Oral lesions in HIV infected individuals from Ribeirão Preto, Brazil

Objectives: The aim of this study was to diagnosis oral lesions related to HIV infection in individuals followed in the General Hospital of the School of Medicine of Ribeirão Preto, University of São Paulo, Brazil. The presence of oral lesions was correlated with gender, age, smoking habit, levels of CD4 lymphocytes, HIV load, time of HIV seropositivity, AIDS condition, use of removable dental prosthesis, and use of HAART. Materials and Methods: 340 HIV infected individuals were selected for this study, all participants of the study were examined by only one practiced dentist which performed anamnesis, peribuccal and oral examination. Results: Oral lesions were observed in 113 of 340 (33.2%) HIV infected individuals. These oral lesions included: oral candidiasis (17.7%) of pseudomembranous (10.8%) and of erythematous types (6.9%), angular cheilitis (13.9%), hairy leukoplakia (11.8%), and oral ulcers (2.1%). Oral candidiasis lesions were more frequently observed in women (p.033). Smoking addict participants presented a high frequency of tongue hairy leukoplakia (p.038) and a reduced frequency of oral ulcers (p.018). Hairy leukoplakia and pseudomembranous candidiasis were inversely correlated to CD4+L levels and directly correlated with HIV load, behaving as immune depression markers. Hairy leukoplakia and pseudomembranous candidiasis also showed an inverse correlation with HAART use (p<.0001). Patients using mobile dental prosthesis presented a high frequency of erythematous candidiasis (p.003). Conclusion: The inverse correlation with CD4+L level and the direct correlation with HIV load suggest that oral lesions could be used as alternative clinical markers for poor immune condition in HIV infected individuals

Estudo sorológico de infecção por hantavírus em humanos na região de fronteira, entre Brasil e Argentina

INTRODUCTION: According to reports by the Ministry of Health, in the far western region of the State of Santa Catarina, there have been no reports of hantavirus pulmonary syndrome, a zoonotic disease transmitted by feces of infected rodents. A seroepidemiological study of residents of this region, was conducted, with the aim of determining the presence of hantavirus infections. A total of 340 volunteers of both genus, from the towns of Belmonte and Paraíso, were studied. METHODS: The serum of these patients was collected and used to detect IgG antibodies against recombinant N protein of Araraquara hantavirus, by ELISA assay. The positive samples were then titrated and confirmed by immunofluorescence assay. RESULTS: This study demonstrated the presence of IgG antibodies against hantavirus N protein in 3.5% of the population. The most frequent occupation was farm worker, 81% had direct and indirect contact with rodents, 91.7% of positive cases were farm workers, indicating that the probable cause of infection occurred during barn cleaning. These antibodies are noteworthy, given that the levels of antibodies were verified in individuals whose contact with hantavirus may have occurred many years ago. CONCLUSIONS: This study shows the circulation of hantavirus in the region, a fact that until now, had not reported. All the serum reagents had contact with the pathogen, but did not develop pulmonary and cardiovascular syndrome. It is important to remain alert, because hantavirus is a serious and emerging disease of some relevance.INTRODUÇÃO: De acordo com relatórios do Ministério da Saúde, na região do extremo oeste do Estado de Santa Catarina, não há relatos de síndrome pulmonar por hantavírus, doença zoonótica transmitida por excretas de roedores contaminados. Com a finalidade de demosntrar a infecção por hantavírus, um estudo soroepidemiológico de moradores da região foi realizado. Assim, foi estudado um total de 340 voluntários de ambos os gêneros, dos municípios de Belmonte e Paraíso. MÉTODOS: O soro destes pacientes foi coletado e usado para a detecção de anticorpos IgG contra a proteína N recombinante de hantavírus Araraquara, pelo teste de ELISA. As amostras positivas foram tituladas e confirmadas por imunofluorescência indireta. RESULTADOS: Este estudo demonstrou a presença de anticorpos IgG contra a proteína N hantavírus em 3,5% da população. A ocupação de lavrador foi a mais frequente, e 81% tiveram contato direto e indireto com os roedores, 91,7% dos casos positivos foram os agricultores, a causa provável da infecção foi através da limpeza de celeiros. Estes anticorpos são notáveis, dado que os níveis de anticorpos são encontrados nos indivíduos cujo contato com o hantavírus pode ter ocorrido há muitos anos. CONCLUSÕES: Este estudo mostra a circulação de hantavírus na região, um fato que até então não havia relatado, todos os reagentes soro tiveram contato com o patógeno, mas não desenvolveram a síndrome pulmonar e cardiovascular. É preciso estar alerta, porque é uma doença grave e emergente com grande importância.Universidade de São Paulo USP - Center for Research in Virology, FMR

