Major cysteine protease (cruzipain) in Z3 sylvatic isolates of Trypanosoma cruzi from Rio de Janeiro, Brazil.

Trypanosoma cruzi, the etiologic agent of Chagas' disease, is represented by a set of parasites which circulate between man, vectors, domestic and wild animals. Recently, our group isolated from Triatoma vitticeps strains of T. cruzi that were characterized as belonging to the Z3 phylogenetic lineage. Since very little is known about the biological and/or biochemical markers of sylvatic Z3 isolates, we have studied the protein and protease profiles of distinct Z3 isolates designated as SMM10, SMM53, SMM88, and SMM98. By means of sodium dodecyl sulfate-polyacrylamide gel electrophoresis, both quantitative and qualitative differences were observed in the protein profiles of these strains. All strains produced an acidic cysteine protease of 45 kDa, resembling cruzipain activity. The strain SMM10 synthesized an additional 55 kDa metalloprotease. Using Western blotting and anti-cruzipain antibody to detect cruzipain-like molecules, a 40-kDa reactive molecule was identified in all strains; in the strain SMM10, an 80-kDa protein was also reacted. Studies about cruzipain isoforms from sylvatic parasites could be valuable tools in the comprehension of the genetic variability in the pathogenesis of Chagas' disease.

Molecular epidemiology of hepatitis B virus in an isolated Afro-Brazilian community.

This study was conducted in an Afro-Brazilian, slave-descendant community with high (42.4%) hepatitis B virus (HBV) prevalence. Twenty (8.4%) out of the 239 subjects under study were HBsAg-positive, and HBV-DNA was detected in 59 (25%) individuals. A high rate (18.3%) of occult infection was therefore observed that was associated to low HBV loads (mean, 1.8 x 10(4) copies/ml) and to a specific amino acid substitution (C100Y) in the small surface antigen. Genotyping of 50 isolates showed that 43 (86%) were of subgenotype A1, one (2%) from subgenotype A2, and five (10%) from subgenotype D. Mixed genotypes A1 and E were observed in one (2%) sample. The genetic distance (0.8 +/- 0.3%) among the HBV/A1 isolates from the community was smaller than the intragroup divergence among A1 isolates from Brazil as a whole, but it was similar to that found between A2 isolates from different countries, suggesting that HBV/A1 was introduced in the community through different sources. The substitution W501R (polymerase), previously reported only in Gambia, was observed in 46% of the HBV/A1 isolates. The precore/core promoter region of HBsAg-positive isolates showed several substitutions that could explain the anti-HBe phenotype found in 18 of 20 (90%) of the HBsAg-positive subjects.

Severe hyperkalemic type 4 renal tubular acidosis after kidney transplantation: a case report.

BACKGROUND: Hyperkalemia after transplantation is a common event, occurring in up to 70% of patients. It is usually asymptomatic but sometimes manifests as muscle weakness or cardiac arrhythmias. METHODS: Case report. RESULTS: At 102 days after a second cadaveric kidney transplantation, a 15-year-old boy, was admitted to the emergency room with severe muscle weakness. His examinations showed a serum potassium of 9.8 mEq/L; blood pH 7.1; serum bicarbonate 7.6 mmol/L; and creatinine 2.5 mg/dL. He was initially treated with sodium bicarbonate, calcium gluconate, and furosemide. Subsequent investigation showed hyperchloremic metabolic acidosis, urinary pH <5.5, positive urinary anion gap, reduced transtubular potassium gradient (TTKG, 1.5) and low levels of aldosterone (0.7 ng/mL), suggesting the presence of type 4 renal tubular acidosis (RTA). Other causes of hyperkalemia were excluded in the present case. Serum levels of potassium returned to normal when fludrocortisone was added to the bicarbonate supplementation. This case of severe hyperkalemic secondary to type 4 RTA after kidney transplantation only responded to the combination of alkali and mineralocorticoid therapies.

