Spleen rupture in a case of untreated Plasmodium vivax infection

We report the unique case of a 19-yearold nonimmune patient with Plasmodium vivax monoinfection, confirmed by PCR in the peripheral blood and in the spleen section, who was splenectomized due to spleen rupture two days prior to the diagnosis and treatment of the malarial infection. Microscopic analyses evidenced white pulp expansion and a diffuse hypercellularity in the splenic red pulp, with intense proliferating plasmablasts in the subcapsular and perivascular compartments as well as large numbers of intact P. vivax-infected reticulocytes in the cords, in the absence of other concomitant infectious diseases. To our knowledge, this is the first full detailed immunohistopathological characterization of a nontreated P. vivax-infected spleen

Risk Factors and Characterization of Plasmodium Vivax-Associated Admissions to Pediatric Intensive Care Units in the Brazilian Amazon

BACKGROUND: Plasmodium vivax is responsible for a significant proportion of malaria cases worldwide and is increasingly reported as a cause of severe disease. The objective of this study was to characterize severe vivax disease among children hospitalized in intensive care units (ICUs) in the Western Brazilian Amazon, and to identify risk factors associated with disease severity. METHODS AND FINDINGS: In this retrospective study, clinical records of 34 children, 0-14 years of age hospitalized in the 11 public pediatric and neonatal ICUs of the Manaus area, were reviewed. P. falciparum monoinfection or P. falciparum/P. vivax mixed infection was diagnosed by microscopy in 10 cases, while P. vivax monoinfection was confirmed in the remaining 24 cases. Two of the 24 patients with P. vivax monoinfection died. Respiratory distress, shock and severe anemia were the most frequent complications associated with P. vivax infection. Ninety-one children hospitalized with P. vivax monoinfections but not requiring ICU were consecutively recruited in a tertiary care hospital for infectious diseases to serve as a reference population (comparators). Male sex (p = 0.039), age less than five years (p = 0.028), parasitemia greater than 500/mm(3) (p = 0.018), and the presence of any acute (p = 0.023) or chronic (p = 0.017) co-morbidity were independently associated with ICU admission. At least one of the WHO severity criteria for malaria (formerly validated for P. falciparum) was present in 23/24 (95.8%) of the patients admitted to the ICU and in 17/91 (18.7%) of controls, making these criteria a good predictor of ICU admission (p = 0.001). The only investigated criterion not associated with ICU admission was hyperbilirubinemia (p = 0.513)]. CONCLUSIONS: Our study points to the importance of P. vivax-associated severe disease in children, causing 72.5% of the malaria admissions to pediatric ICUs. WHO severity criteria demonstrated good sensitivity in predicting severe P. vivax infection in this small case series

Cardiopatia chagásica crônica na Amazônia: uma etiologia a ser lembrada Cardiopatía chagásica crónica en la Amazonía: una etiología que recordar Chronic chagasic cardiopathy in Amazon region: an etiology to remember

Este estudo avaliou a frequência de cardiopatia chagásica crônica (CCC) em 37 pacientes autóctones da Amazônia com disfunção sistólica ventricular esquerda sem etiologia definida. Foram diagnosticados três casos com frequência de 8,1% no grupo estudado.<br>Este estudio evaluó la frecuencia de cardiopatía chagásica crónica (CCC) en 37 pacientes autóctonos de la Amazonía con disfunción sistólica ventricular izquierda sin etiología definida. Se diagnosticaron tres casos con frecuencia del 8,1% en el grupo estudiado.<br>This study assessed the frequency of chronic chagasic cardiopathy (CCC) in 37 autochthonus patients from Amazon region with left ventricular systolic dysfunction of undefined etiology. Three cases were diagnosed in the studied sample, with an 8.1% frequency

Unravelling the patterns of host immune responses in Plasmodium vivax malaria and dengue co‑infection

