Search

IntroductionImmune 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 MethodsTreatment-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.ResultsOf 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.ConclusionsThe 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.

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.

Chagas disease is a parasitic infection with a large reemergent rates in some Amazon regions with usual features of outbreaks of the acute disease mainly by oral transmission. The main vectors of Trypanosoma cruzi are hematophagous insects, the triatomines. Some of them can establish themselves in human dwellings and their annexes but others are mostly wild. In the state of Pará, few records have been made about the occurrence of those wild vectors in fortuitous contact with inhabitants in riverside regions in the Amazon. These vector behaviours have been studied by our group since 2006, trying to explain their role in transmission of the silent disease or asymptomatic infection. The objective of this study is to describe the epidemiological profile of populations exposed to random triatomine home invasion in riverside areas with this registered occurrence. This is a cross-sectional study developed in Abaetetuba city, in the state of Pará, where we conducted a seroepidemiologic survey in inhabitants that registered triatomine home invasion. The results demonstrated that triatomine invasions occur especially in the in-home environment and in the rural zone. The genus Rhodnius was the most found in residences of the municipalities. Direct contact through the vector was reported by 15.55% of the total participants, and an unusual vector behaviour were observed during the day. Despite this small casuistic, 0.47% of the enrolled inhabitants had positive serology IgG anti- T. cruzi antibodies. We confirm one occurrence of asymptomatic infection in a child and, also, favourable links to the Chagas disease transmission chain. Faced with the scarcity of information on triatomine aggression in the Amazon, the authors recommended an entomological study of greater scope in those areas. The record of unusual vector behaviour and the serological surveillance of human populations under this risk may constitute a new tool for the early detection of silent infections and reinforce the knowledges about the behaviour of invading insects. At the same time, health education can assist in strategies for the prevention of Chagas' disease.

Background: Two types of Epstein Barr virus (EBV1/EBV2) have been shown to infect humans by causing infectious mononucleosis, their genome being very similar, except for regions of the EBNA genes. This study aimed to describe the EBV genotypes in cases of infectious mononucleosis in the metropolitan region of Belém, Brazil, from 2005 to 2016. Methods: A total of 8.295 suspected cases with symptoms/signs of infectious mononucleosis (MI) were investigated by doctors of infectious diseases at the Evandro Chagas Institute Health Care Service from January 2005 to December 2016. In 3.0% (251/8.295) of the cases were positive by enzymatic immunoassay were submitted to PCR for EBNA3C region to detect the types of EBV. Biochemical testing involving aspartate aminotransferase, alanine aminotransferase and gamma-glutamyl transferase were realized. Results: The identification of EBV types by PCR was verified in 30.3% (76/251) of individuals, being 71.1% (54/76) classified as EBV1, 17.1% (13/76) as EBV2 and 11.8% (9/76) as EBV1+EBV2. The number of women infected with EBV1 was higher (61.1% - 33/54) than for men (38.9% - 21/54), most were over 14 years old (66.7%-36/54). The main symptoms/clinical signs observed in EBV1 infection were: cervical lymphadenopathy (64.8%-35/54), fever (63%-34/54), headache (20.3%-11/54), arthralgia (20.3%-11/54) and exanthema (18.5%-10/54). In EBV2 infection, it was also detected in all age groups, with the exception of two groups, with an average age of 24 years. The presence of fever in 76.9% (10/13) with an average duration of 18 days and lymphadenopathy in 53.8 (7/13) were the most relevant signs/symptoms in EBV2. In contrast, EBV1+EBV2 co-infection was more frequent in the £5 year age group, affecting 20.0% (2/10). Women presented 66.7% (6/9) more positive cases. The symptoms involving EBV1+EBV2 co-infection were more related to fever (66.7%-6/9) and cervical lymphadenopathy (55.6% -5/9). The average of enzymatic values according to type of EBV was statistically significant (p

Financial support provided by the Evandro Chagas Institute. 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 do Estado do Par?. Bel?m, PA, Brazil. Universidade do Estado do Par?. Bel?m, PA, Brazil. 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. 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. 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, Par?, 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.

Background: Two types of Epstein Barr virus (EBV1 and 2) have been shown to infect humans. This study aimed to detect the types of EBV that cause infectious mononucleosis and correlate these viral types with clinical parameters in the metropolitan region of Belém from 2005 to 2016.Methods: A total of 76 cases of infectious mononucleosis (IM) were processed at the Instituto Evandro Chagas, Ananindeua, Brazil. PCR was used to analyze the EBNA 3C region for the recognition of EBV types. Biochemical testing (aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) was performed by the COBAS INTEGRA clinical biochemistry PLUS 400 / ROCHE automatic analyzer. The data were evaluated using the Statistical Package for Social Science - SPSS 17.0 and GraphPadPrism 7.0 for Windows.Results: EBV1 infection was observed in 71.1% (54/76) of individuals, among whom those > 14 years constituted 66.7% (36/54); the average age was 23 years, and the number of women infected was higher (61.1% [33/54]) than that of men 38.9%[21/54]). The symptoms/clinical signs observed in infection by EBV1 were cervical lymphadenopathy in 64.8% (35/54), fever in 63% (34/54), headache and arthralgia in 20.3% (11/54), and exanthema in 18.5% (10/54). Infection by EBV2 was observed in only 17.1% (13/76) of cases. Coinfections by EBV1 and EBV2, most frequently showing symptoms of fever and cervical lymphadenopathy, occurred in 66.7% (6/9) and 55.6% (5/9) of individuals. Alterations to AST were confirmed in 14.8% (8/54), EBV2 of cases in 7.7% (1/13) in EBV1 infection. Conclusions: EBV1 was predominant in 71% of clinical cases of infectious mononucleosis. The correlation of biochemical parameters in infection by EBV1, EBV2, and coinfections by EBV1/2 revealed a statistically significant difference in mean changes of EBV1 in individuals older than 14 years.

