Marcadores sorológicos de infecções virais, sífilis e toxoplasmose em crianças e adolescentes com síndrome nefrótica: série de casos de Mato Grosso, Brasil

Algumas infecções podem ser causa de síndrome nefrótica. O objetivo desse estudo foi descrever a experiência de clínica pediátrica de doenças renais do Brasil Central, onde marcadores sorológicos de algumas doenças infecciosas são sistematicamente avaliados em crianças com síndrome nefrótica. Dados foram obtidos de registros médicos de todas as crianças com menos de 15 anos que preenchiam critérios de síndrome nefrótica. Os participantes foram testados para presença de IgG e IgM contra Toxoplasma gondii e citomegalovirus; anticorpos contra herpes simples, vírus da hepatite C e HIV, além do antígeno de superfície da hepatite B (HBsAg). VDRL também foi testado. 169 casos foram estudados. A idade média na primeira visita foi 44 meses e 103 eram do sexo masculino (60.9%). Anti-CMV IgG e IgM foram identificados em 70,4% e 4,1%, respectivamente. IgG e IgM contra T. gondii eram positivos em 32,5% e 5,3%. Dois pacientes eram HBsAg positivos, mas nenhum mostrou positividade para HIV, hepatite C ou sífilis. IgG e IgM contra herpes simples foram realizados em 54 pacientes, dos quais 48,1% e 22,2% eram positivos. Anticorpos IgM positivos em algumas crianças com sinais clínicos de infecção recente sugerem que essas doenças podem exercer um papel na gênese da síndrome nefrótica.Some infections can be the cause of secondary nephrotic syndrome. The aim of this study was to describe the experience of a Renal Disease Reference Clinic from Central Brazil, in which serological markers of some infectious agents are systematically screened in children with nephrotic syndrome. Data were obtained from the assessment of medical files of all children under fifteen years of age, who matched nephrotic syndrome criteria. Subjects were tested for IgG and IgM antibodies against T. gondii and cytomegalovirus; antibodies against Herpes simplex, hepatitis C virus and HIV; and surface antigen (HBsAg) of hepatitis B virus. The VDRL test was also performed. 169 cases were studied. The median age on the first visit was 44 months and 103 (60.9%) patients were male. Anti-CMV IgG and IgM were found in 70.4% and 4.1%, respectively. IgG and IgM against Toxoplasma gondii were present in 32.5% and 5.3%, respectively. Two patients were positive for HBsAg, but none showed markers for HIV, hepatitis C, or Treponema pallidum. IgG and IgM against herpes simplex virus were performed on 54 patients, of which 48.1% and 22.2% were positive. IgM antibodies in some children with clinical signs of recent infection suggest that these diseases may play a role in the genesis of nephrotic syndrome

Outcome of 42 thousands cases of SARS-CoV-2 in a municipality: Role of symptoms in outcome.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic is a major public health problem worldwide with high rates of morbidity and mortality. Elderly patients or patients with comorbidities are more likely to develop more severe conditions and consequently have a high rate of hospital lethality. The presence of some symptoms in SARS-CoV-2 infection can be associated with lower rates of mortality and admission to the ICU in patients. The aim of this study was to determine the associations between the clinical and epidemiological characteristics and clinical outcomes of SARS-CoV-2 infection patients. METHODS: This was a retrospective cohort study of patients with COVID-19 in 2020–2021 in a municipality in the Midwest region of Brazil. The variables analyzed were age, sex, clinical characteristics, clinical results and presence of comorbidities in patients. Associations between the clinical or epidemiological characteristics were analyzed using appropriate tests for categorical variables and continuous normal or parametric distributions. An alpha value of 5% was used as the maximum error limit allowed to reject the null hypothesis in all analysis. RESULTS: In total, 42,469 patients were analyzed, with lethality rates of 4.4% and 2.9% in 2020 and 2021, respectively. There was a higher prevalence among women (53.8%) and a higher mortality in men (p = 0.000), the elderly (p = 0.000), patients with dyspnea (p = 0.000), and patients with comorbidities (p = 0.000). The presence of headache, sore throat, anosmia, dysgeusia or diarrhea were related with a lower mortality (p = 0.000). MAIN CONCLUSIONS: This study demonstrated higher lethality, revealing a higher mortality rate in patients who were male, aged over 65 years, with dyspnea, and with comorbidities. However, headache, sore throat, anosmia, dysgeusia, and diarrhea were associated with an improved prognosis. Further studies to elucidate these findings are warranted.INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic is a major public health problem worldwide with high rates of morbidity and mortality. Elderly patients or patients with comorbidities are more likely to develop more severe conditions and consequently have a high rate of hospital lethality. The presence of some symptoms in SARS-CoV-2 infection can be associated with lower rates of mortality and admission to the ICU in patients. The aim of this study was to determine the associations between the clinical and epidemiological characteristics and clinical outcomes of SARS-CoV-2 infection patients. METHODS: This was a retrospective cohort study of patients with COVID-19 in 2020–2021 in a municipality in the Midwest region of Brazil. The variables analyzed were age, sex, clinical characteristics, clinical results and presence of comorbidities in patients. Associations between the clinical or epidemiological characteristics were analyzed using appropriate tests for categorical variables and continuous normal or parametric distributions. An alpha value of 5% was used as the maximum error limit allowed to reject the null hypothesis in all analysis. RESULTS: In total, 42,469 patients were analyzed, with lethality rates of 4.4% and 2.9% in 2020 and 2021, respectively. There was a higher prevalence among women (53.8%) and a higher mortality in men (p = 0.000), the elderly (p = 0.000), patients with dyspnea (p = 0.000), and patients with comorbidities (p = 0.000). The presence of headache, sore throat, anosmia, dysgeusia or diarrhea were related with a lower mortality (p = 0.000). MAIN CONCLUSIONS: This study demonstrated higher lethality, revealing a higher mortality rate in patients who were male, aged over 65 years, with dyspnea, and with comorbidities. However, headache, sore throat, anosmia, dysgeusia, and diarrhea were associated with an improved prognosis. Further studies to elucidate these findings are warranted

