HLA-B*13, B*35 and B*39 Alleles Are Closely Associated With the Lack of Response to ART in HIV Infection: A Cohort Study in a Population of Northern Brazil.

Introduction: Immune reconstitution failure after HIV treatment is a multifactorial phenomenon that may also be associated with a single polymorphism of human leukocyte antigen (HLA); however, few reports include patients from the Brazilian Amazon. Our objective was to evaluate the association of the immunogenic profile of the "classical" HLA-I and HLA-II loci with treatment nonresponse in a regional cohort monitored over 24 months since HIV diagnosis. Materials and Methods: Treatment-free participants from reference centers in the state of Pará, Brazil, were enrolled. Infection screening was performed using enzyme immunoassays (Murex AG/AB Combination DiaSorin, UK) and confirmed by immunoblots (Bio-Manguinhos, FIOCRUZ). Plasma viral load was quantified by real-time PCR (ABBOTT, Chicago, Illinois, USA). CD4+/CD8+ T lymphocyte quantification was performed by immunophenotyping and flow cytometry (BD Biosciences, San Jose, CA, USA). Infection was monitored via test and logistics platforms (SISCEL and SICLOM). Therapeutic response failure was inferred based on CD4+ T lymphocyte quantification after 1 year of therapy. Loci A, B and DRB1 were genotyped using PCR-SSO (One Lambda Inc., Canoga Park, CA, USA). Statistical tests were applied using GENEPOP, GraphPad Prism 8.4.3 and BioEstat 5.3. Results: Of the 270 patients monitored, 134 responded to treatment (CD4+ ≥ 500 cells/µL), and 136 did not respond to treatment (CD4+ < 500 cells/µL). The allele frequencies of the loci were similar to heterogeneous populations. The allelic profile of locus B was statistically associated with treatment nonresponse, and the B*13, B*35 and B*39 alleles had the greatest probabilistic influence. The B*13 allele had the highest risk of treatment nonresponse, and carriers of the allele had a detectable viral load and a CD4+ T lymphocyte count less than 400 cells/µL with up to 2 years of therapy. The B*13 allele was associated with a switch in treatment regimens, preferably to efavirenz (EFZ)-based regimens, and among those who switched regimens, half had a history of coinfection with tuberculosis. Conclusions: The allelic variants of the B locus are more associated with non-response to therapy in people living with HIV (PLHIV) from a heterogeneous population in the Brazilian Amazon.

Epstein-Barr Virus (EBV) Genotypes Associated with the Immunopathological Profile of People Living with HIV-1: Immunological Aspects of Primary EBV Infection.

BACKGROUND: The aim of the present study was to evaluate the immunological profile of adult HIV-1+ patients coinfected with primary Epstein-Barr virus (EBV) infection who were free of antiretroviral drugs and inhabitants of the Brazilian Amazon region. MATERIALS AND METHODS: Primary EBV infection was screened by the semiquantitative detection of IgM and IgG anti-VCA. Genotypes were determined by conventional PCR. EBV and HIV viral load (VL) were quantified by real-time PCR. Cytokine dosage and cell quantification were performed by cytometry. RESULTS: Only HIV-1+ individuals had primary EBV infection (7.12%). The EBV-1 genotype was the most prevalent (47.37%). The VL of HIV-1 was lower in the HIV/EBV-2 group. CD4+ T lymphocytes were inversely proportional to the VL of EBV in HIV/EBV-1/2 multi-infected patients. The HIV/EBV-2 group had the lowest cytokine levels, especially IFN-γ and IL-4. Different correlations were proposed for each coinfection. The late search for specific care related to HIV infection directly affected the cytokine profile and the number of CD8+ T lymphocytes. Symptoms were associated with the increase in VL of both viruses and cytokine profile. CONCLUSIONS: Different immunological profiles were associated with EBV genotypes in primary infection, with EBV-2 being more frequent in patients with low levels of HIV viral load. With late infection monitoring and consequent delay in the initiation of HAART, clinical changes and effects on the maintenance of the immune response were observed.

