RESUMO
Objective: To describe and analyze transmitted drug resistance (TDR) between 2014 and 2019 in newly infected patients with HIV-1 in Portugal and to characterize its transmission networks. Methods: Clinical, socioepidemiological, and risk behavior data were collected from 820 newly diagnosed patients in Portugal between September 2014 and December 2019. The sequences obtained from drug resistance testing were used for subtyping, TDR determination, and transmission cluster (TC) analyses. Results: In Portugal, the overall prevalence of TDR between 2014 and 2019 was 11.0%. TDR presented a decreasing trend from 16.7% in 2014 to 9.2% in 2016 (p for-trend = 0.114). Multivariate analysis indicated that TDR was significantly associated with transmission route (MSM presented a lower probability of presenting TDR when compared to heterosexual contact) and with subtype (subtype C presented significantly more TDR when compared to subtype B). TC analysis corroborated that the heterosexual risk group presented a higher proportion of TDR in TCs when compared to MSMs. Among subtype A1, TDR reached 16.6% in heterosexuals, followed by 14.2% in patients infected with subtype B and 9.4% in patients infected with subtype G. Conclusion: Our molecular epidemiology approach indicates that the HIV-1 epidemic in Portugal is changing among risk group populations, with heterosexuals showing increasing levels of HIV-1 transmission and TDR. Prevention measures for this subpopulation should be reinforced.
RESUMO
[This corrects the article DOI: 10.1371/journal.pone.0162797.].
RESUMO
Psittacosis is a rare disease caused by Chlamydophila psittaci, an intracellular bacteria transmitted by contaminated birds. The clinical and radiological presentations are nonspecific. We describe a case of a 42-year-old woman, with known exposure to birds, who presented to the emergency department with one-week evolution of myalgia, polyarthritis, and respiratory symptoms. At admission, she had fever, respiratory failure, raised inflammatory markers and bilateral interstitial infiltrates at chest radiography. Considering the clinical findings and epidemiological background, we raised the hypothesis of a Chlamydophila psittaci atypical pneumonia that was serologically confirmed. Tetracyclines are the mainstay of treatment and the macrolides are an effective alternative. We highlight the importance of the epidemiological context in the early diagnosis and treatment of this infection.
A psitacose é uma entidade rara provocada pela Chlamydophila psittaci, uma bactéria intracelular obrigatória que se transmite através do contacto com aves contaminadas. A apresentação clínica e imagiológica é inespecífica. Reporta-se o caso clínico de uma mulher de 42 anos, com história de exposição a pássaros, que se apresenta no Serviço de Urgência com um quadro de mialgias, poliartralgias e clínica de infeção respiratória, com uma semana de evolução. À admissão, encontrava-se febril, com insuficiência respiratória do tipo 1, elevação dos parâmetros inflamatórios e infiltrados intersticiais difusos bilaterais na radiografia de tórax. Considerando o quadro clínico e o contexto epidemiológico de risco, colocou-se a hipótese de pneumonia atípica por Chlamydophila psittaci, confirmada serologicamente. As tetraciclinas são o esteio do tratamento, sendo os macrólidos uma alternativa eficaz. Realça-se a importância do contexto epidemiológico, para uma abordagem diagnóstica e terapêutica apropriadas.
