Edvaldo Carlos Brito Loureiro

Acute diarrhoea associated with rotavirus among children living in Belém, Brazil

Between January 1979 and December 1980, rotaviruses were detected in faecal samples from 122 (33.1%) of 369 diarrhoeic children less than six years old, living in Belém, Brazil. In 55 (45.1%) of the 122 rotavirus-positive specimens, no bacteria or parasite associated with gastro-enteritis was found. Salmonella typhimurium, Shigella and Escherichia coli were found in 92 (35%) of the 263 faecal specimens examined for bacterial pathogens. Rotaviruses were readily detected throughout the year, which may indicate no seasonal pattern of incidence in the Belém region. A comparison of the excretion of rotavirus was made between children of two socio-economic groups. Of 144 children from the higher level group, 63 (47.3%) excreted rotavirus, whereas only 12 (16.7%) of those from the lower level did so. Vomiting (68.0%) and fever (65.6%) were the main symptoms, other than diarrhoea, exhibited by the 122 rotavirus-positive children.

Diagnóstico das condições de saúde de uma comunidade garimpeira na região do Rio Tapajós, Itaituba, Pará, Brasil, 1992

O objetivo do trabalho foi conhecer as condicoes de vida e de saude de uma comunidade garimpeira e, particularmente, a superposicao da contaminacao Mercurial com outros agravos. Foi realizada no garimpo do igarape do Rato, na bacia hidrografica do rio Tapajos, Itaituba-Para. A populacao abrangeu 223 individuos aos quais foi aplicado um questionario epidemiologico, e feito atendimento medico e coleta de especimes biologicos. Na coproscopia, 96,1% individuos estavam parasitados e 66,4% anemicos. A prevalencia para o virus da hepatite B ficou em 85,0%; 11 (6,0%) eram portadores do virus. Dentre os pacientes investigados para malaria, 35,0% (65) estavam com a doenca e desses 52,3% (34) eram pacientes assintomaticos. A prevalencia para sifilis foi de 41.6%. As dosagens de mercurio em urina de 173 individuos revelaram 16 (9,2%) pacientes com dosagens maiores do que 10 ug/l e ate 19 ug/l, enquanto que 9 pacientes (5,2%) do total investigado revelaram teores acima de 20 ug/l. O estudo revela individuos com superposicao de agravos, sem diagnostico adequado por falta de atendimento medico, praticando a automedicacao, e, agora, vivendo a ameaca da intoxicacao por mercurio. Concluindo, o presente trabalho ofereceu apenas uma visao geral das condicoes de saude encontradas na comunidade garimpeira estudada. Impossivel, sob pena de alongar demasiadamente o artigo, detalhar todos os diversos aspectos que foram pesquisados, e que serao objeto de publicacoes futuras. Entretanto, essa visao geral atinge a finalidade de por em evidencia a multicausalidade encontrada quando se precisa avaliar as condicoes de saude na regiao amazonica, e que deve ser levada em consideracao por ocasiao do atendimento clinico e da administracao terapeutica.

Avaliação dos níveis de exposição ao mercúrio entre índios Pakaanóva, Amazônia, Brasil