Triatomine home invasions in active foci of Chagas disease in Abaetetuba, Pará, Brazil.

BACKGROUND: Chagas disease is a parasitic infection with high re-emergence rates in some Amazon regions. The main vectors of Trypanosoma cruzi are haematophagous insects, the triatomines. Only a few reports are available about the occurrence of these wild vectors and their contact with the inhabitants of the riverside regions of the Amazon. This study describes the unusual behaviour of the triatomines that have invaded the homes of the residents of Abaetetuba, the city that has the second highest number of cases of Chagas disease. METHODS: Two cross-sectional studies were conducted using sero-epidemiological surveys of the inhabitants of Abaetetuba with registered triatomine home invasions. The frequencies of the variables of interest were analysed using Epi Info version 7.2. RESULTS: In 2014 and 2017, 145 persons registered home invasions of triatomines in their domiciles and 16.55% reported having been bitten by insects. The environmental features described indicated potential conditions for the persistence of the parasite's life cycle. Of the enrolled inhabitants, 0.47% were positive for immunoglobulin G anti-T. cruzi antibodies. CONCLUSIONS: Home invasions of triatomines were confirmed in two periods, with a description of unusual behaviour for the genus Rhodnius. The use of serological surveillance in human populations at risk of this occurrence may constitute a new tool for the early detection of silent infections.

Risk of Zika virus-associated birth defects in congenital confirmed cases in the Brazilian Amazon.

OBJECTIVE: To establish the risk of microcephaly in neonates born to women infected with ZIKV during pregnancy. METHODS: A cohort of laboratory-confirmed ZIKV cases of congenital infections (109 mothers infected during pregnancy and 101 newborns) among 308 suspect cases was followed in Belem, Pará, Brazil, from October 2015 to December 2017. RESULTS: A microcephaly risk of 1.98% (95% CI 0.54-6.93%) was found, or 2 cases among the 101 neonates infected with ZIKV during pregnancy. 72% of the pregnant women had ZIKV infection confirmed by RT-qPCR during gestation. CONCLUSIONS: Results showed a low incidence of ZIKV-associated birth defects, stillbirth, and miscarriage, which contrasts with previous studies in other Brazilian regions. Previous exposure to yellow fever vaccine and/or multiserotype DENV infection could be implicated in the protection from ZIKV congenital infection.

OBJETIVO: Establecer el riesgo de microcefalia en los recién nacidos de mujeres infectadas con ZIKV durante el embarazo. MÉTODOS: Se siguió a una cohorte de casos con infección congénita por ZIKV confirmada por laboratorio (109 madres infectadas durante el embarazo, 101 recién nacidos) conformada a partir de 308 casos sospechosos en Belem, Pará, Brasil, de octubre de 2015 a diciembre de 2017. RESULTADOS: Se encontró un riesgo de microcefalia de 1,98% (IC95% 0,54-6,93%), o 2 casos entre los 101 neonatos infectados con ZIKV durante el embarazo. En el 72% de las mujeres embarazadas se confirmó mediante RT-qPCR la infección por ZIKV durante la gestación. CONCLUSIONES: Los resultados mostraron una baja incidencia de malformaciones congénitas, mortinatos y abortos asociados al ZIKV, lo que contrasta con estudios anteriores de otras regiones de Brasil. La exposición previa a la vacuna contra la fiebre amarilla o la infección previa por varios serotipos de virus del dengue podrían estar implicados en la protección contra la infección congénita por ZIKV.

Risk of Zika virus-associated birth defects in congenital confirmed cases in the Brazilian Amazon

Objective. To establish the risk of microcephaly in neonates born to women infected with ZIKV during pregnancy. Methods. A cohort of laboratory-confirmed ZIKV cases of congenital infections (109 mothers infected during pregnancy and 101 newborns) among 308 suspect cases was followed in Belem, Pará, Brazil, from October 2015 to December 2017. Results. A microcephaly risk of 1.98% (95% CI 0.54-6.93%) was found, or 2 cases among the 101 neonates infected with ZIKV during pregnancy. 72% of the pregnant women had ZIKV infection confirmed by RT-qPCR during gestation. Conclusions. Results showed a low incidence of ZIKV-associated birth defects, stillbirth, and miscarriage, which contrasts with previous studies in other Brazilian regions. Previous exposure to yellow fever vaccine and/ or multiserotype DENV infection could be implicated in the protection from ZIKV congenital infection.

