Daniel Vítor de Vasconcelos Santos

Prenatal toxoplasmosis diagnosis from amniotic fluid by PCR

Toxoplasmosis is one of the most common infections all over the world. Most cases are asymptomatic, except in immunosuppressed individuals and fetuses, which can be seriously damaged. Prenatal diagnosis should be made as soon as possible since treatment of the mother can minimize fetal sequelae. Our aim in this study was to test the polymerase chain reaction technique (PCR) in 86 samples of amniotic fluid from women who seroconverted during pregnancy. DNA was amplified using external primers and, in a second step, internal primers, in a nested PCR system. Samples were also inoculated into mice and the newborn were evaluated by T. gondii serology, skull x-ray, transfontanel ultrasound, fundoscopic examination, lumbar puncture and clinical examination. PCR was positive in seven cases and negative in 79. Among PCR-positive cases, two were negative by inoculation into mice and by clinical evaluation; among PCR-negative ones, three had clinical evidence of toxoplasmosis and one was positive after inoculation into mice. PCR showed values of sensitivity = 62.5% and specificity = 97.4%; the values of inoculation into mice where 42.9% and 100%, respectively. Although PCR should not be used alone for prenatal diagnosis of congenital toxoplasmosis, it is a promising method and deserves more studies to improve its efficacy.

Congenital cytomegalovirus infection in a neonatal intensive care unit in Brazil evaluated by PCR and association with perinatal aspects

Cytomegalovirus (CMV) infection is the most common congenital infection, affecting 0.4% to 2.3% newborns. Most of them are asymptomatic at birth, but later 10% develop handicaps, mainly neurological disturbances. Our aim was to determine the prevalence of CMV shed in urine of newborns from a neonatal intensive care unit using the polymerase chain reaction (PCR) and correlate positive cases to some perinatal aspects. Urine samples obtained at first week of life were processed according to a PCR protocol. Perinatal data were collected retrospectively from medical records. Twenty of the 292 cases (6.8%) were CMV-DNA positive. There was no statistical difference between newborns with and without CMV congenital infection concerning birth weight (p=0.11), gestational age (p=0.11), Apgar scores in the first and fifth minutes of life (p=0.99 and 0. 16), mothers age (p=0.67) and gestational history. Moreover, CMV congenital infection was neither related to gender (p=0.55) nor to low weight (<2,500 g) at birth (p=0.13). This high prevalence of CMV congenital infection (6.8%) could be due to the high sensitivity of PCR technique, the low socioeconomic level of studied population or the severe clinical status of these newborns.

Despigmentação aguda bilateral da íris (BADI): primeiro relato de caso no Brasil

Despigmentacao aguda bilateral da iris (BADI) e uma nova doenca caracterizada pela despigmentacao aguda da iris, dispersao de pigmentos na câmara anterior e intensa deposicao de pigmentos no seio camerular. O acometimento e sempre bilateral, simultâneo e simetrico. Relatamos o caso de um paciente de 61 anos, com dor ocular bilateral aguda, hiperemia e intensa fotofobia. Ao exame, apresentava denso fuso de Krukenberg, importante dispersao de pigmentos na câmara anterior, extensos defeitos a transiluminacao iriana e densa deposicao de pigmentos no seio camerular em ambos os olhos. O paciente recebeu corticoide topico, terapia hipotensora maxima e valacyclovir oral. A pressao intraocular chegou a 48 mmHg em ambos os olhos mas foi reduzindo gradativamente ao longo do segundo e terceiro meses, permitindo a suspensao gradativa da medicacao. A resolucao completa da dispersao pigmentar demorou 18 semanas. A acuidade e os campos visuais permaneceram normais, mas o paciente manteve a fotofobia.

Avaliação clínica e incidência de endoftalmite infecciosa e não-infecciosa após injeção intravítrea de acetonida de triancinolona

PURPOSE: To report the incidence of infectious and noninfectious endophthalmitis after intravitreal injection of 4 mg of triamcinolone acetonide (Kenalog® - 40 mg/ml; 0.1 ml) and to evaluate distinguishing characteristics that may assist the clinician in differentiating these entities. Design: Observational nonconcurrent prospective study. METHODS: Charts of 121 patients (154 injections) who consecutively underwent intravitreal injection of triamcinolone acetonide to treat various chorioretinal diseases were evaluated. All procedures were performed in an operating room with careful antiseptic protocol. RESULTS: Two eyes (1.29%/injection and 1.65%/patient) presented a noninfectious endophthalmitis characterized by decreased vision, hyperemia, hypopyon and vitreous inflammatory reaction, on the first day after the injection. These eyes were treated with topical and subconjunctival corticosteroids with complete resolution of the inflammatory reaction. CONCLUSION: In the present case series, no case of infectious endophthalmitis occurred. Despite being relatively rare, noninfectious endophthalmitis can be associated with intravitreal injection of triamcinolone simulating an infectious endophthalmitis. In selected cases, the differential diagnosis can be made solely by clinical evaluation.

