Anna Bárbara de Freitas Carneiro Proietti

HTLV-I/II and blood donors: determinants associated with seropositivity in a low risk population

OBJECTIVE Blood donors in Brazil have been routinely screened for HTLV-I/II since 1993. A study was performed to estimate the prevalence of HTLV-I/II infection in a low risk population and to better understand determinants associated with seropositivity. METHODS HTLV-I/II seropositive (n=135), indeterminate (n=167) and seronegative blood donors (n=116) were enrolled in an open prevalence prospective cohort study. A cross-sectional epidemiological study of positive, indeterminate and seronegative HTLV-I/II subjects was conducted to assess behavioral and environmental risk factors for seropositivity. HTLV-I/II serological status was confirmed using enzyme-linked immunosorbent assay (EIA) and Western blot (WB). RESULTS The three groups were not homogeneous. HTLV-I/II seropositivity was associated to past blood transfusion and years of schooling, a marker of socioeconomic status, and use of non-intravenous illegal drugs. CONCLUSIONS The study results reinforce the importance of continuous monitoring and improvement of blood donor selection process.

The Dynamics of the Human Immunodeficiency Virus Epidemics in the South of Brazil: Increasing Role of Injection Drug Users

Changes in human immunodeficiency virus (HIV) infection among injection drug users (IDUs) are provoking a shift in the pattern of the HIV/AIDS epidemic in some regions of Brazil. IDUs living in 2 cities (Porto Alegre and Itajaí) in southern Brazil were contacted, interviewed, and tested for HIV. In 1998, 187 IDUs were surveyed and, in 2000, 352 IDUs. In Porto Alegre, HIV seroprevalence, age, and duration of injection history increased significantly over time. In contrast, a trend toward decline was observed in Itajaí. Homelessness, joblessness, and prison incarceration, as well as lifetime needle sharing, also increased over time in Porto Alegre. At the time of the study, at both sites, rates of needle sharing and condom use were similar, but use of syringe exchange programs, health and drug treatment, and HIV testing had increased over time. IDUs living in southern Brazil are at increased risk of HIV infection, indicating the continued need for permanent surveillance and preventive strategies.

Undisclosed human immunodeficiency virus risk factors identified through a computer-based questionnaire program among blood donors in Brazil

Human immunodeficiency virus (HIV) risk factor screening among blood donors remains a cornerstone for the safety of blood supply and is dependent on prospective donor self‐disclosure and an attentive predonation interview. Audio computer‐assisted structured interview (ACASI) has been shown to increase self‐reporting of risk behaviors.

HTLV-I Associated uveitis, myelopathy, rheumatoid arthritis and Sjögren's syndrome

A 62 year-old white female presented with a 10-year-history of slowly progressive spastic paraparesis, pain and dysesthesia in the lower limbs and sphincter disturbance. A few years after the onset of the neurologic symptoms she developped migratory arthritis with swelling of the knees and pain on palpation of knees and fingers, dry eyes, mouth and skin. Two months before admission she presented bilateral nongranulomatous anterior uveitis. Examination revealed spastic paraparesis with bilateral Babinski sign, a decreased sensation level below L3, decreased vibration sense in the lower extremities, and a postural tremor of the upper limbs. Laboratory work-up disclosed HTLV-I positive tests in the blood and cerebrospinal fluid (CSF), and a mild pleocytosis in the CSF with a normal protein content. Nerve conduction velocity studies were normal. The present case shows the association of uveitis, arthritis and Sjögrens syndrome in a patient with tropical spastic paraparesis/human T-cell lymphotropic virus type I (HTLV-I) associated myelopathy (TSP/HAM), and illustrates the wide spectrum of clinical manifestations which may accompany this infection with this virus.

Sickle Cell Disease: quality of life in patients with hemoglobin SS and SC disorders.

Objective Sickle cell disease comprises chronic, genetically determined disorders, presenting significant morbidity and high prevalence in Brazil. The goal of this study was to evaluate the quality of life of sickle cell disease patients (hemoglobin SS and SC) and their sociodemographic and clinical characteristics. Methods Data was collected from clinical records and semi-structured interviews consisting of clinical questionnaires and the World Health Organization Quality of Life-brief questionnaire. Results Interviews were conducted with 400 patients, aged between 18 and 72, treated in the Fundação HEMOMINAS in Belo Horizonte. The participants predominantly had sickle cell disease hemoglobin SS variant (65.5%), were female (61.8%), single (55.3), with up to 8 years of schooling (49.6%), and self-defined as mulattos (50%). Pain crises, hospitalizations, blood transfusions, and other morbidities of sickle cell disease had a significant impact on the quality of life of these patients. Conclusion Within this group, the social profile was that of low income and unemployed with sickle cell disease considered to be a significant impediment to finding a job. Evaluating quality of life as a determining factor of health is essential for the creation of specific policies and measures, appropriate for the specific characteristics and social context of sickle cell disease.

