Factores asociados con la contracción de enterobacterias resistentes al carbapenem

Objetivo: identificar possíveis fatores de risco para a aquisição de cepas de Enterobactérias com marcador de resistência a carbapenem. Métodos: estudo caso-controle exploratório realizado em instituições hospitalares. A amostra do estudo consistiu de pacientes com espécimes biológicos positivos para Enterobactérias resistentes aos carbapenêmicos (casos) por teste de difusão em disco e Etest e controles com amostras biológicas negativas para Enterobactérias resistentes aos carbapenêmicos. No total, foram incluídos 65 pacientes: 13 (20%) casos e 52 (80%) controles. Resultados: os microrganismos isolados foram Serratia marcescens (6), Klebsiella pneumoniae (4) e Enterobacter cloacae (3). A análise univariada revelou que o tempo de internação antes da coleta da amostra (p=0,002) e o procedimento cirúrgico (p=0,006) foram estatisticamente significantes. No modelo de regressão logística multivariável, ambos foram ainda significativos, com odds ratios de 0,93 (p=0,009; IC 95%: 0,89 a 0,98) para o período de hospitalização antes da coleta da amostra e 9,28 (p=0,05; IC 95%: 1,01 a 85,14) para o procedimento cirúrgico. Conclusão: tempo de internação mais curto e maior vigilância de pacientes submetidos a cirurgia podem desempenhar um papel decisivo na redução da disseminação de microrganismos resistentes aos carbapenêmicos em instituições hospitalares.Objetivo: identificar posibles factores de riesgo para la contracción de cepas de enterobacterias con marcador de resistencia a carbapenem. Métodos: estudio exploratorio de casos y controles realizado en entornos hospitalarios. La muestra del estudio consistió en pacientes con muestras biológicas que dieron positivo para enterobacterias resistentes a carbapenem (casos) con prueba de difusión en disco y Etest y controles con muestras biológicas negativas para enterobacterias resistentes a carbapenem. En total, se incluyeron 65 pacientes: 13 (20%) casos y 52 (80%) controles. Resultados: los microorganismos aislados fueron Serratia marcescens(6), Klebsiella pneumoniae(4) y Enterobacter cloacae(3). El análisis univariado reveló que la duración de la hospitalización antes de la recolección de la muestra (p = 0.002) y el Intervención quirúrgica (p = 0.006) fueron estadísticamente significativas. En el modelo de regresión logística multi variable, ambos fueron significativos, con razón de momios de 0.93 (p = 0.009; IC del 95%: 0.89 a 0.98) para la duración de la hospitalización antes de la recolección de la muestra y 9.28 (p = 0.05; IC del 95%: 1.01 a 85.14) por haberse sometido a un Intervención quirúrgica. Conclusión: tiempos de hospitalización más cortos y una mayor vigilancia de los pacientes sometidos a cirugía podrían desempeñar un papel decisivo en la reducción de la propagación de los microorganismos resistentes a los carbapenem en los hospitales.Objective: to identify possible risk factors for acquisition of Enterobacterial strains with a marker for resistance to carbapenems. Methods: exploratory case-control study performed in hospital settings. The study sample consisted of patients with biological specimens that tested positive for carbapenem-resistant Enterobacteriaceae (cases), with the disk diffusion test and Etest, and controls with biological samples testing negative for carbapenem-resistant Enterobacteriaceae. In all, 65 patients were included: 13 (20%) cases and 52 (80%) controls. Results: the microorganisms isolated were Serratia marcescens (6), Klebsiella pneumoniae (4), and Enterobacter cloacae (3). Univariate analysis revealed that length of hospitalization prior to sample collection (p=0.002) and having a surgical procedure (p=0.006) were statistically significant. In the multivariable logistic regression model, both were still significant, with odds ratios of 0.93 (p = 0.009; 95% CI: 0.89 to 0.98) for length of hospitalization prior to sample collection, and 9.28 (p = 0.05; 95% CI: 1.01 to 85.14) for having a surgical procedure. Conclusion: shorter hospitalization times and increased surveillance of patients undergoing surgery could play a decisive role in reducing the spread of carbapenem-resistant microorganisms in hospital settings

Determination of clusters and factors associated with dengue dispersion during the first epidemic related to Dengue virus serotype 4 in Vitoria, Brazil