Objetivo. Establecer el riesgo de microcefalia en los recién nacidos de mujeres infectadas con ZIKV durante el embarazo. Métodos. Se siguió a una cohorte de casos con infección congénita por ZIKV confirmada por laboratorio (109 madres infectadas durante el embarazo, 101 recién nacidos) conformada a partir de 308 casos sospechosos en Belem, Pará, Brasil, de octubre de 2015 a diciembre de 2017. Resultados. Se encontró un riesgo de microcefalia de 1,98% (IC95% 0,54-6,93%), o 2 casos entre los 101 neonatos infectados con ZIKV durante el embarazo. En el 72% de las mujeres embarazadas se confirmó mediante RT-qPCR la infección por ZIKV durante la gestación. Conclusiones. Los resultados mostraron una baja incidencia de malformaciones congénitas, mortinatos y abortos asociados al ZIKV, lo que contrasta con estudios anteriores de otras regiones de Brasil. La exposición previa a la vacuna contra la fiebre amarilla o la infección previa por varios serotipos de virus del dengue podrían estar implicados en la protección contra la infección congénita por ZIKV.

Genotypes of Epstein-Barr virus (EBV1/EBV2) in individuals with infectious mononucleosis in the metropolitan area of Belém, Brazil, between 2005 and 2016.

Two types of Epstein Barr virus (EBV1/EBV2) have been shown to infect humans. Although their genomes are similar, the regions containing the EBNA genes differ. This study aimed to characterize the EBV genotypes of infectious mononucleosis (IM) cases in the metropolitan region of Belém, Brazil, from 2005 to 2016. A total of 8295 suspected cases with symptoms/signs of IM were investigated by infectious disease physicians at Evandro Chagas Institute, Health Care Service, from January 2005 to December 2016. Out of the total, 1645 (19.8%) samples had positive results for EBV by enzyme immunoassay and 251 (15.3%) were submitted to polymerase chain reaction (PCR) technique, using the EBNA3C region, in order to determine the type of EBV. Biochemical testing involving aspartate aminotransferase, alanine aminotransferase and gamma-glutamyl transferase were also performed. EBV type was identified by PCR in 30.3% (76/251) of individuals; of those, 71.1% (54/76) were classified as EBV1, 17.1% (13/76) as EBV2, and 11.8% (9/76) as EBV1 + EBV2. The main symptoms/signs observed with EBV1 infection were cervical lymphadenopathy (64.8%, 35/54), fever (63%, 34/54), headache (20.4%, 11/54), arthralgia (20.4%, 11/54), and exanthema (18.5%, 10/54). EBV2 infection was detected in all but two age groups, with an average age of 24 years. The most common signs/symptoms of EBV2 were fever (76.9%, 10/13), average duration of 18 days, and lymphadenopathy (69.2%, 9/13). In contrast, EBV1 + EBV2 coinfections were more frequent in those aged five years or less (20.0%, 2/10). The symptoms of EBV1 + EBV2 coinfection included fever (66.7%, 6/9), and cervical lymphadenopathy and headache (33.3%, 3/9) each. The mean values of hepatic enzymes according to type of EBV was significantly different (p < 0.05) in those EBV1 infected over 14 years of age. Thus, this pioneering study, using molecular methods, identified the EBV genotypes in 30.3% of the samples, with circulation of EBV1, EBV2, and EBV1 + EBV2 co-infection in cases of infectious mononucleosis in the northern region of Brazil.