Infecções virais e depressão

OBJETIVO: A associacao entre depressao e viroses e estudada ha quase dois seculos, com resultados conflitantes. O objetivo deste trabalho e fazer uma analise critica dos estudos existentes na literatura sobre essa relacao. METODOS: A pesquisa bibliografica utilizou as fontes eletronicas de busca MEDLINE e LILACS (1966 a agosto 2005). As referencias dos artigos foram utilizadas como fonte adicional de consulta. RESULTADOS: Foram abordados os trabalhos que trataram da associacao entre depressao e os virus HIV, HCV, EBV, influenza, HSV, HBV, HAV, BDV e HTLV. A relacao entre HIV e depressao mostrou-se bem documentada na literatura. Existem indicios de que a prevalencia desse transtorno nos individuos infectados pelo HIV seja maior que a encontrada nos soronegativos. Alem disso, estudos constataram que a depressao esta associada a pior prognostico da infeccao. Quanto a associacao entre HCV e depressao, os trabalhos sugeriram maior prevalencia desse transtorno psiquiatrico nos portadores do HCV comparados a populacao geral. Nao existem evidencias cientificas suficientes para dar suporte a relacao entre os demais virus e depressao. CONCLUSAO: As associacoes mais bem fundamentadas foram aquelas entre depressao e os virus HIV e HCV. A relacao entre as demais viroses e depressao precisa ser mais bem estudada, e trabalhos com delineamento adequado se fazem necessarios.

FC-TRIPLEX Chagas/Leish IgG1: A Multiplexed Flow Cytometry Method for Differential Serological Diagnosis of Chagas Disease and Leishmaniasis

Differential serological diagnosis of Chagas disease and leishmaniasis is difficult owing to cross-reactivity resulting from the fact that the parasites that cause these pathologies share antigenic epitopes. Even with optimized serological assays that use parasite-specific recombinant antigens, inconclusive test results continue to be a problem. Therefore, new serological tests with high sensitivity and specificity are needed. In the present work, we developed and evaluated the performance of a new flow cytometric serological method, referred to as FC-TRIPLEX Chagas/Leish IgG1, for the all-in-one classification of inconclusive tests. The method uses antigens for the detection of visceral leishmaniasis, localized cutaneous leishmaniasis, and Chagas disease and is based on an inverted detuned algorithm for analysis of anti-Trypanosomatidae IgG1 reactivity. First, parasites were label with fluorescein isothiocyanate or Alexa Fluor 647 at various concentrations. Then serum samples were serially diluted, the dilutions were incubated with suspensions of mixed labeled parasites, and flow cytometric measurements were performed to determine percentages of positive fluorescent parasites. Using the new method, we obtained correct results for 76 of 80 analyzed serum samples (95% overall performance), underscoring the outstanding performance of the method. Moreover, we found that the fluorescently labeled parasite suspensions were stable during storage at room temperature, 4°C, and –20°C for 1 year. In addition, two different lots of parasite suspensions showed equivalent antigen recognition; that is, the two lots showed equivalent categorical segregation of anti-Trypanosomatidae IgG1 reactivity at selected serum dilutions. In conclusion, we have developed a sensitive and selective method for differential diagnosis of Chagas disease, visceral leishmaniasis, and localized cutaneous leishmaniasis.

Identification of a Novel HIV-1 Circulating Recombinant Form (CRF72_BF1) in Deep Sequencing Data from Blood Donors in Southeastern Brazil.

ABSTRACT We report the identification of a novel HIV-1 circulating recombinant form (CRF72_BF1) in deep sequencing data from peripheral blood mononuclear cells (PBMC) of five blood donors in southeastern Brazil. Detection of this circulating recombinant form (CRF) confirms the need for effective surveillance to monitor the prevalence and distribution of HIV variants in a variety of settings in Brazil.

Epidemiology of Schistosoma mansoni infection in a low-endemic area in Brazil: clinical and nutritional characteristics

A cross-sectional case-control study designed to evaluate the role of malnutrition in the association between the intensity of Schistosoma mansoni infection and clinical schistosomiasis, was conducted in an area with both low frequency of infection and low morbidity of schistosomiasis in Brazil. Cases (256) were patients with a positive stool examination for S. mansoni; their geometrical mean number of eggs/gram of feces was 90. Controls (256) were a random sample of the negative participants paired to the cases by age, sex and length of residence in the area. The clinical signs and symptoms found to be associated with S. mansoni infection, comparing cases and controls, were blood in stools and presence of a palpable liver. A linear trend in the relative odds of these signs and symptoms with increasing levels of infection was detected. Adjusting by the level of egg excretion, the existence of an interaction between palpable liver and ethnic group (white) was suggested. No differences in the nutritional status of infected and non-infected participants were found.

Teaching transfusion medicine: current situation and proposals for proper medical training

The current curricula in medical schools and hospital residence worldwide lack exposure to blood transfusion medicine, and require the reformulation of academic programs. In many countries, training in blood transfusion is not currently offered to medical students or during residency. Clinical evidence indicates that blood transfusions occur more frequently than recommended, contributing to increased risk due to this procedure. Therefore, the rational use of blood and its components is essential, due to the frequent undesirable reactions, to the increasing demand of blood products and the cost of the process. Significant improvements in knowledge of and skills in transfusion medicine are needed by both students and residents. Improvements are needed in both background knowledge and the practical application of this knowledge to improve safety. Studies prove that hemovigilance has an impact on transfusion safety and helps to prevent the occurrence of transfusion-related adverse effects. To ensure that all these aspects of blood transfusion are being properly addressed, many countries have instituted hospital transfusion committees. From this perspective, the interventions performed during the formation of medical students and residents, even the simplest, have proven effective in the acquisition of knowledge and medical training, thereby leading to a reduction in inappropriate use of blood. Therefore, we would like to emphasize the importance of the exposure of medical students and residents to blood services and transfusion medicine in order for them to acquire adequate medical training, as well as to discuss some changes in the current medical curricula regarding transfusion medicine that we judge critical.