Dengue occurrence is partially influenced by the immune status of the population. Consequently, the introduction of a new Dengue virus serotype can trigger explosive epidemics in susceptible populations. The determination of clusters in this scenario can help to identify hotspots and understand the disease dispersion regardless of the influence of the population herd immunity. The present study evaluated the pattern and factors associated with dengue dispersion during the first epidemic related to Dengue virus serotype 4 in Vitoria, Espirito Santo state, Brazil. Data on 18,861 dengue cases reported in Vitoria from September 2012 to June 2013 were included in the study. The analysis of spatial variation in temporal trend was performed to detect clusters that were compared by their respective relative risk, house index, population density, and income in an ecological study. Overall, 11 clusters were detected. The time trend increase of dengue incidence in the overall study population was 636%. The five clusters that showed a lower time trend increase than the overall population presented a higher incidence in the beginning of the epidemic and, compared to the six clusters with higher time trend increase, they presented higher relative risk for their inhabitants to acquire dengue infection (P-value = 0.02) and a lower income (P-value < 0.01). House index and population density did not differ between the clusters. Early increase of dengue incidence and higher relative risk for acquiring dengue infection were favored in low-income areas. Preventive actions and improvement of infrastructure in low-income areas should be prioritized in order to diminish the magnitude of dengue dispersion after the introduction of a new serotype

Caracterização entomológica e infecção natural de anofelinos em área de Mata Atlântica, com casos autóctones de malária, em regiões montanhosas do Espírito Santo

No Espírito Santo, os casos de malária autóctone estão distribuídos na região serrana próximo aos fragmentos de Mata Atlântica. Uma vez que alguns aspectos da doença são obscuros, a detecção das possíveis espécies de vetores pode auxiliar na elucidação de incertezas epidemiológicas. Estudos entomológicos e de infecção natural foram realizados com anofelinos (Diptera: Culicidae) capturados no município de Santa Tereza, ES. Capturas mensais foram realizadas de março de 2004 a fevereiro de 2006. Armadilhas CDC-CO2 foram utilizadas do crepúsculo (18:00h) ao amanhecer (6:00h), para capturar anofelinos nos seguintes habitats: próximo ao domicílio e área aberta (solo), margem e interior da mata (solo e copa). Armadilhas Shannon também foram utilizadas nos mesmos locais que as de CDC-CO2. Capturou-se o total de 2.290 anofelinos distribuídos em 10 espécies. A maior frequência relativa foi de Anopheles (Kerteszia) cruzii Dyar & Knab / A.(K.) homunculus Komp, sendo a maioria capturada em CDC-CO2 instalada na copa da mata. A principal espécie capturada em armadilha Shannon foi A.(Nyssorhynchus) strodei Root. O maior número de anofelinos foi capturado entre julho e setembro das 18:00h às 22:00h. Provavelmente A.(K.) cruzii é responsável pela transmissão da malária dentro ou próximo aos fragmentos de Mata Atlântica. Entretanto, a participação de outras espécies não pode ser ignorada, visto que 53 por cento da amostragem foi constituída pelo subgênero Nyssorhynchus. A detecção de Plasmodium vivax no tórax de A. cruzii, A. parvus (Chagas) e A. galvaoi Causey, Deane & Deane por meio de PCR reforça esse argumentoAutochthonous malaria cases in the state of Espírito Santo, Brazil, are distributed in mountainous regions surrounded by the Atlantic Forest. While some aspects of this disease are unclear, detection of possible vector species can help to elucidate epidemiological uncertainties. Entomological and natural infection studies were carried out using anophelines (Diptera: Culicidae) captured in the municipality of Santa Tereza, ES. Monthly captures were made from March 2004 to February 2006. CDC-CO2 traps were used from dusk (6:00 P.M.) to dawn (6:00 A.M.) to capture anophelines in the following habitats: near the houses, in open areas (at ground level) and inside, and at the margins of the forest (canopy and ground level). Shannon light traps were also used at the same locations of the CDC-CO2 traps. A total of 2,290 anophelines within 10 species were captured. The relative frequency of Anopheles (Kerteszia) cruzii Dyar & Knab / A.(K.) homunculus Komp was the highest, with the majority captured in CDC-CO2 traps installed in the forest canopy. The main species captured in Shannon traps was A.(Nyssorhynchus) strodei Root. The largest number of anophelines was captured from July to September and from 6:00 P.M. to 10:00 P.M. Anopheles (K.) cruzii is the probable vector for malaria transmission inside or near the Atlantic Forest fragments, but the role of other species cannot be ignored, as 53% of the sampled anophelines belonged to the subgenus Nyssorhynchus. The natural infection of A. cruzii, A. parvus (Chagas) and A. galvaoi Causey, Deane & Deane by Plasmodium vivax detected by PCR from DNA extracted from their thoraxes supports this viewFAPESP 2003/07631-

