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Background: Chikungunya fever is an infectious disease that can evolve to a subacute or chronic condition, with changes in the daily activities of patients. Drugs that aim to reduce these symptoms are used, such as corticoids (acute phase) and disease-modifying anti-rheumatic drugs (chronic phase). Objective: To evaluate the clinical response to drug therapy in the subacute and chronic phase of infection by the Chikungunya virus. Methodology: A prospective and a retrospective study with patients with subacute and chronic Chikungunya infection, out at the infection and autoimmunity outpatient clinic at the Nucleus of Tropical Medicine, from January 2016 to December 2019, in the morning of Thursdays. The patient was observed in the Baseline, first and second return, and drugs were introduced according to the stage of the disease with subsequent reassessment. The Visual Analogue Scale (VAS) was applied to all evaluation moments. Results: 101 patients were evaluated, and arthralgia was the predominant symptom in the three evaluated moments. According to the VAS, moderate baseline pain was observed in 58.1% and 58.6% of subacute and chronic cases, respectively. On the first return, moderate pain still predominated in 46.2% in subacute cases and 43% in chronic cases. In the second visit, all patients were in the chronic phase of the disease, 43.8% had VAS with no pain. Regarding the number of compromised joints in the Baseline, polyarticular involvement predominated in both subacute (79%) and chronic (74.1%) cases, in the first return, oligoarticular involvement predominated in 53.8% of subacute cases and 54.7% in chronic cases and, the second return, 40.6% of the patients had oligoarticular involvement and 43.8% had no joint involvement. As for the use of medications in the Baseline, 33.4% of subacute cases used antiinflammatory drugs, and 40% of chronic cases used corticosteroids. At the first visit, 25% of chronic patients were already using combined corticosteroids and methotrexate and 15% were using only methotrexate. In the second return, 35.1% used combined methotrexate and corticosteroids, and 64.9% used only methotrexate. Safety in the use of methotrexate was observed in the context of CHIKV treatment, as the number of adverse reactions was minimal (three patients) and the medication was well tolerated. Conclusion: It was observed that with the adjustment of the medications, there was a reduction in joint impairment, VAS showed mild pain indexes and in some cases with no pain, showing the benefit of using therapy in subacute and chronic cases and improving quality of life of these users.

To identify the prevalence and risk factors for primary Epstein–Barr virus (EBV) infection in human immunodeficiency virus (HIV)-1-positive adult treatment-naïve patients between January 2018 and December 2019 in a state of the Brazilian Amazon region. A total of 268 HIV-1 positive patients and 65 blood donors participated in the study. Epidemiological data were obtained from medical records and through a designed questionnaire. EBV infection was screened by the semiquantitative detection of anti-viral capsid antigen (VCA) EBV IgM and IgG, followed by molecular detection of the EBNA-3C gene. The plasma viral loads of HIV-1 and EBV were quantified using a commercial kit. The prevalence of primary coinfection was 7.12%. The associated risk factors were education level, family income, history of illicit drug use and sexually transmitted infections, homosexual contact and condom nonuse. Approximately 58.5% had late initiation of highly active antiretroviral therapy, which influenced the risk of HIV-EBV 1/2 multiple infection (odds ratio (OR): 4.76; 95% CI 1.51–15.04) and symptom development (p = 0.004). HIV viral load was associated with patient age (OR: 2.04; 95% CI 2.01–2.07; p = 0.026) and duration of illicit drug use (OR: 1.57; 95% CI 1.12–2.22; p = 0.0548). EBV viral load was associated with younger age (OR: 0.82; 95% CI 0.79–1.03; p = 0.0579). The replication of both viruses was associated with symptom development (HIV = OR: 2.06; 95% CI 1.22–3.50; p = 0.0073; EBV = OR: 8.81; 95% CI 1–10; p = 0.0447). The prevalence of HIV/EBV coinfection was lower than that observed in other studies, and social vulnerability and promiscuous sexual behavior were associated risk factors. A long time of HIV-1 infection, without therapy, influenced the risk of coinfection and disease progression. The viral loads of both viruses may be associated with some epidemiological aspects of the population.

Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. P?s-gradua??o em Virologia. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Universidade Estadual do Par?. Resid?ncia M?dica. Bel?m, PA, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Laborat?rio de Rotav?rus. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Laborat?rio de Rotav?rus. Ananindeua, PA, Brasil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. P?s-gradua??o em Virologia. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Universidade Federal do Par?. N?cleo de Medicina Tropical. Bel?m, PA, Brazil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. P?s-gradua??o em Virologia. Ananindeua, PA, Brasil. 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 Bel?m, 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.