Immunogenicity and safety of the combined vaccine for measles, mumps, and rubella isolated or combined with the varicella component administered at 3-month intervals: randomised study.

BACKGROUND: Field testing required to license the combined measles, mumps, and rubella (MMR) vaccine must take into account the current recommendation of the vaccine in Brazil: first dose at 12 months and second dose at 15 months of age in combination with a varicella vaccine. OBJECTIVES: This study aimed to evaluate the clinical consistency, immunogenicity, and reactogenicity of three batches of MMR vaccine prepared with active pharmaceutical ingredients (API) from Bio-Manguinhos, Fiocruz (MMR-Bio), and compare it to a vaccine (MMR produced by GlaxoSmithKline) with different API. METHODS: This was a phase III, randomised, double-blind, non-inferiority study of the MMR-Bio administered in infants immunised at health care units in Pará, Brazil, from February 2015 to January 2016. Antibody levels were titrated by immunoenzymatic assays. Adverse events were recorded in diaries. FINDINGS: Seropositivity levels after MMR-Bio were 97.6% for measles, 84.7% for mumps, and 98.0% for rubella. After the MMRV vaccine, seroconversion rates and GMT increased substantially for mumps. In contrast, approximately 35% of the children had no detectable antibodies to varicella. Systemic adverse events were more frequent than local events. CONCLUSION: The demonstration of batch consistency and non-inferiority of the Bio-MMR vaccine completed the technology transfer. This is a significant technological achievement with implications for immunisation programs.

Immunogenicity and safety of the combined vaccine for measles, mumps, and rubella isolated or combined with the varicella component administered at 3-month intervals: randomised study

BACKGROUND Field testing required to license the combined measles, mumps, and rubella (MMR) vaccine must take into account the current recommendation of the vaccine in Brazil: first dose at 12 months and second dose at 15 months of age in combination with a varicella vaccine. OBJECTIVES This study aimed to evaluate the clinical consistency, immunogenicity, and reactogenicity of three batches of MMR vaccine prepared with active pharmaceutical ingredients (API) from Bio-Manguinhos, Fiocruz (MMR-Bio), and compare it to a vaccine (MMR produced by GlaxoSmithKline) with different API. METHODS This was a phase III, randomised, double-blind, non-inferiority study of the MMR-Bio administered in infants immunised at health care units in Pará, Brazil, from February 2015 to January 2016. Antibody levels were titrated by immunoenzymatic assays. Adverse events were recorded in diaries. FINDINGS Seropositivity levels after MMR-Bio were 97.6% for measles, 84.7% for mumps, and 98.0% for rubella. After the MMRV vaccine, seroconversion rates and GMT increased substantially for mumps. In contrast, approximately 35% of the children had no detectable antibodies to varicella. Systemic adverse events were more frequent than local events. CONCLUSION The demonstration of batch consistency and non-inferiority of the Bio-MMR vaccine completed the technology transfer. This is a significant technological achievement with implications for immunisation programs.

Atrial fibrillation in acute Chagas disease acquired via oral transmission: a case report.

Atrial fibrillation (AF), a type of supraventricular arrhythmia increases the risk of thromboembolism. Chagas disease has been reported in the Brazilian Amazon region over approximately 20 years. Cardiac abnormalities are recorded in at least 50% of patients and among these, 3.3% develop AF. We describe a case of a 41-year-old man from Muaná, Pará State, who reported a 30-day history of a febrile illness. Acute Chagas disease was confirmed, and an electrocardiogram revealed AF. He was treated with antiparasitic and anti-arrhythmic drugs, beta blockers, and anticoagulants. Reversion to sinus rhythm was observed at his 9-month follow-up.

Atrial fibrillation in acute Chagas disease acquired via oral transmission: a case report

Abstract Atrial fibrillation (AF), a type of supraventricular arrhythmia increases the risk of thromboembolism. Chagas disease has been reported in the Brazilian Amazon region over approximately 20 years. Cardiac abnormalities are recorded in at least 50% of patients and among these, 3.3% develop AF. We describe a case of a 41-year-old man from Muaná, Pará State, who reported a 30-day history of a febrile illness. Acute Chagas disease was confirmed, and an electrocardiogram revealed AF. He was treated with antiparasitic and anti-arrhythmic drugs, beta blockers, and anticoagulants. Reversion to sinus rhythm was observed at his 9-month follow-up.

