Poliomielite associada à vacina: descrição de caso por transmissão domiciliar

Poliomyelitis associated with live strain vaccine is defined as the paralytic form of the acute anterior poliomyelitis related to the vaccine strain. Since these strains behave similarly to the wild-type virus, we can differentiate, epidemiologically, two types of vaccine-associated poliomyelitis: cases in which the patient was vaccinated and cases in which the patient had had contact with vaccinated individuals. We herein present the case of an unvaccinated child, with a clinical picture of an acute anterior poliomyelitis associated with the live strain vaccine, whose brother received the Sabin vaccine 20 days before the onset of the symptoms. Vaccine strain of the type 3 poliovirus was isolated in fecal culture and a presented mutation in nucleotide 472 (C;®;U) in the 5' non-coding region, which is strongly related to the higher strain virulence.A poliomielite associada à vacina oral é definida como a forma paralítica da poliomielite anterior aguda decorrente da cepa vacinal. Uma vez que o comportamento da cepa vacinal é semelhante ao do vírus selvagem, epidemiologicamente podemos distinguir dois tipos de poliomielite associada à vacina, os casos em que o paciente foi vacinado e os casos em que o paciente teve contato com pessoas que receberam a vacina. Apresentamos o caso de um lactente não vacinado, que apresentou quadro de poliomielite anterior aguda associada à vacina oral, cujo irmão havia recebido a vacina Sabin 20 dias antes do início do quadro clínico. Na cultura de fezes do paciente foi isolado o poliovírus tipo 3, cepa vacinal, que apresentava mutação do nucleotídeo 472 (C;®;U) na região 5' não codificadora, a qual está significativamente relacionada com a maior virulência da cepa

Evolutionism and genetics of posttraumatic stress disorder

The authors discuss, from the evolutionary concept, how flight and fight responses and tonic immobility can lead to a new understanding of posttraumatic stress disorder. Through the analysis of symptom clusters (revivals, avoidance and hyperexcitation), neurobiological and evolutionary findings are correlated. The current discoveries on posttraumatic stress disorder genetics are summarized and analyzed in this evolutionary perspective, using concepts to understand the gene-environment interaction, such as epigenetic. The proposal is that the research of susceptibility factors in posttraumatic stress disorder must be investigated from the factorial point of view, where their interactions increase the risk of developing the disorder, preventing a unique search of the cause of this disorder. The research of candidate genes in posttraumatic stress disorder must take into consideration all the systems associated with processes of stress response, such as the hypothalamus-pituitary-adrenal and sympathetic axes, mechanisms of learning, formation and extinguishing of declarative memories, neurogenesis and apoptosis, which involve many systems of neurotransmitters, neuropeptides and neurohormones.Os autores discutem, a partir do conceito evolutivo, como a resposta de estresse, nas suas possibilidades de fuga e luta e de imobilidade tônica, pode levar a uma nova compreensão etiológica do transtorno de estresse pós-traumático. Através da análise dos agrupamentos de sintomas desse diagnóstico - revivência, evitação e hiperexcitação -, procuram correlacionar os achados neurobiológicos e evolutivos. As descobertas atuais sobre a genética do transtorno de estresse pós-traumático são resumidas e colocadas nessa perspectiva evolutiva, dentro de conceitos que possibilitam o entendimento da interação gene/ambiente, como a epigenética. Propõem que a pesquisa dos fatores de risco do transtorno de estresse pós-traumático deva ser investigada do ponto de vista fatorial, onde a somatória destes aumenta o risco de desenvolvimento do quadro, não sendo possível a procura da causa do transtorno de forma única. A pesquisa de genes candidatos no transtorno de estresse pós-traumático deve levar em consideração todos os sistemas associados aos processos de respostas ao estresse, sistemas dos eixos hipotálamo-hipofisário-adrenal e simpático, mecanismos de aprendizado, formação de memórias declarativas, de extinção e esquecimento, da neurogênese e da apoptose, que envolvem vários sistemas de neurotransmissores, neuropeptídeos e neuro-hormônios.Universidade Federal de São Paulo (UNIFESP)(UNIFESP)UNIFESP Departamento de PsiquiatriaUniversidade de São Paulo Faculdade de Medicin Hospital de ClínicasUNIFESP, Depto. de PsiquiatriaSciEL

Evaluation of the sensibility and the specificity of an interferon-gamma release assay after lymphocyte stimulation by specific Mycobacterium tuberculosis antigens in children