Pulmonary and cardiovascular syndrome due to hantavirus: clinical aspects of an emerging disease in southeastern Brazil

A síndrome pulmonar e cardiovascular por hantavírus é doença causada pela aspiração de aerossóis dos dejetos de roedores silvestres contaminados por vírus da família Bunyaviridae. Estudamos manifestações clínicas e laboratoriais de 70 casos ocorridos de 1998 a 2007 na região de Ribeirão Preto, SP. A freqüência de sintomas foi dispnéia (87%), febre (81%), tosse (44%), cefaléia (34%), taquicardia (81%), hipotensão arterial (56%), hipóxia (49%), acidose metabólica (57%), linfocitopenia (51%), hematócrito >45% (70%), leucocitose com desvio à esquerda (67%), creatinina (51%) e uréia (42%) séricas elevadas. A letalidade (54,3%) ocorreu principalmente no 4o dia. Insuficiência respiratória, hipotensão arterial e choque ocorreu 24-48 horas; o hematócrito elevado e a plaquetopenia são sinais fortemente sugestivos da doença. A hipótese diagnóstica de pneumonia atípica associada a bom prognóstico (p:0,0136); a infusão hídrica >2.000ml e hipotensão arterial associadas a mau prognóstico (p:0,0286 e p:0,0453).Pulmonary and cardiovascular syndrome due to hantavirus is a disease caused by inhalation of aerosols from the excreta of wild rodents contaminated by viruses of the Bunyaviridae family. We studied the clinical and laboratory manifestations of 70 cases that occurred in the region of Ribeirão Preto, SP, Brazil, between 1998 and 2007. The frequency of symptoms was as follows: dyspnea (87%), fever (81%), coughing (44%), headache (34%), tachycardia (81%), low arterial blood pressure (56%), metabolic acidosis (57%), lymphocytopenia (51%), hematocrit > 45% (70%), leukocytosis with left deviation (67%), creatinine (51%) and urea (42%). Mortality (54.3%) occurred mainly on the fourth day. Respiratory insufficiency, low arterial blood pressure and shock occurred after 24 to 48 hours. High hematocrit and decreased platelet levels were signs strongly suggestive of the disease. The diagnostic hypothesis of atypical pneumonia was associated with a good prognosis (p = 0.0136). Fluid infusion greater than 2,000 ml and arterial hypotension were associated with a poor prognosis (p = 0.0286 and p = 0.0453)

Chapparvoviruses occur in at least three vertebrate classes and have a broad biogeographic distribution

Chapparvoviruses are a highly divergent group of parvoviruses (family Parvoviridae) that have recently been identified via metagenomic sampling of animal faeces. Here we report the sequences of six novel chapparvoviruses identified through both metagenomic sampling of bat tissues and in silico screening of published vertebrate genome assemblies. The novel chapparvoviruses share several distinctive genomic features, and group together as a robustly supported monophyletic clade in phylogenetic trees. Our data indicate that chapparvoviruses have a broad host range in vertebrates, and a global distribution

Inquérito sorológico para hantavírus em doadores de sangue no Estado de Santa Catarina, Brasil

