Clinical correlations of human cytomegalovirus strains and viral load in kidney transplant recipients.

Little is known about clinical differences associated with cytomegalovirus (CMV) infection by distinct strains in renal transplant patients. Different clinical pictures may be associated with specific viral genotypes, viral load, as well as host factors. The objective of this study was to identify CMV strains to determine viral load (antigenemia), and their correlation with clinical data in renal transplant recipients. Seventy-one patients were enrolled, comprising 91 samples. After selection, polymorphonuclear cells were used to amplify and sequence the gB region of CMV DNA. The sequences were analyzed to ascertain the frequency of different genotypes. Additionally, the results of this study showed that the gB coding gene presents a great variability, revealing a variety of patterns: classical gB1 (1.4%), gB1V (46.4%), classical gB2 (35.2%), gB2V (2.8%), gB3 (1.4%), classical gB4 (4.9%) and gB4V (4.9%). The mean viral load in kidney transplant patient was 75.1 positive cells (1-1000). A higher viral load was observed in patients with genotype 4 infection. Statistically significant differences were detected between gB1 and gB4 (p=0.010), and between gB2 and gB4 (p=0.021). The average numbers of positive cells in relation to clinical presentation were: 34.5 in asymptomatic, 49.5 in CMV associated syndrome and 120.7 in patients with invasive disease (p=0.048). As a group, gB1 was the most frequent strain and revealed a potential risk for developing invasive disease. Viral load also seemed to be important as a marker associated with clinical presentation of the disease.

The use of sirolimus in ganciclovir-resistant cytomegalovirus infections in renal transplant recipients.

BACKGROUND: The widespread use of prophylactic ganciclovir and anti-lymphocyte/thymocyte therapies are associated with increased induction of ganciclovir-resistant cytomegalovirus (CMV) strains. The use of sirolimus has been associated with a lower incidence of CMV infection in transplant recipients. We questioned whether it could also be effective as a therapeutic treatment of resistant CMV infection. METHODS: Patients with ganciclovir-resistant CMV infections determined clinically and by DNA sequencing analysis were enrolled. Antigenaemia and DNA sequencing were used to diagnosis and follow the mutations. RESULTS: Nine transplant patients were given sirolimus plus mycophenolate mofetil (n = 4) or a calcineurin inhibitor (n = 5). Seven out of nine recipients were CMV IgG negative before transplantation. We observed a rapid decrease in antigenaemia levels, reaching zero in eight out of nine (88.9%) patients within a median of 20.3 +/- 10.1 d. Graft function remained stable and no patient presented acute rejection or recurrence of the CMV infection. CONCLUSIONS: This suggests that the use of sirolimus plus ganciclovir therapy could be useful in ganciclovir-resistant CMV infections.

Frequency of Valpha24+Vbeta11+ NKT cells in peripheral blood of human kidney transplantation recipients.

There are still lacking data supporting a role for natural killer T (NKT) cells in the maintenance of human tissue-specific tolerance. We are interested to study NKT cell frequency in kidney transplant recipients and its correlation with graft function. Peripheral blood T cell receptors (TCR) Valpha24(+)Vbeta11(+) NKT cells were phenotyped according to CD4 and CD8 expression in normal controls (NC), in 10 years rejection-free cadaver kidney allografts maintained with minimal immunosuppression (long-term rejection free [LTRF]), in patients with acute rejection (AR) and in patients with acute tubular necrosis (ATN). Results were expressed as percentages of CD4(+)CD8(-) (CD4(+) NKT) or CD4(-)CD8(-) (double negative--DN NKT) Valpha24(+)Vbeta11(+) cells. The percentages of Valpha24(+)Vbeta11(+) cells were 0.09%, 0.14%, 0.02% and 0.09% on gated lymphocytes respectively in AR, ATN, LTRF and NC groups (p=0.263). DN NKT cells were more frequent in NC patients (52.11%) and less present in ATN patients (11.04%). In contrast, CD4(+) NKT (IL-4-producing NKT cells subset) was more frequent in AR (42.86%), and corresponded to almost 3 to 7 folds more what we obtained in the other groups. Although total Valpha24(+)Vbeta11(+) cells did not significantly differ among the groups, the lowest frequency was observed in the LTRF group. In conclusion, we observed that total number of NKT cells did not differ significantly among transplant patients when compared to normal controls, although specific-subsets seem to be more frequent in determined events.