Trabeculectomia com mitomicina C em pacientes com glaucoma congênito refratário

PURPOSE: To describe the results of mitomycin-C (MMC) in refractory congenital glaucoma surgery. METHODS: Fourty-four eyes of 30 patients with refractory primary congenital glaucoma submitted to trabeculectomy with MMC (0.5 mg/ml for 5 minutes) between 1993 and 2002 at the Sao Geraldo Eye Hospital/HC-UFMG were retrospectively studied, through review of medical records with a minimum follow-up of six months. RESULTS: The mean intraocular pressure (IOP) under antiglaucomatous medication was reduced from 21.7±7.2 to 12.2± 6.8 mmHg at a mean follow-up of 42.8 months (p<0.001). The only postoperative complication was chronic ocular hipotony (IOP<6mmHg) in four eyes (9,1%) with aqueous humor leakage from the bleb (positive Seidel test) in one of them. No statistical relationship was detected between the incidence of complications and gender (p=0.14), age at the time of surgery (p=0.65), initial IOP (p=0.29), initial number of antiglaucomatous drugs (p=0.39) and number of previous surgeries (p=0.94). CONCLUSION: MMC in filtering surgery of refractory primary congenital glaucoma has shown to be effective in the reduction of IOP. However, the ocular hypotony is a great concern.

Ressecção de bolsa hiperfuncionante para tratamento de hipotonia ocular crônica: relato de casos

To present the results of bleb resection for the treatment of overfiltering bleb after trabeculectomy with mitomycin C (MMC) associated with chronic ocular hypotony. Five patients with chronic ocular hypotony caused by overfiltering bleb underwent bleb resection. The authors established the criteria for the diagnosis of overfiltering bleb. Ocular hypotony was reversed in all patients without medication. The mean follow-up was 14.0 ± 7.9 months. Bleb resection is a good approach for the treatment of chronic ocular hypotony secondary to overfiltering bleb.

Establishing tools for early diagnosis of congenital toxoplasmosis: Flow cytometric IgG avidity assay as a confirmatory test for neonatal screening.

The aim of this study was to evaluate the performance of conventional serology (Q-Preven™ and ELFAVIDAS™) and flow cytometry-based serologic tools for early serologic diagnosis of congenital toxoplasmosis. The study groups included prospectively confirmed cases of congenital toxoplasmosis (TOXO=88) and age-matching non-infected controls (NI=15).The results demonstrated that all samples tested positive/indeterminate for anti-T. gondii IgM screening at birth using air-dried whole blood samples. Serum samples collected at 30-45days after birth tested positive for ELFAVIDAS™ IgG in both groups. While all NI tested negative for ELFAVIDAS™ IgM and IgA, only 78% and 36% of TOXO tested positive for IgM and IgA, respectively. Flow cytometry-based anti-T. gondii IgM, IgA and IgG reactivity displayed moderate performance with low sensitivity (47.6%, 72.6% and 75.0%, respectively). Regardless the remarkable specificity of IgG1, IgG2 and IgG3 subclasses for early diagnosis, weak or moderate specificity was observed (Se=73.9%, 60.2% and 83.0%, respectively). The analysis of IgG avidity indices (AI) demonstrated the highest performance among the flow cytometry-based methods (Se=96.6%; Sp=93.3%), underscoring the low avidity index (AI<60%) within TOXO (97.0%) in contrast with the high avidity index (AI>60%) in NI (93%). Analysis of anti-T. gondii IgG and IgG3 reactivity for mother:infant paired samples may represent a relevant complementary tests for early diagnosis. In conclusion, a feasible high-standard algorithm (Accuracy=97.1%) was proposed consisting of Q-Preven™ IgM screening at birth, followed by ELFAVIDAS™ IgM and flow cytometric IgG avidity analysis at 30-45days after birth as a high performance tool for early serological diagnosis of congenital toxoplasmosis.