Causas de óbito relacionadas ao HIV/AIDS em Instituição de referência, Amazonas, 2016 / Deaths related to HIV/AIDS in reference institution, Amazonas, 2016

Objetivo: Descrever o perfil e as causas mencionadas ao óbito de pacientes com HIV/AIDS, em uma instituição de referência no município de Manaus, Amazonas, 2016.  Métodos:  O estudo é uma série de casos de HIV/AIDS notificados no SINAN com data de óbito em 2016.  As causas associadas de morte foram obtidas do protocolo de registros da instituição de referência e a data do início da dispensação de TARV foi consultada pelo prontuário dos pacientes. As causas de morte foram agrupadas por consulta eletrônica em capítulos, conforme a CID10.  Resultados:  Em 2016 ocorreram 246 óbitos em casos notificados como HIV/AIDS.   A distribuição de casos por mês ocorreu sucessivamente, sendo o mês de abril (28/246-11,4%) com maior registro.  Os casos de óbito foram mais frequentes entre os homens (193/246-78,5%). Com relação a distribuição por idade, a faixa etária de 13-40 anos não diferiu significativamente em relação ao grupo maior de 40 anos (p valor= 0,63) e a idade média ao morrer nas mulheres foi igual a dos homens (p valor=0,37). A sobrevida dos pacientes foi definida pelo tempo decorrido entre o diagnóstico de HIV/AIDS e o óbito,variando em 1 mês (78/246-31,7%), 1 ano (54/246-22,0%), entre 1-2 (26/246-10,6%), 2-5 (36/246-14,6%) e mais de 5 anos (52/246-21,1%). Nos casos com mais de 5 anos de TARV observou-se menor registros de óbito (13/246-5,3%). A distribuição por causas associadas de morte por capítulos da CID teve como destaque doenças infecciosas e parasitárias. Conclusões: As doenças indicativas de AIDS foram as mais mencionadas no óbito. Diagnóstico precoce e melhorias no acompanhamento e tratamento no cenário em que a TARV melhorou expressivamente a sobrevida dos pacientes estão relacionados à maior qualidade de vida ao portador de HIV/AIDS.

Malária durante a gravidez: efeito sobre o curso da gestação na região amazônica

Submitted by Patricia Stilpen ([email protected]) on 2011-04-14T11:37:37Z No. of bitstreams: 1 Malária durante a gravidez.pdf: 177675 bytes, checksum: 4d24675984ec33c6302e1eb0cd5f8734 (MD5)Made available in DSpace on 2011-04-14T11:37:37Z (GMT). No. of bitstreams: 1 Malária durante a gravidez.pdf: 177675 bytes, checksum: 4d24675984ec33c6302e1eb0cd5f8734 (MD5) Previous issue date: 2009Fundação de Medicina Tropical do Amazonas. Manaus, AM, Brasil.Fundação de Medicina Tropical do Amazonas. Manaus, AM, Brasil.Fundação de Medicina Tropical do Amazonas. Manaus, AM, Brasil.Universidade Federal do Amazonas. Manaus, AM, Brasil.Fundação de Medicina Tropical do Amazonas, Manaus, AM, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisas Leônidas e Maria Deane. Manaus, AM, Brasil.Objetivo. Estimar o efeito da malária sobre o curso da gestação em mulheres na região amazônica e investigar possíveis fatores de risco nessa população. Métodos. Este estudo transversal é parte de um projeto maior para estudar malária e gravidez na região amazônica. Foram incluídas gestantes com malária atendidas na Fundação de Medicina Tropical do Amazonas que responderam a entrevistas estruturadas. Dados socioeconômicos, comportamentais e clínicos foram levantados na primeira consulta relacionada a cada novo episódio de malária na gestante. Todas as gestantes foram acompanhadas ao longo de sua gestação. Foram considerados os seguintes fatores de risco para alterações no curso da gestação: idade materna menor do que 20 anos, primeira gestação, primeira infecção malárica e espécie de plasmódio infectante. Resultados. Foram avaliados 535 episódios de malária em 417 gestantes, sendo 20,56% causados pelo P. falciparum, 78,69% pelo P. vivax e 0,75% pela associação dos dois parasitas. Alteração no curso da gestação foi um evento muito frequente (26,2%). Ameaça de aborto ocorreu em 49 casos (25,5%), aborto em dois (1,0%), ameaça de parto prematuro em 74 (25,1%) e parto prematuro em três (1,0%). Ser primigesta e adolescente apresentou associação estatisticamente significativa com ameaça de parto prematuro e abortamento. Conclusão. A alteração no curso da gestação foi um evento muito frequente durante o episódio agudo de malária, embora a interrupção da gestação tenha tido baixa ocorrência em nossa casuística. Os resultados não evidenciaram um fator de risco de destaque, sugerindo que qualquer gestante pode apresentar ameaça de interrupção ou interrupção da gestação na vigência de episódio agudo de malária

Zika Virus in Rectal Swab Samples

We detected Zika virus RNA in rectal swab samples from 10 patients by using real-time reverse transcription PCR, and we isolated the virus from 1 patient. The longest interval from symptom onset to detection was 14 days. These findings are applicable to diagnosis and infection prevention recommendations

Cohort profile: Study on Zika virus infection in Brazil (ZIKABRA study).