INTRODUÇÃO: A tuberculose é um problema grave de saúde pública, acometendo indivíduos em todas as faixas etárias e em todos os estratos socioeconômicos. Apesar de estarem sob grande risco de adoecimento, as crianças carecem de meios diagnósticos sensíveis e específicos. Neste estudo avaliou-se em crianças a acurácia de um teste baseado na dosagem de interferon-gama liberado por linfócitos após estímulo com antígenos específicos do Mycobacterium tuberculosis (QuantiFERON-TB Gold In Tube® [Cellestis, Carnegie, Austrália] ).MÉTODO: Foram incluídas no estudo 184 crianças não infectadas e 11 crianças com infecção pelo Mycobacterium tuberculosis. Todas as crianças receberam previamente o BCG. Foram excluídas crianças com comprometimento do sistema imunológico. Obteve-se amostra de sangue de cada criança, e o material foi processado conforme as instruções do laboratório fabricante. O desempenho do teste foi avaliado pela construção de uma curva de características operacionais (ROC). RESULTADOS: Do total de 184 crianças sem infecção pela micobatéria, 74 (40,2%) eram do sexo feminino, e 130 (70,6%) tinham menos de quatro anos de idade. A idade média neste grupo foi de 35 meses. Seis (3,2%) crianças apresentaram resultado indeterminado do teste, uma criança (0,5%) apresentou um resultado positivo e 177 (96,2%) apresentaram resultado negativo. No grupo de 11 crianças infectadas, sete (63,0%) eram meninas, e a idade média era de 58,5 meses. Duas (18,0%) crianças neste grupo apresentaram resultado negativo do teste. A curva ROC obtida evidenciou uma área sob a curva de 0,876 (I. C 95% - 0,82 a 0,92; p<0,001), refletindo o desempenho preditivo elevado do teste. A sensibilidade do teste foi de 81,8% (IC 95% - 48,2% a 97,2%) e a especificidade de 98,8% (IC 95% - 96,0 a 99,8%), o valor preditivo positivo foi de 81,8% (IC 95%: 46,3% a 97,4%) e o valor preditivo negativo foi de 98,9% (IC 95%: 96,0% a 99,8%). CONCLUSÕES: Neste estudo o teste mostrou ter uma boa acurácia no diagnóstico da infecção pelo Mycobaterium tuberculosis em crianças previamente vacinadas com o BCG, e sua utilização rotineira pode contribuir para a melhor avaliação de crianças expostas a um doente bacilífero e na tomada de decisões sobre a introdução de quimioprofilaxia ou tratamento.BACKGROUND: Tuberculosis is a major public health problem, affecting people from all ages and diverse socioeconomic incomes. Despite the high risk that children have to develop the disease, accurate methods for diagnosis are not yet available. In this study the accuracy of an interferon-gamma release assay (QuantiFERON-TB Gold In Tube® [Cellestis, Carnegie, Australia]) was evaluated for the diagnosis of Mycobacterium tuberculosis infection in children. METHODS: 195 children were evaluated, 184 children without mycobacterial infection, and 11 children infected by the Mycobacterium tuberculosis. All the children had been previously vaccinated with BCG. Immunocompromised children were excluded from the study. A blood sample was obtained from each child, and it was processed according the manufacturer´s instructions. The performance of the assay was evaluated by a receiver operating characteristic (ROC) curve. RESULTS: In the group of 184 noninfected children, 74 (40.2%) were female and 130 (70.6%) were younger than four years old. The mean age in this group was 35 months. Six children (3.2%) had indeterminate test result, one child (0.5%) had a positive test result, and 177 (96.2%) children had negative test results. In the group of 11 infected children, seven (63.0%) were female, and the mean age in this group was 58.5 months. Two children (18.0%) in this group had a negative test result. The ROC curve determined an area under the curve of 0.876 (95% CI 0.82 to 0.92; p< 0.001), disclosing a high positive predictive value for the test. The assay sensibility was 81.8% (95% CI, 48.2% to 97.2%) and the assay specificity was 98.8% (95% CI, 96.0% to 99.8%), the positive predictive value was 81.8% (95% CI: 46.3% to 97.4%) and the negative predictive value was 98.9% (95% CI: 96.0% to 99.8%). CONCLUSIONS: In this study, the accuracy of the assay was high for the diagnosis of Mycobacterium tuberculosis infection in children previously vaccinated with BCG. The use of this assay for the routine evaluation of children exposed to the disease may help physicians to decide on whether to start chemoprophylaxis or tuberculosis treatment

SARS-CoV-2 infections with emphasis on pediatric patients: a narrative review

This narrative review summarizes the main aspects underlying the new coronavirus SARS-CoV-2, its epidemiology, pathophysiology, pointing to differences of SARS-CoV-2 main receptors ACE2, in terms of expression and the amount of soluble ACE2 in the circulation of children, men and women, and also in those with risk factors such as the smokers and pregnant women or presenting with comorbidities (diabetes, obesity, hypertension and other cardiovascular diseases, renal and CNS pre-existing diseases). Clinical manifestations in adults and children were also described, emphasizing the particularities already seen in children, regarding signs, symptoms, viral excretion time and the involvement of all organs and systems. The COVID-19 in the pediatric population was divided into two sections: one dedicated to previously healthy children and adolescents with COVID-19, and the other to those who live with comorbidities and acquired COVID-19. A few paragraphs were reserved to the recently described severe multisystemic inflammatory syndrome associated with COVID-19 (MIS-C) that shares certain characteristics with Kawasaki disease. Some studies on the infection in pregnant and postpartum women, as well as neonates were shown. This review has also covered the laboratory diagnosis of COVID-19, passing through the imaging diagnosis made by the chest tomography revealing ground glass patching opacities, and results of non-specific exams such as the total blood with lymphopenia, the coagulation tests with increased prothrombin times, as well as marked increments of the D-dimer, troponin and proinflammatory cytokines. In the section devoted to the specific laboratory diagnosis of COVID-19, the most used RT-PCR protocols were described and some studies on the serological diagnosis with IgA, IgM and IgG detection were detailed, including the use of rapid immunochromatographic assays and discussing the ideal period after the onset of symptoms to perform each type of test. In the end, the management of pediatric patients with COVID-19 based mainly on supportive measures has been briefly commented