Federal University of Par?. Center for Tropical Medicine. Bel?m, PA, Brazil / State University of Par?. Center for Biological and Health Sciences. Bel?m, PA, Brazil. State University of Par?. Center for Biological and Health Sciences. Bel?m, PA, Brazil. Federal University of Par?. Center for Tropical Medicine. Bel?m, PA, Brazil. State University of Par?. Center for Biological and Health Sciences. Bel?m, PA, Brazil. State University of Par?. Center for Biological and Health Sciences. Bel?m, PA, Brazil. State University of Par?. Center for Biological and Health Sciences. Bel?m, PA, Brazil. State University of Par?. Center for Biological and Health Sciences. Bel?m, PA, Brazil. Federal University of Par?. Center for Tropical Medicine. Bel?m, PA, Brazil / Santa Casa de Miseric?rdia Foundation. Bel?m, PA, Brazil. State University of Par?. Center for Biological and Health Sciences. Bel?m, PA, Brazil. Federal University of Par?. Center for Tropical Medicine. Bel?m, PA, Brazil. State University of Par?. Center for Biological and Health Sciences. Bel?m, PA, Brazil. Federal University of Par?. Center for Tropical Medicine. Bel?m, PA, Brazil / State University of Par?. Center for Biological and Health Sciences. Bel?m, PA, Brazil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. This study analyzed the relationship between infection by human T-cell lymphotropic virus type 1 (HTLV-1) and changes in the pulmonary system. Cohort and case-control study models that analyzed a causal association between HTLV-1 and changes in the pulmonary system were considered. There were no restrictions on language and publication period. The study was registered in the PROSPERO systematic analysis database (Protocol No. CRD42017078236) and was prepared according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The following databases were used: PubMed, BVS Regional Portal, Embase, CINAHL and Web of Science. We utilized the Newcastle-Ottawa Scale to assess the methodological quality of published studies and the Kappa coefficient to assess the agreement level between two reviewers. Of the total 1156 studies retrieved by the search strategy, 28 were considered potentially eligible (Kappa test = 0.928). Of the 28 studies, three fully met the inclusion criteria. These indicated that pulmonary lesions, such as bronchiectasis and bronchitis/bronchiolitis, were observed in patients with HTLV-1, with high-resolution computed tomography of the chest being the main method of diagnostic investigation. The analyzed cohort and case-control studies indicated an etiological relationship between HTLV-1 infection and the presence of lung lesions, with emphasis on bronchiectasis in the presence of high viral loads, as well as a higher mortality in these individuals compared with the general population.

The human T-cell lymphotropic virus type 1 (HTLV-1) is a retrovirus from the Retroviridae family that infects cluster of differentiation 4 (CD4) T-lymphocytes and stimulates their proliferation. A severe consequence of this infection can be the HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP), which is associated with a progressive demyelinating disease of the upper motor neurons. The HAM/TSP conditions frequently present with neurological complaints such as gait impairment, sphincter disturbances, and several sensory losses. We compared findings from the posturographic evaluation from the asymptomatic HTLV-1 infected subjects, HTLV-1 infected subjects having HAM/TSP, and control group database. A force plate was used to record the postural oscillations. Analysis of variance and multivariate linear discriminant analysis were used to compare the data obtained from the three groups of participants. In general, HAM/TSP patients had worse postural balance control than did the HTLV-1 patients and the controls (p

Human T-lymphocytic virus 1 (HTLV-1) is mainly associated with adult T-cell leukemia/lymphoma (ATLL) and HTLV-1–associated myelopathy/tropical spastic paraparesis (HAM/TSP). Patients with HAM/TSP exhibit significant changes in their immune response, and HTLV-1 infection can interfere in cytokine production and perhaps in T cell production. The aims of this study were to evaluate thymic function in HAM/TSP patients and HTLV-1 healthy carriers (HCs) and correlate it to age and interleukin 7 (IL-7) gene expression. Thymic function in 21 HAM/TSP patients and 12 HCs was evaluated by quantifying T cell receptor rearrangement excision circle (TREC) particles and IL-7 gene expression, both measured by quantitative polymerase chain reaction. HAM/TSP patients presented lower TREC particle counts (p = 0.0112) and lower IL-7 expression (p = 0.0102) than HCs. Both TREC particles and IL-7 gene expression were separately analyzed in two age groups: ≤ 59 years and ≥60 years, The ≤59-year-old HAM/TSP patients had a lower TREC count compared with the ≤59-year-old HCs (p = 0.0476). In conclusion, HAM/TSP development could interfere with thymic function because the results showed TREC particle reduction in HAM/TSP patients in relation to HCs, and it could be associated with a concomitant reduction in IL-7 expression.

