levels, were tested for immunoglobulin G (IgG) and M (IgM) B19 antibodies and DNA. All 42 samples were positive for B19 IgG antibodies, and three were weakly positive for IgM antibodies. Only one sample, collected coincident with HIV seroconversion, was unequivocally positive for B19 DNA. No persistent hematologic adverse effects of B19 infection were observed. Thus, although B19 IgG antibodies are highly prevalent among HIV-infected persons with hemophilia or related disorders, B19 viremia and its hematologic consequences were not detected, even with severe depletion of CD4+ lymphocytes. If primary B19 infection occurs after immune deficiency, however, the consequences may be more adverse.


Assuntos
Infecções por HIV/complicações , HIV-1 , Hemofilia A/complicações , Infecções por Parvoviridae/complicações , Parvovirus B19 Humano/isolamento & purificação , Adolescente , Adulto , Anticorpos Antivirais/análise , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/imunologia , Criança , Pré-Escolar , Estudos de Coortes , DNA Viral/análise , Infecções por HIV/imunologia , Infecções por HIV/virologia , Hemofilia A/imunologia , Hemofilia A/virologia , Humanos , Hospedeiro Imunocomprometido , Imunoglobulina G/análise , Imunoglobulina M/análise , Pessoa de Meia-Idade , Infecções por Parvoviridae/imunologia , Infecções por Parvoviridae/virologia , Parvovirus B19 Humano/genética , Parvovirus B19 Humano/imunologia , Reação em Cadeia da Polimerase , Estudos Prospectivos , Viremia/complicações
6.
J Infect Dis ; 176(6): 1423-7, 1997 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9395350

RESUMO

Croup is a common manifestation of respiratory tract infection in children, and human parainfluenza virus 1 (HPIV-1) is the agent most commonly associated with croup. In the United States, HPIV-1 produces a distinctive pattern of biennial epidemics of respiratory illness during the autumn months of odd-numbered years. National Hospital Discharge Survey data for croup hospitalizations among patients <15 years old between 1979 and 1993 were examined along with laboratory-based surveillance data on HPIV-1 activity in the United States. The mean annual number of croup hospitalizations was 41,000 (range, 27,000-62,000/year). Ninety-one percent of hospitalizations occurred among children <5 years of age. Minor peaks in croup hospitalizations occurred each year in February, and major peaks occurred in October of odd-numbered years, coincident with peak HPIV-1 activity. Each biennial epidemic of HPIV-1 was associated with 18,000 excess croup hospitalizations nationwide.


Assuntos
Crupe/epidemiologia , Surtos de Doenças , Vírus da Parainfluenza 1 Humana , Infecções por Respirovirus/epidemiologia , Infecções por Adenovirus Humanos/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Crupe/virologia , Feminino , Hospitalização , Humanos , Lactente , Influenza Humana/epidemiologia , Masculino , Infecções por Paramyxoviridae/epidemiologia , Infecções por Picornaviridae/epidemiologia , Pneumonia por Mycoplasma/epidemiologia , Vigilância da População , Estações do Ano , Fatores Sexuais , Estados Unidos/epidemiologia
7.
J Med Virol ; 53(3): 233-6, 1997 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9365888

RESUMO

To look for genetic changes in human parvovirus B19 that might be associated with chronic infection, we sequenced B19 DNA obtained from serum specimens collected over an approximately 1-year period from a patient with systemic vasculitis. A comparison of the nucleotide sequences of the VP1/VP2 gene from four specimens revealed an abrupt change in the B19 genotype that coincided with initiation of intravenous immune globulin (IVIG) therapy. We suspect that one or more of the lots of IVIG administered to the patient were contaminated with B19. If true, this finding suggests that investigators must be careful in linking B19 infection to disease based on detection of B19 DNA in persons who have received multiple unit blood products.


