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Brazilian Journal of Infectious Diseases, Volume: 24, Número: 3, Publicado: 2020
  • After the pandemic: the role of science in the future of the countries Editorial

    Palacios, Ricardo; Covas, Dimas Tadeu; Pereira Júnior, Luiz Carlos; Cimerman, Sergio
  • Cost minimization analysis of an in-house molecular test for cytomegalovirus in relation to a commercial molecular system Original Articles

    Caurio, Cássia F.B.; Allende, Odelta S.; Kist, Roger; Vasconcellos, Izadora C.S.; Rozales, Francieli P.; Reck-Kortmann, Maikel; Dalla Lana, Daiane F.; Alegretti, Ana Paula; Neto, Giácomo B.; Pasqualotto, Alessandro C.

    Resumo em Inglês:

    ABSTRACT Introduction: Cytomegalovirus may cause severe disease in immunocompromised patients. Nowadays, quantitative polymerase chain reaction is the gold-standard for both diagnosis and monitoring of cytomegalovirus infection. Most of these assays use cytomegalovirus automated molecular kits which are expensive and therefore not an option for small laboratories, particularly in the developing world. Objective: This study aimed to optimize and validate an in-house cytomegalovirus quantitative polymerase chain reaction test calibrated using the World Health Organization Standards, and to perform a cost-minimization analysis, in comparison to a commercial cytomegalovirus quantitative polymerase chain reaction test. Study design: The methodology consisted of determining: optimization, analytical sensitivity, analytical specificity, precision, curve variability analysis, and inter-laboratorial reproducibility. Patients (n = 30) with known results for cytomegalovirus tested with m2000 RealTime System (Abbott Laboratories, BR) were tested with the in-house assay, as well as patients infected with other human herpes virus, in addition to BK virus. A cost-minimization analysis was performed, from a perspective of the laboratory, assuming diagnostic equivalence of the methodologies applied in the study. Results: The in-house assay had a limit of detection and quantification of 60.3 IU/mL, with no cross-reactivity with the other viral agents tested. Moreover, the test was precise and had a R 2 of 0.954 when compared with the m2000 equipment. The cost analysis showed that the assay was economically advantageous costing a median value of 37.8% and 82.2% in comparison to the molecular test in use at the hospital and the m2000 equipment, respectively. Conclusions: These results demonstrated that in-house quantitative polymerase chain reaction testing is an attractive alternative in comparison to automated molecular platforms, being considerably less expensive and as efficacious as the commercial methods.
  • Reactivity of sera from dogs living in a leishmaniasis-endemic area to the COOH-terminal region of cysteine proteinase B Original Articles

    Barral-Veloso, Laura; Melo, Barbara Cristina de Albuquerque; Santos-de-Souza, Raquel; Cysne-Finkelstein, Léa; Souza-Silva, Franklin; Santos, Fernanda Nunes; Sousa, Joel Fontes de; Alves, Carlos Roberto

    Resumo em Inglês:

    ABSTRACT Cysteine proteinases are well-known virulence factors of Leishmania spp. with demonstrated actions in both experimental mouse infection and human infection. However, studies on these enzymes in canine leishmaniasis are scarce. Here, we show, for the first time, the reactivity of sera from dogs living in an endemic area to a recombinant protein from the COOH-terminal region of cysteine B protease. In this work, enzyme-linked immunosorbent assays were performed using a 14 kDa rcyspep protein obtained through a pET28-a expression system in Escherichia coli. First, 96-well plates were coated with rcyspep (500 ng/well) and incubated with sera from dogs (1:100). Subsequently, IgG antibody detection was performed using rabbit anti-dog IgG antibodies conjugated with peroxidase. Sera from dogs (n = 114), including suspect (n = 30) and positive (n = 50) dogs from a leishmaniasis-endemic area and dogs from a nonendemic area, (n = 34), negative for leishmaniasis, were assessed. The results showed that sera from the suspect (42%) and positive (68%) groups responded differently to the antigen titers tested above the cut-off (Optical Density = 0.166). This finding suggests that the immune response detected against cyspep may be related to clinical disorders present in these animals. Collectively, the data gathered here suggest that cyspep can sensitize the immune systems of dogs from a leishmaniasis-endemic area to elicit a humoral response, an immunological parameter indicating the contribution of this protein in host-parasite interaction.
  • First molecular detection of Coxiella burnetii in Brazilian artisanal cheese: a neglected food safety hazard in ready-to-eat raw-milk product Original Articles