Covid-19 em áreas de aglomerados subnormais e não subnormais no Espírito Santo, Brasil

Objectives: to estimate the prevalence of SARS-CoV-2 infection in residents of the Greater Vitória region living in subnormal and non-subnormal agglomerations; and, compare sociodemographic and clinical characteristics of total residents (infected and not infected with SARS-CoV-2), among these clusters. Method: Population-based prevalence study, through serological testing carried out in 2020, with a study unit in households in Greater Vitória, grouped into census tracts classified as sub-normal clusters (AGSN) and non-sub-normal clusters (AGNSN ). The two groups were compared in terms of prevalence and associated factors. The significance level adopted was 5%. Results: The prevalence found in the AGSN was 12.05% (95% CI from 9.59 to 14.50%), and in the AGNSN group it was 10.23% (95% CI from 7.97% to 12.50% ) this difference was not statistically significant (p = 0.273). Comparing the sociodemographic characteristics, more people who declare themselves to be of mixed race were found in the SGNA, a higher percentage of illiterates and people with only elementary education, greater number of residents per household, longer stay in public transport, sharing a bathroom with another household , fewer bedrooms per residence and higher frequency of irregular water supply when compared to AGNSN(P&lt;0.05). Conclusions: The epidemiological characteristics of the SNGA residents show the social inequalities that can hinder control measures in a pandemic situation.Objetivos: estimar prevalência de infecção pelo SARS-CoV-2 em residentes na região da Grande Vitória moradores de aglomerados subnormais e não subnormais; e, comparar características sociodemográficas e clínicas dos residentes totais (infectados e não infectados com o SARS-CoV-2), entre esses aglomerados.&nbsp; Método: Estudo de prevalência de base populacional, por meio de teste sorológico realizado em 2020, com unidade de estudo em domicílios da Grande Vitória, agrupados em setores censitários classificados como Aglomerados sub-normais (AGSN) e os Aglomerados não sub-normais (AGNSN). Os dois grupos foram comparados quanto a prevalência e fatores associados. O nível de significância adotado foi de 5%. Resultados: A prevalência encontrada no AGSN foi 12,05% (IC 95% de 9,59 a 14,50%), e no grupo AGNSN foi 10,23% (IC 95% de 7,97% a 12,50%) esta diferença não foi estatisticamente significante (p = 0,273). Comparando-se as características sociodemográficas foram encontradas nos AGSN mais pessoas que se autodeclaram da raça cor parda, percentual maior de analfabetos e pessoas apenas com ensino fundamental, maior número de moradores por domicílio, maior permanência em transporte coletivo, compartilhamento de banheiro com outro domicílio, menos dormitórios por residência e maior frequência de abastecimento irregular de água quando comparadas aos AGNSN(P&lt;0,05). Conclusões: As características epidemiológicas dos moradores de AGSN evidenciam as desigualdades sociais que podem dificultar as medidas de controle em uma situação de pandemia

Prevalência e fatores associados à infecção por SARS-CoV-2: estudo de base populacional seriado, no Espírito Santo, em maio-junho/2020.

