Relação entre anticorpos Anti-PGL-1 e presença de DNA De Mycobacterium leprae na mucosa nasal de pacientes com hanseníase e contatos

A transmissão da hanseníase é mais intensa em áreas hiperendêmicas nas quais o número de indivíduos clinicamente sadios infectados com Mycobacterium leprae é elevado e pode ser identificado por meio da detecção da presença do DNA bacteriano na mucosa nasale teste sorológico com pesquisa de anticorpos IgM contra PGL-I específico do M.leprae. O objetivo deste estudo foi avaliar a relação entre presença de anticorpos IgM anti-PGL-I e a presença DNA do M.leprae na mucosa nasal em indivíduos em área endêmica. Foram selecionados 337 indivíduos classificados em 6 grupos: a) 71 contatos consanguíneos intradomiciliares – CCOSI, b) 50 contatos consanguíneos extradomiciliares – CCOSE, c) 23 contatos não consanguíneos intradomiciliares – CNCOSI, d) 170 contatos não consanguíneos extradomiciliares – CNCOSE, e) 19 pacientes com hanseníase multibacilar – MB e f) 20 pacientes com hanseníase paucibacilar – PB. Dos 71 CCOSI, 19 foram positivos para PCR (26.76%-19/71) e 34 positivos para PGL-I (47.88% - 34/71); de 50 CCOSE, 7 foram positivos para PCR (14.00 - 7/50) e 11 positivos para PGL-I (22.00%, 11/50); de 23 CNCOSI,  4 positivos para PCR (17.39%- 4/23) e 3 positivos para PGL-I (13.04%-3/23); de 170 CNCOSE, 28 positivos para PCR (16.47% - 28/170) e 35 positivos para PGL-I (20.58% -35/170); de 19 pacientes MB, 6 positivos para PCR (31.57%- 6/19) e 11 positivos para PGL-I (57.89% - 11/19) e de 20 pacientes PB, 3 positivos para PCR (15.00% - 3/20) e 4 positivos para PGL-I (20.00%- 4/20). A PCR de swab nasal foi inversamente proporcional ao PGL-I (p = 0.02, ᵪ² = 5.27), embora ambos os métodos sejam importantes para a vigilância epidemiológica, eles não possuem correlação positiva.ABSTRACTRelationship between Anti-PGL-1 antibodies and presence of DNA and Mycobacterium leprae in the nasal mucosa of leprosy patients and contacts.The transmission of leprosy is more intense in hyperendemic areas. The number of clinically healthy individuals infected with Mycobacterium leprae is high. It can be identified by detecting bacterial DNA in the nasal mucosa and serological testing with IgM antibodies against M. leprae specific PGL-I. This study aimed to evaluate the relationship between anti-PGL-I IgM antibodies and the presence of M. leprae DNA in the nasal mucosa in individuals in an endemic area. A total of 337 individuals were selected, classified into 6 groups: a) 71 intradomiciliary consanguineous contacts - CCOSI, b) 50 extradomiciliary consanguineous contacts - CCOSI, c) 23 intradomiciliary non-consanguineous contacts - CNCOSI, d) 170 extradomiciliary non-consanguineous contacts - CNCOSE e) 19 patients with multibacillary leprosy - MB and f) 20 patients with paucibacillary leprosy - PB. Of the 71 CCOSI, 19 were PCR positive (26.76% -19 / 71) and 34 PGL-I positive (47.88% - 34/71); of 50 CCOSE, 7 were PCR positive (14.00 - 7/50) and 11 PGL-I positive (22.00%, 11/50); 23 CNCOSI, 4 PCR positive (17.39% - 4/23) and 3 PGL-I positive (13.04% -3 / 23); 170 CNCOSE, 28 PCR positive (16.47% - 28/170) and 35 PGL-I positive (20.58% -35/170); of 19 MB patients, 6 PCR positive (31.57% - 6/19) and 11 PGL-I positive (57.89% - 11/19) and 20 PB patients, 3 PCR positive (15.00% - 3/20) and 4 positive for PGL-I (20.00% - 4/20). Nasal swab PCR was inversely proportional to PGL-I (p = 0.02, ᵪ² = 5.27). Although both methods are important for epidemiological surveillance, they have no positive correlation

Phylogenomic Perspective on a Unique Mycobacterium bovis Clade Dominating Bovine Tuberculosis Infections among Cattle and Buffalos in Northern Brazil.