Introduction Individuals infected with the human T-cell lymphotropic virus type 1 (HTLV-1) commonly present skin lesions, which may be a warning sign for the diagnosis of infection. This study describes the most prevalent skin manifestations in HTLV carriers attended at the clinic of Nucleo de Medicina Tropical (NMT) of the Universidade Federal do Para (UFPA) in Belem, Para, Brazil. Methods This is a study of a series of cases of patients infected with human T-cell lymphotropic virus types 1 and 2 (HTLV-1/2) treated at NMT UFPA between 1999 and 2016. A descriptive analysis of data was applied. Results Among 788 surveyed medical records in the service, 15.10% (n = 119) were referred to the dermatology clinic. From the series of cases that presented with skin lesions, 66.39% were female and 33.61% were male, and the average age of this group was 48 years. There was a predominance of patients with noninfectious inflammatory manifestations (64.2%), followed by infectious ones (24.6%), and 1.58% with lymphoproliferative diseases. As for the group of lesions, 45.26% of the erythematous-squamous type were observed, followed by dyschromia (24.21%), and eczematous (14.74%). One patient with a diagnosis of adult T-cell leukemia/lymphoma, another with parapsoriasis, and four with infective dermatitis are highlighted. Conclusion Skin disorders in the HLTV positive patient are important causes of referral to the dermatologist with etiological and skin lesions groups diversity. In the series of cases studied, lymphoproliferatives diseases and infective dermatitis associated with HTLV-1 were presented as a challenge for the diagnosis and clinical management of these patients.

The aim of this study was to compare computed tomography (CT) scans of chest and lung function among patients with Human T-Lymphotropic Virus Type 1 (HTLV) with and without HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). In this cross-sectional study performed between January 2013 and June 2016, we included 48 patients with HAM/TSP (19 women and 11 men) and without HAM/TSP (12 women and 6 men). We compared CT findings and lung functions of these groups. Patients who had HAM/TSP had abnormal CT findings (P = 0.000), including more frequent bronchiectasis (P = 0.049), parenchymal bands (P = 0.007), interlobular septal thickening (P = 0.035), and pleural thickening (P = 0.009). In addition, neither patients with HAM/TSP (9/30; 30%) nor the controls (0/18; 0%) had obstructive or restrictive lung disease (P = 0.009). HTLV diagnosis should be considered in all patients with abnormal CT findings in whom no other cause is apparent. It is important to remember that lung disease increases the rates of morbidity and mortality in developing countries.

Malaria remains a major public health problem in Brazil where Plasmodium vivax is the predominant species, responsible for 82% of registered cases in 2013. Though benign, P. vivax infection may sometimes evolve with complications and a fatal outcome. Here, we report a severe case of P. vivax malaria in a 35-year-old Brazilian man from a malaria endemic area, who presented with reversible myocarditis.

This paper proposes a new methodology to diagnose the rheumatology manifestations and HTLV-I-Associated Myelopathy/Tropical Spastic Paraparesis, or HAM/TSP, in patients who have Lymphotropic virus of T cells in Humans or HTLV of type I and II. Computational intelligence algorithms are used to classify HTLV patient carriers with or without the presence of rheumatology manifestations and of HAM / TSP. A benchmarking is performed among artificial neural intelligence, naive bayes, Bayesian networks and decision tree to evaluate the most suitable technique for solving this application issue. The obtained results demonstrate the potential of the methodology on the helping non-specialist doctors to classify the patient with the disease suspicion.