    Rozental, Tatiana; Faria, Letícia Scafutto De; Forneas, Danielle; Guterres, Alexandro; Ribeiro, João Batista; Araújo, Flábio Ribeiro; Lemos, Elba Regina Sampaio; Silva, Marcio Roberto

    Resumo em Inglês:

    ABSTRACT Background: Global publications on Q fever have increased after the 2007 epidemic in the Netherlands. However, the epidemiology of Q fever/coxiellosis in Brazil is still poorly understood. Accordingly, there have been few studies investigating the presence of Coxiella burnetii in dairy products around the world, especially in Brazil, where consumption of fresh cheese made from raw-milk is very high. Objective: This study was a random survey to assess the prevalence of C. burnetii by PCR in traditional Minas artisanal cheese from the Serro microregion, Brazil, which is manufactured from bovine raw-milk. Methods: DNA extracted from 53 cheese samples were analyzed by nested PCR with C. burnetii-specific primers and the products confirmed by DNA sequencing. Results: Out of the 53 cheese samples five (9.43%) were C. burnetii DNA-positive, each coming from one of the respective randomly selected manufacturing agroindustries.Based on our results, it is estimated that 1.62 tons/day of ready-to-eat cheese made from raw-milk from a total of 16.2 tons produced daily in the study region are contaminated with C. burnetii. Conclusion: To our knowledge, this is the first report of highly heat-resistant zoonotic pathogen in raw-milk Brazilian artisanal cheese. This food safety hazard has been completely neglected in ready-to-eat raw-milk Brazilian artisanal cheese and could imply potential threats to consumers, since C. burnetii survives in artisanal cheese submitted to long ripening periods. Thus, this work established random and representative baseline prevalence of C. burnetii in this food product in Brazil. Further epidemiological studies, monitoring trends and setting control targets are warranted. Finally, these results point out the importance of including C. burnetii in animal and public health surveillance programs.
  • Nontuberculous mycobacterial infection in a tertiary care center in Mexico, 2001-2017 Original Articles

    Lopez-Luis, Bruno Ali; Sifuentes-Osornio, José; Pérez-Gutiérrez, María Teresa; Chávez-Mazari, Bárbara; Bobadilla-del-Valle, Miriam; Ponce-de-León, Alfredo

    Resumo em Inglês:

    ABSTRACT Introduction: Nontuberculous mycobacteria (NTM) comprise several pathogens with a complex profile of virulence, diverse epidemiological and clinical patterns as well as host specificity. Recently, an increase in the number of NTM infections has been observed; therefore, the objective of this study was to evaluate the clinical characteristics and outcomes of these infections. Methods: We included patients with NTM infections between 2001-2017 and obtained risk factors, clinical features and outcomes; finally, we compared this data between slowly growing (SGM) and rapidly growing mycobacteria (RGM). Results: A total of 230 patients were evaluated, 158 (69%) infected and 72 (31%) colonized/pseudoinfected. The average annual incidence in the first 11 years of the study was 0.5 cases per 1000 admissions and increased to 2.0 cases per 1000 admissions later on. The distribution of NTM infections was as follows: bloodstream and disseminated disease 72 (45%), lung infection 67 (42%), skin and soft tissue infection 19 (12%). Mycobacterium avium complex was the most common isolate within SGM infections, and HIV-infected patients were the most affected. Within RGM infections, M. fortuitum was the most common isolate from patients with underlying conditions such as cancer, type-2 diabetes mellitus, presence of invasive devices, and use of immunosuppressive therapy. We did not find significant differences in deaths and persistent infections between disseminated SGM infection when compared to disseminated RGM infection (42% vs. 24%, p = 0.22). However, disseminated SGM infection required a longer duration of therapy than disseminated RGM infection (median, 210 vs. 42 days, p = 0.01). NTM lung disease showed no significant differences in outcomes among treated versus non-treated patients (p = 0.27). Conclusions: Our results show a significant increase in the number of Non-tuberculosis-mycobacteria infections in our setting. Patients with slow-growing-mycobacteria infections were mainly persons living with human immunodeficiency virus . Older patients with chronic diseases were common among those with rapidly-growing-mycobacteria infections. For non-tuberculosis-mycobacteria lung infection, antibiotic therapy should be carefully individualized.
  • A broad-spectrum beta-lactam-sparing stewardship program in a middle-income country public hospital: antibiotic use and expenditure outcomes and antimicrobial susceptibility profiles Original Articles

    Zequinao, Tiago; Gasparetto, Juliano; Oliveira, Dayana dos Santos; Silva, Gabriel Takahara; Telles, João Paulo; Tuon, Felipe Francisco

    Resumo em Inglês:

    ABSTRACT Background: Antimicrobial stewardship programs are an efficient way to reduce inappropriate use of antimicrobials and costs; however, supporting data are scarce in middle-income countries. The aim of this study was to evaluate antibiotic use, bacterial susceptibility profiles, and the economic impact following implementation of a broad-spectrum beta-lactam-sparing antimicrobial stewardship program. Methods: An interrupted time-series analysis was performed to evaluate antibiotic use and expenditure over a 24-month period (12 months before the antimicrobial stewardship program and in the 12 months after implementation of the antimicrobial stewardship program). Antibiotics were classified into one of two groups: beta-lactam antibiotics and beta-lactam-sparing antibiotics. We also compared the antimicrobial susceptibility profiles of key pathogens in each period. Results: Beta-lactam antibiotics use decreased by 43.04 days of therapy/1000 patient-days (p = 0.04) immediately following antimicrobial stewardship program implementation, whereas beta-lacta-sparing antibiotics use increased during the intervention period (slope change 6.17 days of therapy/1000 patient-days, p < 0.001). Expenditure decreased by $2089.99 (p < 0.001) immediately after intervention and was maintained at this level over the intervention period ($−38.45; p = 0.24). We also observed that a greater proportion of pathogens were susceptible to cephalosporins and aminoglycosides after the antimicrobial stewardship program. Conclusions: The antimicrobial stewardship program significantly reduced the use of broad-spectrum beta-lactam-antibiotics associated with a decrease in expenditure and maintenance of the susceptibility profile in Gram-negative bacteria.
  • Mobile genetic elements associated with carbapenemase genes in South American Enterobacterales Review Articles

    Reyes, Jorge Aníbal; Melano, Roberto; Cárdenas, Paúl Andrés; Trueba, Gabriel

    Resumo em Inglês:

    ABSTRACT Introduction: Carbapenem resistance in members of order Enterobacterales is a growing public health problem causing high mortality in developing and industrialized countries. Its emergence and rapid propagation worldwide was due to both intercontinental spread of pandemic strains and horizontal dissemination via mobile genetic elements (MGE) such as plasmids and transposons. Objective: To describe MGE carrying carbapenem resistance genes in Enterobacterales which have been reported in South America. Search strategy and selection criteria: A search of the literature in English or Spanish published until 2019 in PubMed, Google Scholar, LILACS and SciELO databases was performed for studies of MGE in Enterobacterales reported in South American countries. Results: Seven South American countries reported MGE related to carbapenemases. Carbapenemase-producing Klebsiella pneumoniae belonging to clonal complex 258 were the most prevalent pathogens reported; others carbapenemase-producing Enterobacterales such as Escherichia coli, Serratia marcescens, and Providencia rettgeri also have been reported. The MGE implicated in the spread of the most prevalent carbapenemase genes are Tn4401 and non-Tn4401 elements for bla KPC and ISAba125 for bla NDM, located in different plasmid incompatibility groups, i.e. L/M, A/C, FII and bacterial clones. Conclusion: This review indicates that, like in other parts of the world, the most commonly reported carbapenemases in Enterobacterales from South America are being disseminated through clones, plasmids, and transposons which have been previously reported in other parts of the world.
  • Clinical utilization of bacteriophages: a new perspective to combat the antimicrobial resistance in Brazil Review Articles

    Martins, Willames M.B.S.; Toleman, Mark A.; Gales, Ana C.

    Resumo em Inglês:

    ABSTRACT Due to the emergence of multi-drug resistant bacteria, and the evident limitation in therapeutic options, alternatives to combat bacterial infections have been sought. One of these is phage therapy, which is the use of bacterial viruses to kill pathogenic bacteria responsible for the infection. These viruses called bacteriophages are very abundant organisms in the world and are harmless to humans. There are several advantages in using phage therapy, especially against multi-drug resistant pathogens, which tend to be dominated by individual strains. The advantages include fewer collateral effects such as lower disturbance of gut microbiota and less antimicrobials consumption, which itself leads to reducing antibiotic resistance rates. Unfortunately, few clinical studies have been initiated in Brazil and this area is little explored in our country. This manuscript describes clinical evidence of successful phage utilization on pathogens considered a threat in Brazil, highlighting the benefits of a possible phage utilization as an important tool to combat antimicrobial resistance in our country.
  • An infant with a mild SARS-CoV-2 infection detected only by anal swabs: a case report Case Report

    Li, Juan; Feng, Jing; Liu, Tian-hu; Xu, Feng-cheng; Song, Guo-qiang

    Resumo em Inglês:

    ABSTRACT Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China and has spread rapidly worldwide. We present a mild SARS-CoV-2 infection in a baby with non-productive cough and normal chest computed tomography, in whom only anal swabs tested positive by real-time PCR testing for SARS-CoV-2. She was given atomization inhalation therapy with recombinant human interferon alfa-1b for 10 days. Her anal swabs remained positive for eight days, whereas her throat swabs were persistently negative by real-time PCR testing. Mild and asymptomatic cases, especially in children, might present with PCR negative pharyngeal/nasal swabs and PCR positive anal swabs. Those patients are potential sources of infection via fecal-oral transmission for COVID-19.
  • Viral metagenomics performed in patients with acute febrile syndrome during Toxoplasma gondii outbreak in south Brazil Brief Communications

    Bezerra, Rafael dos Santos; Diefenbach, Cristiane Fração; Pereira, Dalnei Veiga; Kashima, Simone; Slavov, Svetoslav Nanev

    Resumo em Inglês:

    ABSTRACT Toxoplasmosis is a zoonotic infection caused by the protozoan parasite Toxoplasma gondii. The infection is widely disseminated in the human population and is usually benign or asymptomatic. Systemic T. gondii infection presents risks for pregnant women and AIDS patients. Although rare, T. gondii can cause outbreaks in urban centers. The origin of these outbreaks is not completely understood but probably results from introduction of zoonotic T. gondii strains in the population. During such outbreaks other pathogens which mimic T. gondii acute febrile syndrome may also circulate; therefore, detailed investigation of the outbreak is of extreme importance. In this study we performed viral metagenomics next-generation sequencing (mNGS) in patient samples obtained during T. gondii outbreak in Santa Maria city, South Brazil. Specific bioinformatics pipelines specialized in virus discovery were applied in order to identify co-circulating vial agents. Epstein Barr virus and Parvovirus B19 contigs were assembled and these viruses can cause symptoms similar to toxoplasmosis. In conclusion, our findings show the importance of Metagenomics next generation sequencing (mNGS) use to help characterize the outbreak more completely and in the management of the affected patients.
  • High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in Western French Guiana Brief Communications