Response to an oral calcium load in nephrolithiasis patients with fluctuating parathyroid hormone and ionized calcium levels

The response to an oral calcium load test was assessed in 17 hypercalciuric nephrolithiasis patients who presented elevated parathyroid hormone (PTH) irrespective of the ionized calcium (sCa2+) levels. Blood samples were collected at baseline (0 min) and at 60 and 180 min after 1 g calcium load for serum PTH, total calcium, sCa2+, and 1.25(OH)2D3 determinations. According to the sCa2+ level at baseline, patients were classified as normocalcemic (N = 9) or hypercalcemic (N = 8). Six healthy subjects were also evaluated as controls. Bone mineral density was reduced in 14/17 patients. In the normocalcemic group, mean PTH levels at 0, 60 and 180 min (95 ± 76, 56 ± 40, 57 ± 45 pg/ml, respectively) did not differ from the hypercalcemic group (130 ± 75, 68 ± 35, 80 ± 33 pg/ml) but were significantly higher compared to healthy subjects despite a similar elevation in sCa2+ after 60 and 180 min vs baseline in all 3 groups. Mean total calcium and 1.25(OH)2D3 were similar in the 3 groups. Additionally, we observed that 5 of 9 normocalcemic patients presented a significantly higher concentration-time curve for serum PTH (AUC0',60',180') than the other 4 patients and the healthy subjects, suggesting a primary parathyroid dysfunction. These data suggest that the individual response to an oral calcium load test may be a valuable dynamic tool to disclose a subtle primary hyperparathyroidism in patients with high PTH and fluctuating sCa2+ levels, avoiding repeated measurements of both parameters.

Response to an oral calcium load in nephrolithiasis patients with fluctuating parathyroid hormone and ionized calcium levels.

The response to an oral calcium load test was assessed in 17 hypercalciuric nephrolithiasis patients who presented elevated parathyroid hormone (PTH) irrespective of the ionized calcium (sCa2+) levels. Blood samples were collected at baseline (0 min) and at 60 and 180 min after 1 g calcium load for serum PTH, total calcium, sCa2+, and 1.25(OH)2D3 determinations. According to the sCa2+ level at baseline, patients were classified as normocalcemic (N = 9) or hypercalcemic (N = 8). Six healthy subjects were also evaluated as controls. Bone mineral density was reduced in 14/17 patients. In the normocalcemic group, mean PTH levels at 0, 60 and 180 min (95 +/- 76, 56 +/- 40, 57 +/- 45 pg/ml, respectively) did not differ from the hypercalcemic group (130 +/- 75, 68 +/- 35, 80 +/- 33 pg/ml) but were significantly higher compared to healthy subjects despite a similar elevation in sCa2+ after 60 and 180 min vs baseline in all 3 groups. Mean total calcium and 1.25(OH)2D3 were similar in the 3 groups. Additionally, we observed that 5 of 9 normocalcemic patients presented a significantly higher concentration-time curve for serum PTH (AUC0',60',180') than the other 4 patients and the healthy subjects, suggesting a primary parathyroid dysfunction. These data suggest that the individual response to an oral calcium load test may be a valuable dynamic tool to disclose a subtle primary hyperparathyroidism in patients with high PTH and fluctuating sCa2+ levels, avoiding repeated measurements of both parameters.

High proportion of subgroup A' (genotype A) among Brazilian isolates of Hepatitis B virus.

Hepatitis B virus (HBV) genotype A has been divided recently into two subgroups, designated A-A' (genotype A excluding A') and A'. Isolates belonging to subgroup A' have been identified in Africa. A new genotyping method, based on PCR amplification of the pre-S/S genome region and subsequent restriction fragment length polymorphism (RFLP) analysis, was developed, that established a correlation between RFLP subtypes and subgroups within genotype A. To investigate the occurrence of subgroup A' in South America, 119 Brazilian HBV isolates were analyzed. Ninety-three (78%) of them belonged to genotype A, with three predominating RFLP subtypes: 44 (37%) isolates were classified as AI, 30 (25%) were AII, and 18 (15%) were AIII. Pre-S/S nucleotide sequences of 15 genotype A isolates were determined. Phylogenetic analysis performed with these 15 and an additional 41 sequences revealed that isolates AI and AII clustered in subgroup A', whereas isolates AIII were classified into subgroup A-A'. The correlation RFLP subtypes-subgroups was confirmed by the presence of amino acid residues specific for subgroup A' in the surface antigens and polymerase of isolates AI and AII. The high proportion (63%) of isolates from subgroup A' suggested an African origin for a large number of Brazilian HBVs.