Detecção de bactérias enteropatogênicas e enteroparasitas em pacientes com diarreia aguda em Juruti, Pará, Brasil / Detection of enteropathogenic bacteria and enteroparasites in patients with acute diarrhea in Juruti, Pará, Brazil

Com o intuito de determinar a frequência de bactérias enteropatogênicas e enteroparasitas em pacientes com diarreia aguda no Município de Juruti, Pará, o qual passa por intenso processo imigratório face o grande projeto de exploração mineral, avaliaram-se 263 casos de diarreia aguda, dos quais 19 por cento foram atribuídos a bactérias enteropatogênicas, destacando-se a Shigella spp, que representou 13,7 por cento. Salmonella spp, Aeromonas spp e Plesiomonas shigelloides também foram detectados. Os sorotipos de Shigella mais frequentemente encontrados foram S. flexneri (61,1 por cento) e S. sonnei (38,9 por cento). Entre as Salmonella, identificaram-se os seguintes sorotipos: S. Panama (2), S. Newport (2), S. Bredeney, S. Saintpaul e S. Gaminara. A infecção pelos protozoários alcançou 85,3 por cento tendo como principais responsáveis, por ordem de frequência, Blastocystis hominis (37,3 por cento), Entamoeba histolytica/E. dispar (22,8 por cento), Endolimax nana (16,7 por cento), Entamoeba coli (9,5 por cento) e Giardia lamblia (8,4 por cento). Esses resultados fornecem valiosos subsídios à vigilância epidemiológica e ambiental, demonstrando as condições insatisfatórias de saneamento básico em que vive a população do Município.

With the aim of determining the frequency rate of enteropathogenic bacteria and enteroparasites in patients with acute diarrhea in the Municipality of Juruti, Pará State, which has been facing an intense migratory process due to a great mining project, we analyzed 263 cases of acute diarrhea. A total of 19 percent of those cases were related to enteropathogenic bacteria, particularly Shigella spp. that accounted for 13.7 percent of the cases. Salmonella spp, Aeromonas spp and Plesiomonas shigeloide were also detected. The most frequent Shigella serotypes found were S. flexneri (61.1 percent) and S. sonnei (38.9 percent). Among the Salmonella, we could observe the following serotypes: S. Panama (2), S. Newport (2), S. Bredeney, S. Saintpaul and S. Gaminara. The infection caused by protozoa reached 85.3 percent, mostly due to Blastocystis hominis (37.3 percent), Entamoeba histolytica/E. dispar (22.8 percent), Endolimax nana (16.7 percent), Entamoeba coli (9.5 percent) and Giardia lamblia (8.4 percent). These results provide valuable data to epidemiological and environmental surveillance because it presents the unsatisfactory basic sanitary conditions of the local population.

Caracterização fenotípica e genotípica de Serratia marcescens provenientes de Unidade Neonatal de Referência em Belém, Pará, Brasil / Phenotypic and genotypic characterization of Serratia marcescens from a Neonatal Unit in Belém, Pará State, Brazil