Assuntos
Proteínas do Capsídeo , Imunoglobulinas Intravenosas/efeitos adversos , Infecções por Papillomavirus/transmissão , Parvovirus B19 Humano , Anticorpos Antivirais/sangue , Capsídeo/genética , Pré-Escolar , DNA Viral , Contaminação de Medicamentos , Humanos , Masculino , Infecções por Papillomavirus/sangue , Infecções por Papillomavirus/imunologia , Parvovirus B19 Humano/genética , Parvovirus B19 Humano/isolamento & purificação , Vasculite/sangue , Vasculite/imunologia , Vasculite/virologia
8.
Pediatr Infect Dis J ; 16(10): 941-6, 1997 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9380468

RESUMO

BACKGROUND: Rotavirus is the leading cause of severe pediatric gastroenteritis worldwide. A vaccine may soon be licensed for use in the United States to prevent this disease. To characterize US geographic and temporal trends in rotavirus activity, we made contour maps showing the timing of peak rotavirus activity. METHODS: From July, 1991, through June, 1996, 79 laboratories participating in the National Respiratory and Enteric Virus Surveillance System reported on a weekly basis the number of stool specimens that tested positive for rotavirus. The peak weeks in rotavirus detections from each laboratory were mapped using kriging, a modeling technique originally developed for geostatistics. RESULTS: During the 5-year period 118,716 fecal specimens were examined, of which 27,616 (23%) were positive for rotavirus. Timing of rotavirus activity varied by geographic location in a characteristic pattern in which peak activity occurred first in the Southwest from October through December and last in the Northeast in April or May. The Northwest exhibited considerable year-to-year variability (range, December to May) in the timing of peak activity, whereas the temporal pattern in the remainder of the contiguous 48 states was relatively constant. CONCLUSION: Kriging is a useful method for visualizing geographic and temporal trends in rotavirus activity in the United States. This analysis confirmed trends reported in previous years, and it also identified unexpected variability in the timing of peak rotavirus activity in the Northwest. The causes of the seasonal differences in rotavirus activity by region are unknown. Tracking of laboratory detections of rotavirus may provide an effective surveillance tool to assess the impact of a rotavirus vaccination campaign in the United States.


Assuntos
Infecções por Rotavirus/epidemiologia , Humanos , Vigilância da População , Estações do Ano , Estados Unidos/epidemiologia
9.
J Infect Dis ; 176(3): 760-3, 1997 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-9291327

RESUMO

Outbreaks of acute respiratory disease caused by adenovirus are rarely documented in civilian populations, and adenovirus 35 is an uncommon serotype best recognized as a cause of serious disease in immunocompromised patients. An outbreak of adenovirus 35 pneumonia among residents and staff of a chronic care psychiatric facility was investigated. Fourteen (26%) of 53 residents and 4 (2%) of approximately 200 staff had radiographically confirmed pneumonia. Thirteen (93%) of 14 residents with pneumonia were hospitalized, 5 (36%) required mechanical ventilation, and 1 (7%) died. One staff member was hospitalized. Adenovirus infection was diagnosed in 17 (94%) persons with pneumonia by culture or serology and was confirmed as adenovirus 35 infection in 8 persons. Residents with pneumonia had resided at the facility longer than other residents. Chronic illness was not a risk factor for severe disease. Crowding and poor hygienic behaviors probably facilitated transmission among residents.


Assuntos
Infecções por Adenoviridae/epidemiologia , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Hospitais Psiquiátricos , Recursos Humanos em Hospital , Pneumonia Viral/epidemiologia , Infecções por Adenoviridae/virologia , Adenovírus Humanos/classificação , Adulto , Infecção Hospitalar/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sorotipagem , Células Tumorais Cultivadas
10.
JAMA ; 278(5): 389-95, 1997 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-9244330

RESUMO

CONTEXT: This large outbreak of foodborne disease highlights the challenge of investigating outbreaks caused by intentional contamination and demonstrates the vulnerability of self-service foods to intentional contamination. OBJECTIVE: To investigate a large community outbreak of Salmonella Typhimurium infections. DESIGN: Epidemiologic investigation of patients with Salmonella gastroenteritis and possible exposures in The Dalles, Oregon. Cohort and case-control investigations were conducted among groups of restaurant patrons and employees to identify exposures associated with illness. SETTING: A community in Oregon. Outbreak period was September and October 1984. PATIENTS: A total of 751 persons with Salmonella gastroenteritis associated with eating or working at area restaurants. Most patients were identified through passive surveillance; active surveillance was conducted for selected groups. A case was defined either by clinical criteria or by a stool culture yielding S Typhimurium. RESULTS: The outbreak occurred in 2 waves, September 9 through 18 and September 19 through October 10. Most cases were associated with 10 restaurants, and epidemiologic studies of customers at 4 restaurants and of employees at all 10 restaurants implicated eating from salad bars as the major risk factor for infection. Eight (80%) of 10 affected restaurants compared with only 3 (11%) of the 28 other restaurants in The Dalles operated salad bars (relative risk, 7.5; 95% confidence interval, 2.4-22.7; P<.001). The implicated food items on the salad bars differed from one restaurant to another. The investigation did not identify any water supply, food item, supplier, or distributor common to all affected restaurants, nor were employees exposed to any single common source. In some instances, infected employees may have contributed to the spread of illness by inadvertently contaminating foods. However, no evidence was found linking ill employees to initiation of the outbreak. Errors in food rotation and inadequate refrigeration on ice-chilled salad bars may have facilitated growth of the S Typhimurium but could not have caused the outbreak. A subsequent criminal investigation revealed that members of a religious commune had deliberately contaminated the salad bars. An S Typhimurium strain found in a laboratory at the commune was indistinguishable from the outbreak strain. CONCLUSIONS: This outbreak of salmonellosis was caused by intentional contamination of restaurant salad bars by members of a religious commune.