Fiocruz. Bio-Manguinhos. Instituto de Tecnologia em Imunobiol?gicos, Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto Oswaldo Cruz. Laborat?rio de V?rus Respirat?rios e Sarampo. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Bio-Manguinhos. Rio de Janeiro, RJ, 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. Funda??o Oswaldo Cruz. Escola Nacional de Sa?de P?blica Sergio Arouca. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. 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 Par?, 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.

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 do Estado do Par?. Bel?m, PA, Brasil. Universidade do Estado do Par?. 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. 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. O v?rus Zika ? um arbov?rus emergente e, desde a sua confirma??o no nordeste do Brasil, em maio de 2015, dispersou-se rapidamente para quase todos os pa?ses da Am?rica Latina e do Caribe. A maioria das pessoas infectadas com o v?rus Zika s?o assintom?ticas; no entanto, em mulheres gr?vidas, a infec??o pode causar graves complica??es para o feto. Na investiga??o de 60 gr?vidas com exantema e com m?dia de idade gestacional de 20 semanas, houve confirma??o laboratorial para o v?rus Zika (biologia molecular e/ou sorologia) e, at? o momento, sem coinfec??o e nenhum registro de altera??es ultrassonogr?ficas ou desfechos com microcefalia ou outra malforma??o. Zika virus is an emerging arbovirus and, since its occurrence in the northeast Brazil in May 2015, it has dispersed rapidly to most of the Latin American and Caribbean countries. Most people infected with Zika virus are asymptomatic; however in pregnant women the infection can cause serious complications to the fetus. A total of 60 pregnant women with exanthema, at an average gestational age of 20 weeks, were investigated for Zika virus infection (molecular biology and/or serology) with positive result. So far, no co-infection and no record of ultrasonographic changes or out comes indicating microcephaly or any other malformation have been identified.

This study received funding/financial support from Instituto Evandro Chagas, Secretaria de Vigil?ncia em Sa?de (SVS), Minist?rio da Sa?de do Brasil. Universidade do Estado do Par?. Bel?m, PA, Brasil. Funda??o Hospital de Cl?nicas Gaspar Viana. 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. 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 Muan?, Par? 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.

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. CCI Nefro. Cl?nica de Hemodi?lise. Bel?m, PA, Brasil / Central de Esteriliza??o do Par?. Bel?m, PA, Brasil. Centro de Ensino Superior do Par?. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. A resist?ncia antimicrobiana ? um assunto amplamente estudado em todos os g?neros bacterianos, sobretudo entre agentes respons?veis por doen?as epid?micas como a febre tifoide. A incid?ncia de surtos contribui para o aumento abusivo da administra??o err?nea de antimicrobianos colaborando para o surgimento de amostras bacterianas resistentes. Portanto, o presente estudo avaliou a resist?ncia de 44 amostras de Salmonella Typhi aos principais antimicrobianos utilizados no tratamento da febre tifoide. Das 44 amostras isoladas no per?odo de 2003 a 2005, dez (22,7%) foram resistentes a pelo menos um antimicrobiano. Dentre as dez amostras de Salmonella Typhi resistentes, observou-se que nove apresentaram monorresist?ncia ? nitrofuranto?na ou ? tetraciclina. Apenas um caso de resist?ncia concomitante a duas drogas (cloranfenicol e nitrofuranto?na) foi observado no ano de 2005. A Regi?o Norte, por ser considerada ?rea end?mica para febre tifoide e ter apresentado resist?ncia crescente em rela??o aos tr?s anos em estudo, deve permanecer com o monitoramento da resist?ncia 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 Regi?o, al?m 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%) 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.

