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Brazilian Journal of Infectious Diseases, Volume: 9, Número: 1, Publicado: 2005
  • Brazilian Society of Infectious Diseases: 25 years! Editorial

    Mendonça, João Silva de; Badaró, Roberto; Sousa, Anastácio Q.
  • Performance of an immunoenzymatic assay for Cryptosporidium diagnosis of fecal samples Brief Communications

    Marques, Fabiana Rangel; Cardoso, Luciana Ventura; Cavasini, Carlos Eugênio; Almeida, Magali Carmem de; Bassi, Nair Aparecida; Almeida, Margarete Teresa Gottardo de; Rossit, Andréa Regina Baptista; Machado, Ricardo Luiz Dantas

    Resumo em Inglês:

    We evaluated the diagnostic performance of a Cryptosporidium immunoenzymatic assay (ELISA). Fecal samples were collected from 94 HIV-seropositive patients. All specimens were processed with a commercially-available ELISA to detect C. parvum specific coproantigen and with a modified Ziehl-Neelsen stain (ZNm) microscope exam. Overall, sensitivity of the immunoenzymatic test was 100%, with a specificity of 96%; positive and negative predictive values were 89% and 100%, respectively. The commercial ELISA and ZNm proved to be valuable diagnostic tools for Cryptosporidium infection.
  • Spontaneous inflammatory pelvic disease in adult non-castrated female rats treated with estrogen Brief Communications

    Ramos, Aristóteles M G; Perazzio, Sandro; Camargos, Aroldo F. de; Pereira, Fausto E.L.

    Resumo em Inglês:

    The adaptive immune response of the genital tract is under the control of sexual steroids; however, the influence of sex hormones on innate immune mechanisms of the genital mucosa are only beginning to be understood. We found that long-term estrogen treatment increases the risk for inflammatory pelvic diseases in adult non-castrated female rats. Female rats (110 g to 130 g) received estrogen (10 rats; 17-beta estradiol, 50 mg pellet; 10 rats: subcutaneous weekly injection of estradiol valerate 0.166 mg/kg). Ten rats received a pellet of 17-beta estradiol and were treated with amoxicillin, 50 mg/kg after the 90th day of exposure to estrogen. Three control groups of ten rats were also used. The estrogen-treated rats developed an inflammatory pelvic disease, with abscess formation after the third month of hormonal treatment. All the surviving animals were killed after six months of hormonal exposure. Among 15 survivors of the two groups that received estrogen 13 animals presented tuboovarian abscesses. Among eight survivors of the group treated with amoxicillin, six had tuboovarian abscesses. None of the 30 control rats presented macro or microscopic signs of inflammatory disease in the uterus, tubes or ovaries. We conclude that estrogen impairs the defense mechanisms of the genital tract of non-castrated female rats, enhancing bacterial growth in the vagina and ascending infection to the uterus, tubes and ovaries.
  • Regional patterns of the temporal evolution of the AIDS epidemic in Brazil following the introduction of antiretroviral therapy Original Papers

    Brito, Ana Maria de; Castilho, Euclides Ayres de; Szwarcwald, Célia Landmann

    Resumo em Inglês:

    We examined the characteristics of the AIDS epidemic in the northeastern region of Brazil, comparing it to the epidemic in Brazil as a whole, and to the state of São Paulo, with respect to the temporal evolution of morbidity and mortality during the period 1990 to 1999, using information from communicable disease reports and mortality records. Since 1996, the incidence rate of AIDS in adults in Brazil as a whole and in São Paulo has been showing a trend towards stability, whereas in the Brazilian northeast the incidence rates of the disease continue to grow. In the northeast, sexual transmission is responsible for more than 80% of cases, injectable drug users (IDU) comprising only a small percentage of cases. There is a greater incidence of AIDS among groups with lower educational levels throughout the country. The comparative analysis of cases of AIDS and of deaths from AIDS shows growth, both in the number of cases and in the number of deaths; however, from 1996 onwards there has been a progressive reduction in the number of deaths in all regions analyzed. With respect to the incidence of cases of the disease acquired by vertical transmission, a significant growth trend can be seen in all regions for cases born in the period 1990-6, but in 1997 temporal analysis showed evidence of a reduction in this growth. In conclusion, temporal changes have occurred in the AIDS epidemic in Brazil, which has been showing a trend towards stability since 1996, when potent ARV therapy was introduced. However, this deceleration is not homogenous throughout all the regions.
  • Prospective study on the prevention of vertical transmission of HIV in Campo Grande, Mato Grosso do Sul, Brazil, from 1996 to 2001 Original Papers

    Dal Fabbro, Márcia Maria Ferrairo Janini; Cunha, Rivaldo Venâncio da; Paniago, Anamaria Mello Miranda; Lindenberg, Andréa de Siqueira C.; Freitas, Gisele Maria Brandão de; Nogueira, Susie Andries