Assuntos
Crime , Surtos de Doenças , Contaminação de Alimentos , Restaurantes , Intoxicação Alimentar por Salmonella/epidemiologia , Busca de Comunicante , Medicina Legal , Humanos , Modelos Logísticos , Oregon/epidemiologia , Intoxicação Alimentar por Salmonella/diagnóstico , Salmonella typhimurium/isolamento & purificação
11.
Infect Control Hosp Epidemiol ; 18(2): 109-14, 1997 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-9120238

RESUMO

OBJECTIVE: To evaluate the risk of nosocomial transmission of parvovirus B19 (B19) infection to healthcare workers (HCWs) exposed to patients with transient aplastic crisis (TAC) caused by acute B19 infection. DESIGN: Cohort study. SETTING: 1,000-bed, urban teaching hospital in Atlanta, Georgia. PARTICIPANTS: Eighty-seven exposed HCWs who cared for two patients with TAC prior to the time they were isolated and a comparison group of 88 unexposed HCWs from wards or clinics where the patients did not receive care. INTERVENTION: Self-administered questionnaire on hospital contact with index patients, B19 community risk factors, and signs and symptoms suggestive of B19 disease. Serology for B19-specific IgM and IgG antibodies measured by antibody-capture enzyme-linked immunosorbent assay. RESULTS: 1 (3.1%) of the 32 nonimmune exposed HCWs had serologic evidence of recent B19 infection compared to 3 (8.1%) of the 37 nonimmune HCWs in the comparison group (P = .6). In a subgroup analysis of exposed HCWs who cared for index patients during the time when the virus load was expected to be greatest, a recent infection rate of 5.8% (1/17) was found among nonimmune HCWs. CONCLUSIONS: The finding of similar rates of recent infection in nonimmune exposed and unexposed HCWs suggests that transmission to HCWs did not occur, despite failure to place the patients in isolation at the onset of hospitalization.


Assuntos
Infecção Hospitalar/epidemiologia , Transmissão de Doença Infecciosa do Paciente para o Profissional , Infecções por Parvoviridae/epidemiologia , Parvovirus B19 Humano , Recursos Humanos em Hospital , Adolescente , Adulto , Estudos de Coortes , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/transmissão , Feminino , Georgia , Hospitais com mais de 500 Leitos , Hospitais de Ensino , Humanos , Infecções por Parvoviridae/diagnóstico , Infecções por Parvoviridae/transmissão , Isolamento de Pacientes , Gravidez , Complicações Infecciosas na Gravidez , Fatores de Risco , Estudos Soroepidemiológicos , Testes Sorológicos
13.
J Infect Dis ; 172(4): 1076-9, 1995 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-7561182

RESUMO

A suspected nosocomial outbreak of parvovirus B19 infection in a maternity ward was investigated in February 1994. Questionnaires were administered and sera collected from maternity ward staff (n = 91), other ward staff in the same hospital (n = 101), and maternity ward staff at a nearby hospital (n = 81). Blood donors (n = 265) were used as community controls. Recent infection (parvovirus B19 IgM positivity) in susceptible persons (parvovirus B19 IgG-negative or IgM-positive) was common among all 4 groups (23%-30%). This high rate of recent infection occurred during a large community outbreak of fifth disease. Environmental samples collected from a room where a stillborn parvovirus B19-infected fetus was delivered were positive for parvovirus B19 DNA. Thus, this suspected nosocomial outbreak actually reflected transmission outside the hospital, but contaminated environmental surfaces were identified as one potential source for transmission of parvovirus B19.