Uncommon mutation pattern of a hepatitis B virus isolate from genotype F infecting a patient with AIDS.

OBJECTIVE: To study the genomic variations of a hepatitis B virus (HBV) isolate in a patient coinfected with human immunodeficiency virus type 1 (HIV-1) who developed severe hepatitis and died of AIDS. METHODS: Two blood samples were collected, the first one during the asymptomatic phase of HIV-1 infection, and the other, 3 years later, few months before the death of the patient. Both samples were HBsAg and anti-HBe positive. Pre-S/S and precore-core genome regions were PCR amplified and analyzed. RESULTS: The HBV isolate belonged to genotype F, cluster IV. A number of unique amino acid substitutions were found in the surface antigen gene and the overlapping polymerase coding region of HBV genomes derived from both samples. However, these substitutions reflected natural variations rather than mutations of clinical significance. The precore stop codon mutation A(1896) was present in both genomes. Furthermore, the HBV genome derived from the second, but not first sample, showed two out-of-frame core interval deletions, one and 103 nucleotides in length, respectively. CONCLUSIONS: This is the first report of an HBV isolate from genotype F with core internal deletions. Our results suggest an association between specific core mutations and the severe hepatitis developed by the patient.

Frequent occult hepatitis B virus infection in patients infected with human immunodeficiency virus type 1.

The presence of hepatitis B virus (HBV) serological markers was investigated in 170 patients (137 male, 33 female) infected with human immunodeficiency virus (HIV) type 1. Antibodies to the hepatitis B core antigen (anti-HBc antibodies) were detected in 115 (68%) patients. Of these 115, 14 (12%) were hepatitis B surface antigen (HBsAg) positive, 60 (52%) presented anti-HBs antibodies, and 41 (35%) were anti-HBc positive only. All 115 of the anti-HBc positive samples were tested for HBV DNA by using two polymerase chain reaction (PCR) assays that amplify the core and pre-S regions of the HBV genome, respectively. HBV DNA was detected in 23 samples: 7 of 14 (50%) HBsAg-positive samples, 12 of 60 (20%) anti-HBs-positive samples, and 4 of 41 (10%) samples positive for anti-HBc only. Six samples (all HBsAg positive) were positive in both PCR assays and 17 samples were HBV DNA positive in only one assay. The mean viral load in HBsAg-positive patients was higher than that observed in HBsAg-negative patients. A number of patients were receiving treatment with lamivudine, a drug that interferes with both HBV and HIV replication. However, neither the rate of HBV DNA positivity nor HBV load was significantly different between patients treated with lamivudine and those not treated with this drug.

Prevalence and genetic diversity of TT virus genotype 21 (YONBAN virus) in Brazil.

Isolates of the newly characterized, single-stranded DNA virus TTV, have been tentatively classified into four major phylogenetic groups and at least 28 genotypes. Four Japanese isolates, designated as YONBAN viruses, belong to the fourth group and to genotype 21. In this study, a genotype 21-specific PCR assay was standardized. With this assay, 48/184 (26%) serum samples and 76/167 (46%) saliva samples, collected from unselected ambulatory patients (aged 2 to 82) of a Brazilian public hospital, were positive. A total of 110 (66%) patients had TTV genotype 21 DNA in serum, saliva, or both fluids. Furthermore, 18/37 (49%) serum samples, collected from Indians belonging to three ethnic groups of the Western Brazilian Amazon, were also positive. Nucleotide sequences (253 bases at the 3' end of the non-coding region of the genome) were determined, that derived from 25 individuals, i.e. 17 patients and eight Indians. Phylogenetic analysis showed that three isolates from Indians of a particular ethnic group formed a separate subgroup within genotype 21. Among non-Indians, a clustering of strains was observed according to their country of origin (Japan or Brazil), with all 17 sequences derived from Brazilian patients located in a unique subgroup.