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2016-04-26T17:20:49Z No. of bitstreams: 1 Mendonça VRR Unravelling the....pdf: 1769522 bytes, checksum: 9e588aa167adfadd6783622be1f69634 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2016-04-26T17:32:23Z (GMT) No. of bitstreams: 1 Mendonça VRR Unravelling the....pdf: 1769522 bytes, checksum: 9e588aa167adfadd6783622be1f69634 (MD5)Made available in DSpace on 2016-04-26T17:32:23Z (GMT). No. of bitstreams: 1 Mendonça VRR Unravelling the....pdf: 1769522 bytes, checksum: 9e588aa167adfadd6783622be1f69634 (MD5) Previous issue date: 2015Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Laboratório Integrado de Microbiogia e Imunoregulação. LIMI. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Laboratório Integrado de Microbiogia e Imunoregulação. LIMI. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Laboratório Integrado de Microbiogia e Imunoregulação. LIMI. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, BrasilFundação de Medicina Tropical Dr. Heitor Vieira Dourado. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Manaus, AM, BrasilFundação de Medicina Tropical Dr. Heitor Vieira Dourado. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Manaus, AM, BrasilFundação de Medicina Tropical Dr. Heitor Vieira Dourado. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Manaus, AM, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Laboratório Integrado de Microbiogia e Imunoregulação. LIMI. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brasil / Instituto Nacional de Ciência e Tecnologia. Instituto de Investigação em Imunologia. São Paulo, SP, BrasilBackground: Concurrent malaria and dengue infection is frequently diagnosed in endemic countries, but its immunopathology remains largely unknown. In the present study, a large panel of cytokines/chemokines and clinical laboratory markers were measured in patients with Plasmodium vivax and dengue co-infection as well as in individuals with malaria or dengue mono-infections in order to identify biosignatures of each clinical condition. Methods: Individuals from the Brazilian Amazon were recruited between 2009 and 2013 and classified in three groups: vivax malaria (n = 52), dengue (n = 30) and vivax malaria and dengue co-infection (n = 30). P. vivax malaria was diagnosed by thick blood smear and confirmed by PCR; dengue cases were detected by IgM ELISA or NS1 protein. The plasma levels of cytokines and chemokines were determined by multiplex assay. Results: Individuals with malaria and dengue co-infection displayed lower levels of platelets and haemoglobin than those with malaria or dengue mono-infections (p = 0.0047 and p = 0.0001, respectively). The group of individuals coinfected exhibited the highest median concentrations of IFN-γ, IL-6, CCL4 than the mono-infected groups. Network analyses of plasma cytokines/chemokines revealed that malaria and dengue co-infection exhibits a distinct immune profile with critical roles for TNF, IL-6 and IFN-γ. Further, parasitaemia levels displayed positive significant interactions with IL-6, CCL4 and IL-10 in the group of patients co-infected with malaria and dengue. No differences were observed in distribution of dengue virus serotypes and Plasmodium parasitaemia levels between the groups. Conclusions: The findings described here identify unique patterns of circulating immunological markers in cases of malaria and dengue co-infection and provide insights on the immunopathology of this co-morbid condition

Inquérito sorológico para doença de Chagas em áreas rurais de Manaus, Coari e Tefé na Amazônia Ocidental