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. Laborat?rio de Geoprocessamento. Ananindeua, PA, Brasil. Secretaria de Estado de Sa?de P?blica do Par?. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Universidade do Estado do Par?. Bel?m, PA, Brasil. Universidade Federal do Par?. Bel?m, PA, Brasil. Universidade Estadual de Feira de Santana. Feira de Santana, BA, Brasil. Secretaria Municipal de Sa?de. Ponta de Pedras, PA, Brasil. Secretaria Municipal de Sa?de. Ponta de Pedras, PA, Brasil. Universidade do Estado do Par?. 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. Introdu??o: Em maio de 2013, o Instituto Evandro Chagas confirmou o diagn?stico de toxoplasmose aguda em cinco indiv?duos que apresentaram quadro febril linfadenop?tico, todos procedentes do Munic?pio de Ponta de Pedras, Estado do Par?, onde havia tamb?m outros casos similares, de acordo com a Secretaria Municipal de Sa?de. Diante disso, suspeitou-se da ocorr?ncia de um surto de toxoplasmose e, assim, uma investiga??o foi conduzida para identificar e caracterizar o referido evento. Objetivo: Descrever as caracter?sticas cl?nicas, laboratoriais e epidemiol?gicas de um surto de toxoplasmose aguda ocorrido no Munic?pio de Ponta de Pedras. Materiais e M?todos: Um total de 270 indiv?duos, sintom?ticos ou n?o, foram submetidos ?s an?lises cl?nica e sorol?gica pelo ensaio imunoenzim?tico para detectar IgG e IgM anti-Toxoplasma gondii. Para confirma??o dos casos com perfil sugestivo de infec??o aguda (IgG+/IgM+), foi determinado o ?ndice de avidez de IgG pelo ensaio imunofluorim?trico. Por meio de question?rio padronizado individual, foram obtidas informa??es sociodemogr?ficas, comportamentais e sobre h?bitos alimentares. Foi realizado mapeamento geogr?fico dos casos identificados, os quais foram analisados conjuntamente com alguns par?metros epidemiol?gicos por m?todos de geoestat?stica. Resultados: Durante a investiga??o, foram confirmados 73 casos com perfil cl?nico e laboratorial compat?vel com toxoplasmose aguda. Foi observada correla??o espacial dos casos apenas com o consumo de suco de a?a?, comercializado em tr?s principais pontos de venda do produto, durante o surto. Conclus?o: Os dados cl?nicos, laboratoriais e epidemiol?gicos demonstraram que o surto de doen?a aguda verificada em Ponta de Pedras foi causado pelo T. gondii. As evid?ncias sugerem que a origem do mesmo foi alimentar, sendo o consumo de suco de a?a?, provavelmente contaminado com oocistos do parasito, a fonte de contamina??o. Introduction: In May 2013, Instituto Evandro Chagas confirmed the diagnosis of acute toxoplasmosis in five individuals with a clinical presentation of lymphadenopathy and fever. They were all from the Municipality of Ponta de Pedras, Par? State, Brazil, where other similar cases were noted by Municipal Health Secretariat. An outbreak of toxoplasmosis was suspected and an investigation was conducted. Objective: To describe the clinical, laboratory, and epidemiological characteristics of an acute toxoplasmosis outbreak in Ponta de Pedras. Materials and Methods: A total of 270 individuals, symptomatic or not, were clinically examined and had their samples analyzed using enzyme-linked immunosorbent assay to detect IgG and IgM anti-Toxoplasma gondii. To confirm cases suggestive of acute infection (IgG+/IgM+), the IgG avidity index was determined by immunofluorometric assay. Information on socio-demographic aspects, behavior, and eating habits was obtained using a questionnaire. Identified cases were geographically mapped, and the resultant data were analyzed together with epidemiological parameters using geo-statistic methods. Results: During the investigation, 73 cases of acute toxoplasmosis were identified. Spatial correlation of cases was observed only with the consumption of a?a? juice, sold in three places during the outbreak. Conclusion: The outbreak of acute disease in Ponta de Pedras was caused by T. gondii. The evidence suggests that the origin was a?a? juice, probably contaminated with oocysts of the parasite.

Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Centro Universit?rio Augusto Motta. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto Nacional de Infectologia. Rio de Janeiro, RJ, 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. No ?mbito da promo??o da sa?de, a epidemiologia exerce importante papel ao se preocupar n?o apenas com o controle de doen?as e de seus vetores, mas, sobretudo, com a melhoria da sa?de da popula??o. Os estudos que privilegiam tem?ticas da sa?de p?blica, em geral, est?o frequentemente interessados em investigar o modo pelo qual as condi??es sociais influenciam e determinam o processo sa?de-doen?a das popula??es, o que tem gerado uma forte articula??o entre a epidemiologia e as ci?ncias sociais. ? assim que se constr?i um ramo epidemiol?gico denominado por alguns estudiosos como epidemiologia social. A epidemiologia social tem como foco principal o estudo do modo pelo qual a sociedade e os diferentes modos de organiza??o social influenciam a sa?de e o bem-estar dos indiv?duos e dos grupos sociais, possibilitando a incorpora??o de suas experi?ncias societ?rias, para a melhor compreens?o de como, onde e porque se d?o as desigualdades na sa?de. O presente artigo de revis?o realiza uma discuss?o que pretende indicar as contribui??es que a abordagem da epidemiologia social pode trazer para os estudos realizados pela pesquisa cl?nica em doen?as infecciosas, de modo a se desenvolver um olhar mais amplo sobre o paciente em conjunto com o seu sistema de rela??es e de produ??o do adoecimento e da recupera??o da sa?de. In the context of health promotion, epidemiology plays an important role. It emphasizes not only on control of diseases and their vectors, but also on improving the health of the population. Researches that focus on the themes of public health in general are frequently interested in investigating how social conditions affect and determine the population's health-disease process. This has generated a strong articulation between epidemiology and social sciences, emerging an epidemiological branch named by some scholars as social epidemiology. The focus of social epidemiology is studying how society and the different modes of social organization influence the health and well-being of individuals and social groups, enabling the incorporation of the social experiences to better understand how, where, and why health inequalities occur. This review article discusses and demonstrates the contributions of social epidemiology studies in clinical research studies on infectious diseases in order to develop a broader viewpoint of patients in conjunction with their system of relations and with illness production and health recovery.