Um estudo seccional foi realizado para avaliar os niveis de exposicao ao mercurio (Hg) entre 910 indios Pakaanova, residentes nos municipios de Guajara Mirim e Nova Marmore no Estado de Rondonia, Brasil. Amostras de cabelo da regiao occipital foram coletadas de cada participante do estudo e os teores de Hg determinados por Espectrofotometria de Absorcao Atomica com Geracao de Vapor Frio. Os teores medios de Hg nas amostras de cabelo foram de 8,37µg/g (0,52-83,89µg/g), indicando exposicao elevada. Criancas de ate 2 anos e entre 3 e 5 anos de idade apresentaram medias de 10,54µg/g e 9,34µg/g, respectivamente. Os teores medios de Hg nas mulheres (8,91µg/g ) sao mais elevados do que os valores observados nos homens (7,55µg/g), sendo esta diferenca estatisticamente significante (t = 3,26; p < 0,01). Estes resultados indicam a necessidade de desenvolvimento de programas de vigilância e estudos complementares envolvendo os indios Pakaanova no Estado de Rondonia.A cross-sectional study was conducted to evaluate mercury (Hg) exposure among 910 Pakaanova Indians from the counties of Guajara Mirim and Nova Marmore, Rondonia State, Brazil. Individual hair samples were taken from the occipital region, and Hg was measured by atomic absorption spectrometry with cold vapor generation. Mean Hg in hair samples was 8.37 µg/g (range 0.52-83.89), indicating high exposure. Young children (< 2 years old) showed a mean Hg of 10.54 µg/g, and children from 3 to 5 years old had a mean Hg of 9.34µg/g. Mercury levels in women (8,91µg/g) were higher than in men (7.55µg/g), and this difference was significant (t = 3.26; p < 0.01). These results indicate the need for surveillance programs and complementary studies including the Pakaanova Indians in Rondonia State.

Antimicrobial resistance of Shigella spp. isolated in the State of Pará, Brazil.

INTRODUCTION Shigella spp. are Gram-negative, nonsporulating, rod-shaped bacteria that belong to the family Enterobacteriaceae and are responsible for shigellosis or bacillary dysentery, an important cause of worldwide morbidity and mortality. METHODS We studied the antibiotic resistance profiles of 122 Shigella spp. strains (81 S. flexneri, 41 S. sonnei, 1 S. boydii) isolated from patients (female and male from 0 to 80 years of age) presenting diarrhea in different districts of the State of Pará, in the North of Brazil. The antibiotic resistance of the strains, isolated from human fecal samples, was determined by the diffusion disk method and by using the VITEK-2 system. RESULTS The highest resistance rate found was the resistance rate to tetracycline (93.8%), followed by the resistance rate to chloramphenicol (63.9%) and to trimethoprim/sulfamethoxazole (63.1%). Resistance to at least three drugs was more common among S. flexneri than S. sonnei (39.5% vs. 10%). Six (4.9%) strains were susceptible to all the antibiotics tested. All strains were susceptible to cefotaxime, ceftazidime, ciprofloxacin, nalidixic acid and nitrofurantoin. CONCLUSIONS High rates of multidrug resistance in Shigella spp. are a serious public health concern in Brazil. It is extremely important to continuously monitor the antimicrobial resistances of Shigella spp. for effective therapy and control measures against shigellosis.

Occurrence and composition of class 1 and class 2 integrons in clinical and environmental O1 and non-O1/non-O139 Vibrio cholerae strains from the Brazilian Amazon

This study identified and characterised class 1 and 2 integrons in clinical and environmental Vibrio cholerae O1 and non-O1/non-O139 strains isolated from the Brazilian Amazon. The aadA2 and aadA7 gene cassettes were found in class 1 integrons in two genotypes of environmental V. cholerae non-O1/non-O139. Empty integrons were found in strains from the Brazilian cholera epidemic. A class 2 integron was detected in one strain from the V. cholerae Amazonia lineage harbouring sat1 and aadA1 genes. All isolates were resistant to aminoglycosides, indicating aadA functionality. These findings suggest that environmental bacteria act as cassette reservoirs that favour the emergence of resistant pathogens.

