HIV acute infection and long-term undisclosed HIV status among blood donors from the highly endemic Amazonas state, located in the Brazilian Amazon

ABSTRACT Background: The Amazonas state/AM and Manaus rank among the highest AIDS detection rates in Brazil. High proportion of HIV infected blood donors and transmission clusters of multidrug antiretroviral/ARV resistant viruses were described in HEMOAM blood donors, a main Amazonas public blood bank. Recent and long-term infections among previously genotyped donors are reported. Methods/materials: The recency immunoassay Lag Avidity EIA (Maxim, USA) was employed. Clinical/CD4/viral load medical file data of the main local HIV management center (FMTHVD) and ARV treatment/ART data were reviewed. Results: Among 142 HIV-blood donors, chronic infection predominated (n = 87; 61.3 %), 79 based on LAg EIA and 8 undisclosed HIV identified in FMT-HVD records, mostly young adult, single males, 4 repeat donors, all ART-naive. Recent infections represented 30.3 % (n = 43),39 identified by LAg EIA and 4 immunologic windows (antibody negative/NAT/RNA positive). The overall profile of recent and long-term infections was similar, including moderate rate of transmitted drug resistance/TDR, however with multiple resistance mutations to more than one ARV-class, suggesting ART/failure. Discussion: Recent/acute and undisclosed/long-term HIV infections represent blood safety alerts suggesting test-seeking behavior of at-risk populations. Early ART use in Brazil, can turn HIV diagnosis more challenging representing a blood transfusion risk in the highly endemic Brazilian Amazon.

Prevalence of arboviruses in sickle cell disease patients from two different regions of Brazil, the North and Northeast

ABSTRACT Sickle Cell Disease (SCD) is a hereditary disease characterized by extravascular and intravascular hemolysis and clinical variability, from mild pain to potentially life-threatening. Arboviruses include mainly Zika (ZIKV), Chikungunya (CHKV), and Dengue (DENV) virus, and are considered a public and social health problem. The present cross-sectional observational study aimed to investigate the prevalence of arbovirus infection in SCD patients from two Brazilian cities, Salvador and Manaus located in Bahia and Amazonas states respectively. A total of409 individuals with SCD were included in the study, and 307 (75.06 %) patients tested positive for DENV-IgG, 161 (39.36 %) for ZIKV-IgG, and 60 (14.67 %) for CHIKV-IgG. Only one individual was positive for DENV-NS1 and another for DENV-IgM, both from Salvador. No individuals had positive serology for ZIKV-IgM or CHIKV-IgM. Arbovirus positivity by IgG testing revealed that the SCD group presented high frequencies in both cities. Interestingly, these differences were only statistically significant for ZIKV-IgG (p = 0.023) and CHIKV-IgG (p = 0.005) among SCD patients from Manaus. The reshaping of arbovirus from its natural habitat by humans due to disorderly urban expansion and the ease of international Mobility has been responsible for facilitating the spread of vector-borne infectious diseases in humans. We found the need for further studies on arboviruses in this population to elucidate the real association and impact, especially in acute infection. We hope that this study will contribute to improvements in the personalized clinical follow-up of SCD patients, identifying the influence of arbovirus infection in severe disease manifestations.

Clinical and laboratory features of HTLV-I asymptomatic carriers and patients with HTLV-I-associated myelopathy/tropical spastic paraparesis from the Brazilian Amazon