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. 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 / 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 / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Este ? um estudo do tipo transversal, em que o crit?rio cl?nico para inclus?o das amostras foi a suspeita cl?nica e/ou aparecimento dos sintomas da varicela ou herpes-zoster para identifica??o dos gen?tipos do v?rus da varicela-zoster (VVZ), por meio das t?cnicas de rea??o em cadeia da polimerase (PCR) e sequenciamento, com posterior pesquisa de polimorfismo de nucleot?deo ?nico (SNP). De novembro de 2008 a mar?o de 2012, foram coletadas 93 amostras (85 casos de varicela e oito de herpes-zoster) de swab nasal, oral e de secre??o de ves?culas rompidas em v?rios s?tios anat?micos (49 de indiv?duos do sexo masculino e 44 do feminino). As estirpes Dumas e Oka parental foram inclu?das como refer?ncia padr?o dos gen?tipos europeu (classe 1 ou 3) e japon?s (classe 2), respectivamente. Estirpes com variabilidade no SNP foram classificadas dentro de um grupo de gen?tipo denominado mosaico (classe 5). As classes 1 ou 3 foram identificadas em 11 amostras do VVZ, nove casos de varicela e dois casos de herpes-zoster, enquanto que duas amostras apresentaram o gen?tipo de classe 5, ambos casos de varicela. O gen?tipo classe 1 ou 3 foi encontrado nos Munic?pios de Ananindeua, Bel?m e Marituba, Estado do Par?, Brasil, sendo que o gen?tipo classe 5 apenas em Ananindeua. A PCR foi sens?vel em 13 amostras de material direto de ves?culas, enquanto que em amostras de saliva n?o se obteve sucesso. This is a cross-sectional study in which the clinical criteria for inclusion of the samples was the clinical suspicion and/or onset of symptoms of chickenpox or shingles in order to genotype varicella-zoster virus (VZV) by the polymerase chain reaction (PCR) and sequencing techniques, with a search of single nucleotide polymorphisms (SNP) subsequently. From November 2008 to March 2012, 93 samples (85 cases of varicella and eight herpes zoster) were collected from oral, nasal swab and secretion of ruptured vesicles in several anatomical sites (49 male and 44 female). Dumas and Oka parental strains were included as European genotypes of the reference standard (class 1 or 3) and Japanese (class 2) genotypes, respectively. Strains with the SNP variability were classified into a group of genotype describe as Mosaic (class 5). Classes 1 or 3 were identified in 11 samples of VZV, nine cases of varicella and two cases of herpes zoster, while two samples showed the class genotype 5, both cases of varicella. The genotype class 1 or 3 was found in the Municipalities of Ananindeua, Bel?m and Marituba, Par? State, Brazil, and genotype class 5 only in Ananindeua. PCR was sensitive in just 13 samples of direct vesicles material, but in saliva samples there were not positive results.

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. Paciente com queixa principal de tosse produtiva cr?nica com tr?s meses de dura??o e expectora??o de muco purulento, perda de peso, falta de apetite, dispneia, dor na regi?o tor?cica e cansa?o, sendo ainda observados sintomas cl?nicos de hansen?ase, ?ndice bacilosc?pico da linfa de 4,25 e t?tulos de IgM anti-PGL-I positivos. Do escarro, pelo m?todo de Ziehl-Neelsen, foram observados bacilos isolados e globias, com aus?ncia de crescimento em L?wenstein-Jensen. Foi demonstrada amplifica??o do DNA de Mycobacterium leprae nas amostras de escarro e secre??o nasal. Assim, ilustramos um caso sintom?tico de tuberculose e hansen?ase, mas somente com hansen?ase multibacilar, podendo ter ocorrido dissemina??o do M. leprae para os pulm?es por contiguidade, uma vez que o bacilo ? encontrado rotineiramente na nasofaringe. Patient with main complaints of chronic productive cough lasted three months and expectoration of purulent sputum, weight loss, loss of appetite, dyspnea, pain in the thoracic region and tiredness, clinical symptoms of leprosy, lymph index of 4.25 and positive IgM anti-PGL-I titers. Of the sputum, by using the Ziehl-Neelsen method, isolated bacilli and in groups with lack of growth in L?wenstein-Jensen were observed. It was shown DNA amplification of Mycobacterium leprae in the sputum samples and nasal secretion. It is demonstrated a symptomatic case of tuberculosis and leprosy, but only in multibacillary leprosy, so the dissemination by contiguity of M. leprae to the lungs can occur, once bacillus is frequently found in the nasopharynx.