Objective: To analyze the seroprevalence of SARS-CoV-2 and the association of sociodemographic and clinical aspects in the state of Espírito Santo, Brazil. Methods: Serial cross-sectional study carried out in four phases, using households as the unit of analysis, from May to June 2020. 11 municipalities were surveyed, with a sample of 4,500 households in each phase. Results: the prevalence ranged from 2.1% (95%CI: 1.7;2.5) on May 10 (first stage) to 9.6% (95%CI: 8.8;10.4), on June 21 (fourth stage). In the metropolitan region of Greater Vitória, the prevalences were 2.7% (95%CI: 2.2;3.3), in the first, and 11.5% (95%CI: 10.5;12.6) in the fourth stage; within the state it ranged from 0.4% (95%CI: 0.1;0.9) to 4.4% (95%CI: 3.2;5.5) between the two stages. Conclusion: The increase in SARS-CoV-2 seroprevalence observed in the fourth phase highlighted the high transmission of the virus, supporting the management of the pandemic.Objetivo: Analizar la seroprevalencia del SARS-CoV-2 y la asociación de aspectos sociodemográficos y clínicos en el estado de Espírito Santo, Brasil. Métodos: Estudio transversal seriado realizado en cuatro fases, utilizando los hogares como unidad de análisis, de mayo a junio de 2020. Se encuestaron 11 municipios, con una muestra de 4.500 hogares en cada fase. Resultados: la prevalencia varió de 2,1% (IC95%: 1,7;2,5) el 10 de mayo (primera etapa) a 9,6% (IC95%: 8,8;10,4), el 21 de junio (cuarta etapa). En la región metropolitana de la Gran Vitória, las prevalencias fueron de 2,7% (IC95%: 2,2;3,3), en la primera, y de 11,5% (IC95%: 10,5;12,6) en la cuarta etapa; dentro del estado osciló entre 0,4% (IC95%: 0,1;0,9) y 4,4% (IC95%: 3,2;5,5). Conclusión: El aumento de la seroprevalencia del SARS-CoV-2 observado en la cuarta fase destacó la alta transmisión del virus, apoyando el manejo de la pandemia.Objetivo: Analisar a soroprevalência de SARS-CoV-2 e sua associação com aspectos sociodemográficos e clínicos, no estado do Espírito Santo, Brasil. Métodos: Estudo transversal seriado, realizado em quatro fases, no período de maio a junho de 2020, utilizando os domicílios como unidade de análise. Foram pesquisados 11 municípios, com amostra de 4.500 domicílios em cada fase. Resultados: a soroprevalência de SARS-CoV2 variou de 2,1% (IC95%: 1,7;2,5) em 10 de maio (primeira etapa) a 9,6% (IC95%: 8,8;10,4) em 21 de junho (quarta etapa). Na região metropolitana da Grande Vitória, as prevalências foram de 2,7% (IC95%: 2,2;3,3), na primeira, e de 11,5% (IC95%: 10,5;12,6) na quarta etapa; no interior do estado, a prevalência variou de 0,4% (IC95%: 0,1;0,9) a 4,4% (IC95%: 3,2;5,5) entre a primeira e a quarta etapas. Conclusão: O aumento da soroprevalência de SARS-CoV-2 observado na quarta fase destacou a elevada transmissão do vírus, subsidiando a gestão da pandemia

Human migration and the spread of malaria parasites to the New World

We examined the mitogenomes of a large global collection of human malaria parasites to explore how and when Plasmodium falciparum and P. vivax entered the Americas. We found evidence of a significant contribution of African and South Asian lineages to present-day New World malaria parasites with additional P. vivax lineages appearing to originate from Melanesia that were putatively carried by the Australasian peoples who contributed genes to Native Americans. Importantly, mitochondrial lineages of the P. vivax-like species P. simium are shared by platyrrhine monkeys and humans in the Atlantic Forest ecosystem, but not across the Amazon, which most likely resulted from one or a few recent human-to-monkey transfers. While enslaved Africans were likely the main carriers of P. falciparum mitochondrial lineages into the Americas after the conquest, additional parasites carried by Australasian peoples in pre-Columbian times may have contributed to the extensive diversity of extant local populations of P. vivax

Serotype influences on dengue severity: a cross-sectional study on 485 confirmed dengue cases in Vitória, Brazil

Abstract Background Dengue is caused by a RNA virus of the family Flaviviridae, which presents four serotypes (DENV-1 to DENV-4) capable of inducing hemorrhage. The purpose of this study was to evaluate the influence of serotype on the outcome of dengue. Methods This cross-sectional study included data from dengue cases with serotyping results that occurred between 2009 and 2013 in Vitória, Espírito Santo, Brazil. Data were accessed through the Information System for Notifiable Diseases. Chi-square test, Fisher exact test, Mann–Whitney U test, and logistic regression were performed to assess associations between different serotypes and dengue severity, while considering gender and age. Results The sample consisted of 485 laboratory confirmed dengue cases, of which 46.4 % were females, with median age of 26 years. Regarding overall samples, 77.3 % were caused by DENV-1, 16.1 % by DENV-4, 6.4 % by DENV-2, and 0.2 % by DENV-3. Severe dengue affected 6.6 % of all cases, of which 32.3 % of the cases caused by DENV-2, 6.4 % of those caused by DENV-4, 4.5 % of those caused by DENV-1, and none of those caused by DENV-3. Severe dengue was found to be seven times more frequent among cases of DENV-2 than among those of the other serotypes. Conclusions The present study found that cases of DENV-2 had a higher proportion of severe dengue than among those of DENV-1 and DENV-4. Consequently, early detection of serotypes circulating in the territory could be an important approach to prevent increasing numbers of severe outcomes during dengue outbreaks by predicting the health support needed for early diagnoses and treatment of dengue cases