    Manca, Maria-Francesca; Rochat-Stettler, Laurence; Carod, Jean-François; Agostini, Camille; Jolivet, Anne

    Resumo em Inglês:

    ABSTRACT The purpose of this study was to estimate the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in western French Guiana and to analyze associated factors with both infections. A retrospective study was conducted in a sexually transmitted infections clinic in 2017. Women (n = 338) were tested by real-time polymerase chain reaction for vaginal, anal and throat CT and NG infections. Men (n = 192) were evaluated using urine specimens. Socio-demographic and sexual behaviour data were collected by nurses with a structured questionnaire. The prevalence of CT and NG infections among women were 24.3% and 13.3%, respectively, and 12.0% and 7.3% among men. Women aged under 25 years had a higher risk of CT and NG infections than women aged 35 years or more. Another risk factor for CT infection was low educational level, and occasional unprotected sex for NG infection. CT and NG infections were associated with reporting symptoms among men. Very high prevalences of CT and NG infections among women and men were found, which suggest that a large-scale screening strategy should be implemented in French Guiana.
  • Will environmental changes in temperature affect the course of COVID-19? Brief Communications

    Del Rio, Carlos; Camacho-Ortiz, Adrián

    Resumo em Inglês:

    ABSTRACT While the outbreak has reached every region of the world, it is undeniable that countries in the southern hemisphere seem to be less affected, where cases have been reported, these have been imported and travel related. We analyzed the climate temperature from various regions according to their current ongoing human-to-human transmission status. We studied 3 groups; Group 1, 10 provinces from China with majority of COVID-19 cases; Group 2, areas where continuous horizontal transmission outside of China had been reported; and group 3, areas where imported cases had been detected and no horizontal transmission had been documented after at least seven days since the first case was reported. The regions without ongoing human-to-human transmission showed significantly higher temperatures when compared to China and countries with ongoing human-to-human transmission, with over an 11-degree difference. The average rainfall during the study period was significantly higher in those regions without OHHT when compared to the Chinese provinces with ongoing human-to-human transmission and the regions with active transmission of SARS-CoV-2. Our findings show statistically significant differences between regions with ongoing human-to-human transmission of COVID-19 cases compared to those regions without horizontal transmission. This phenomenon could have implications in the behavior of the ongoing COVID-19 outbreak in the following months.
  • “Penumbra sign” of Brodie's abscess Clinical Images

    Wright, William F.
  • Pulmonary involvement in patients with measles Clinical Images

    Hochhegger, Bruno; Zanetti, Gláucia; Marchiori, Edson
  • First lung transplantation in a HIV patient in Brazil Letters To The Editor

    Pola-dos-Reis, Flávio; Camargo, Luis Fernando Aranha; Afonso-Junior, José Eduardo; Samano, Marcos Naoyuki; Pego-Fernandes, Paulo Manoel
  • The 2019-2020 coronavirus pandemic in Italy: immunologic and cultural hurdles on the road to a cure Letters To The Editor

    Virgilio, Edoardo
  • Real-world evidence in antiretroviral therapy: drug safety data Letters To The Editor

    Silva, Ana-Marta; Pereira, Marta; Dias, Cláudia Camila; Ventura, Ângela; Sousa-Pinto, Bernardo
  • Analysis of clinical and demographic heterogeneity of patients dying from COVID-19 in Brazil versus China and Italy Letters To The Editor

    Oliveira, Maria Helena Santos de; Wong, Johnny; Lippi, Giuseppe; Henry, Brandon Michael
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