A Serratia marcescens tem sido relatada como importante agente de infecções relacionadas à saúde, destacando-se por apresentar elevado nível de resistência intrínseca aos antimicrobianos usados em neonatologia, além de persistir por longos períodos no ambiente hospitalar. Neste trabalho foram avaliadas, por métodos fenotípicos e moleculares, S. marcescens recuperadas a partir de colonização do trato gastrointestinal ou sepse tardia em neonatos internados em Unidade Neonatal em Belém. A identificação das S. marcescens e o teste de sensibilidade foram realizados por meio de sistema automatizado Vitek (BioMérieux); a suscetibilidade ao ertapenem foi avaliada com auxílio de disco contendo 10 μg da droga (Oxoide). A genotipagem foi feita por ERIC-PCR usando os primers ERIC1 (5'-TGAATCCCCAGGAGCTTACAT-3')e ERIC2 (5'-AAGTAAGTGACTGGGGTGAGCG-3'). Foram obtidas 22 cepas de S. marcescens, sendo 15 recuperadas de hemoculturas, e sete de vigilância (swab retal); todas apresentaram resistência a: ampicilina, ampicilina-sulbactam, gentamicina e cefalotina. Não foi observada resistência a: ciprofloxacina, imipenem, meropenem e ertapenem. Quanto aos demais antibióticos avaliados, o perfil de suscetibilidade foi variável. Foram obtidos 11 padrões de amplificação por ERIC-PCR, dois foram compartilhados por 14 isolados. Foi possível observar um padrão polimórfico característico para as cepas provenientes de colonização gastrointestinal, exceto em dois casos, que apresentaram padrões genotípicos relacionadas a casos de sepse. Os dados obtidos neste trabalho confirmam o elevado índice de resistência da S. marcescens aos antimicrobianos; no entanto, todos os isolados apresentaram sensibilidade à ciprofloxacina e aos carbapenêmicos. A tipagem por meio de antibiograma e ERIC-PCR sugere dispersão de clones associados à colonização ou sepse entre alas na Unidade Neonatal do hospital estudado.

Serratia marcescens has been reported as an important agent of health care-related infections and has been highlighted for presenting a high level of intrinsic resistance to antimicrobials used in neonatology, besides persisting in hospital environments for long periods. In this work, S. marcescens was recovered from colonies in the gastrointestinal tract or late sepsis in newborn infants hospitalized in a Neonatal Unit in Belém. The identification of S. marcescens and the sensitivity test was carried out using a Vitek (BioMérieux) automated system; susceptibility to ertapenem was assessed using e-test strips (Oxoid). Genotyping was executed by ERIC-PCR using the primers ERIC1 (5’-TGAATCCCCAGGAGCTTACAT-3’) and ERIC2 (5’-AAGTAAGTGACTGGGGTGAGCG-3’). Twenty-two strains of S. marcescens were recovered: 15 from hemocultures and seven from surveillance (rectal swab culture). All presented resistance to ampicillin, ampicillin-sulbactam, gentamicin and cephalothin. There were no indications of resistance to ciprofloxacin, imipenem, meropenemor ertapenem. The susceptibility profiles varied for other antibiotics. Eleven amplification patterns by ERIC-PCR were obtained, and two were shared by 14 isolates. It was possible to observe a characteristic polymorphic pattern in the strains from gastrointestinal colonization, except for two cases, which presented genotypic patterns related to cases of sepsis. The data obtained in this work confirm the high level of resistance of S. marcescens against antimicrobials; however, all isolates displayed sensitivity to ciprofloxacin and carbapenemics. Antibiogram and ERIC-PCR typing suggest a dispersion of clones associated with colonization or sepsis among the wards of the Neonatal Unit in the surveyed hospital.

Sorovares de Salmonella de origem humana identificados no Estado do Pará, Brasil, no período de 1991 a 2008 / Salmonella serovars of human origin identified in Pará State, Brazil from 1991 to 2008

A salmonelose é de distribuição cosmopolita, acometendo todas as faixas etárias, tanto nos países desenvolvidos, como naqueles em desenvolvimento. Este estudo tem como objetivo identificar os sorovares de Salmonella isolados de casos deinfecção humana ocorridos em 43 municípios do Estado do Pará no período de 1991 a 2008. Foram utilizadas 890 amostras de Salmonella em coproculturas e hemoculturas, aí incluídos 55 isolamentos de S. Typhi nas fezes e sangue, simultaneamente, de indivíduos sintomáticos. Os casos de infecção por Salmonella foram distribuídos em 13 sorogrupos,com destaque para o grupo O:9 (68,1 por cento). Foram identificados 47 sorovares de Salmonella, destacando-se S. Typhi (58,9 por cento), S. Enteritidis (5,4 por cento) e S. Saintpaul (2,5 por cento). Ressalta-se a maior prevalência de S. Typhi (58,9 por cento) dentre os 47 sorovares identificados, o que demonstra que a febre tifóide representa um sério problema de saúde pública na Região Norte do País, e que necessita de maior atenção dos serviços de saúde quanto à vigilância epidemiológica e ambiental,assim como medidas efetivas para a prevenção e controle.