Assuntos
Infecções Comunitárias Adquiridas , Infecção Hospitalar , Surtos de Doenças , Eritema Infeccioso/epidemiologia , Recursos Humanos em Hospital , Anticorpos Antivirais/sangue , Centers for Disease Control and Prevention, U.S. , Edema , Monitoramento Ambiental , Monitoramento Epidemiológico , Eritema Infeccioso/imunologia , Eritema Infeccioso/transmissão , Feminino , Morte Fetal , Humanos , Imunoglobulina M/sangue , Missouri/epidemiologia , Unidade Hospitalar de Ginecologia e Obstetrícia , Gravidez , Estados Unidos
14.
Am J Hematol ; 50(2): 84-90, 1995 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-7573005

RESUMO

Thrombotic thrombocytopenic purpura (TTP) is a rare disease and the epidemiologic features have been incompletely characterized. Because of the historically high case-fatality rate for TTP, we analyzed U.S. multiple cause-of-death mortality data with TTP listed on the death record for the period 1968-1991, in order to estimate the incidence of TTP, to characterize demographic features of the decedents, and to determine if trends in mortality correlate with findings from clinical studies showing improved survival in recent years. There were 4,523 TTP-associated deaths during the 24-year study period. The annual age-adjusted mortality rate decreased initially and reached its lowest point at 0.4 per 1,000,000 residents for the years 1970 through 1973, and then increased steadily to 1.1 during the last 4 years of the study period, 1988 through 1991. We estimate the current incidence of TTP to be approximately 3.7 cases per 1,000,000 residents. Deaths were rare below the age of 20 years, but the age-specific mortality rate for those 20 years and older increased steadily with increasing age. Regardless of age, females were affected more often than males, and the overall female-to-male age-adjusted rate ratio was 1.9 (95% confidence interval (CI), 1.8 to 2.0). The greatest age-specific difference was between females and males in their twenties (rate ratio 3.2; 95% CI, 2.6 to 3.9). The mortality rate for blacks, and especially black females, was higher than the mortality rate for whites (black-to-white age-adjusted rate ratio 3.4; 95% CI, 3.2 to 3.6; black female-to-white female age-adjusted rate ratio 3.6; 95% CI, 3.3 to 3.9), although the majority of deaths were among whites (71.5%). Infection with the human immunodeficiency virus (HIV) or an HIV-related diagnosis was reported in 61 (1.3%) decedents overall and in 51 (4.4%) decedents from 1988 through 1991. The TTP mortality rate has increased over time despite reports of significant improvement in survival associated with clinical use of plasma infusion and plasma exchange. This trend in mortality suggests that the incidence of TTP is increasing. Blacks, and black females in particular, are affected at a disproportionately high rate. The increased incidence of HIV infection and related disease may have contributed to some of the increase in TTP mortality in recent years, but it does not explain the majority of the increase, which began before the onset of the HIV epidemic.


Assuntos
Púrpura Trombocitopênica Trombótica/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , População Negra , Criança , Pré-Escolar , Feminino , Infecções por HIV/complicações , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Púrpura Trombocitopênica Trombótica/complicações , Caracteres Sexuais , Estados Unidos , População Branca
15.
J Infect Dis ; 170(4): 986-90, 1994 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-7930745

RESUMO

Respiratory syncytial virus (RSV) causes pneumonia and bronchiolitis in infants and young children and serious disease in the elderly and persons with compromised immune systems. To determine the temporal and geographic patterns of RSV outbreaks in the United States, monthly reports from 74 laboratories were analyzed for July 1985 through June 1990. RSV outbreaks were identified in 197 (93%) of the 211 laboratory years analyzed, with widespread activity beginning each fall, peaking in winter, and returning to baseline in April or May. Each year, the timing of outbreaks did not differ significantly between most regions; the few differences were small, and no region consistently had early or late outbreaks. These findings are consistent with RSV transmission within communities rather than between communities or regions. Health care personnel should consider the possibility of RSV infection in their treatment and prevention efforts from November through April each year in the United States.


