Abstract INTRODUCTION Brazilian spotted fever is an infectious disease with a high mortality rate if not treated early. Differential diagnosis is difficult, as the first clinical signs are non-specific and can be confused with other diseases. The aim of the study was to investigate evidence of infection with Rickettsia rickettsii and Rickettsia parkeri in negative sera samples, collected in 2014, from patients with suspected leptospirosis, dengue fever, and meningococcal disease in Atibaia and Bragança Paulista municipalities of the State of São Paulo. METHODS The samples stored at the Institute Adolfo Lutz in Campinas were tested using an indirect immunofluorescence assay (IFA) with IgG and IgM against R. rickettsii and R. parkeri. Real-time polymerase chain reaction (PCR) testing was performed for the sera samples of patients who died (n = 3), those with initial suspicion of meningococcal disease (n = 6), and those with positive IFA results. RESULTS Of 258 samples from Bragança Paulista, 4 (1.6%) were positive, with IgG titers of 1:64 and 1:128 against R. rickettsii and R. parkeri, respectively. Of 155 samples from Atibaia, 2 (1.3%) were positive, with IgG titers of 1:64 and 1:128 against R. rickettsii and R. parkeri, respectively. No sample showed positive PCR results. CONCLUSIONS This serological investigation suggests there is evidence of exposure to Rickettsia spp. in residents of areas that have environmental conditions favorable to the spread of bacteria, in which Brazilian spotted fever incidence was not previously confirmed.

OBJETIVO: Analisar a relação entre o grau de obesidade ou sobrepeso medido pelo índice de massa corpórea (IMC) de crianças e adolescentes asmáticos com a gravidade clínica e funcional da doença e com a intensidade do broncoespasmo induzido pelo exercício (BIE). MÉTODOS: 20 pacientes com idade entre seis e 18 anos, asma persistente e sobrepeso ou obesidade foram submetidos ao teste padronizado com exercício em bicicleta ergométrica e avaliação seriada dos parâmetros espirométricos, realizada aos 3, 6, 10, 15, 20 e 30 minutos após o exercício. BIE foi definido como a queda do volume expiratório forçado no primeiro segundo (VEF1) >10% e/ou do fluxo médio expiratório forçado medido entre 25 e 75% da capacidade vital forçada (FEF25-75%) >26% em relação aos valores pré-teste. Foram avaliadas as freqüências de positividade do teste e as maiores quedas de VEF1 e FEF25-75% após o término do exercício. RESULTADOS: A gravidade clínica da asma foi considerada leve, moderada e grave em dez, cinco e cinco pacientes, respectivamente. Houve BIE em 50% dos pacientes testados. Não houve correlação significativa entre os seguintes parâmetros confrontados: valores de IMC e valores basais do VEF1 e FEF25-75% percentuais em relação ao previsto; valores do IMC e as maiores quedas do VEF1 e do FEF25-75% em relação aos valores basais; valores do IMC e gravidade da asma. A melhor correlação ocorreu entre o IMC e as maiores quedas do FEF25-75% em relação ao basal. CONCLUSÕES: O IMC não teve influência no grau de hiperresponsividade brônquica induzida pelo exercício em crianças asmáticas com sobrepeso e obesas e na gravidade da obstrução basal medida pelo VEF1 e FEF25-75%.

OBJECTIVE: To analyze the association between the degree of obesity or overweight measured by the body mass index (BMI) in children and adolescents with asthma and the clinical and functional severity of the disease and the intensity of exercise-induced bronchospasm (EIB). METHODS: 20 patients (age range: 6-18 years) with persistent asthma, with overweight or obesity, were submitted to a standardized exercise test on an ergometric bicycle, followed by serial evaluations of spirometric parameters performed at 3, 6, 10, 15, 20 and 30 minutes after the exercise. EIB was defined as a decrease in FEV1>10% and/or FEF25-75% >26% when compared to pre-test values. The positivity of the test was evaluated as the highest decreases in FEV1 and FEF25-75% after the end of the exercise. RESULTS: Asthma severity was considered mild, moderate and severe in ten, five and five patients, respectively. EIB was observed in 50% of the studied children. There was no significant correlation among the following parameters: BMI and basal FEV1 and FEF25-75% in relation to the predicted value; BMI and the highest decrease in FEV1 and FEF25-75% in relation to the basal levels; BMI and asthma severity. The best correlation was obtained between BMI and the highest decreases in FEF25-75% in relation to basal levels. CONCLUSIONS: The BMI did not influence the degree of exercise-induced bronchial hyperresponsiveness in overweight and obese children and adolescents with asthma as well as the degree of basal obstruction measured by FEV1 and FEF25-75%.