Suppression of the prophenoloxidase system in Rhodnius prolixus orally infected with Trypanosoma rangeli.

Investigations were carried out to compare aspects of the prophenoloxidase (proPO)-activating pathway in Rhodnius prolixus hemolymph in response to oral infection and inoculation of the insects with two developmental forms of Trypanosoma rangeli epimastigotes strain H14. In vivo experiments demonstrated that in control insects fed on uninfected blood, inoculation challenge with short epimastigotes resulted in high phenoloxidase (PO) activity. In contrast, previous feeding on blood containing either short or long epimastigotes was able to suppress the proPO activation induced by thoracic inoculation of the short forms. In vitro assays in the presence of short epimastigotes demonstrated that control hemolymph or hemolymph provided by insects previously fed on blood containing epimastigotes incubated with fat body homogenates from control insects significantly increased the PO activity. However, fat body homogenates from insects previously fed on blood containing epimastigotes, incubated with hemolymph taken from insects fed on control blood or blood infected with epimastigotes, drastically reduced the proPO activation. The proteolytic activity in the fat body homogenates of control insects was significantly higher than in those obtained from fat body extracts of insects previously fed on blood containing epimastigotes. These findings indicate that the reduction of the proteolytic activities in the fat body from insects fed on infected blood no longer allows a significant response of the proPO system against parasite challenge. It also provides a better understanding of T. rangeli infection in the vector and offer novel insights into basic immune processes in their invertebrate hosts.

Effects of gamma irradiation on the development of Trypanosoma rangeli in the vector Rhodnius prolixus.

Studies on the effects of gamma radiation on the infectivity of Trypanosoma rangeli (strain H14) for the vector Rhodnius prolixus revealed that (i) the LD(50) (lethal dose for 50% of bugs) for uninfected insects was 4147 rads; (ii) irradiated insects with a dose of 1200 rads subsequently infected with the flagellates exhibited a mortality of 45%, while uninfected irradiated insects showed a mortality of 5%, and infected nonirradiated insects exhibited 10% mortality; (iii) flagellates were present in the hemolymph of irradiated insects 7 days postinfection (p.i.), while in nonirradiated insects the parasites appeared in the hemocoel 18 days p.i.; (iv) T. rangeli infection decreased the number of hemocytes significantly and induced the formation of nodules in the hemolymph of both irradiated and nonirradiated insects; and (v) gamma irradiation affected the ultrastructural organization of the epithelial cells of the small intestine, principally the perimicrovillar membranes and microvilli. In this paper, we discuss the significance of the intestinal microenvironment of R. prolixus with regard to its interaction with T. rangeli.

Low frequency of mutations in the core promoter and precore regions of hepatitis B virus in anti-HBe positive Brazilian carriers.

BACKGROUND: Mutations in the core promoter and precore regions of the hepatitis B virus (HBV) genome, notably the double substitution (AGG to TGA) at nt positions 1762-1764 in the core promoter, and the precore stop codon mutation G to A at nt 1896, can often explain the anti-HBe phenotype in chronic carriers. However, the A1896 mutation is restricted to HBV isolates that have T at nt 1858. The double substitution at positions 1762-1764 has been described to occur preferentially in patients infected with strains showing C instead of T at nt 1858. RESULTS: HBV DNAs from 29 anti-HBe Brazilian samples were characterized by nucleotide sequencing of PCR products from precore region. Among them, 18 isolates presented C at nt 1858 (mostly genotype A strains). The 11 remaining isolates (genotypes D and F) had T1858. The stop codon mutation at nt 1896 was found in seven isolates (24% of the total and 63% of the isolates that had T1858). The frequency of the double substitution at positions 1762-1764 was surprisingly low (20%) among C1858 isolates. An association between A1896 and TGA 1762-1764 mutations was observed among genotype D isolates: these showed either none of the two mutations or both. Furthermore, strains mutated at positions 1896 and/or 1762-1764 also presented an elevated number of other, less common substitutions in the core promoter and precore regions. CONCLUSIONS: The data reported here are not in accordance with some reports from other parts of the world. In half of the isolates, none of the mutations previously described could explain the anti-HBe phenotype.