    Resumo em Inglês:

    This prospective study, involving 76 pregnant women infected with HIV, paired with their 79 exposed infants, was carried out between May 1996 and October 2001, at the Reference Department for Pregnant Women Infected with HIV in Campo Grande, Mato Grosso do Sul. The mean age of the pregnant women was 24 years; 88% (67/76) apparently were infected due to sexual practices; 88% (67/76) were housewives; 823% (63/76) graduated from junior high school; 14.5% (11/76) reported co-infection with Hepatitis C, 9.2% with Syphilis; 51% (39/76) learned the diagnosis during prenatal care; 67% (51/76) reported HIV clinical symptomatology and 9.2% (7/76) reported opportunistic infections. Elective cesareans were performed in 57% (43/76). The mean gestational age at delivery was 38 weeks and we found 12.5% (10/80) pronatis; 97% (74/76) had a ruptured membrane time after less than four hours and one child (1.3%) was nursed. ACTG 076 Protocol (AIDS Clinical Trial Group 076) was used in 80% (61/76) of the pregnant women, with 100% adherence; 62% (38/61) used zidovudine plus another antiretroviral in the gestation; 92% (73/79) of the infants used zidovudine after the birth and 19% (14/73) used zidovudine and lamivudine. The transmission rate in this study was 2.5%.
  • Detection of hepatitis C virus RNA in saliva samples from patients with seric anti-HCV antibodies Original Papers

    Gonçalves, Patrícia L.; Cunha, Carla B.; Busek, Solange C. U.; Oliveira, Guilherme C.; Ribeiro-Rodrigues, Rodrigo; Pereira, Fausto EL

    Resumo em Inglês:

    We examined the frequency of HCV-RNA in saliva samples from anti-HCV positive patients. Both plasma and saliva samples from 39 HCV patients (13 with normal liver enzymes, 19 with abnormal liver enzymes and 13 with cirrhosis) were investigated. Stimulated saliva and fresh plasma were centrifuged (900 x g,10 min) and stored at -70ºC, after the addition of guanidine isothiocyanate RNA extraction buffer. HCV-RNA was detected by RT- nested-PCR (amplification of HCV-cDNA for two rounds, using HCV primers 939/209 and 940/211). HCV genotyping was carried out by RFLP (using Mva I and Hinf 1 or Hae III and Rsa I restriction enzymes). Thirty-two out of 39 (82%; 95% CI=70-94%) anti-HCV-positive patients had HCV-RNA in plasma samples. Eight out of 39 (20.5%; 95% CI=6.6-34.4%) had HCV-RNA in the saliva. The HCV genotype in saliva samples from these patients matched the genotype found for plasma HCV-RNA. No significant correlation between the presence of HCV and either age, gender, HCV genotype or any risk factor for HCV infection was found. The observed prevalence (20.5% of anti HCV positive patients or 25% of the patients with HCV-RNA in plasma) was lower than that previously reported from other countries. The low frequency of HCV-RNA in saliva samples observed in our study may be due to the use of cell-free saliva. Other authors reporting higher frequencies of HCV-RNA in saliva used whole saliva, without centrifugation.
  • Combined use of Western blot/ELISA to improve the serological diagnosis of human tuberculosis Original Papers

    Beck, S. T.; Leite, O. M.; Arruda, R. S.; Ferreira, A. W.

    Resumo em Inglês:

    Two recombinant antigens and a crude bacterial antigen of a wild M. tuberculosis strain were used to detect specific IgG antibodies in sera from 52 patients with pulmonary tuberculosis, confirmed by an acid-fast smear and serum culture of these patients and that of 25 contacts. The patients were not infected with HIV. We evaluated the sensitivity and specificity of ELISA, based on the recombinant TbF6® and TbF6/DPEP antigen and a search for reactivity patterns in the Western blot technique, using whole mycobacterium antigen. Serum samples from 22 healthy individuals and from 30 patients with lung diseases other than tuberculosis were used as controls. The best ELISA results were obtained with the TbF6/DPEP antigen combination, which gave 85% sensitivity and 91% specificity. ELISA sensitivity improved from 85% to 92% when the Western blot results were used. Western blot specificity was 100% when antibody reactivity with different antigenic bands was analyzed and associated. The association of TbF6/DPEP antigens used in ELISA with specific patterns of reactivity determined by Western blot can help make an identification when classic methods for the diagnosis of pulmonary tuberculosis are not sufficient.
  • Antimicrobial susceptibility in intensive care units: MYSTIC Program Brazil 2002 Original Papers

    Mendes, Caio; Oplustil, Carmen; Sakagami, Elsa; Turner, Philip; Kiffer, Carlos

    Resumo em Inglês:

    OBJECTIVE: Establish the susceptibility pattern of Gram-negative bacteria causing infections in ICU patients, MYSTIC Program Brazil 2002. MATERIAL AND METHODS: Gram-negative bacteria (n = 503) causing nosocomial infections were collected at seven Brazilian centers. The central laboratory confirmed the identification and performed the susceptibility tests by E-test methodology (AB Biodisk, Solna, Sweden) for meropenem, imipenem, ciprofloxacin, ceftazidime, cefepime, cefotaxime, piperacillin/tazobactam, gentamicin, and tobramycin. Interpretation criteria used were according to National Committee for Clinical Laboratory Standards (NCCLS). RESULTS: Pseudomonas aeruginosa (33%) was the most frequently isolated, followed by A. baumannii (17.1%), K. pneumoniae (12.1%), E. coli (10.5%), and E. cloacae (7.9%). Pseudomonas aeruginosa isolates had susceptibility rates of 67.5% to piperacillin/tazobactam, 59.8% to meropenem, 57.3% to imipenem. A. baumannii presented susceptibility rates to meropenem of 89.5%, 88.4% to imipenem, and 74.4% to tobramycin. E. coli and K. pneumoniae were fully susceptible to both carbapenems. CONCLUSIONS: Carbapenem resistance among Enterobacteriaceae is still rare in this region. A. baumannii and P. aeruginosa presented elevated resistance rates to all antimicrobials. Since these two bacterial species play an important role in nosocomial infections, the use of empirical combination therapy to treat these pathogens may be justified.
  • Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) among patients visiting the emergency room at a tertiary hospital in Brazil Original Papers

    Ribeiro, Julival; Boyce, John M.; Zancanaro, Pedro Q.

    Resumo em Inglês:

    We surveyed patients seen at the emergency room at a tertiary hospital in Brazil from August to November 1997. All patients' (n = 600) anterior nares were cultured for MRSA; the results were confirmed by oxacillin disk diffusion methods and by detection of the mecA gene with PCR. Bacteria were found in 93.3% (560) of the patients and MRSA in 0.7% (n = 4). One patient had community-acquired MRSA. We concluded that MRSA is uncommon among patients visiting the emergency room. The presence of community-acquired MRSA can lead to serious medical and epidemiological issues, although initial clinical presentation may not differ from that of infections with other staphylococci. The empirical use of vancomycin for suspected community-acquired infections is seldom warranted.
  • Prevalence of Staphylococcus aureus introduced into intensive care units of a University Hospital Original Papers

    Cavalcanti, Silvana M.M.; França, Emmanuel R. de; Cabral, Carlos; Vilela, Marinalda A.; Montenegro, Francisco; Menezes, Daniela; Medeiros, Ângela C.R.

    Resumo em Inglês:

    Staphylococcus aureus is one of the principal human pathogens that colonize healthy individuals in the community in general, and it is responsible for severe infections in hospitalized patients. Due to an increase in the prevalence of strains of methicillin-resistant S. aureus (MRSA), combating these microorganisms has become increasingly difficult. A descriptive study was carried out on 231 patients in intensive care at the Oswaldo Cruz University Hospital (HUOC) in Recife, Brazil between January and April 2003 to determine the prevalence of S. aureus and MRSA and to evaluate risk factors for colonization by these bacteria when introduced into Intensive Care Units (ICUs). Body secretions were collected from the nostrils, axillary and perineal regions, and from broken skin lesions, of all patients during the first 48 hours following admission to the ICU. Samples were inoculated into blood agar and mannitol-salt-agar culture medium and identified by Gram staining, and by coagulase, DNAse and agglutination (Slidex Staph Test®) tests. Growth in Mueller-Hinton agar with 4% sodium chloride and 6mg/L oxacillin was used to identify MRSA. In addition, the latex agglutination test was performed to identify penicillin-binding protein, PBP 2A. The prevalence of S. aureus and MRSA was 87/231 (37.7%) and 30/231 (12.98%), respectively. There was no association between any risk factor studied (age, sex, origin of the patient - whether hospital or community, previous hospitalization, use of current or previous antibiotic therapy, corticotherapy and/or immunotherapy, reason for hospitalization and place of hospitalization) and the presence of S. aureus. However, a significant association was established between previous hospitalization and the presence of MRSA (RR:1.85; CI:1.00-3.41; p=0.041). The nostrils were the principal site of colonization by both S. aureus (80.4%) and MRSA (26.4%), followed by the perineal area, with rates of 27.6% and 12.6%, respectively. If only the nostrils had been investigated, the study would have failed to diagnose 17 patients (19.5%) as carriers of the pathogen into the ICU, thus contributing towards cross-dissemination.
  • Prevalence and factors associated with rectal vancomycin-resistant enterococci colonization in two intensive care units in São Paulo, Brazil Original Papers