BackgroundThe human T-Cell Lymphotropic Virus Type 1 (HTLV-1) is a retrovirus associated with neurological alterations; individuals with HTLV-1 infection may develop HTLV-1 associated myelopathy / tropical spastic paraparesis (HAM/TSP). Frequent neurological complaints include foot numbness and leg weakness. In this study, we compared the distribution of the body weight on different areas of the foot in HTLV-1 patients with HAM/TSP, asymptomatic HTLV-1 patients, and healthy individuals.MethodologyWe studied 36 HTLV-1 infected patients, who were divided in two groups of 18 patients each based on whether or not they had been diagnosed with HAM/TSP, and 17 control subjects. The evaluation included an interview on the patient's clinical history and examinations of the patient's reflexes, foot skin tactile sensitivity, and risk of falling. The pressure distribution on different areas of the foot was measured with baropodometry, using a pressure platform, while the patients had their eyes open or closed.Main findingsThe prevalence of neurological disturbances-altered reflexes and skin tactile sensitivity and increased risk of falling-was higher in HTLV-1 HAM/TSP patients than in HTLV-1 asymptomatic patients. The medium and maximum pressure values were higher in the forefoot than in the midfoot and hindfoot in both HTLV-1 groups. In addition, the pressure on the hindfoot was lower in HAM/TSP patients compared to control subjects.ConclusionsThe neurological disturbances associated with HTLV-1 infection gradually worsened from HTLV-1 asymptomatic patients to HAM/TSP patients. Baropodometry is a valuable tool to establish the extent of neurological damage in patients suffering from HTLV-1 infection.

HTLV-1 infects principally CD4+ T cells that are the main reservoirs of the virus in vivo, which play an important role in the immunological response. Most of the infected patients are asymptomatic. However, 2-3% of patients will develop HAM/TSP or Adult T lymphoma. HAM/TSP is a chronic inflammatory disease of the central nervous system, which is characterized by unremitting myelopathic symptoms. Studies have shown that cytokines levels alterations (IFN-γ and TNF-α) were associated with tissue injury in HAM/TSP. The aims of this study were to compare the gene expression of IFN-γ, IL-4 and IL-10 of asymptomatic and HAM/TSP HTLV-1 infected patients, and to correlate the gene expression with those of clinical symptoms. 28 subjects were included, 20 asymptomatic HTLV-1 and 8 with HAM/TSP. Spasticity was evaluated using the Modified Ashworth Scale and the degree of walking aid was classified on a progressive scale. The relative gene expression of IFN-γ, IL-4, and IL-10 was measured by Real-Time PCR. Results showed high gene expression of IFN-γ for all patients, but it was higher among HAM/TSP. A significant correlation was observed between IFN-γ gene expression and the degree of walking aid, and IFN-γ gene expression was higher among wheelchair users compared to non-wheelchair users. No association was found with IL-4 and IL-10. These findings indicate that HAM/TSP patients express higher amounts of IFN-γ than asymptomatic patients, and more importantly, the expression of this cytokine was strongly correlated with the need of walking aid.

Several environmental factors have been studied as triggers of autoimmune diseases, infectious agents in particular. The human T-lymphotropic virus (HTLV) is a retrovirus associated with disease in humans, especially adult T-cell leukemia/lymphoma and HTLV-1-associated myelopathy/tropical spastic paraparesis, but growing evidence has identified the association of HTLV and other diseases, such as rheumatoid arthritis and Sjogren’s syndrome. In this chapter we review the influence of HTLV in autoimmune diseases, particularly rheumatic diseases.

Backgound and Objectives: The Testing and Counseling Center’s (CTA) are characterized for offer actions directed toward HIV testing and counseling pretest and after test that the systematic collection of information involves allowing to know important characteristics epidemiologists and behaviors associates to the HIV seropositivity of the users of the service. This study it had as objective to describe the sociodemographic and behavioral aspects of the users with positive serology taken care of in the biggest CTA of the state of Para, between 2008 and 2010. Methods: The collection and analysis of data had been carried through on the basis of the System of information of CTA (SI-CTA), in the serological tests and interviews of 547 HIV infected users respecting all the ethical rules. Results: in relation to the epidemiological features, 60.6% were men, with average of age of 33,4 years, 54.2% were single, in the majority medium brown (77.6%), with education of 8 to the 11 years (54%) and in the majority heterosexuals (64,3%). In relation to the use of condoms, 53.7% (IC95% 33,4; 41,7) with fixed partnership and 40.2 (IC95% 14,5; 21,1) with eventual partnerships had told not the use of condoms in the sexual relations. Amongst the main reasons for the use of condoms they had not been distinguished it confidence in the partner, the non-availability at the moment of the relation and other reasons. Conclusion: The results suggest that even so it has similarities in relation to the current trend of the epidemic of HIV/Aids, exist peculiarities in our region that deserve differentiated preventive interventions. KEYWORDS: HIV Infections. Epidemiology. HIV Seroprevalence.