Nosocomial spread of hepatitis B virus in two hemodialysis units, investigated by restriction fragment length polymorphism analysis.

A method for genotyping hepatitis B virus (HBV) strains, based on restriction fragment length polymorphism (RFLP) analysis of four different amplified fragments of the HBV genome, was used to investigate nosocomial infections that occurred in two Brazilian hemodialysis centers. Viral isolates from hepatitis B surface antigen (HBsAg)-positive serum samples from 27 hemodialysis patients and 39 HBV-positive unrelated control patients were grouped according to their RFLP patterns. Strains isolated from the control patients were divided into nine RFLP patterns: A1, A2, A3 (genotype A), D1, D2, D3, D4 (genotype D), F1, and F2 (genotype F). In hemodialysis unit A (Rio de Janeiro), 14 HBV isolates were grouped into five different RFLP patterns: A1, A2, A3, D3, and D4. Pattern A2, present at a relatively low prevalence (18%) in the control group, was observed in the majority (53%) of the hemodialysis patients. Notably, all five patients who seroconverted to HBsAg positivity in 1995 carried the strain A2. In hemodialysis unit B (state of São Paulo), where an outbreak of HBV infection occurred in 1996-1997, RFLP analysis showed that all 13 patients who seroconverted were infected with HBV isolates of genotype D. Coinfection with strain A1 was detected in seven of them. The results demonstrate the value of RFLP analysis in establishing common sources of infection in hemodialysis centers.

Metalloproteases in Trypanosoma rangeli-infected Rhodnius prolixus

Protease activities in the haemolymph and fat body in a bloodsucking insect, Rhodnius prolixus, infected with Trypanosoma rangeli, were investigated. After SDS-polyacrylamide gel electrophoresis containing gelatin as substrate, analysis of zymograms performed on samples of different tissues of controls and insects inoculated or orally infected with short or long epimastigotes of T. rangeli, demonstrated distinct patterns of protease activities: (i) proteases were detected in the haemolymph of insects which were fed on, or inoculated with, short epimastigotes of T. rangeli (39 kDa and 33 kDa, respectively), but they were not observed in the fat body taken from these insects; (ii) protease was also presented in the fat bodies derived from naive insects or controls inoculated with sterile phosphate-saline buffer (49 kDa), but it was not detected in the haemolymph of these insects; (iii) no protease activity was observed in both haemolymph and fat bodies taken from insects inoculated with, or fed on, long epimastigotes of T. rangeli. Furthermore, in short epimastigotes of T. rangeli extracts, three bands of the protease activities with apparent molecular weights of 297, 198 and 95 kDa were detected while long epimastigotes preparation presented only two bands of protease activities with molecular weights of 297 and 198 kDa. The proteases from the insect infected with T. rangeli and controls belong to the class of either metalloproteases or metal-activated enzymes since they are inhibited by 1,10-phenanthroline. The significance of these proteases in the insects infected with short epimastigotes of T. rangeli is discussed in relation to the success of the establishment of infection of these parasites in its vector, R. prolixus

Age-specific prevalence and transmission of TT virus.