    Furtado, Guilherme Henrique Campos; Martins, Sinaida Teixeira; Coutinho, Ana Paula; Wey, Sérgio Barsanti; Medeiros, Eduardo Alexandrino Servolo

    Resumo em Inglês:

    Vancomycin-resistant enterococci (VRE) are important pathogens causing nosocomial infections, and there is reason for concern about their resistance and great ability to spread in hospital environments, especially intensive-care units (ICU). To determine the prevalence of rectal colonization by VRE, and the risk factors associated with their presence, rectal surveillance swabs were taken from patients under treatment in two intensive-care units (one medical and another both medical and surgical) at São Paulo Hospital, over a two-year period. Thirty-three percent of the 147 patients evaluated had VRE. The only significant variable in the logistic regression was the length of stay in the ICU.
  • Staphylococcus aureus bacteremia: what is the impact of oxacillin resistance on mortality? Original Papers

    Cassettari, V.C.; Strabelli, T.; Medeiros, E.A.S.

    Resumo em Inglês:

    In order to analyse the impact of oxacillin resistance on the mortality of Staphylococcus aureus bacteremia, and to assess the antimicrobial susceptibility of community-acquired strains in two large university hospitals (the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo and the Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo), we carried out a four-month-long prospective cohort study, which included 163 consecutive cases of S. aureus bacteremia. Of these, 140 (85.9%) were hospital-acquired, 9 (5.5%) were community-acquired and 14 (8.6%) were of indeterminate origin. No cases of community-acquired infection by oxacillin-resistant S. aureus was identified. Among hospital-acquired infections, oxacillin-resistant S. aureus was responsible for 64.3% of cases. Mortality up to 15 days after diagnosis of bacteremia was 27% (18/67) for infections caused by susceptible strains and 33% (32/96) for infections caused by oxacillin-resistant strains (p=0.10). The following independent risk factors for the acquisition of oxacillin-resistant S. aureus were identified in multiple logistical regression analysis: age over 60 years, use of corticoids; presence of a central vascular catheter, and previous use of antibiotics.
  • Epidemiological and microbiological aspects of acute bacterial diarrhea in children from Salvador, Bahia, Brazil Original Papers

    Diniz-Santos, Daniel R.; Santana, José S.; Barretto, Junaura R.; Andrade, Maria Goreth M.; Silva, Luciana R.

    Resumo em Inglês:

    In the few cases of acute childhood diarrhea that require antimicrobial therapy, the correct choice of the drug depends on detailed previous knowledge of local strains. In order to establish such parameters in our city, we reviewed the results of all 260 positive stool cultures of children between 0 and 15 years of age during two years at a pediatric tertiary care facility in Salvador, Brazil. Bacterial strains had been presumptively identified by culturing in selective media and by biochemical testing, and their antimicrobial susceptibility patterns were automatically detected by the MicroScan Walkaway System. Data about patients' sex and age, monthly distribution of the cases, pathogens isolated and their antimicrobial resistance patterns were recorded. Males corresponded to 55.4% of our sample, and most of our patients (42.7%) were between one and four years of age. Shigella was the commonest pathogen, being found in 141 (54.3%) cultures, while Salmonella was found in 100 (38.4%) cultures and Enteropathogenic E. coli in 19 (7.3%). Salmonella was the main causal agent of diarrhea in children younger than five years old, whereas Shigella was the most frequent pathogen isolated from the stools of children between five and 15 years old. The peaks of incidence correspond to the periods of school vacations. Shigella specimens presented a very high resistance rate to trimethoprim-sulfamethoxazole (90.1%) and to ampicillin (22.0%), while Salmonella presented very low resistance rates to all drugs tested. These data are useful for practitioners and they reinforce the need for continuous microbiological surveillance.
  • Dapsone syndrome with acute renal failure during leprosy treatment: case report Case Reports

    Alves-Rodrigues, Edson Nogueira; Ribeiro, Luciano Correa; Silva, Margareth Dióz; Takiuchi, Arley; Fontes, Cor Jesus Fernandes

    Resumo em Inglês:

    Dapsone syndrome is a rare hypersensitivity reaction to dapsone and is characterized by high fever, papular or exfoliative dermatitis, progressing to liver toxicity and generalized lymphadenopathy, resembling a mononucleosis infection. We report a patient who developed acute renal failure, as well as other complications characteristic of dapsone syndrome, during leprosy treatment. Renal involvement had not been previously described as a dapsone syndrome feature.
  • Conference: Abstract Viii International Symposium About Htlv In Brazil

  • Tema Livre Viii Simpósio Internacional Sobre Htlv No Brasil

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