Efeito da vacina contra hepatite B em indivíduos com anticorpos contra o antígeno central da hepatite B (anti-HBc) como único mercador / Effect of the hepatitis B vaccine in indididuals with antibodies against the central antigen of hepatitis B virus as the sole marker

Indivíduos repetidamente positivos para o anticorpo contra o antígeno central da hepatite B (anti-HBc), mas nao reativos para o antígeno de superficie (HBsAg) assim como para o seu anticorpo (anti-HBs), podem ter seu teste falso-positivo, ser ainda portadores do VHB ou ter infecçao passada já resolvida. Doadores de sangue com esse padrao sorológico receberam vacina contra o vírus da hepatite B (VHB), com o intuito de estimular o surgimento de anti-HBs na circulaçäo. Dos 33 indivíduos incluidos no estudo, 13 (39por cento) positivaram o anti-HBs após uma dose de vacina. Dos 20 restantes, 15 (75por cento) aresentaram soroconversäo do anti-HBs após duas doses e um depois de tres doses. No total, 29 (88por cento) seroconverteram. Dos 33, 24 foram submetidos a pesquisa de DNA do VHB por tecnica de cadeia de polimerase. O exame foi negativo em todos. Os autores sugerem que estimular o surgimento de anti-HBs atraves de desafio de vacina contra o VHB pode ser uma maneira acessivel de tranquilizar os doadores de sangue com anti-HBc isolado que seroconverteram posteriormente, assegurando-lhes seu bom prognostico

Pesquisa de anticorpos contra o vírus da hepatite C em pool de 5 soros: sua utilizaçäo em inquéritos soroepidemiológicos / Detection of antibodies against hepatitis C virus in a 5 sera pool testing: its use in seroepidemiological survey

Para avaliar reduçäo de custo da pesquisa de anticorpos contra hepatite C, por ELISA, em pool de cinco soros, realizou-se o teste em grupos de baixo e alto risco. Dois terços dos conjuntos de alto risco tiveram que ser repetidos. A reduçäo do gasto de reagente foi de 80 por cento na populaçäo de baixo risco e de 13 por cento na amostra de alto risco. Estes dados sugerem que a pesquisa do anti-VHC em pool reduz o custo do procedimento em populaçöes de baixo risco

Infecçäo pelos vírus das hepatites B e C entre odontólogos de Cuiabá e Várzea Grande, Estado de Mato Grosso / Hepatitis B and C virus infection among dentists of Cuiabá and Várzea Grande, Mato Grosso state

A infecçäo pelos vírus das hepatites B(VHB) e C(VHC), entre odontólogos da regiäo metropolitana de Cuiabá, Mato Grosso, foi o objeto deste inquérito epidemiológico. A amostra contou com 106 voluntários, dentre os 480 dentistas que compareceram à campanha de imunizaçäo contra hepatite B em 1995, quando nä se identificaram portadores de hepatite B ou C. O anticorpo contra o antígeno de superfície do VHB(anti-HBs) foi positivo em 36 por cento, principalmente nos indivíduos que já haviam recebido doses de vacina contra a hepatite B anteriormente. O anticorpo contra o antígeno central da hepatite B(anti-HBc), testado nos indivíduos com anti-HBs, foi positivo em 50 por cento deles. O marcador de infecçäo prévia pelo vírus da hepatite B foi mais detectado nos profissionais nä vacinados ou naqueles com esquema incompleto de imunizaçäo.

Diagnóstico de paracoccidioidomicose disseminada grave em aspirado de medula óssea: relato de caso / Severe disseminated paracoccidioidomycosis diagnosis in bone marrow aspirate: a case report

Acute or chronic disseminated paracoccidioidomycosis can be associated with changes in blood and bone marrow cell counts, mainly in the severe forms of this disease. However, there are few reports about the microbiological confirmation of the mycosis in bone marrow tissue. The present report describes a case of an adult patient with severe chronic multifocal paracoccidioidomycosis, whose etiological diagnosis has been done by the microscopical exam and culture fo the bone marrow aspirate. The authors emphasize the importance of these exams as an alternative way for the diagnosis of suspected cases of severe paracoccidioidomycosis.