Submitted by Sandra Infurna ([email protected]) on 2017-06-13T16:28:06Z No. of bitstreams: 1 josecoura_etal_IOC_2011.pdf: 713583 bytes, checksum: 4b85288d95ee4f1ee962b5f383123892 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2017-06-13T16:43:07Z (GMT) No. of bitstreams: 1 josecoura_etal_IOC_2011.pdf: 713583 bytes, checksum: 4b85288d95ee4f1ee962b5f383123892 (MD5)Made available in DSpace on 2017-06-13T16:43:07Z (GMT). No. of bitstreams: 1 josecoura_etal_IOC_2011.pdf: 713583 bytes, checksum: 4b85288d95ee4f1ee962b5f383123892 (MD5) Previous issue date: 2011Universidade do Estado do Amazonas. Programa de Pós-graduação em Medicina Tropical. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.Fundação de Medicina Tropical Heitor Vieira Dourado. Gerência de Entolomogia e Leishmaniose. Manaus, AM, Brasil / Universidade Federal do Amazonas. Faculdade de Farmácia. Manaus, AM, Brasil / Universidade Federal do Amazonas. Faculdade de Medicina. Manaus, AM, BrasilUniversidade do Estado do Amazonas. Programa de Pós-graduação em Medicina Tropical. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.Universidade Federal do Amazonas. Faculdade de Farmácia. Manaus, AM, Brasil / Universidade Federal do Amazonas. Faculdade de Medicina. Manaus, AM, BrasilInstituto de Medicina Tropical de São Paulo. Laboratório de Doenças Parasitárias. São Paulo, SP, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Doenças Parasitárias. Rio de Janeiro, RJ. Brasil.Universidade do Estado do Amazonas. Programa de Pós-graduação em Medicina Tropical. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil./ Fundação de Medicina Tropical Heitor Vieira Dourado. Gerência de Entolomogia e Leishmaniose. Manaus, AM, Brasil.Universidade do Estado do Amazonas. Programa de Pós-graduação em Medicina Tropical. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil./ Fundação de Medicina Tropical Heitor Vieira Dourado. Gerência de Entolomogia e Leishmaniose. Manaus, AM, Brasil / Universidade Nilton Lins. Departamento de Biologia. Manaus, AM, Brasil.Introduction: Deforestation, uncontrolled forest, human population migration from endemic areas, and the large number of reservoirs and wild vectors naturally infected by Trypanosoma cruzi promote the endemicity of Chagas disease in the Amazon region. Methods: We conducted an initial serological survey (ELISA) in a sample of 1,263 persons; 1,095 (86.7%) were natives of the state of Amazonas, 666 (52.7%) were male, and 948 (75.1%) were over 20 years old. Serum samples that were found to be reactive, indeterminate, or inconclusive by indirect immunofluorescence (IFI) or positive with low titer by IFA were tested by Western blot (WB). Serologically confirmed patients (WB) were evaluated in terms of epidemiological, clinical, ECG, and echocardiography characteristics. Results: Fifteen patients had serologically confirmed T. cruzi infection, and 12 of them were autochthonous to the state of Amazonas, for an overall seroprevalence of 1.2% and 0.9% for the state of Amazonas. Five of the 15 cases were males, and the average age was 47 years old; most were farmers with low education. One patient who was not autochthonous, having originated from Alagoas, showed right bundle branch block, bundle branch block, and anterosuperior left ventricular systolic dysfunction with an ejection fraction of 54%. Conclusions: The results of this study ratify the importance of monitoring CD cases in Amazonia, particularly in the state of Amazonas

DDX39B (BAT1), TNF and IL6 gene polymorphisms and association with clinical outcomes of patients with Plasmodium vivax malaria.

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2014-08-08T18:48:38Z No. of bitstreams: 1 Mendonça VRR DDX39B Bat1....pdf: 1174442 bytes, checksum: 1c795f10853ff55ec140429586c673db (MD5)Made available in DSpace on 2014-08-08T18:48:38Z (GMT). No. of bitstreams: 1 Mendonça VRR DDX39B Bat1....pdf: 1174442 bytes, checksum: 1c795f10853ff55ec140429586c673db (MD5) Previous issue date: 2014Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, BrasilFndação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilFundação de Medicina Tropical Dr Heitor Vieira Dourado. Manaus, BrasilFundação de Medicina Tropical Dr Heitor Vieira Dourado. Manaus, BrasilNational Institutes of Health. Immunobiology Section, Laboratory of Parasitic Diseases National Institute of Allergy and Infectious Diseases. Bethesda, MD, USAFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, Brasil / Instituto Nacional de Ciência e Tecnologia. Instituto de Investigação em Imunologia. São Paulo, SP, BrasilBACKGROUND: DDX39B (BAT1) encodes an RNA helicase known to regulate expression of TNF and IL-6. Elevated levels of these two cytokines are associated with increased severity of clinical malaria. The aim of this study was to investigate the relationship between single nucleotide polymorphisms (SNPs) in the DDX39B, TNF and IL6 genes and the clinical outcomes of patients with Plasmodium vivax malaria. METHODS: Cross-sectional investigations were carried out in two regions of the Brazilian Amazon where several studies on the pathogenesis of vivax malaria had been performed. Individuals were categorized according to infection status as well as clinical presentation into the following groups: uninfected, asymptomatic infection, mild infection, or complicated infection. Polymorphisms were identified using PCR restriction fragment-length polymorphism analysis and the restriction enzymes NlaIII or NcoI. The plasma levels of cytokines were determined using ELISA. RESULTS: The G allele of DDX39B-22C > G was associated with absent or decreased manifestations of malaria and the C allele was a risk factor for disease complications. Study participants heterozygous for TNF-308 (GA) and DDX39B-348 (CT) had higher TNF levels than wild-type participants. Haplotypes that included DDX39B (-22C > G and -348C > T) and TNF polymorphisms were not directly associated with mild or complicated malaria infections; however, haplotypes AGC, ACC, GGT, AGT and ACT were associated with increased TNF levels. Participants with genotype combinations GC/CC/GG/GG and GG/CT/GG/GG (DDX39B-22/DDX39B-348/TNF-308/IL6-176) had decreased and increased risk of mild malaria, respectively, compared with asymptomatic and uninfected participants. GC/CC/GG/GG was linked to decreased TNF and IL-6 levels. CONCLUSIONS: This is the first study to describe patients with DDX39B and IL6 SNPs who had vivax malaria. These findings support the postulation that a set of mutations in immune-related genes is associated with inflammatory mediators and the clinical outcomes of patients with malaria