Lack of routine surveillance in countries endemic for bovine tuberculosis (TB) and limited laboratory support contributes to the inability to differentiate the Mycobacterium tuberculosis Complex species, leading to an underestimated burden of the disease. Here, Whole-Genome Sequencing of Mycobacterium bovis isolated from tissues with TB-like lesions obtained from cattle and buffalos at Marajó Island, Brazil, demonstrates that recent transmission of M. bovis is ongoing at distinct sites. Moreover, the M. bovis epidemiology in this setting is herein found to be dominated by an endemic and unique clade composed of strains evolved from a common ancestor that are now genetically differentiated from other M. bovis clades. Additionally, envisioning a rapid strain differentiation and tracing across multiple settings, 28 globally validated strain-specific SNPs were identified, three of which considered as robust markers for the M. bovis Marajó strain. In conclusion, this study contributes with data regarding the identification of a novel M. bovis phylogenetic clade responsible for ongoing transmission events in both cattle and buffalo species in Brazil, provides a framework to investigate the dissemination of this highly prevalent strain and, holds the potential to inform TB control strategies that may help to prevent the spread of bovine and zoonotic TB

Widespread nasal carriage of Mycobacterium lepraeamong a healthy population in a hyperendemic region of northeastern Brazil.

A case-control study was conducted to determine the presence ofMycobacterium lepraeDNA in nasal secretions of leprosy cases and nonleprosy individuals in Fortaleza, Brazil. It included 185 cases identified by physicians at the Dona Libânia National Reference Centre for Sanitary Dermatology (CDERM). A control group (Co) (n = 136) was identified among individuals from CDERM not diagnosed as leprosy cases. To augment the spatial analysis of M. leprae specific repetitive element (RLEP) positive prevalence, an external group (EG) (n = 121), a convenience sample of healthy students, were included. Polymerase chain reaction for the RLEP sequence was conducted for all participants. Prevalence of RLEP positivity for cases and Co were 69.2% and 66.9%, respectively, significantly higher than for EG (28.1%), and reported elsewhere. Male sex, belonging to a lower socioeconomic status (D/E), history of a previous contact with a case and being older, were associated with being a leprosy case. Our geographical analysis demonstrated that the bacillus is widespread among the healthy population, with clusters of RLEP positive multibacillary cases concentrated in distinct areas of the city. Our results suggest that in endemic areas, as in Fortaleza, surveillance for both nonhousehold leprosy contacts and members of the general population living in cluster areas should be implemented

Perfil epidemiológico e espacial da síndrome gripal confirmada para COVID-19 no início da pandemia no estado do Pará-Brasil

Introduction: COVID-19 broke out in Wuhan in China in December 2019, soon reached pandemic level causing thousands of deaths worldwide. It presents mostly mild flu cases; however, it can evolve into a severe respiratory syndrome that is responsible for hospitalizations and deaths. Objective: To describe the epidemiological and spatial profile of confirmed cases of influenza-like syndrome (GB) by COVID-19 in the state of Pará. Method: Descriptive and ecological study, referring to cases of COVID-19 reported in the E-SUS VE. From the variables of the epidemiological profile, spatial distribution and temporal trend of the disease. Results: The spatial distribution showed that the concentration of cases is located in the southern municipalities of the state. In the profile variables: female gender (53.16%), age group (61.14%) 30 and 59 years, chronic heart disease represented (41.99%), diabetes (31.22%) and (16.30%) chronic respiratory diseases Health professionals infected (8%). Clinical features: fever (71.99%), cough (64.57%), and sore throat (46.78%). Confirmation criteria: rapid antibody test (84.39%), rapid antigen test (7.61%), and RT-PCR (7.48%). The temporal trend of the disease showed the peak of cases in the 20th epidemiological week. Conclusion: Mostly women, most frequent heart diseases and diabetes, confirmed by rapid test and classical symptoms of GS. A flattening of the curve was observed after the 21st week, possibly due to the lockdown intervention. However, it was shown the high number of cases on 07/07/2020 in several regions, specifically in municipalities of the southern region of the state.Introdução: A COVID-19 surgiu em Wuhan na China em dezembro de 2019, logo alcançou o nível de pandemia causando milhares de mortes no mundo. Se apresenta em sua maioria casos gripais leves, entretanto pode evoluir para uma síndrome respiratória grave que é responsável pelas hospitalizações e óbitos. Objetivo: Descrever o perfil epidemiológico e espacial dos casos confirmados de Síndrome Gripal (SG) por COVID-19 no estado do Pará. Método: Estudo descritivo e ecológico, referente aos casos de COVID-19 notificados no E-SUS VE. A partir das variáveis do perfil epidemiológico, distribuição espacial e tendência temporal da doença. Resultados: A distribuição espacial mostrou que a concentração dos casos localiza-se nos municípios do Sul do estado. Nas viariáveis do perfil: sexo feminino (53,16%), faixa etária (61,14%) 30 e 59 anos, doenças cardíacas crônicas representou (41,99%), diabetes (31,22%) e (16,30%) doenças respiratórias crônicas Profissionais da saúde infectados (8%). Características clínicas: febre (71,99%),tosse (64,57%) e dor de garganta (46,78%). Critério de confirmação: teste rápido- anticorpo (84.39%), teste rápido antígeno (7.61%) e RT-PCR (7.48%). Na tendência temporal da doença evidenciou-se o pico de casos na 20º semana epidemiológica. Conclusão: A maioria mulheres, doenças cardíacas e diabetes mais evidentes, confirmados a maioria por teste rápido e sintomatologia clássica da SG. Observou-se o achatamento da curva após a 21º semana, possivelmente, por conta da intervenção lockdown. Entretanto mostrou-se a alta de casos na data de 07/07/2020 em diversas regiões, especificamente em municípios da região sul do estado