TT virus (TTV) is an unenveloped, single-stranded DNA virus that was discovered recently in the sera of Japanese patients with posttransfusion hepatitis of unknown etiology. A high prevalence of TTV infection in blood donors of several countries, including Brazil, has been demonstrated. To study the variation in TTV prevalence between different age groups, sera from 223 individuals without liver disease, aged 0-80 years, were tested by the polymerase chain reaction for the presence of TTV DNA. All subjects were inhabitants of the city of Rio de Janeiro, Brazil. The prevalence increased continuously with age (P <.001), from 17% among children under the age of 11 years, to 57% in people older than 50 years. To assess vertical transmission, sera from 105 unselected, consecutive parturient women attending a public maternity hospital were paired with cord bloods and examined for the presence of TTV DNA. Thirty-seven (35%) mothers were found to be TTV infected. Seven cord bloods were also positive, suggesting the possible transplacental transmission of the virus. Furthermore, a direct correlation between TTV viremia and presence of antibodies to the enterically transmissible hepatitis A virus (HAV) was observed in this group of women, with a relative risk of TTV infection of 5.09 (95% confidence interval 0.76-34.03) for women with anti-HAV, compared with women without. This finding suggested that the fecal-oral route might be an important route of TTV transmission.

Rhodnius prolixus infected with Trypanosoma rangeli: In vivo and in vitro experiments.

Studies were carried out on the activation of the prophenoloxidase (proPO) in adults of Rhodnius prolixus infected by short and long epimastigote forms of Trypanosoma rangeli. The in vitro activation of the proPO cascade using l-DOPA as substrate was very low in the absence of fat body extract, hemolymph, and parasites. On the other hand, a higher PO activity was observed when short, but not long, epimastigotes of T. rangeli were incubated with fresh hemolymph, fat body extract, and l-DOPA. Supernatant from lysed long epimastigotes increased the PO activity at levels identical to those observed with supernatants from lysed short epimastigotes. Similarly, the PO activity of hemolymph obtained from inoculated insects with long epimastigotes of T. rangeli showed a very low activity when incubated with l-DOPA compared to the PO activity of hemolymph taken from insects inoculated with short epimastigotes of T. rangeli. Control insects inoculated with sterile PBS showed no PO activity. These data indicate the presence of (a) factor(s) in the hemolymph as well as in the fat body extract that may be released (or induced) by the presence of short epimastigotes of T. rangeli and which results in the activation of the R. prolixus proPO system. The implications of these findings are discussed in relation to the development of T. rangeli and its ability to overcome the proPO system, survive, and successfully colonize the hemolymph of R. prolixus.

A polymerase chain reaction-based assay to identify genotype F of hepatitis B virus.

We have developed a polymerase chain reaction (PCR) assay which distinguishes genotype F from the other genotypes of hepatitis B virus (HBV). The method was used to characterize HBV strains isolated in urban areas of the Brazilian Amazon. DNA was amplified in 54 of a total of 78 HBsAg-positive serum samples, using universal, non-genotype-specific primers. Only 4 (7.4%) were identified as genotype F by our genotype-specific PCR assay. This proportion is notably lower than that previously reported in Argentina, Venezuela, Peru, and Central America.

High prevalence of TT virus infection in Brazilian blood donors.

A recent report has described the molecular cloning and characterization of a novel, single-stranded DNA virus, named TT virus (TTV), which was present in the sera of Japanese patients with posttransfusion hepatitis of unknown etiology [Okamoto et al. (1998) Hepatology Research 10:1-16]. Using a nested polymerase chain reaction assay, sera from Brazilian patients with acute non A-C hepatitis and blood donors were examined for the presence of TTV DNA sequences. Thirty-seven of 52 (71%) patients with acute non A-C hepatitis and 45 of 72 (62%) blood donors were found to have TTV sequences in their sera. Such a high proportion in blood donors indicated that TTV infection is common in the general Brazilian population. Partial nucleotide sequences (326 bases in open reading frame 1) from seven isolates were determined. By phylogenetic analysis, four TTV strains were classified into the genomic subgroup G1a described previously. The three others belonged to subgroup G1b. Sequence homologies between strains belonging to a same subgroup were 92.9-99.1%, whereas homologies of 85.9-90.2% were calculated between isolates from different subgroups.