Salmonellosis presents a cosmopolitan distribution and affects all age groups, not only in developed countries, but also in developing ones. This study aimed to identify the serovars of Salmonella isolated from human infections occurring in 43 areas of Pará State from 1991 to 2008. Eight hundred and ninety samples of Salmonella isolated in coprocultures and blood cultures were analyzed, including 55 isolations of S. Typhi from feces and blood of symptomatic individuals, simultaneously. The cases of Salmonella infections were distributed into 13 serogroups. The majority of them were in group O:9 (68.1 percent), and 47 serovars of Salmonella were identified, including S. Typhi (58.9 percent), S. Enteritidis (5.4 percent) and S. Saintpaul (2.5 percent). S. Typhi was the most prevalent (58.9 percent) among the 47 identified serovars, which demonstrates that typhoid fever is a serious public health problem in northern Brazil and requires increased attention from health agencies regarding epidemiological and environmental surveillance as effective measures for its prevention and control.

Resistência antimicrobiana de Salmonella Typhi identificadas no Estado do Pará, Brasil / Antimicrobial resistance of Salmonella Typhi isolated in the State of Pará, Brazil

A resistência antimicrobiana é um assunto amplamente estudado em todos os gêneros bacterianos, sobretudo entre agentes responsáveis por doenças epidêmicas como a febre tifoide. A incidência de surtos contribui para o aumento abusivo da administração errônea de antimicrobianos colaborando para o surgimento de amostras bacterianas resistentes. Portanto, o presente estudo avaliou a resistência de 44 amostras de Salmonella Typhi aos principais antimicrobianos utilizados no tratamento da febre tifoide. Das 44 amostras isoladas no período de 2003 a 2005, dez (22,7 por cento) foram resistentes a pelo menos um antimicrobiano. Dentre as dez amostras de Salmonella Typhi resistentes, observou-se que nove apresentaram monorresistência à nitrofurantoína ou à tetraciclina. Apenas um caso de resistência concomitante a duas drogas (cloranfenicol e nitrofurantoína) foi observado no ano de 2005. A Região Norte, por ser considerada área endêmica para febre tifoide e ter apresentado resistência crescente em relação aos três anos em estudo, deve permanecer com o monitoramento da resistência de Salmonella Typhi aos antimicrobianos, principalmente ao cloranfenicol, para garantir que o mesmo continue sendo o medicamento de escolha para o tratamento da febre tifoide na Região, além de possuir baixo custo e boa aceitabilidade do paciente ao tratamento...

Antimicrobial resistance has been widely studied in every bacterial genus, especially among those agents responsible for epidemic diseases, such as typhoid fever. Outbreaks have lead to increased usage and erroneous administration of antimicrobial drugs, contributing to the emergence of resistant bacterial strains. Therefore, this study evaluated the resistance of 44 strains of Salmonella Typhi to the main antibiotics used in the treatment of typhoid fever. Of the 44 strains isolated from 2003 to 2005, ten (2.7 per cent) were resistant to at least one microbial drug. Among the ten resistant Salmonella Typhi strains, nine showed monoresistance to nitrofurantoin or tetracycline. Only one case of concomitant resistance to two drugs (chloramphenicol and nitrofurantoin) was observed, in 2005. The Northern Region of Brazil is considered an endemic area for typhoid fever and has shown growing drug resistance in the three years studied. Thus, we must continue to monitor the resistance of Salmonella Typhi to antimicrobial drugs, especially chloramphenicol, to ensure that it remains the drug of choice for the treatment of typhoid fever in the Region, as it is inexpensive and the disease responds well to it...