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. Na Amaz?nia brasileira n?o ? incomum o achado de ?reas com interse??o de ocorr?ncia de diversas doen?as tropicais, entre estas s?o destaque a doen?a de Chagas aguda e a leishmaniose visceral (LV), em especial pelas mudan?as na epidemiologia desses agravos nos ?ltimos anos. Os achados cl?nicos s?o por vezes tamb?m comuns em alguns casos, e os testes sorol?gicos podem apresentar rea??es cruzadas entre essas doen?as. O objetivo deste relato de caso ? ressaltar a import?ncia da avalia??o cl?nica criteriosa para uma interpreta??o correta dos testes sorol?gicos. ? apresentado um caso com s?ndrome febril com dois meses de evolu??o, associada ? s?ndrome consumptiva e hepatoesplenomegalia, em que o primeiro teste diagn?stico para doen?a de Chagas aguda, utilizando o m?todo de imunofluoresc?ncia indireta, foi positivo para IgM e IgG. Tamb?m obteve-se o mesmo resultado com o teste de hemaglutina??o indireta. O teste sorol?gico para LV mostrou-se igualmente positivo, com elevada titula??o para IgG (1:2560). Os demais achados cl?nicos, como hepatoesplenomegalia e pancitopenia, ajudaram na elucida??o do diagn?stico de LV. A resposta terap?utica efetiva ao tratamento espec?fico para LV com antimoniais foi uma evid?ncia final para o diagn?stico da doen?a nesse caso. ? enfatizada a necessidadede uma avalia??o cl?nica bastante criteriosa para a interpreta??o adequada dos testes sorol?gicos e tamb?m o desenvolvimento de testes com maior especificidade ? destacado em um contexto de ocorr?ncia simult?nea desses agravos, como o que ocorre na Regi?o Amaz?nica. In the Brazilian Amazon is not uncommon to find areas with intersecting occurrence of several tropical diseases, among these acute Chagas disease and visceral leishmaniasis (VL) are highlighted, particularly by changes in the epidemiology of these diseases in recent years. Clinical findings are also common in some cases and serological tests can present cross-reactivity between those diseases. The objective of this case report is to highlight the importance of careful clinical evaluation in order to obtain a correct interpretation of serological tests. A case with febrile syndrome with two months of evolution was presented, associated with wasting syndrome and hepatosplenomegaly, where the first diagnostic test for acute Chagas disease, using the indirect immunofluorescence method, was positive for IgM and IgG. It was obtained the same result with the hemagglutination test. Serological tests for VL was equally positive, with high titer IgG (1:2560). Other clinical findings such as hepatosplenomegaly and pancytopenia helped to elucidate the diagnosis of VL. The effective therapeutic response to the treatment with antimonial for VL was a final evidence for the diagnosis in this case. It is emphasized the necessity of a careful clinical evaluation for the proper interpretation of serological tests and also the development of more specific tests that is highlighted in a context of simultaneous occurrence of these health problems as occur in the Amazon region.

Se evaluo la inocuidad, inmunogenicidad y eficacia de una vacuna tetravalente obtenida por recombinacion genetica de rotavirus aislados de monos rhesus y seres humanos (RRV-TV) (4 x 10(4) unidades formadoras de placas por dosis) en un ensayo prospectivo, aleatorio, a doble ciego y controlado con placebo que se efectuo con 540 lactantes brasilenos. Se administraron dosis de vacuna o de placebo a la edad de 1, 3 y 5 meses. No se observaron diferencias significativas en la frecuencia de diarrea o vomito en los bebes de ninguno de los dos grupos despues de administrar la dosis correspondiente. De 2 a 3% de los vacunados tuvieron fiebre baja los dias tercero a quinto despues de recibir la primera dosis, pero no despues de las dosis segunda o tercera. Se observo una respuesta de anticuerpos del tipo IgA al rotavirus aislado de monos rhesus (RRV) en 58% de los vacunados y en 33% de quienes recibieron placebo. La respuesta de anticuerpos neutralizantes a cada serotipo no paso de 20% cuando se determino con la prueba de reduccion de focos de fluorescencia, pero fue superior a 40% al medirse con la prueba de neutralizacion a base de reduccion de placas. Se presentaron 91 casos de diarrea causada por rotavirus entre los ninos que recibieron las tres dosis (de vacuna o de placebo) durante un seguimiento de 2 anos, 36 de ellos en los ninos vacunados. La eficacia general de la vacuna fue de 8% (P = 0,005) contra toda clase de diarrea y de 35% (P = 0,03) contra la diarrea causada por rotavirus. La proteccion durante el primer ano de seguimiento, cuando predomino el rotavirus G del serotipo 1, fue de 57% (P = 0,008), pero se redujo a 12% en el segundo ano. Se obtuvieron resultados similares al restringir el analisis a episodios en que el rotavirus fue el unico agente patogeno identificado. Se observo en la vacuna una mayor tendencia a proteger contra casos de enfermedad con un promedio de seis o mas deposiciones diarias. Estos resultados son lo suficientemente alentadores para justificar que en paises en desarrollo se hagan otros estudios de esta vacuna con una dosis mayor para tratar de mejorar su inmunogenicidad y eficacia.

Faecal samples were obtained from 190 children, aged 0 to 5 years, admitted to a public hospital in Belém, Pará, Brazil. These patients were placed in a pediatric ward with 40 beds distributed in six rooms. Case were classified into three groups: (a) nosocomial: children who developed gastroenteritis 72 hr or later after admission; (b) community-acquired: patients admitted either with diarrhoea or who had diarrhoea within 72 hr following admission; (c) non-diarrhoeic: those children who had no diarrhoea three days before and three days after collection of formed faecal sample. Specimens were routinely processed for the presence of rotaviruses, bacteria and parasites. Rotaviruses were detected through enzyme-linked immunosorbent assay (ELISA) and subsequently serotyped/electrophoretyped. Rotaviruses were the most prevalent enteropathogens among nosocomial cases, accounting for 39 % (9/23) of diarrhoeal episodes; on the other hand, rotaviruses ocurred in 8.3 % (11/133) and 9 % (3/34) of community-acquired and non-diarrhoeic categories, respectively. Mixed infections involving rotavirus and Giardia intestinalis and rotavirus plus G. intestinalis and Entamoeba histolytica were detected in frequencies of 8.6 and 4.3 %, respectively, in the nosocomial group. The absence of bacterial pathogens in this category, and the unusual low prevalence of these agents in the other two groups may reflect the early and routine administration of antibiotics following admission to this hospital. Rotavirus serotype 2 prevailed over the other types, accounting for 77.8 % of isolates from nosocomial diarrhoeal episodes. In addition, at least five different genomic profiles could be observed, of which one displayed an unusual five-segment first RNA cluster. Dehydration was recorded in all cases of hospital-acquired, rotavirus-associated diarrhoea, whereas in only 57 % of nosocomial cases of other aetiology. It was also noted that nosocomial, rotavirus-associated diarrhoeal episodes occur earlier (7 days), following admission, if compared with those hospital-acquired cases of other aetiology (14 days).