Inquérito sobre o HIV entre HSH no Brasil em 2016 usando respondent-driven sampling (RDS) : descrição dos métodos e dos diagnósticos do RDS

Introdução: Este artigo detalha os métodos utilizados na segunda Pesquisa Nacional de Vigilância Biológica e Comportamental (BBSS) do HIV, sífilis e hepatite B e C entre os homens que fazem sexo com homens no Brasil. Métodos: O método Respondent-driven Sampling (RDS) foi utilizado em 12 cidades em 2016. A amostra foi iniciada com cinco a seis sementes em cada cidade. Testes rápidos para o HIV, sífilis e Hepatite B e C foram oferecidos aos participantes. O software RDS Analyst com o estimador de amostragem sucessiva (SS) de Gile foi utilizado para ajustar os resultados como recomendado, gerando um peso para cada indivíduo para análises. Osdados das 12cidades foram unidos em um único banco e analisados usando as ferramentas de dados complexos do Stata 14.0, com cada cidade sendo tratada como seu próprio estrato. Resultados: A duração da coleta de dados variou de 5,9 a 17,6 semanas e 4.176 homens foram recrutados nas 12 cidades. Dois sites não alcançaram o tamanho da amostra alvo devido a uma demora de seis meses na aprovação local do Comitê de Ética. Todas as cidades atingiram a convergência na principal variável estudada (HIV). Conclusão: O BBSS foi representativo e concluído conforme planejado e dentro do orçamento. A descrição dos métodos aqui é mais detalhada do que o habitual, devido às novas ferramentas e requisitos de diagnóstico das novas diretrizes do STROBE-RDS.Introduction: This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil. Methods: Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile’s successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum. Results: Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV). Conclusion: The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines

Discrimination based on sexual orientation against MSM in Brazil : a latent class analysis

Introdução: A discriminação por orientação sexual (DPOS) pode influenciar a vulnerabilidade ao HIV aumentando a exposição a comportamentos sexuais de risco entre homens que fazem sexo com homens (HSH). Objetivos: Examinar dados utilizando a análise de classes latentes (ACL) para identificar grupos de indivíduos com padrões específicos de DPOS. Métodos: Estudo transversal com entrevistados recrutados pelo processo amostral respondent driven sampling em 12 cidades brasileiras em 2016. A ACL foi usada para caracterizar o DPOS entre HSH com base em 13 variáveis do bloco de discriminação do questionário da pesquisa. As proporções de DPOS e das variáveis de interesse, bem como seus intervalos de confiança (95%) foram ponderados usando o estimador de Gile. Resultados: A maioria era de jovens, solteiros, com alguma religião, escolaridade média ou superior, cor da pele preta ou parda e com nível socioeconômico médio. Mais da metade referiu ter sido discriminado nos últimos 12 meses por sua orientação sexual (65%), mais de um terço referiu ter tido medo de andar em lugares públicos nos últimos 12 meses e em torno de um quinto dos participantes reportaram ter sofrido agressão física ou sexual na vida. A DPOS foi classificada em 4 classes latentes, “muito alta”, “alta”, “média” e “baixa”, com estimativas de 2,2%, 16,4%, 35,1% e 46,19%, respectivamente. Conclusão: Observou-se alta proporção de discriminação entre os HSH participantes deste estudo. A utilização da ACL discriminou de maneira parcimoniosa as classes de DPOS.Introduction: Discrimination based on sexual orientation can influence vulnerability to HIV, increasing exposure to risky sexual behavior among men who have sex with men (MSM). Objectives: To analyze data using latent class analysis (LCA) to identify groups of individuals with specific patterns of discrimination based on sexual orientation (DSO). Methods: Cross-sectional study using respondent-driven sampling in 12 Brazilian cities in 2016. LCA was used to characterize discrimination among MSM based on 13 variables in the survey questionnaire. The proportions of men reporting DSO and other variables of interest were estimated using Gile’s Successive Sampling estimator. Results: Most MSM were young, single, had a religion, had a high school or college degree, black or brown skin color, and socioeconomic status classified as average. More than half of the participants reported that they had been discriminated against during the last 12 months due to their sexual orientation (65%), more than a third said they had felt afraid of walking in public places during the past 12 months, and about one-fifth of participants reported having been victims of physical or sexual assault due to DSO. DSO was classified into four latent classes: “very high”, “high”, “moderate” and “low”, with estimates of 2.2%, 16.4%, 35.1%, and 46.19%, respectively. Conclusion: We observed a high proportion of discrimination against MSM in this study. The use of LCA differentiated parsimoniously classes of discrimination