Introduction: Actinic keratosis is the most common premalignant lesion. The therapeutic approach to patients with multiple lesions involves field-directed treatment. Objective: To evaluate the efficacy and safety of ingenol mebutato, a new drug treatment for topical field-directed treatment of actinic keratosis. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs) trials. Data sources: Medline and Cochrane Library (June 2014). Study selection: Two reviewers independently searched for studies and retrieved their characteristics and data estimates. Data synthesis: Random-effects meta-analysis. Heterogeneity was assessed with the I2 test. Results: Six trials (n = 1,492) versus placebo were included. The odds of a patient experiencing complete removal of the lesions was 17 (95%CI: 9 to 31, I2 = 0%) and 8.5 (95% CI: 5 to 15, I2 = 0%) times higher, compared to placebo, in the face/scalp and trunk/extremities, respectively. The incidence of adverse events related to treatment was higher in the group of mebutato ingenol (+23%, 95%CI: 11 to 35%), with no differences between groups in the discontinuation rate due to adverse events. Conclusions: Mebutato of ingenol is efficacious in the treatment of actinic keratosis. Compared to other field-directed treatments available in Portugal, its therapeutic value comes from the favourable safety profile and tolerability, simplicity and short duration of the treatment regimen and the possibility of different treatment to injuries according to anatomical location (individualization of therapy). Future studies should directly compare the different therapeutic options and evaluate the effectiveness of the same in the real world., Introdução: A queratose actínica é a lesão pré-maligna mais frequente. A abordagem terapêutica dos doentes com múltiplas lesões envolve terapêuticas de campo. Objetivo: Avaliar a eficácia e segurança de mebutato de ingenol, um novo medicamento destinado à terapêutica tópica de campo. Desenho: Revisão sistemática e meta-análise dos ensaios clínicos controlados e aleatorizados (RCTs). Fontes bibliográficas: Medline e Cochrane Library (junho 2014). Seleção dos estudos: A seleção e avaliação dos RCTs foram feitas de forma independente. Análise quantitativa: Meta-análise de efeitos aleatórios. A heterogeneidade foi avaliada com o teste I2. Resultados: Foram incluídos 6 ensaios (n=1.492) versus placebo. Mebutato de ingenol esteve associado a uma possibilidade de um doente ter remoção completa das lesões 17 (IC95%: 9 a 31; I2=0%) e 8,5 (IC95%: 5 a 15; I2=0%) vezes superior, comparativamente ao placebo, no rosto/couro cabeludo e no tronco/extremidades, respetivamente. A incidência de eventos adversos relacionados com o tratamento foi superior no grupo mebutato de ingenol (+23%, IC95%: 11 a 35%), sem diferenças entre grupos na taxa de abandono por eventos adversos. Conclusões: Mebutato de ingenol é eficaz no tratamento da queratose actínica. Comparativamente às restantes terapêuticas de campo disponíveis em Portugal, o seu valor erapêutico advém do favorável perfil de segurança e tolerabilidade, da simplicidade e curta duração do esquema terapêutico e da possibilidade de tratar de forma diferenciada as lesões de acordo com a localização anatómica (individualização da terapêutica). Estudos futuros deveriam comparar diretamente as diferentes opções terapêuticas e avaliar a efetividade das mesmas no mundo real.