High prevalence of G12P[8] rotavirus strains in Rio Branco, Acre, Western Amazon, in the post‐rotavirus vaccine introduction period

The present study aimed to provide a molecular characterization of circulating rotavirus (RVA) strains in Rio Branco, Acre, in the post‐rotavirus vaccination period, particularly with regard to the emerging, increasingly prevalent G12P[8] genotype. A total of 488 fecal specimens from diarrheic and non‐diarrheic children were obtained between January and December 2012. RVA detection was initially performed using enzyme‐linked immunosorbent assay (ELISA) method, followed by reverse‐transcription polymerase chain reaction (RT‐PCR) using specific primers. RVA was detected in 18.3% (44/241) of the children with acute diarrhea and in 1.2% (3/247) of the non‐diarrheic children (P < 0.001), with overall RVA‐positivity of 9.6% (47/488). The most common genotype was G2P[4] with 43.2% (19/44) of the diarrheic cases, followed by G12P[8] (27.3%, 12/44), G3P[6] (18.2%, 8/44), G3P[8] (4.5%, 2/44), and G12P[6] (2.3%, 1/44). G12 samples belonged to lineage III and were from children aged 4–52 months. All of these children had acute diarrhea associated with fever (83.3%, 10/12) and vomiting (66.7%, 8/12). Most of the cases occurred in August (58.3%, 7/12), 75% (9/12) of which having received the full vaccination scheme with Rotarix™. For the first time G12 was reported at relative high prevalence in Brazil. Our findings warrant further monitoring studies on the molecular characterization of circulating RVA strains after rotavirus vaccine introduction in Brazil and elsewhere, since the occurrence of either unusual our emerging genotypes may pose a challenge to vaccination strategies. J. Med. Virol. 88:782–789, 2016.

Genome-wide study of the defective sucrose fermenter strain of Vibrio cholerae from the Latin American cholera epidemic

The 7th cholera pandemic reached Latin America in 1991, spreading from Peru to virtually all Latin American countries. During the late epidemic period, a strain that failed to ferment sucrose dominated cholera outbreaks in the Northern Brazilian Amazon region. In order to understand the genomic characteristics and the determinants of this altered sucrose fermenting phenotype, the genome of the strain IEC224 was sequenced. This paper reports a broad genomic study of this strain, showing its correlation with the major epidemic lineage. The potentially mobile genomic regions are shown to possess GC content deviation, and harbor the main V. cholera virulence genes. A novel bioinformatic approach was applied in order to identify the putative functions of hypothetical proteins, and was compared with the automatic annotation by RAST. The genome of a large bacteriophage was found to be integrated to the IEC224s alanine aminopeptidase gene. The presence of this phage is shown to be a common characteristic of the El Tor strains from the Latin American epidemic, as well as its putative ancestor from Angola. The defective sucrose fermenting phenotype is shown to be due to a single nucleotide insertion in the V. cholerae sucrose-specific transportation gene. This frame-shift mutation truncated a membrane protein, altering its structural pore-like conformation. Further, the identification of a common bacteriophage reinforces both the monophyletic and African-Origin hypotheses for the main causative agent of the 1991 Latin America cholera epidemics.

Criptosporidiose em crianças de 1 a 2 anos de idade, com diarréia aguda em Belém, Pará, Brasil

Num periodo de 12 meses, 201 especimes fecais de 61 criancas foram examiandos com vista a deteccao de Cryptosporidium. Cento e quinze especimes foram obtidos durante os episodios diarreicos e 86 de criancas sem diarreia (grupo controle). Todos os especimes fecais foram examinados pelo metodo de coloracao de Ziehl-Neelsen modificado. Cryptosporidum foi identificado em seis (5,2%) das 115 amostras das criancas com diarreia. Em nenhum dos controles foi obtida a presenca desse parasito. O presente estudo sugere que o Cryptosporidium e um agente causal de diarreia auto-limitada em criancas imunocompetentes em Belem, Para.Two hundred and one samples obtained from 61 children were examined for Cryptosporidium infection during a period of 12 months. One hundred fifteen specimens were collected during diarrhoea episodes and the remaining 86 obtained out of diarrhoea period, as controls. All samples were examined by a modified Ziehl-Neelsen staining method. Cryptosporidium was detected in 6 (5.2%) of 115 samples from diarrhoeic children. All non-diarrhoeic control patients were negative for Cryptosporidium. The present study suggests that Cryptosporidium is an agent of self-limited diarrhoea among immunocompetent children from Belém, Pará.