Assuntos
Vigilância da População , Infecções por Vírus Respiratório Sincicial/epidemiologia , Vírus Sincicial Respiratório Humano , Idoso , Criança , Pré-Escolar , Surtos de Doenças , Humanos , Lactente , Fatores de Tempo , Estados Unidos/epidemiologia
16.
Lancet ; 343(8908): 1255-8, 1994 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-7910276

RESUMO

We describe three patients who had infection with human parvovirus B19 in association with new-onset systemic necrotising vasculitis syndromes, two with features of polyarteritis nodosa and one with features of Wegener's granulomatosis. Chronic B19 infection, lasting 5 months to more than 3 years, was shown by enzyme immunoassay for IgG and IgM antibodies to B19 and polymerase chain reaction for B19 DNA in serum and tissue samples. The patients had atypical serological responses to the B19 infection, although none had a recognisable immunodeficiency disorder. Treatment with corticosteroids and cyclophosphamide did not control vasculitis. Intravenous immunoglobulin (IVIG) therapy led to rapid improvement of the systemic vascultis manifestations, clearing of the chronic parvovirus infection, and long-term remission. These observations suggest an aetiological relation between parvovirus B19 infection and systemic necrotising vasculitis in these patients and indicate a potentially curative role for IVIG in such disorders.


Assuntos
Eritema Infeccioso/complicações , Granulomatose com Poliangiite/microbiologia , Imunoglobulinas Intravenosas/uso terapêutico , Parvovirus B19 Humano/isolamento & purificação , Poliarterite Nodosa/microbiologia , Adolescente , Sequência de Bases , Pré-Escolar , Doença Crônica , Primers do DNA , DNA Viral/análise , Eritema Infeccioso/terapia , Feminino , Granulomatose com Poliangiite/imunologia , Granulomatose com Poliangiite/terapia , Humanos , Masculino , Dados de Sequência Molecular , Parvovirus B19 Humano/genética , Parvovirus B19 Humano/imunologia , Poliarterite Nodosa/imunologia , Poliarterite Nodosa/terapia
17.
J Virol Methods ; 44(2-3): 155-65, 1993 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-8263112

RESUMO

Human parvovirus B19 is the etiologic agent of erythema infectiosum and transient aplastic crisis in patients with hemolytic anemias and has been associated with fetal death, arthritis, and chronic anemia. Acute B19 infection is best diagnosed by detection of IgM antibodies, whereas the diagnosis of chronic infection often requires the sensitivity of PCR to demonstrate presence of virus over time. To improve our ability to detect B19 DNA by polymerase chain reaction (PCR), we evaluated 19 primers combined into 16 different primer pairs for their ability to detect temporally and geographically diverse B19 isolates. All 16 pairs reacted with all isolates tested but with different sensitivity. Sequence analysis showed few nucleotide changes compared with published sequences. These changes did not explain observed differences in sensitivity between primer pairs. The most sensitive primer pairs detected 350 to 3500 DNA copies after 35 cycles. A second amplification cycle with nested primers improved the sensitivity 100-fold. These 16 primer pairs provide the diagnostic virologist with multiple options for B19 PCR assays.


Assuntos
DNA Viral/análise , Eritema Infeccioso/diagnóstico , Parvovirus B19 Humano/genética , Reação em Cadeia da Polimerase/métodos , Doença Aguda , Biotina , Doença Crônica , Primers do DNA , Surtos de Doenças , Genoma Viral , Humanos , Sensibilidade e Especificidade , Análise de Sequência de DNA , Homologia de Sequência de Aminoácidos , Homologia de Sequência do Ácido Nucleico
18.
J Infect Dis ; 167(5): 1201-5, 1993 May.
Artigo em Inglês | MEDLINE | ID: mdl-8387565

RESUMO

In an investigation of a school outbreak of enterovirus-like illness and aseptic meningitis, an IgM antibody assay was used to identify persons with evidence of recent coxsackie virus B2 infection. During September and October 1989, 81 (25%) of 319 students and staff reported an enterovirus-like illness; of these, 17 (21%) also had aseptic meningitis. Attack rates for enterovirus-like illness were highest among varsity football team members (53%), and most of this illness occurred between 6 and 15 October. Coxsackie virus B2 was isolated from 2 varsity football players. IgM antibody studies confirmed that coxsackie virus B2 was the cause of the outbreak in the varsity football team and suggested it was not responsible for much of the disease in other students and staff: 63% of football team members were seropositive compared with 12% for other students in grades 6-12. This report illustrates the value of an IgM antibody assay in the investigation of enterovirus outbreaks to distinguish infection from illness.