ABSTRACT Clinical and laboratory parameters including blood and cerebrospinal fluid (CSF) neopterin were investigated in human-T-lymphotropic-virus-type-I associated-myelopathy/tropical-spastic-paraparesis-HAM/TSP and in HTLV-I carriers. HAM/TSP (n = 11, 2 males/9 females, median age = 48 years), recently diagnosed HTLV-I carriers (n = 21, 15 females/6 males, median age = 44 years), healthy individuals (n = 20, 10 males/10 females, median age = 34.6 years) from the Brazilian Amazon (Manaus, Amazonas State) were investigated. Neopterin was measured (IBL ELISA Neopterin, Germany) in serum samples of all the participants, in CSF of 9 HAM/TSP patients as well as in 6 carriers. In HAM/TSP patients, CSF cell counts, protein and glucose were measured, the Osame’s motor-disability-score/OMDS was determined, and brain/spinal cord magnetic-resonance-imaging (MRI) was performed. HAM/TSP patients had normal CSF glucose, leukocyte counts; and normal protein levels predominated. Brain-MRI showed white-matter lesions in 7 out of 11 HAM/TSP patients. OMDS varied from 2-8: 9 were able to walk, 2 were wheel-chair-users. The median serum neopterin concentration in HAM/TSP patients was 6.6 nmol/ L; min. 2.8- max. 12.5 nmol/ L); was lower in carriers (4.3 nmol/L; min. 2.7- max. 7.2 nmol/ L) as well as in healthy participants (4.7 nmol/ L; min. 2.7- max. 8.0 nmol/ L) (p < 0.05). CSF neopterin concentrations in HAM/TSP patients were higher than in serum samples, and higher compared to carriers (p < 0.05). Carriers had similar serum-CSF neopterin concentrations compared to healthy participants. Variable clinical and laboratory profiles were seen in HAM/TSP patients, however our results support the neopterin measurement as a potential biomarker of disease activity.

Pesquisa de Micobactérias Ambientais em água de torneira, luvas e soluções utilizadas em procedimentos cirúrgicos no Hospital Universitário Getúlio Vargas - Manaus/AM

Using bacteriological (culture) and molecular (PCR - Restriction Enzyme Analysis, PRA) methods, we investigated the presence of environmental mycobacteria in tap water, antiseptic solutions and surgical gloves, used in carrying out surgical procedures at the Getúlio Vargas University Hospital Surgical Center, in Manaus -Amazonas/Brazil. Samples (105) were collected and analyzed from: tap water (24 - collected from 3 taps in the surgical center); povidone-iodine solution, PVP-I, (8); Chlorhexidine solution (7), that were used to hygienize surgeons' hands; surgical gloves (39); and solutions that were effectively used during the surgical procedure (27). Using bacteriological method 41 mycobacteria were isolated, all from samples of tap water. Using PRA, mycobacterial DNA was detected only in the sample from water that provided over 100 colonies per inoculated culture tubes. The isolated were identified as Mycobacterium celatum pattern II, M. gordonae pattern III, M. gordonae pattern VI, M. intracellulare pattern I, M. lentiflavum pattern III and M. mucogenicum pattern I. The isolating of M. mucogenicum, a species that had already been incriminated for causing post-surgical outbreaks in tap water from the surgical center, indicates that cleaning and monitoring procedures must be carried out in every place of water distribution. This may be necessary to prevent nosological mycobacteriosis outbreaks induced by the use of water in different activities such as handling and hygienizing patients submitted to invasive procedures.

Investigou-se por métodos bacteriológicos (cultivo) e moleculares (PCR - Restriction Enzyme Analysis, PRA), a presença de micobactérias ambientais em águas de torneira, soluções e luvas cirúrgicas, utilizadas nas etapas dos procedimentos cirúrgicos executados no centro cirúrgico do Hospital Universitário Getulio Vargas (HUGV), na cidade de Manaus-Amazonas/Brasil. Foram colhidas e analisadas 105 amostras sendo: 24 de águas (colhidas das 2 torneiras existentes no centro cirúrgico), 8 de solução de Povidine e 7 de solução de Clorhexidina, que servem para a higienização das mãos dos cirurgiões; 39 de luvas cirúrgicas (superfícies internas e externas); e 27 de soluções que foram efetivamente utilizadas durante o ato cirúrgico. Por método bacteriológico obteve-se 41 isolados micobacterianos apenas de águas das torneiras. Pelo PRA obteve-se a detecção de DNA micobacteriano somente na amostra de água que forneceu acima de 100 colônias de micobactérias por tubo semeado. Os isolados foram identificados como sendo Mycobacterium celatum perfil 2, M. gordonae perfil 3, M. gordonae perfil 6, M. intracellulare perfil 1, M. lentiflavum perfil 3 e M. mucogenicum perfil 1. O encontro de M. mucogenicum, espécie já incriminada em surtos pós-cirúrgicos, indica que devem ser efetuados procedimentos de limpeza e monitoramento em todos os pontos de distribuição de águas, visando à prevenção de surtos de micobacterioses nosocomiais induzidos pelo uso das águas nas diferentes atividades de manuseio ou higienização dos pacientes submetidos a procedimentos invasivos.