Additional financial support for this study was provided by Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) and Pr?-Reitoria de Pesquisa e P?sGradua??o da UFPA (PROPESP) of Universidade Federal do Par? (UFPA). Universidade Federal do Par?. Faculdade de Enfermagem. Bel?m, PA, Brasil / Universidade Federal do Par?. Hospital Universit?rio Jo?o de Barros Barreto. Enfermaria de Doen?as Infecciosas. Bel?m, PA, Brasil. Universidade Estadual do Par?. Departamento de Doen?as Infecciosas. Bel?m, PA, Brasil / Universidade Federal do Par?. Departamento de Doen?as Infecciosas. Bel?m, PA, Brasil. Universidade Estadual do Par?. Departamento de Doen?as Infecciosas. Bel?m, PA, Brasil / Centro Universit?rio do Par?. Bel?m, PA, Brasil. Universidade Federal do Par?. Hospital Universit?rio Jo?o de Barros Barreto. Comit? de Controle de Infec??o Hospitalar. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Universidade Federal do Par?. Departamento de Doen?as Infecciosas. Bel?m, PA, Brasil. OBJECTIVE: To investigate and compare the incidence of healthcare-associated infections (HAIs) involving HIV and non-HIV/AIDS patients. METHODS: Analytical, observational and prospective study. Setting: The Infectious Disease Nursery at the Hospital Universit?rio Jo?o de Barros Barreto in Bel?m, Par? State, Brazil. Patients: HIV and non-HIV/AIDS inpatients from February to December 2007. The patients were monitored daily from admission to the day of discharge. RESULTS: During the study period, there were 20,276 reported patient-days. Out of the 1,130 discharged patients, 40 patients acquired HAIs, and HAIs occurred more frequently in the HIV-positive patients (57.5%), with 29 (60.4%) HAI episodes (p ? 0.05). A total of 11 (55%) HIV-positive patients showed a TCD4 cell count < 100 cell/mm3, and 15 (65.22%) HIV-positive patients died from complications associated with the HAIs (p = 0.009). The most frequent infections were urinary tract infections related to urinary catheter use per 1,000 catheter-days in non-HIV patients, with 12.11 episodes (p = 0.13). However, HIV-positive patients were more often infected with pneumonia, with 1.6 episodes per 1,000 patient-days (p = 0.04). CONCLUSION: HAI are more likely to occur in HIV-positive patients, most likely as a consequence of their immune condition, and this risk, which is associated with invasive procedures, justifies the need for preventive measures. OBJETIVO: Investigar e comparar a incid?ncia de infec??es relacionadas ? assist?ncia ? sa?de (IRAS), envolvendo pacientes HIV e n?o HIV/aids. M?TODO: Estudo anal?tico, observacional e prospectivo ocorrido na Enfermaria de Doen?as Infecciosas do Hospital Universit?rio Jo?o de Barros Barreto em Bel?m, Estado do Par?, Brasil. Pacientes: Internos, portadores de HIV e n?o HIV/aids, de fevereiro a dezembro de 2007, com monitoramento di?rio da admiss?o at? a alta hospitalar. RESULTADOS: Durante o per?odo de estudo, foram relatados 20.276 pacientes/dia. De 1.130 pacientes com alta, 40 contra?ram IRAS, e as IRAS ocorreram mais frequentemente nos HIV-positivos (57,5%), com 29 (60,4%) epis?dios de IRAS (p ? 0,05). Um total de 11 (55%) HIV-positivos apresentou contagem de c?lulas TCD4 < 100 c?lulas/mm3, e 15 (65,22%) HIV-positivos morreram de complica??es associadas com as IRAS (p = 0,009). A infec??o mais frequente foi a do trato urin?rio, associada ao uso de cateter urin?rio, 1.000 cateteres-dia em pacientes n?o HIV, com 12,11 epis?dios (p = 0,13). Entretanto, os HIV-positivos apresentaram pneumonia mais frequentemente, com 1,6 epis?dios em 1.000 pacientes-dia (p = 0,04). CONCLUS?O: As IRAS apresentam maior probabilidade de ocorr?ncia em HIV-positivos, provavelmente devido as suas condi??es de imunidade, e esse risco, que est? associado com procedimentos invasivos, justifica a necessidade de medidas preventivas.

Background HTLV-1 is a retrovirus that causes lymphoproliferative disorders and inflammatory and degenerative diseases of the central nervous system in humans. The prevalence of this infection is high in parts of Brazil and there is a general lack of public health care programs. As a consequence, official data on the transmission routes of this virus are scarce. Objective To demonstrate familial aggregation of HTLV infections in the metropolitan region of Belém, Pará, Brazil. Method A cross-sectional study involving 85 HTLV carriers treated at an outpatient clinic and other family members. The subjects were tested by ELISA and molecular methods between February 2007 and December 2010. Results The prevalence of HTLV was 43.5% (37/85) for families and 25.6% (58/227) for the family members tested (95% CI: 1.33 to 3.79, P = 0.0033). Sexual and vertical transmission was likely in 38.3% (23/60) and 20.4% (29/142) of pairs, respectively (95% CI: 1.25 to 4.69, P = 0.0130). Positivity was 51.3% (20/39) and 14.3% (3/21) in wives and husbands, respectively (95% CI: 0.04 to 0.63, P = 0.0057). By age group, seropositivity was 8.0% (7/88) in subjects, Author Summary Human T-cell lymphotropic virus (HTLV) has a slow replication rate and infection is characterized by low morbidity and mortality, as well as silent transmission within the population. While rare, HTLV-associated diseases are usually debilitating and life-threatening. The virus is endemic in the state of Pará (Brazil), although there have been no studies of the distribution of the virus within the local population. The results of the present study confirm the existence of familial aggregations of HTLV infection in the metropolitan region of the state capital, Belém. Considerably higher rates of sexual transmission of HTLV from men to women were also demonstrated. Rates of infection were similar for the two virus types, although HTLV-2 appears to be increasing in the population. The frequency of positivity among family members increased in direct proportion to age and was associated with a relatively large proportion of asymptomatic carriers. In addition, widespread ignorance of the virus increases the risk of transmission. The available evidence indicates that significant human suffering is caused by this virus in patients suffering complications, and this is little justification for the lack of intervention on the part of public health authorities, which might impede the ongoing proliferation of this infection in the population.

Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Universidade Federal do Par?. N?cleo de Medicina Tropical. Bel?m, PA, Brasil. Universidade Federal do Par?. Hospital Universit?rio Jo?o de Barros Barreto. Bel?m, PA, Brasil. Secret?ria Municipal de Sa?de. Casa Dia. Bel?m, PA, Brasil. A resist?ncia ?s drogas antirretrovirais resulta da incompleta supress?o da replica??o do HIV-1. O presente estudo caracterizou o perfil de resist?ncia genot?pica aos antirretrovirais (ARV) em amostras sorol?gicas de 127 pacientes HIV positivos, origin?rias dos Estados do Amazonas e Par?, Regi?o Norte do Brasil, no per?odo de 2002 a 2006. As amostras TM foram submetidas ao teste de resist?ncia pelo kit ViroSeq Genotyping System. Considerando as informa??es gen?ticas obtidas das regi?es da protease e/ou transcriptase reversa do HIV-1, a muta??o M184V (81,1%) foi a mais associada aos inibidores nucleos?dicos da transcriptase reversa (ITRN), em indiv?duos usando ARV no Estado do Par?, e a muta??o T215F/Y (56,3%) em indiv?duos do Estado do Amazonas. A muta??o K103N foi a mais prevalente (33,5%) para os inibidores n?o nucleos?dicos da transcriptase reversa (ITRNN) em ambos os Estados. Para o gene da protease a muta??o minor L63P (65,3%) apresentou-se como a mais frequente em ambos os Estados. O estudo revelou a import?ncia da identifica??o de muta??es associadas ? resist?ncia ?s drogas antirretrovirais para o uso racional em esquemas terap?uticos e seus resultados apresentaram-se semelhantes aos obtidos em outras regi?es do Brasil. Resistance to antiretroviral drugs results from the incomplete suppression of HIV-1 replication. The present study characterized the profile of genotypic resistance to antiretroviral drugs (ARVs) in serum samples from 127 HIV-positive patients from the States of Amazonas and Par?, in Northern Brazil, from 2002 to 2006. The samples were tested for TM resistance using the ViroSeq Genotyping System kit. Based on the genetic information obtained from the HIV-1 protease (PR) and/or reverse transcriptase (RT) genes, the M184V mutation (81.1%) was the most frequently associated with resistance to nucleoside reverse transcriptase inhibitors (NRTIs) in individuals using ARVs in Par?, while the T215F/Y mutation (56.3%) was the most frequently associated with resistance in individuals from Amazonas. The K103N mutation was the most prevalent (33.5%) resistance mutation to non-nucleoside reverse transcriptase inhibitors (NNRTIs) in both states. For the PR gene, the minor mutation L63P (65.3%) was the most frequent in both states. The present study showed the importance of identifying mutations associated with resistance to ARVs to the rational selection of therapeutic schemes. Additionally, the results found in Par? and Amazonas were found to be similar to those of other areas in Brazil.

