Scielo RSS <![CDATA[Revista do Instituto de Medicina Tropical de São Paulo]]> http://www.scielo.br/rss.php?pid=0036-466520190050&lang=en vol. 61 num. lang. en <![CDATA[SciELO Logo]]> http://www.scielo.br/img/en/fbpelogp.gif http://www.scielo.br <![CDATA[Safety assessment of seasonal trivalent influenza vaccine produced by Instituto Butantan from 2013 to 2017]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652019005000400&lng=en&nrm=iso&tlng=en ABSTRACT Vaccination has been a successful strategy in influenza prevention. However, despite the safety and efficacy of the vaccines, they can cause adverse events following immunization (AEFI). Moreover, due to the vaccination success, most of vaccine-preventable diseases (VPD) have become rare, and public attention has been shifted from VPD to the AEFI associated with vaccination. This manuscript describes the safety of Instituto Butantan (IB) seasonal trivalent influenza vaccine (TIV) from 2013 to 2017. AEFI data were received by the Department of Pharmacovigilance of IB (PV-IB), from January the 1st 2013 to December the 31st 2017, and were recorded in an electronic database (OpenClinica©). PV-IB received 1,415 Individual Case Safety Reports (ICSR) associated with the TIV; 1,253 ICSR with at least one AEFI were analyzed and 4,140 AEFI were identified. The other 162 (11.4%) cases did not present any symptom. Among the total of AEFI, 405 (9.8%) were classified as serious. AEFI with the highest incidence rates per 100,000 doses of TIV were: “local pain” (0.28), “local erythema” (0.23), “local warmth” (0.22), “local swelling” (0.20) and “fever” (0.19). PV-IB received 175 (4.2%) occurrences of SAE of special interest, of which 75 (1.8%) anaphylaxis/anaphylactic reactions, 56 (1.4%) neurological syndromes (including seven Guillain-Barré Syndrome) and 44 (1.1%) convulsion/febrile convulsion. The results of this manuscript suggested that Instituto Butantan trivalent influenza vaccine (IB-TIV) is safe, as most of the reported AEFI were classified as non-serious. AEFI described for the IB-TIV are in agreement with the ones described in the literature for similar vaccines. <![CDATA[First report of an autochthonous human visceral leishmaniasis in a child from the South of Minas Gerais State, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652019005000500&lng=en&nrm=iso&tlng=en ABSTRACT American visceral leishmaniasis (VL) is a vector-borne disease transmitted by some species of phlebotomine sandflies from the genus Lutzomyia. This neglected tropical zoonosis shows increasing urbanization process, since the end of the 1980s. After the emergence of foci of the disease in urban areas, VL has assumed an important role in public health. Although VL is widely prevalent in several parts of the world, diagnosing the illness is still difficult. We present a case of a 12-year-old girl with a history of recurrent fever, anorexia, cachexia, chronic fatigue, weight loss, left palpebral unilateral edema, persistent cough and pancytopenia. A diagnosis of VL was performed using a reference immunochromatographic rapid test. Identification of the infecting protozoan was directly obtained by PCR of bone marrow. The patient responded favorably to treatment using liposomal amphotericin B. This is the first report of human visceral leishmaniasis in the city of Lavras in the South of Minas Gerais State. This first report of VL highlighted the need of maintenance of permanent surveillance and control programs in the city of Lavras, including the active search of sandflies, human and canine cases. The current situation of Lavras should also be taken as an alert to other near cities where favorable eco-epidemiological conditions may exist. <![CDATA[Quantitation of pulmonary fungal burden in <em>Paracoccidioides brasiliensis-infected</em> mice by real-time PCR]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652019005000600&lng=en&nrm=iso&tlng=en ABSTRACT Although colony-forming unit (CFU) counting is widely used to quantify fungal load in tissue from animal experimentally infected with Paracoccidioides brasiliensis, several technical disadvantages have been described. Here we developed highly accurate quantitative PCR (qPCR) assays to determine the relative P brasiliensis load in lungs from infected mice. SYBR Green- and TaqMan-based assays using primers and probe for the 43-kDa glycoprotein (gp43) gene detected as little as 270 gene copies (about 2 fg of DNA) per reaction. Although qPCR assays cannot distinguish between living and dead yeasts, we found a highly positive linear correlation between CFU and qPCR. <![CDATA[Bloodstream infection in hematopoietic stem cell transplantation outpatients: risk factors for hospitalization and death]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652019005000601&lng=en&nrm=iso&tlng=en ABSTRACT We described 235 bloodstream infection (BSI) episodes in 146 hematopoietic stem cell transplantation (HSCT) outpatients and evaluated risk factors for hospitalization and death. Records of outpatients presenting with positive blood cultures over a 5-year period (January 2005 to December 2008) were reviewed. Variables with p&lt; 0.1 in bivariate analysis were used in a regression logistic model. A total of 266 agents were identified, being 175 (66.7%) gram-negative, 80 (30.3%) gram-positive bacteria and 9 (3.4%) fungi. The most common underlying disease was acute leukemia 40 (27.4%), followed by lymphoma non-Hodgkin 26 (18%) and 87 patients (59.6%) were submitted to allogeneic hematopoietic stem cell transplant (HSCT). BSI episodes were more frequent during the first 100 days after transplantation (183 or 77.8%), and ninety-one (38.7%) episodes of BSI occurred up to the first 30 days. Hospitalization occurred in 26% of the episodes and death in 10% of cases. Only autologous HSCT was protector for hospitalization. Although, central venous catheter (CVC) withdrawal and the Multinational Association of Supportive Care in Cancer (MASCC) score up to 21 points were protector factors for death in the bivariate analysis, only MASCC remained as protector.