Accuracy of the QuantiFERON-TB Gold in Tube for diagnosing tuberculosis in a young pediatric population previously vaccinated with Bacille Calmette-Guerin

Objective: To evaluate the accuracy of an interferongamma release assay (QuantiFERON-TB Gold in Tube) for diagnosing Mycobacterium tuberculosis infection in a young pediatric population. Methods: 195 children previously vaccinated with BCG were evaluated, being 184 healthy individuals with no clinical or epidemiological evidence of mycobacterial infection, and 11 with Mycobacterium tuberculosis infection, according to clinical, radiological, and laboratory parameters. A blood sample was obtained from each child and processed according to the manufacturer's instructions. The assay performance was evaluated by a Receiver Operating Characteristic (ROC) curve. Results: In the group of 184 non-infected children, 130 (70.6%) were under the age of four years (mean age of 35 months). In this group, 177 children (96.2%) had negative test results, six (3.2%) had indeterminate results, and one (0.5%) had a positive result. In the group of 11 infected children, the mean age was 58.5 months, and two of them (18%) had negative results. The ROC curve had an area under the curve of 0.88 (95%CI 0.82-0.92; p<0.001), disclosing a predictive positive value of 81.8% for the test (95%CI 46.3-97.4). The assay sensitivity was 81.8% (95%CI 48.2-97.2) and the specificity was 98.8% (95%CI 96-99.8). Conclusions: In the present study, the QuantiFERON-TB Gold in Tube performance for diagnosing M. tuberculosis infection was appropriate in a young pediatric population

Candidate-Gene Approach in Posttraumatic Stress Disorder After Urban Violence: Association Analysis of the Genes Encoding Serotonin Transporter, Dopamine Transporter, and BDNF

Posttraumatic stress disorder (PTSD) is a prevalent, disabling anxiety disorder marked by behavioral and physiologic alterations which commonly follows a chronic course. Exposure to a traumatic event constitutes a necessary, but not sufficient, factor. There is evidence from twin studies supporting a significant genetic predisposition to PTSD. However, the precise genetic loci still remain unclear. The objective of the present study was to identify, in a case-control study, whether the brain-derived neurotrophic factor (BDNF) val66met polymorphism (rs6265), the dopamine transporter (DAT1) three prime untranslated region (3`UTR) variable number of tandem repeats (VNTR), and the serotonin transporter (5-HTTPRL) short/long variants are associated with the development of PTSD in a group of victims of urban violence. All polymorphisms were genotyped in 65 PTSD patients as well as in 34 victims of violence without PTSD and in a community control group (n = 335). We did not find a statistical significant difference between the BDNF val66met and 5-HTTPRL polymorphism and the traumatic phenotype. However, a statistical association was found between DAT1 3`UTR VNTR nine repeats and PTSD (OR = 1.82; 95% CI, 1.20-2.76). This preliminary result confirms previous reports supporting a susceptibility role for allele 9 and PTSD.FAPESP Fundacao de Amparo a Pesquisa do Estado de Sao Paulo[2004/15039-0]Ministry of Education (CAPES

Genome-wide DNA methylation profile in the peripheral blood of cocaine and crack dependents

Objective: Cocaine use disorders (CUDs) represent a major public health problem in many countries. To better understand the interaction between the environmental modulations and phenotype, the aim of the present study was to investigate the DNA methylation pattern of CUD patients, who had concomitant cocaine and crack dependence, and healthy controls. Methods: We studied DNA methylation profiles in the peripheral blood of 23 CUD patients and 24 healthy control subjects using the Illumina Infinium HumanMethylation450 BeadChip arrays. Results: Comparison between CUD patients and controls revealed 186 differentially methylated positions (DMPs; adjusted p-value [adjP] < 10-5) related to 152 genes, with a subset of CpGs confirmed by pyrosequencing. DNA methylation patterns discriminated CUD patients and control groups. A gene network approach showed that the EHMT1, EHMT2, MAPK1, MAPK3, MAP2K1, and HDAC5 genes, which are involved in transcription and chromatin regulation cellular signaling pathways, were also associated with cocaine dependence. Conclusion: The investigation of DNA methylation patterns may contribute to a better understanding of the biological mechanisms involved in CUD