Emergent diseases such as Hantavirus Cardio-pulmonary Syndrome (HCPS) are able to create a significant impact on human populations due to their seriousness and high fatality rate. Santa Catarina, located in the South of Brazil, is the leading state for HCPS with 267 reported cases from 1999 to 2011. We present here a serological survey on hantavirus in blood donors from different cities of the state of Santa Catarina, with an IgG-ELISA using a recombinant nucleocapsid protein from Araraquara hantavirus as an antigen. In total, 314 donors from blood banks participated in the study, geographically covering the whole state. Among these, 14 individuals (4.4%) had antibodies to hantavirus: four of 50 (8% positivity) from Blumenau, four of 52 (7.6%) from Joinville, three of 50 (6%) from Florianópolis, two of 50 (4%) from Chapecó and one of 35 (2.8%) from Joaçaba. It is possible that hantaviruses are circulating across almost the whole state, with important epidemiological implications. Considering that the seropositive blood donors are healthy individuals, it is possible that hantaviruses may be causing unrecognized infections, which are either asymptomatic or clinically nonspecific, in addition to HCPS. It is also possible that more than one hantavirus type could be circulating in this region, causing mostly benign infections.Doenças emergentes como a Síndrome Cárdio-Pulmonar por Hantavírus (SCPH) são capazes de promover um grande impacto nas populações humanas devido a sua severidade e alta letalidade. Santa Catarina, localizada ao Sul do Brasil, é o estado com o maior número de relatos de SCPH, com 267 casos desde 1999 a 2011. Apresentamos aqui um inquérito sorológico para hantavírus em doadores de sangue de diferentes cidades do Estado de Santa Catarina, usando um teste IgG-ELISA com proteína recombinante de nucleocapsídeo do hantavírus Araraquara como antígeno. No total, 314 doadores de banco de sangue participaram do estudo, cobrindo geograficamente todo o Estado. Dentre estes, 14 indivíduos (4,4%) apresentaram anticorpos para hantavírus: quatro de 50 (8% de positividade) provenientes de Blumenau, quatro de 52 (7,6%) de Joinville, três de 50 (6%) de Florianópolis, dois de 50 (4%) de Chapecó e um de 35 (2,8%) de Joaçaba. É possível que hantavírus estejam circulando praticamente em todo o Estado, com implicações epidemiológicas importantes. Considerando que os doadores de sangue soropositivos são indivíduos saudáveis, é possível que hantavírus possam estar causando infecções não diagnosticadas, sejam elas assintomáticas ou clinicamente inespecíficas, além da SCPH. É possível ainda que mais de um tipo de hantavírus possa estar circulando na região, causando infecções mais benignas

ATUALIZAÇÃO DE CONHECIMENTOS SOBRE A PATOGÊNESE DA SÍNDROME PULMONAR E CARDIOVASCULAR

A S&iacute;ndrome Pulmonar e Cardiovascular por Hantav&iacute;rus (SPCVH) &eacute; uma doen&ccedil;a grave e com elevada taxa de letalidade. Decorrente da infec&ccedil;&atilde;o humana por hantav&iacute;rus, ela vem ocorrendo em n&uacute;mero crescente de casos em diversos pa&iacute;ses das Am&eacute;ricas, inclusive no Brasil. A pneumonite intersticial, o edema pulmonar e o choque cardiog&ecirc;nico, que caracterizam a doen&ccedil;a, ocorrem, em grande parte, em virtude da ativa&ccedil;&atilde;o da resposta imune, especialmente linf&oacute;citos T CD8+ e macr&oacute;fagos, ambos produtores de citocinas inflamat&oacute;rias. Embora as c&eacute;lulas endoteliais, alvos da infec&ccedil;&atilde;o viral, produzam uma resposta antiviral de interferon, muitas esp&eacute;cies de hantav&iacute;rus podem inibir ou retardar ativamente tais respostas. Al&eacute;m disso, os hantav&iacute;rus exercem efeito inibidor sobre receptores celulares respons&aacute;veis pela manuten&ccedil;&atilde;o da integridade vascular. Quadros cl&iacute;nicos de maior gravidade tamb&eacute;m t&ecirc;m sido associados a elevadas cargas virais. Inversamente, anticorpos neutralizantes parecem exercer um efeito protetor contra as formas graves. Neste artigo s&atilde;o tratados, de forma detalhada, aspectos relevantes da patog&ecirc;nese da SPCV