Detailed clinical information from 24 children 0–14 years old, admitted to any of the pediatric or neonatal ICUs in Manaus, from 2004 to 2009, with parasitological diagnosis of <i>P. vivax</i>.

<p>y years; mo: months; d: days; NA: Non-available; ARDS: Acute Respiratory Distress Syndrome; ARF: Acute Renal Failure; PIM: Pediatric Index of Mortality; ITP: Immune Trombocytopenic Purpura.</p>*<p><b>Viral encephalitis</b> confirmed by autopsy; diagnosis of <b>malnutrition</b> confirmed by body mass index (BMI) Z-score <−2; <b>rotavirus gastroenteritis</b> confirmed by immunochromatographic rapid test in the stool; <b>cystic fibrosis</b> suggested by lung biopsy; <b>sepsis</b> confirmed by two positive blood cultures; <b>G6PD deficiency</b> confirmed by qualitative Brewer's test; <b>lung empyema</b> confirmed by computed tomography; <b>urosepsis</b> confirmed by both positive urine and blood culture; <b>ITP</b> confirmed by ASH criteria; ARDS defined as acute bilateral lung infiltrates and a PaO₂∶FiO₂<200 mmHg.</p

Univariate and multivariate (logistic regression) analysis of factors associated to the admission in the ICUs of children 0–14 years old with <i>P. vivax</i> infection, in Manaus, from 2004 to 2009.

<p>Univariate and multivariate (logistic regression) analysis of factors associated to the admission in the ICUs of children 0–14 years old with <i>P. vivax</i> infection, in Manaus, from 2004 to 2009.</p

Clinical information from 10 children 0–14 years of age admitted to any of the pediatric or neonatal ICUs in Manaus, from January 2004 to December 2009, with parasitological diagnosis of <i>P. falciparum</i> or mixed infection (<i>P. falciparum/P. vivax</i>).

<p>Y: years; mo: months; d: days; NA: Non-available; ARDS: acute respiratory distress syndrome; ARF: acute renal failure; PIM: Pediatric Index of Mortality.</p>*<p><b>Malnutrition</b> confirmed by body mass index (BMI) Z-score <−2; <b>rotavirus gastroenteritis</b> confirmed by immunochromatographic rapid test in the stool; <b>sepsis</b> confirmed by two positive blood cultures; <b>G6PD deficiency</b> confirmed by qualitative Brewer's test; <b>congenital cardiopathy</b> confirmed by echocardiogram; <b>sickle cell anemia</b> confirmed by electrophoresis; ARDS defined as acute bilateral lung infiltrates and a PaO₂:FiO₂<200 mmHg.</p>**<p>Blackwater fever.</p