Zika virus (ZIKV) has been detected in blood, urine, semen, cerebral spinal fluid, saliva, amniotic fluid, and breast milk. In most ZIKV infected individuals, the virus is detected in the blood to one week after the onset of symptoms and has been found to persist longer in urine and semen. To better understand virus dynamics, a prospective cohort study was conducted in Brazil to assess the presence and duration of ZIKV and related markers (viral RNA, antibodies, T cell response, and innate immunity) in blood, semen, saliva, urine, vaginal secretions/menstrual blood, rectal swab and sweat. The objective of the current manuscript is to describe the cohort, including an overview of the collected data and a description of the baseline characteristics of the participants. Men and women ≥ 18 years with acute illness and their symptomatic and asymptomatic household contacts with positive reverse transcriptase-polymerase chain reaction test for ZIKV in blood and/or urine were included. All participants were followed up for 12 months. From July 2017 to June 2019, a total of 786 participants (284 men, 502 women) were screened. Of these, 260 (33.1%) were enrolled in the study; index cases: 64 men (24.6%), 162 (62.3%) women; household contacts: 12 men (4.6%), 22 (8.5%) women. There was a statistically significant difference in age and sex between enrolled and not enrolled participants (p<0.005). Baseline sociodemographic and medical data were collected at enrollment from all participants. The median and interquartile range (IQR) age was 35 (IQR; 25.3, 43) for men and 36.5 years (IQR; 28, 47) for women. Following rash, which was one of the inclusion criteria for index cases, the most reported symptoms in the enrollment visit since the onset of the disease were fever, itching, arthralgia with or without edema, non-purulent conjunctivitis, headache, and myalgia. Ten hospitalizations were reported by eight patients (two patients were hospitalized twice) during follow up, after a median of 108 days following symptom onset (range 7 to 266 days) and with a median of 1.5 days (range 1 to 20 days) of hospital stay. A total of 4,137 visits were performed, 223 (85.8%) participants have attended all visits and 37 (14.2%) patients were discontinued

Does the Presence or a High Titer of Yellow Fever Virus Antibodies Interfere with Pregnancy Outcomes in Women with Zika Virus Infection?

Zika virus (ZIKV) and yellow fever virus (YFV) originated in Africa and expanded to the Americas, where both are co-circulated. It is hypothesized that in areas of high circulation and vaccination coverage against YFV, children of pregnant women have a lower risk of microcephaly. We evaluated the presence and titers of antibodies and outcomes in women who had ZIKV infection during pregnancy. Pregnancy outcomes were classified as severe, moderate, and without any important outcome. An outcome was defined as severe if miscarriage, stillbirth, or microcephaly occurred, and moderate if low birth weight and/or preterm delivery occurred. If none of these events were identified, the pregnancy was defined as having no adverse effects. A sample of 172 pregnant women with an acute ZIKV infection confirmed during pregnancy were collected throughout 2016. About 89% (150 of 169) of them presented immunity against YFV, including 100% (09 of 09) of those who had severe outcomes, 84% (16 of 19) of those who had moderate outcomes, and 89% (125 of 141) of those who had non-outcomes. There was no difference between groups regarding the presence of anti-YFV antibodies (p = 0.65) and YFV titers (p = 0.6). We were unable to demonstrate a protective association between the presence or titers of YFV antibodies and protection against serious adverse outcomes from exposure to ZIKV in utero

Evidence of Zika Virus Reinfection by Genome Diversity and Antibody Response Analysis, Brazil

We generated 238 Zika virus (ZIKV) genomes from 135 persons in Brazil who had samples collected over 1 year to evaluate virus persistence. Phylogenetic inference clustered the genomes together with previously reported ZIKV strains from northern Brazil, showing that ZIKV has been remained relatively stable over time. Temporal phylogenetic analysis revealed limited within-host diversity among most ZIKV-persistent infected associated samples. However, we detected unusual virus temporal diversity from >5 persons, uncovering the existence of divergent genomes within the same patient. All those patients showed an increase in neutralizing antibody levels, followed by a decline at the convalescent phase of ZIKV infection. Of interest, in 3 of those patients, titers of neutralizing antibodies increased again after 6 months of ZIKV infection, concomitantly with real-time reverse transcription PCR re-positivity, supporting ZIKV reinfection events. Altogether, our findings provide evidence for the existence of ZIKV reinfection events

Study on the persistence of Zika virus (ZIKV) in body fluids of patients with ZIKV infection in Brazil