Novel parvoviruses from wild and domestic animals in Brazil provide new insights into parvovirus distribution and diversity

Parvoviruses (family Parvoviridae) are small, single-stranded DNA viruses. Many parvoviral pathogens of medical, veterinary and ecological importance have been identified. In this study, we used high-throughput sequencing (HTS) to investigate the diversity of parvoviruses infecting wild and domestic animals in Brazil. We identified 21 parvovirus sequences (including twelve nearly complete genomes and nine partial genomes) in samples derived from rodents, bats, opossums, birds and cattle in Pernambuco, São Paulo, Paraná and Rio Grande do Sul states. These sequences were investigated using phylogenetic and distance-based approaches and were thereby classified into eight parvovirus species (six of which have not been described previously), representing six distinct genera in the subfamily Parvovirinae. Our findings extend the known biogeographic range of previously characterized parvovirus species and the known host range of three parvovirus genera (Dependovirus, Aveparvovirus and Tetraparvovirus). Moreover, our investigation provides a window into the ecological dynamics of parvovirus infections in vertebrates, revealing that many parvovirus genera contain well-defined sub-lineages that circulate widely throughout the world within particular taxonomic groups of hosts

Microbiological and therapeutic aspects of 180 infectious endocarditis patients occured in Ribeirão Preto between 1992 and 1997

In this study, we analyzed bacteria isolates obtained from 180 infectious endocarditis cases occurred in Ribeirão Preto, SP, Brazil, between 1992 to 1997, including the antimicrobial drug sensitivity of these agents. Blood cultures were performed in 93,8% of the cases, and in 60,7% of them a microorganism has been isolated. The most commonly isolated bacteria were Staphylococcus aureus, 31,0 % (52/168), Streptococcus viridans, 15,9 % (27/168), Group D Streptococcus, 6,6 % (11/168), Gram negatives, 5,3 % (9/168), and Staphylococcus epidermidis, 4,2 % (7/168). All the Staphylococcus aureus, isolates were vancomycin and teicoplanyn sensitive, 86,5%, were aminoglycoside-sensitives, 85% were also first generation cephalosporinssensitives and 79% oxacillin-sensitives. Streptococcus viridans isolates were all chloramphenicolsensitives, vancomycin-sensitives and only 2 isolates were resistants to ampicillin and G penicillin. The Group D Streptococcus were all G penicillin, ampicillin, chloramphenicol and vancomycinsensitives.Neste trabalho, analisaram-se bactérias isoladas em 180 episódios de endocardite infecciosa, ocorridos em Ribeirão Preto, entre 1992 e 1997, e suas susceptibilidades a antimicrobianos. Hemoculturas foram realizadas em 93,8% dos casos, sendo que, em 60,7% deles, foi identificado, pelo menos, um agente etiológico. As bactérias mais comumente isoladas nos pacientes com EI foram Staphylococcus aureus, 31,0 % (52/168), Streptococcus viridans, 15,9 % (27/168), Streptococcus do Grupo D, 6,6% (11/168), Gram negativas, 5,3 % (9/168) e Staphylococcus epidermidis, 4,2 % (7/168). Dos Staphylococcus aureus, todos os testados mostraram-se sensíveis à vancomicina e à teicoplanina, 86,5%, mostraram-se sensíveis a aminoglicosídios (gentamicina e amicacina), 85% à cefalosporina de primeira geração (cefalotina) e 79% à oxacilina. Streptococcus viridans isolados, todos foram sensíveis ao cloranfenicol, à vancomicina e apenas dois foram resistentes à ampicilina e à penicilina G. Quanto aos Streptococcus do Grupo D, todos mostraram-se sensíveis à penicilina G, à ampicilina, ao cloranfenicol e à vancomicina