HIV prevalence among men who have sex with men in Brazil : results of the 2nd national survey using respondent-driven sampling

This paper reports human immuno-deficiency virus (HIV) prevalence in the 2nd National Biological and Behavioral Surveillance Survey (BBSS) among men who have sex with men (MSM) in 12 cities in Brazil using respondent-driven sampling (RDS). Following formative research, RDS was applied in 12 cities in the 5 macroregions of Brazil between June and December 2016 to recruit MSM for BBSS. The target sample size was 350 per city. Five to 6 seeds were initially selected to initiate recruitment and coupons and interviews were managed online. On-site rapid testing was used for HIV screening, and confirmed by a 2nd test. Participants were weighted using Gile estimator. Data from all 12 cities were merged and analyzed with Stata 14.0 complex survey data analysis tools in which each city was treated as its own strata. Missing data for those who did not test were imputed HIV+ if they reported testing positive before and were taking antiretroviral therapy. A total of 4176 men were recruited in the 12 cities. The average time to completion was 10.2 weeks. The longest chain length varied from 8 to 21 waves. The sample size was achieved in all but 2 cities. A total of 3958 of the 4176 respondents agreed to test for HIV (90.2%). For results without imputation, 17.5% (95%CI: 14.7–20.7) of our sample was HIV positive. With imputation, 18.4% (95%CI: 15.4–21.7) were seropositive. HIV prevalence increased beyond expectations from the results of the 2009 survey (12.1%; 95%CI: 10.0–14.5) to 18.4%; CI95%: 15.4 to 21.7 in 2016. This increase accompanies Brazil’s focus on the treatment to prevention strategy, and a decrease in support for community-based organizations and community prevention programs

Risk of SARS-CoV-2 infection among front-line healthcare workers in Northeast Brazil : a respondent-driven sampling approach

Objectives We assessed the prevalence of SARS-CoV-2 infection, personal protective equipment (PPE) shortages and occurrence of biological accidents among front-line healthcare workers (HCW). Design, setting and participants Using respondent-driven sampling, the study recruited distinct categories of HCW attending suspected or confirmed patients with COVID-19 from May 2020 to February 2021, in the Recife metropolitan area, Northeast Brazil. Outcome measures The criterion to assess SARS-CoV-2 infection among HCW was a positive self-reported PCR test. Results We analysed 1525 HCW: 527 physicians, 471 registered nurses, 263 nursing assistants and 264 physical therapists. Women predominated in all categories (81.1%; 95% CI: 77.8% to 84.1%). Nurses were older with more comorbidities (hypertension and overweight/obesity) than the other staff. The overall prevalence of SARS-CoV-2 infection was 61.8% (95% CI: 55.7% to 67.5%) after adjustment for the cluster random effect, weighted by network, and the reference population size. Risk factors for a positive RT-PCR test were being a nursing assistant (OR adjusted: 2.56; 95% CI: 1.42 to 4.61), not always using all recommended PPE while assisting patients with COVID-19 (OR adj: 2.15; 95% CI: 1.02 to 4.53) and reporting a splash of biological fluid/respiratory secretion in the eyes (OR adj: 3.37; 95% CI: 1.10 to 10.34). Conclusions This study shows the high frequency of SARS-CoV2 infection among HCW presumably due to workplace exposures. In our setting, nursing assistant comprised the most vulnerable category. Our findings highlight the need for improving healthcare facility environments, specific training and supervision to cope with public health emergencies