Anticorpos anti-eritrocitários em pacientes com Coombs direto positivo infectados com malária por P. vivax e P. falciparum / Anti-erithrocytes antibodies in patients with positive direct Coombs infected with P. vivax and P. falciparum malaria

Para se determinar a prevalência de anticorpos anti-eritrocitários de grupo sanguíneo foram analizadas 247 amostras de sangue de pacientes com malária vivax e falciparum com teste de Coombs direto positivo atendidos na Fundação de Medicina Tropical Manaus-Amazonas no período entre setembro/99 a março/2000.Realizaram-se os testes laboratoriais de Coombs direto, dosagens de hemoglobina, bilirrubina e eletroforese de proteínas.Das amostras testadas, 13,3 apresentaram Coombs direto positivo, sendo o anticorpo da classe IgG (33,3) o mais freqüente. Dos pacientes com malária vivax e Coombs direto positivo, 17 apresentaram anemia possivelmente devido a hemólise por auto-imunidade com o envolvimento da gamaglobulina IgG.Não foram detectados anticorposcontra antígenos de grupos sanguíneos nem aloanticorpos séricos.Torna-se necessário a realização de outras pesquisas para avaliação da existência de associação entre a positividade do Coombs direto e anemia ou se a mesma interfere ou não com o curso da doença.

Prevalência de marcadores sorológicos e moleculares do vírus da hepatite B em gestantes do Estado do Amazonas, Brasil / Prevalence of serologic and molecular markers of hepatitis B virus infectio among pregnant women in Amazonas State, Brazil

A infecção pelo vírus da hepatite B (VHB) constitui um importante problema de Saúde Pública na Amazônia brasileira, onde a exposição precoce, durante a infância, ocorre em áreas de maior endemicidade. Com a finalidade de contribuir para as políticas regionais de controle do VHB na região, foi conduzido um inquérito de prevalência de marcadores sorológicos e moleculares do VHB entre 1.460 gestantes atendidas pelo Programa Pré-Natal, nas nove sub-regiões do Estado do Amazonas, Brasil. Entre essas subregiões, a prevalência do antígeno de superfície (HBsAg) variou de 0 por cento a 8,7 por cento; dos anticorpos anti-core (anti-HBc), de 5,3 a 75,9 por cento;e de anticorpos anti-superfície (anti-HBs), de 10,6 a 73,4 por cento. Entre as 46 gestantes reativas para o HBsAg, 36 (78,3 por cento) foram positivas para VHB-DNA na reação em cadeia da polimerase (PCR). A carga viral de VHB-DNA foi menor que 1x103 cópias/ml em 73,9 por cento das gestantes HBsAg-reativas; porém, 8,7 por cento apresentavam níveis superiores a 1x105 cópias/ml, indicando infecção ativa. Os resultados encontrados mostram sub-regiões do Amazonas com elevada prevalência de VHB entre mulheres grávidas e, embora a maioria apresente baixa viremia, algumas podem representar risco potencial de transmissão mãe-filho, devido à elevada carga viral

Métodos de triagem para malária, em doadores de sangue de área endêmica / Screening methods for malaria, in blood donors in endemic area

Relizou-se um estudo controlado para comparar a presença parasitemiaa e anticorpos antiplasmódios em doadores expostos ao risco de infecçäo malárica, segundo os critérios fixados nas Normas Técnicas em Hemoterapia, do Miníterio da Saúde. Eles estabelecem a rejeiçäo dos candidatos à doaçäo que apresentaram quadro febril há 30 dias e malária há 12 meses, ou que frequentaram área de malária há 6 meses. Foram estudados 395 candidatos incluídos nos critérios de rejeiçäo (expostos) e 383 candidatos aptos (controles), selecionados na triagem de doadores do Hemocentro de Manaus (AM). Em ambos os grupos, realizou-se a gota espessa e o teste da laranja acridina (QBC) para o diagnóstico parasitológico e a imunofluorescência indireta para a pesquisa de anticorpos IgM e IgG ao Plamodium vivax e falciparum. Observou-se diferença significante entre expostos e controles em relaçäo à presença de parasitemia, porém mäo para a presença de anticorpos antiplasmódios (P<0.05). O QBC foi mais sensível do que a gota espessa para detectar parasitemia e a concordância entre ambos foi de 0.66 ao Indice Kappa