Universidade Federal do Par?. N?cleo de Medicina Tropical. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Universidade Federal do Par?. N?cleo de Medicina Tropical. Bel?m, PA, Brasil. INTRODU??O: As Infec??es Respirat?rias Agudas (IRA) permanecem como um dos principais problemas de sa?de p?blica em todo o mundo. Essas infec??es s?o associadas a diversos pat?genos sendo os v?rus os prevalentes. Recentemente, foi descrito na literatura um novo parvov?rus denominado Bocav?rus Humano (HBoV). Investiga??es ainda s?o escassas na associa??o deste novo agente a casos de IRA na popula??o em geral. Neste contexto, o presente artigo relata a pesquisa do HBoV em um segmento populacional da Amaz?nia. MATERIAIS E M?TODOS: Neste estudo, foram analisadas amostras de aspirado nasofar?ngeo de pacientes com diagn?stico de IRA atendidos ambulatorialmente na Cidade de Bel?m, Par?, Brasil. A pesquisa, com a identifica??o laboratorial do v?rus, foi realizada mediante o emprego da t?cnica de rea??o em cadeia mediada pela polimerase, utilizando pares de oligonucleot?deos espec?ficos, seguida da an?lise filogen?tica das sequ?ncias nucleot?dicas encontradas. RESULTADOS: Das 397 amostras cl?nicas analisadas, encontrou-se positividade em amostras de tr?s pacientes, sendo um destes em coinfec??o com o v?rus respirat?rio sincicial. DISCUSS?O: O percentual de positividade obtido na investiga??o se revelou inferior ao descrito na literatura. Entretanto, vale ressaltar que os estudos j? publicados envolveram pacientes hospitalizados, diferentemente do grupo populacional presentemente abordado. As an?lises filogen?ticas realizadas evidenciaram expressiva similaridade dos v?rus encontrados com as cepas virais j? descritas. CONCLUS?O: A presente pesquisa se caracteriza como o primeiro relato associando o HBoV ? IRA na Regi?o Amaz?nica. INTRODUCTION: Acute Respiratory Infections (ARI) are one of the main public health problems in the world. Most of these infections are associated with several pathogens, and viruses are the most prevalent agents. Recently, a new parvovirus named Human Bocavirus (HBoV) has been described. Investigations on the relationship between this new agent and cases of ARI in individuals are still scarce. Herein, we review a study of HBoV in a population segment in the Amazon. MATERIALS AND METHODS: In this study, samples of nasopharyngeal aspirates from patients with ARI treated in Health Care Units in Bel?m, Brazil, were analyzed. Identification of the virus was carried out by polymerase chain reaction using pairs of specific oligonucleotides, followed by phylogenetic analysis of the nucleotide sequences obtained. RESULTS: Of the 397 samples studied, three specimens were HBoV-positive, and one presented as a co-infection with the respiratory syncytial virus. DISCUSSION: The positivity rate obtained in this investigation was lower than that described in other studies; however, previous studies involved hospitalized patients, which constitute a different population group. The phylogenetic analyses revealed a significant similarity between the virus strains found and those previously described. CONCLUSION: This is the first report associating HBoV with ARI in the Amazon.

Universidade Federal do Par?. Laborat?rio de Gen?tica Humana e M?dica. Bel?m, PA, Brasil. Universidade Federal do Par?. N?cleo de Pesquisas em Oncologia. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Laborat?rio de V?rus Respirat?rios. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Laborat?rio de V?rus Respirat?rios. Ananindeua, PA, Brasil. Universidade Federal do Par?. Laborat?rio de Gen?tica Humana e M?dica. Bel?m, Par?, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Laborat?rio de V?rus Respirat?rios. Ananindeua, PA, Brasil. Universidade Federal do Par?. N?cleo de Pesquisas em Oncologia. Bel?m, PA, Brasil / Universidade Federal do Par?. Laborat?rio de Gen?tica Humana e M?dica. Bel?m, Par?, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Bel?m, PA, Brazil / Universidade Federal do Par?. Bel?m, PA, Brasil. Background: The virulence and pathogenicity of different influenza strains are responsible for a more or less severe disease. Recent studies have attempted to understand how host genetic factors may influence the clinical presentation of the disease. In the present study, the His131Arg (rs1801274) polymorphism was investigated in individuals from a Brazilian admixed population with a diagnosis of influenza A(H1N1)pdm09 infection. Methods: In the present study, the influence of the His131Arg (rs1801274) polymorphism, a variant of the FCGR2A gene, was investigated in 436 patients with a diagnosis of influenza A(H1N1)pdm09, evaluated at health services in the northern and northeastern regions of Brazil between June 2009 and August 2010. Patients were divided into a group of non-hospitalized patients (n = 192) and a group of hospitalized patients (n = 244; 100 of them died). Results: No significant difference in the allele or genotype frequencies of the rs1801274 polymorphism was observed between groups (p = 0.952 and p = 0.388). Multinomial logistic regression showed no effect of the rs1801274 polymorphism on severity or death of patients from the Brazilian admixed population (p = 0.368 and p = 0.469). Conclusions: The rs1801274 polymorphism is not associated with severe disease in patients infected with influenza A(H1N1)pdm09.