Hepatitis B Virus infection in HIV-positive population in Brazil: results of a survey in the state of Mato Grosso and a comparative analysis with other regions of Brazil

BACKGROUND: End-stage liver disease is currently a major concern among HIV-positive individuals due to co-infection with hepatotropic virus. Hepatitis C has been pointed out as a remarkable factor for that. More recently, hepatitis B virus (HBV) infection has also been found to play a role on liver disease in this population. HIV-HBV co-infection prevalence remains largely unknown in vast areas of Brazil. The objective of the present study was to estimate the prevalence of HBV and HDV infection in HIV-infected subjects living in the state of Mato Grosso, in the Central region of Brazil, and compare it to other Brazilian studies. We also assess epidemiologic data regarding risk factors and vaccinal status. METHODS: HIV-positive individuals followed at the Central Laboratory of the Department of Public Health of Mato Grosso in the city of Cuiabá composed the sample. Participants answered a specific questionnaire and had a blood sample taken and tested for serologic markers. RESULTS: A thousand individuals were interviewed and tested for HBsAg, anti-HBc, anti-HBs and anti-HDV if positive for HBsAg. Measurements of CD4 and viral load for HIV-1 were also performed. Overall prevalence of HBV exposure (anti-HBc +ve) was 40.0%, and 3.7% for HBsAg. This prevalence data was similar or slightly lower than for other Brazilian regions, which ranged from 40% and 3% to 71% and 24%, respectively. Testing for anti-HDV in the 37 HBsAg positive patients was positive in only one subject. Factors that showed independent association with HBV exposure, after adjustment, were: male gender, older age groups, tattooing, and reporting more than ten sexual partners throughout life (p < 0.01). Eighty-one (27.5%) out of 291 HBV-unexposed individuals who reported vaccination were anti-HBs positive. Anti-HBs prevalence was higher among those who had higher levels of CD4 by multivariate analysis. CONCLUSION: Our data showed HBV infection prevalence similar or slightly lower than that reported in other regions of Brazil. In addition, our data revealed a less important role for drug injection in the spread of HIV and HBV in Mato Grosso compared to other regions of the country. The high rate of non-vaccinated subjects among this HBV-unexposed, HIV-infected population is a matter of considerable health concern in this region. The relationship between CD4 levels and HBV vaccine response found in the present study reinforces the need of keeping health care workers alert to this issue

SAINT LOUIS ENCEPHALITIS VIRUS IN MATO GROSSO, CENTRAL-WESTERN BRAZIL

The dengue virus (DENV), which is frequently involved in large epidemics, and the yellow fever virus (YFV), which is responsible for sporadic sylvatic outbreaks, are considered the most important flaviviruses circulating in Brazil. Because of that, laboratorial diagnosis of acute undifferentiated febrile illness during epidemic periods is frequently directed towards these viruses, which may eventually hinder the detection of other circulating flaviviruses, including the Saint Louis encephalitis virus (SLEV), which is widely dispersed across the Americas. The aim of this study was to conduct a molecular investigation of 11 flaviviruses using 604 serum samples obtained from patients during a large dengue fever outbreak in the state of Mato Grosso (MT) between 2011 and 2012. Simultaneously, 3,433 female Culex spp. collected with Nasci aspirators in the city of Cuiabá, MT, in 2013, and allocated to 409 pools containing 1-10 mosquitoes, were also tested by multiplex semi-nested reverse transcription PCR for the same flaviviruses. SLEV was detected in three patients co-infected with DENV-4 from the cities of Cuiabá and Várzea Grande. One of them was a triple co-infection with DENV-1. None of them mentioned recent travel or access to sylvatic/rural regions, indicating that transmission might have occurred within the metropolitan area. Regarding mosquito samples, one pool containing one Culex quinquefasciatus female was positive for SLEV, with a minimum infection rate (MIR) of 0.29 per 1000 specimens of this species. Phylogenetic analysis indicates both human and mosquito SLEV cluster, with isolates from genotype V-A obtained from animals in the Amazon region, in the state of Pará. This is the first report of SLEV molecular identification in MT