Secretaria de Estado de Sa?de P?blica do Par?. Divis?o de Vigil?ncia em Sa?de. Departamento de Controle de Doen?as Transmitidas por Vetores. Bel?m, PA, Brasil. Secretaria de Estado de Sa?de P?blica do Par?. Divis?o de Vigil?ncia em Sa?de. Departamento de Controle de Doen?as Transmitidas por Vetores. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Centro Universit?rio do Par?. Bel?m, PA, Brasil. Centro Universit?rio do Par?. Bel?m, PA, Brasil. Sistema de Prote??o da Amaz?nia. Divis?o de Prote??o Ambiental. Bel?m, PA, Brasil. Instituto de Estudos Superiores da Amaz?nia. Bel?m, PA, Brasil. Sistema de Prote??o da Amaz?nia. Coordena??o de Opera??es de Centro Regional de Bel?m. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. INTRODUCTION: Leptospirosis is a major health problem, which is responsible for severe financial and social impacts worldwide. Its occurrence is directly related to areas with precarious sanitary conditions, especially the ones located in the suburbs. This work assessed the frequency of cases of leptospirosis and pointed out its risk areas in the Municipality of Bel?m, Par? State, Brazil. METHODS: An epidemiologic study on human leptospirosis was carried out in Bel?m between 2006 and 2011, based on data about confirmed cases provided by the Information System on Diseases of Compulsory Declaration (Sistema de Informa??o de Agravos de Notifica??o ? SINAN) of the Par? State Secretary of Health. RESULTS: Approximately 40% of the confirmed cases were concentrated in three districts with poor sanitary infrastructure. Although the lethality rates remained high, a reduction trend in the incidence historical series was observed. The age group between 15 and 39 years accounted for 53.7% of the cases reported, and individuals older than 40 years showed the highest lethality rate (19.8%, p = 0.0004). Previous contact with contaminated water and mud was the main risk factor for 48.1% of the cases, and the domestic environment was the most probable locus of infection for 45.1%. Guam? district presented the highest density of cases, and the northernmost part of the Municipality was considered a potential risk area for the establishment of leptospirosis. CONCLUSION: This study outlined the high-risk areas for the occurrence of leptospirosis in the Municipality of Bel?m. It also determined the predictive factors of severity of the disease and the social losses due to its mortality. INTRODU??O: A leptospirose ? um problema de sa?de p?blica de interesse mundial, que tem elevados impactos econ?micos e sociais. A doen?a est? relacionada a ?reas com prec?rias condi??es sanit?rias, atingindo principalmente as periferias urbanas. No presente estudo descreveu-se a frequ?ncia de casos de leptospirose, indicando ?reas de risco para sua ocorr?ncia no Munic?pio de Bel?m, Estado do Par?, Brasil. METODOLOGIA: Foi realizado um estudo epidemiol?gico da leptospirose humana em Bel?m no per?odo de 2006 a 2011, utilizando como base de dados os registros de casos confirmados constantes no Sistema de Informa??o de Agravos de Notifica??o (SINAN) da Secretaria de Estado de Sa?de P?blica do Estado do Par?. RESULTADOS: Cerca de 40% dos casos estavam concentrados em tr?s bairros, todos com infraestrutura de saneamento b?sico deficiente. Observou-se uma tend?ncia de redu??o da incid?ncia na s?rie hist?rica, apesar das taxas de letalidade ainda se manterem elevadas. A faixa et?ria de 15 a 39 anos concentrou 53,7% dos registros, com maior letalidade para indiv?duos acima de 40 anos (19,8%, p = 0,0004). Em 48,1% deles a principal situa??o de risco associada ao adoecimento foi o contato pr?vio com ?gua ou lama, e 45,1% tiveram o ambiente domiciliar como prov?vel local de infec??o. O bairro do Guam? apresentou a maior densidade de casos, sendo o extremo norte continental do Munic?pio sugerido como ?rea de risco potencial para o estabelecimento da leptospirose. CONCLUS?O: O presente estudo permitiu o delineamento de ?reas de maior risco para ocorr?ncia de casos, determina??o de preditores de severidade, assim como as perdas sociais resultantes dos ?bitos.

Background Childhood pneumonia and bronchiolitis is a leading cause of illness and death in young children worldwide with Respiratory Syncytial Virus (RSV) as the main viral cause. RSV has been associated with annual respiratory disease outbreaks and bacterial co-infection has also been reported. This study is the first RSV epidemiological study in young children hospitalized with community-acquired pneumonia (CAP) in Belém city, Pará (Northern Brazil). Methods With the objective of determining the prevalence of RSV infection and evaluating the patients’ clinical and epidemiological features, we conducted a prospective study across eight hospitals from November 2006 to October 2007. In this study, 1,050 nasopharyngeal aspirate samples were obtained from hospitalized children up to the age of three years with CAP, and tested for RSV antigen by direct immunofluorescence assay and by Reverse Transcription Polymerase Chain Reaction (RT-PCR) for RSV Group identification. Results RSV infection was detected in 243 (23.1%) children. The mean age of the RSV-positive group was lower than the RSV-negative group (12.1 months vs 15.5 months, pppppp Conclusion The present study highlights the relevance of RSV infection in hospitalized cases of CAP in our region; our findings warrant the conduct of further investigations which can help design strategies for controlling the disease.