Salmonella serovars of human origin identified in Pará State, Brazil from 1991 to 2008

Salmonellosis presents a cosmopolitan distribution and affects all age groups, not only in developed countries, but also in developing ones. This study aimed to identify the serovars of Salmonella isolated from human infections occurring in 43 areas of Para State from 1991 to 2008. Eight hundred and ninety samples of Salmonella isolated in coprocultures and blood cultures were analyzed, including 55 isolations of S. Typhi from feces and blood of symptomatic individuals, simultaneously. The cases of Salmonella infections were distributed into 13 serogroups. The majority of them were in group O:9 (68.1%), and 47 serovars of Salmonella were identified, including S. Typhi (58.9%), S. Enteritidis (5.4%) and S. Saintpaul (2.5%). S. Typhi was the most prevalent (58.9%) among the 47 identified serovars, which demonstrates that typhoid fever is a serious public health problem in northern Brazil and requires increased attention from health agencies regarding epidemiological and environmental surveillance as effective measures for its prevention and control.Salmonellosis presents a cosmopolitan distribution and affects all age groups, not only in developed countries, but also in developing ones. This study aimed to identify the serovars of Salmonella isolated from human infections occurring in 43 areas of Pará State from 1991 to 2008. Eight hundred and ninety samples of Salmonella isolated in coprocultures and blood cultures were analyzed, including 55 isolations of S. Typhi from feces and blood of symptomatic individuals, simultaneously. The cases of Salmonella infections were distributed into 13 serogroups. The majority of them were in group O:9 (68.1%), and 47 serovars of Salmonella were identified, including S. Typhi (58.9%), S. Enteritidis (5.4%) and S. Saintpaul (2.5%). S. Typhi was the most prevalent (58.9%) among the 47 identified serovars, which demonstrates that typhoid fever is a serious public health problem in northern Brazil and requires increased attention from health agencies regarding epidemiological and environmental surveillance as effective measures for its prevention and control.

Sorovares de Salmonella de origem humana identificados no Estado do Pará, Brasil, no período de 1991 a 2008

Salmonellosis presents a cosmopolitan distribution and affects all age groups, not only in developed countries, but also in developing ones. This study aimed to identify the serovars of Salmonella isolated from human infections occurring in 43 areas of Para State from 1991 to 2008. Eight hundred and ninety samples of Salmonella isolated in coprocultures and blood cultures were analyzed, including 55 isolations of S. Typhi from feces and blood of symptomatic individuals, simultaneously. The cases of Salmonella infections were distributed into 13 serogroups. The majority of them were in group O:9 (68.1%), and 47 serovars of Salmonella were identified, including S. Typhi (58.9%), S. Enteritidis (5.4%) and S. Saintpaul (2.5%). S. Typhi was the most prevalent (58.9%) among the 47 identified serovars, which demonstrates that typhoid fever is a serious public health problem in northern Brazil and requires increased attention from health agencies regarding epidemiological and environmental surveillance as effective measures for its prevention and control.Salmonellosis presents a cosmopolitan distribution and affects all age groups, not only in developed countries, but also in developing ones. This study aimed to identify the serovars of Salmonella isolated from human infections occurring in 43 areas of Pará State from 1991 to 2008. Eight hundred and ninety samples of Salmonella isolated in coprocultures and blood cultures were analyzed, including 55 isolations of S. Typhi from feces and blood of symptomatic individuals, simultaneously. The cases of Salmonella infections were distributed into 13 serogroups. The majority of them were in group O:9 (68.1%), and 47 serovars of Salmonella were identified, including S. Typhi (58.9%), S. Enteritidis (5.4%) and S. Saintpaul (2.5%). S. Typhi was the most prevalent (58.9%) among the 47 identified serovars, which demonstrates that typhoid fever is a serious public health problem in northern Brazil and requires increased attention from health agencies regarding epidemiological and environmental surveillance as effective measures for its prevention and control.