Variabilidade genética de amostras de Salmonella Typhi isoladas de surto e de casos esporádicos ocorridos em Belém, Brasil / Genetic variability of Salmonella Typhi samples isolated from outbreaks and sporadic cases of typhoid fever in Belém, Brazil

INTRODUÇÃO: Salmonella Typhi é o agente da febre tifóide (doença caracterizada por febre, cefaléia, mialgia, artralgia, diarréia ou constipação), cujo quadro pode se complicar e levar o paciente a óbito. No Brasil, a febre tifóide é endêmica nas regiões Norte e Nordeste, com surtos ocorridos nos meses de intenso calor. OBJETIVO: Analisar e comparar a variabilidade genética de S. Typhi isoladas de surto e casos esporádicos de febre tifóide ocorridos em determinado período na cidade de Belém (PA). MATERIAL E MÉTODOS: Foram analisadas 20 amostras de S. Typhi: 10 isoladas de um surto ocorrido no bairro do Guamá, Belém, entre os meses de dezembro/2005 e março/2006, e 10 de casos esporádicos ocorridos em diferentes localidades da mesma cidade e no mesmo período do surto. A caracterização genética foi realizada pela análise do perfil de macrorrestrição obtido pela enzima XbaI e definido por eletroforese em gel de campo pulsado (PFGE). RESULTADOS: A análise de XbaI-PFGE das amostras estudadas demonstrou uma similaridade genética de 83 por cento a 100 por cento. CONCLUSÃO: Este estudo pôde demonstrar a relação clonal das amostras S. Typhi causadoras de surto e de casos esporádicos de febre tifóide ocorridos na cidade de Belém no período de dezembro/2005 a março/2006.

BACKGROUND: Salmonella Typhi is the causative agent of typhoid fever, illness characterized by fever, migraine, myalgia, arthralgia, diarrhea or constipation, which may have complications and cause death. In Brazil, the typhoid fever is endemic in the Northern and Northeastern regions, with outbreaks occurring in scorching months. OBJECTIVE: To analyse and compare the genetic variability of S. Typhi strains isolated from outbreaks and sporadic cases of typhoid fever occurred in the city of Belém (PA) between December 2005 and March 2006. MATERIAL AND METHODS: Twenty samples of S. Typhi were analyzed: 10 of them were isolated from an outbreak occurred in Guamá neighborhood in Belém, between December 2005 and March 2006, and the other 10 were isolated from sporadic cases in different neighborhoods of the same city in the same outbreak period. The genetic characterization was performed by macrorestriction analysis of genomic DNA with XbaI enzyme defined by pulsed-field gel electrophoresis (PFGE). RESULTS: The Xbal-PFGE analysis of the studied samples revealed a genetic similarity of 83 percent to 100 percent. CONCLUSION: This study demonstrated the clonal relation between the S. Typhi samples from the outbreak and from the sporadic cases of typhoid fever occurred in the city of Belém between December 2005 and March 2006.

Complicações na febre tifóide: relato de um caso atípico e considerações sobre suas implicações no diagnóstico e no controle / Complications in typhoid fever: description of an anusual case and its bearing on diagnosis and control

Apresenta-se um caso de febre tifóide que cursou com hepatite colestática cujo diagnóstico foi dado pela coprocultura. A negativação das provas para hepatites virais, malária e leptospirose, e a pronta resposta ao tratamento com ciprofloxacina corroboraram o diagnóstico de febre tifóide. Nas áreas endêmicas, essa hipótese deve ser lembrada diante das icterícias febris.

A case of typhoid fever with colestatic hepatitis is described, with diagnosis made by stool culture. Examination for malaria, leptospirosis and viral hepatitis were all negatives. These results and the rapid response of the patient to treatment with ciprofloxacin confirmed the diagnosis of typhoid fever and indicate the importance of considering typhoid fever in cases of fever with jaundice.