Centro Universit?rio do Par?. Curso de P?s-Gradua??o em An?lises Cl?nicas. Bel?m, PA, Brasil / Laborat?rio de Patologia Cl?nica e Laboratorial Dr. Paulo Azevedo. Bel?m, PA, Brasil. Universidade Federal do Par?. Departamento de Medicina. Bel?m, PA, Brasil. Centro Universit?rio do Par?. Curso de P?s-Gradua??o em An?lises Cl?nicas. Bel?m, PA, Brasil. Laborat?rio de Patologia Cl?nica e Laboratorial Dr. Paulo Azevedo. Bel?m, PA, Brasil. Laborat?rio de Patologia Cl?nica e Laboratorial Dr. Paulo Azevedo. Bel?m, PA, Brasil. Centro Universit?rio do Par?. Curso de P?s-Gradua??o em An?lises Cl?nicas. 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. 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. A Serratia marcescens tem sido relatada como importante agente de infec??es relacionadas ? sa?de, destacando-se por apresentar elevado n?vel de resist?ncia intr?nseca aos antimicrobianos usados em neonatologia, al?m de persistir por longos per?odos no ambiente hospitalar. Neste trabalho foram avaliadas, por m?todos fenot?picos e moleculares, S. marcescens recuperadas a partir de coloniza??o do trato gastrointestinal ou sepse tardia em neonatos internados em Unidade Neonatal em Bel?m. A identifica??o das S. marcescens e o teste de sensibilidade foram realizados por meio de sistema automatizado Vitek (BioM?rieux); a suscetibilidade ao ertapenem foi avaliada com aux?lio de disco contendo 10 ?g 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 vigil?ncia (swab retal); todas apresentaram resist?ncia a: ampicilina, ampicilina-sulbactam, gentamicina e cefalotina. N?o foi observada resist?ncia a: ciprofloxacina, imipenem, meropenem e ertapenem. Quanto aos demais antibi?ticos avaliados, o perfil de suscetibilidade foi vari?vel. Foram obtidos 11 padr?es de amplifica??o por ERIC-PCR, dois foram compartilhados por 14 isolados. Foi poss?vel observar um padr?o polim?rfico caracter?stico para as cepas provenientes de coloniza??o gastrointestinal, exceto em dois casos, que apresentaram padr?es genot?picos relacionadas a casos de sepse. Os dados obtidos neste trabalho confirmam o elevado ?ndice de resist?ncia da S. marcescens aos antimicrobianos; no entanto, todos os isolados apresentaram sensibilidade ? ciprofloxacina e aos carbapen?micos. A tipagem por meio de antibiograma e ERIC-PCR sugere dispers?o de clones associados ? coloniza??o 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 Bel?m. The identification of S. marcescens and the sensitivity test was carried out using a Vitek (BioM?rieux) 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, ampicillinsulbactam, gentamicin and cephalothin. There were no indications of resistance to ciprofloxacin, imipenem, meropenem or 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.