Abstract Background Zika virus (ZIKV) has been identified in several body fluids of infected individuals. In most cases, it remained detected in blood from few days to 1 week after the onset of symptoms, and can persist longer in urine and in semen. ZIKV infection can have dramatic consequences such as microcephaly and Guillain-Barré syndrome. ZIKV sexual transmission has been documented. A better understanding of ZIKV presence and persistence across biologic compartments is needed to devise rational measures to prevent its transmission. Methods This observational cohort study will recruit non-pregnant participants aged 18 years and above with confirmed ZIKV infection [positive reverse transcriptase-polymerase chain reaction (RT-PCR) test in blood and/or urine]: symptomatic men and women in ZIKV infection acute phase, and their symptomatic or asymptomatic household/sexual infected contacts. Specimens of blood, urine, semen, vaginal secretion/menstrual blood, rectal swab, oral fluids, tears, sweat, urine and breast milk (if applicable) will be collected at pre-established intervals and tested for ZIKV RNA presence by RT-PCR, other co-infection (dengue, Chikungunya, HIV, hepatitis B and C, syphilis), antibody response (including immunoglobulins M and G), plaque reduction neutralization test (if simultaneously positive for ZIKV and dengue), and ZIKV culture and RNA sequencing. Data on socio-demographic characteristics and comorbidities will be collected in parallel. Participants will be followed up for 12 months. Discussion This prolonged longitudinal follow-up of ZIKV infected persons with regular biologic testing and data collection will offer a unique opportunity to investigate the presence and persistence of ZIKV in various biologic compartments, their clinical and immunological correlates as well as the possibility of ZIKV reactivation/reinfection over time. This valuable information will substantially contribute to the body of knowledge on ZIKV infection and serve as a base for the development of more effective recommendation on the prevention of ZIKV transmission. Trial registration NCT03106714 . Registration Date: April, 7, 201

Risk of adverse outcomes in offspring with RT-PCR confirmed prenatal Zika virus exposure: an individual participant data meta-analysis of 13 cohorts in the Zika Brazilian Cohorts ConsortiumResearch in context

Summary: Background: Knowledge regarding the risks associated with Zika virus (ZIKV) infections in pregnancy has relied on individual studies with relatively small sample sizes and variable risk estimates of adverse outcomes, or on surveillance or routinely collected data. Using data from the Zika Brazilian Cohorts Consortium, this study aims, to estimate the risk of adverse outcomes among offspring of women with RT-PCR-confirmed ZIKV infection during pregnancy and to explore heterogeneity between studies. Methods: We performed an individual participant data meta-analysis of the offspring of 1548 pregnant women from 13 studies, using one and two-stage meta-analyses to estimate the absolute risks. Findings: Of the 1548 ZIKV-exposed pregnancies, the risk of miscarriage was 0.9%, while the risk of stillbirth was 0.3%. Among the pregnancies with liveborn children, the risk of prematurity was 10,5%, the risk of low birth weight was 7.7, and the risk of small for gestational age (SGA) was 16.2%. For other abnormalities, the absolute risks were: 2.6% for microcephaly at birth or first evaluation, 4.0% for microcephaly at any time during follow-up, 7.9% for neuroimaging abnormalities, 18.7% for functional neurological abnormalities, 4.0% for ophthalmic abnormalities, 6.4% for auditory abnormalities, 0.6% for arthrogryposis, and 1.5% for dysphagia. This risk was similar in all sites studied and in different socioeconomic conditions, indicating that there are not likely to be other factors modifying this association. Interpretation: This study based on prospectively collected data generates the most robust evidence to date on the risks of congenital ZIKV infections over the early life course. Overall, approximately one-third of liveborn children with prenatal ZIKV exposure presented with at least one abnormality compatible with congenital infection, while the risk to present with at least two abnormalities in combination was less than 1.0%. Funding: National Council for Scientific and Technological Development - Brazil (Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq); Wellcome Trust and the United Kingdom's Department for International Development; European Union's Horizon 2020 research and innovation program; Medical Research Council on behalf of the Newton Fund and Wellcome Trust; National Institutes of Health/National Institute of Allergy and Infectious Diseases; Foundation Christophe et Rodolphe Mérieux; Coordination for the improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Capes); Ministry of Health of Brazil; Brazilian Department of Science and Technology; Foundation of Research Support of the State of São Paulo (Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP); Foundation of Research Support of the State of Rio de Janeiro (Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro – FAPERJ); Foundation of Support for Research and Scientific and Technological Development of Maranhão; Evandro Chagas Institute/Brazilian Ministry of Health (Instituto Evandro Chagas/Ministério da Saúde); Foundation of Research Support of the State of Goiás (Fundação de Amparo à Pesquisa do Estado de Goiás – FAPEG); Foundation of Research Support of the State of Rio Grande do Sul (Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul – FAPERGS); Foundation to Support Teaching, Research and Assistance at Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto (Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto); São Paulo State Department of Health (Secretaria de Saúde do Estado de São Paulo); Support Foundation of Pernambuco Science and Technology (Fundação de Amparo à Ciência e Tecnologia de Pernambuco – FACEPE)