Assuntos
Infecções por Coxsackievirus/epidemiologia , Surtos de Doenças , Meningite Asséptica/epidemiologia , Adolescente , Adulto , Alabama/epidemiologia , Criança , Infecções por Coxsackievirus/complicações , Enterovirus Humano B/isolamento & purificação , Feminino , Futebol Americano , Humanos , Imunoensaio , Masculino , Meningite Asséptica/complicações , Fatores de Risco , Instituições Acadêmicas
19.
Am J Epidemiol ; 136(12): 1502-6, 1992 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-1337662

RESUMO

Acute hemorrhagic conjunctivitis due to enterovirus 70 has caused extensive outbreaks in tropical areas since 1969. Between December 1, 1990, and March 4, 1991, an outbreak of acute hemorrhagic conjunctivitis due to enterovirus 70 occurred in American Samoa, where an outbreak due to the same agent had occurred in 1981. A survey of 5% of the households (134 households, 1,095 individuals) was conducted throughout the island of Tutuila. The outbreak affected 58% of the population, with age-specific attack rates greater than 50% for all age groups except children younger than 2 years. Attack rates were significantly higher for children 2-10 years old (65%) than in the remainder of the population. Women aged 21-40 years had higher rates than did men the same age (66 vs. 49%), possibly because of the close association of women and young children. At higher preepidemic titers, there was evidence of protection from clinical disease among males but not among females. Enterovirus 70 can cause large outbreaks even in a population already exposed in a previous large outbreak; protection due to previous infection is only partial.


Assuntos
Anticorpos Antibacterianos/sangue , Conjuntivite Hemorrágica Aguda/epidemiologia , Surtos de Doenças , Infecções por Enterovirus/epidemiologia , Enterovirus , Conjuntivite Hemorrágica Aguda/imunologia , Conjuntivite Hemorrágica Aguda/microbiologia , Infecções por Enterovirus/imunologia , Feminino , Humanos , Estado Independente de Samoa/epidemiologia , Masculino , Testes de Neutralização , Fatores Sexuais
20.
Clin Infect Dis ; 14(1): 149-55, 1992 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-1571420

RESUMO

Human parvovirus B19 is a recently recognized cause of fetal hydrops and death. Efforts to characterize the natural history of fetal infection with this virus have been hampered by the lack of sensitive and specific tests for diagnosis in utero. Using the highly sensitive polymerase chain reaction (PCR) assay, we determined the fetal infection status in 56 pregnancies by testing amniotic fluid, fetal serum, and maternal serum for B19 DNA and antibodies. Factors associated with a high risk of B19 infection were fetal disease, exposure to persons with erythema infectiosum, or signs or symptoms of acute B19 infection. Fifteen women (27%) were B19 IgM-positive, a status suggesting recent infection; the positivity of all of the corresponding fetal specimens for B19 DNA in the PCR was indicative of fetal infection. In four of these cases, serial ultrasonographic examinations documented spontaneous resolution of fetal hydrops. Twenty-four women (43%) were IgG-positive and IgM-negative; this pattern suggested prior infection. The PCR gave positive results, consistent with recent maternal infection, in four of these cases. Seventeen women (30%) were IgG-negative and IgM-negative, a pattern suggesting no prior infection; the PCR results in four cases were indicative of a possible early maternal infection or a possible atypical immune response. The PCR is a sensitive and rapid method for the diagnosis of intrauterine infection with human parvovirus B19 and promises to facilitate studies of the natural history and treatment of this infection.


Assuntos
DNA Viral/análise , Eritema Infeccioso/diagnóstico , Doenças Fetais/diagnóstico , Parvovirus B19 Humano/isolamento & purificação , Diagnóstico Pré-Natal , Adolescente , Adulto , Líquido Amniótico/microbiologia , Anemia/diagnóstico , Anticorpos Antivirais/sangue , Sequência de Bases , DNA Viral/sangue , DNA Viral/química , Ensaio de Imunoadsorção Enzimática , Feminino , Sangue Fetal/microbiologia , Humanos , Hidropisia Fetal/diagnóstico , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Dados de Sequência Molecular , Parvovirus B19 Humano/genética , Parvovirus B19 Humano/imunologia , Reação em Cadeia da Polimerase , Gravidez
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