Alcoa/Omnia S.A.; CNPq- 403323.2005.3 e IEC/SVS/MS Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Bel?m, PA, Brasil. Com o intuito de determinar a frequ?ncia de bact?rias enteropatog?nicas e enteroparasitas em pacientes com diarreia aguda no Munic?pio de Juruti, Par?, o qual passa por intenso processo imigrat?rio face o grande projeto de explora??o mineral, avaliaram-se 263 casos de diarreia aguda, dos quais 19% foram atribu?dos a bact?rias enteropatog?nicas, destacando-se a Shigella spp, que representou 13,7%. Salmonella spp, Aeromonas spp e Plesiomonas shigelloides tamb?m foram detectados. Os sorotipos de Shigella mais frequentemente encontrados foram S. flexneri (61,1%) e S. sonnei (38,9%). Entre as Salmonella, identificaram-se os seguintes sorotipos: S. Panama (2), S. Newport (2), S. Bredeney, S. Saintpaul e S. Gaminara. A infec??o pelos protozo?rios alcan?ou 85,3% tendo como principais respons?veis, por ordem de frequ?ncia, Blastocystis hominis (37,3%), Entamoeba histolytica/E. dispar (22,8%), Endolimax nana (16,7%), Entamoeba coli (9,5%) e Giardia lamblia (8,4%). Esses resultados fornecem valiosos subs?dios ? vigil?ncia epidemiol?gica e ambiental, demonstrando as condi??es insatisfat?rias de saneamento b?sico em que vive a popula??o do Munic?pio. With the aim of determining the frequency rate of enteropathogenic bacteria and enteroparasites in patients with acute diarrhea in the Municipality of Juruti, Par? 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% of those cases were related to enteropathogenic bacteria, particularly Shigella spp. that accounted for 13.7% of the cases. Salmonella spp, Aeromonas spp and Plesiomonas shigeloide were also detected. The most frequent Shigella serotypes found were S. flexneri (61.1%) and S. sonnei (38.9%). 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%, mostly due to Blastocystis hominis (37.3%), Entamoeba histolytica/E. dispar (22.8%), Endolimax nana (16.7%), Entamoeba coli (9.5%) and Giardia lamblia (8.4%). These results provide valuable data to epidemiological and environmental surveillance because it presents the unsatisfactory basic sanitary conditions of the local 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. Minist?rio da Sa?de. Funda??o Oswaldo Cruz. Instituto Oswaldo Cruz. Laborat?rio de Enterobact?rias. Rio de Janeiro, RJ, Brasil. Minist?rio da Sa?de. Funda??o Oswaldo Cruz. Instituto Oswaldo Cruz. Laborat?rio de Enterobact?rias. Rio de Janeiro, RJ, Brasil. Minist?rio da Sa?de. Funda??o Oswaldo Cruz. Instituto Oswaldo Cruz. Laborat?rio de Enterobact?rias. Rio de Janeiro, RJ, Brasil. A salmonelose ? de distribui??o cosmopolita, acometendo todas as faixas et?rias, tanto nos pa?ses desenvolvidos, como naqueles em desenvolvimento. Este estudo tem como objetivo identificar os sorovares de Salmonella isolados de casos de infec??o humana ocorridos em 43 munic?pios do Estado do Par? no per?odo de 1991 a 2008. Foram utilizadas 890 amostras de Salmonella em coproculturas e hemoculturas, a? inclu?dos 55 isolamentos de S. Typhi nas fezes e sangue, simultaneamente, de indiv?duos sintom?ticos. Os casos de infec??o por Salmonella foram distribu?dos em 13 sorogrupos, com destaque para o grupo O:9 (68,1%). Foram identificados 47 sorovares de Salmonella, destacando-se S. Typhi (58,9%), S. Enteritidis (5,4%) e S. Saintpaul (2,5%). Ressalta-se a maior preval?ncia de S. Typhi (58,9%) dentre os 47 sorovares identificados, o que demonstra que a febre tif?ide representa um s?rio problema de sa?de p?blica na Regi?o Norte do Pa?s, e que necessita de maior aten??o dos servi?os de sa?de quanto ? vigil?ncia epidemiol?gica e ambiental, assim como medidas efetivas para a preven??o 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 Par? 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%), and 47 serovars of Salmonella were identified, including S. Typhi (58.9%), S. Enteritidis (5.4%) and S. Saintpaul (2.5%). S. Typhi was the most prevalent (58.9%) 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.

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% a 100%. 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% to 100%. 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.

Helminths, particularly some Schistosoma species, have been associated with cancer in humans. Neurocysticercosis, produced by cysticerci of the helminth Taenia solium, has been associated with the emergence of brain tumours and haematological malignancies. Local tumours, such as glioblastoma, could be explained by the induction of DNA damage in cells surrounding the cysticercus and chronically exposed to an inflammatory host response. However, systemic effects such as haematological malignancies are not easy to understand. The present work was conducted in Mexico to find out whether DNA damage arises in peripheral lymphocytes in patients with neurocysticercosis. We utilized a highly sensitive technique to analyse chromosomal aberrations, in-situ hybridization with probes against chromosomes 1, 2 and 4, and in addition the blocked-cytokinesis technique was used to determine the formation of micronuclei, a peculiar form of DNA damage. The study was made in lymphocytes from 8 patients before and after the administration of praziquantel, 1 of the 2 drugs used for neurocysticercosis treatment. The frequencies of chromosome aberrations and micronuclei in peripheral blood lymphocytes were higher in the infected patients as compared to those observed both in healthy donors and in the group of patients after praziquantel therapy. Our results suggest that chromosome aberrations induced in peripheral cells during neurocysticercosis could be associated with the development of haematological neoplasias.

From November 1992 to November 1994 stool samples were obtained from 237 children admitted to a public hospital in Belem. Rotaviruses were detected in 19.3 per cent (60/310) of faecal samples. of these, 32.1 per cent (18/56), 20.9 per cent (38/181), and 5.4 per cent (4/73) were recorded in cases of nosocomial diarrhoea, community-acquired diarrhoea, and controls, respectively. Fifty-two (86.7 per cent) of the 60 rotavirus-positive specimens were subgrouped and the G serotypes of 55 (91.7 per cent) of them were determined. Subgroups I and II were detected in 50 per cent each of the 52 subgrouped strains. G type 2 was present in 46 (83.6 per cent) of the 55 serotyped samples; serotypes G1 and (mixed) G1 and G4 were found in 14.5 per cent and 1.8 per cent, respectively, of these specimens. Viral RNA electrophoresis showed 14 distinct patterns, including 56.7 per cent (34/60) and 43.3 per cent (26/60) of long and short profiles, respectively. in 40 (66.6 per cent) of the 60 rotavirus-positive faecal samples no enteropathogens other than rotavirus were detected. There was an increased incidence of rotavirus infection from July 1993 to February 1994, the rotavirus-related episodes of diarrhoea were more severe than those of other aetiology and greater clinical severity was not related to a specific G type, subgroup, or electrophoretype. Inst Evandro Chagas, Fundacao Nacl Saude, BR-66090000 Belem, Para, Brazil Universidade Federal de São Paulo, Escola Paulista Med, BR-04039031 São Paulo, Brazil Universidade Federal de São Paulo, Escola Paulista Med, BR-04039031 São Paulo, Brazil Web of Science