Elvira Maria Mendes do Nascimento

Brazilian spotted fever: a case series from an endemic area in southeastern Brazil: epidemiological aspects.

Abstract:  Brazilian spotted fever (BSF) is the most important tick‐borne disease in Brazil and is caused by Rickettsia rickettsii and transmitted by the Ixodid tick Amblyomma cajennense, its main vector. We present epidemiologic aspects of a case series of patients admitted to the Hospital das Clínicas da UNICAMP from 1985 to 2003 with a confirmed diagnosis of BSF either by a fourfold rise in indirect immunofluorescence (IFA) titers of IgG antibodies reactive with R. rickettsii or isolation of R. rickettsii from blood or skin specimens. Seasonal variation of case occurrence seems to be associated with the life cycle of the tick. The recent reemergence of cases seems to be associated with the growing numbers of the capybara (Hydrochaeris hydrochaeris) and their expansion into urban areas.

Riquetsioses no Brasil e Portugal: ocorrência, distribuição e diagnóstico

O presente artigo e uma atualizacao sobre a ocorrencia e diagnostico das riquetsioses existentes no Brasil e Portugal, com o objetivo de incentivar e incrementar a vigilância epidemiologica dessas doencas nos dois paises. Realizou-se levantamento bibliografico e foram apresentados dados nao publicados de laboratorios e servicos de epidemiologia. Os resultados descreveram a ocorrencia das riquetsioses no Brasil e Portugal, inclusive aquelas recem-descritas, advindas de riquetsias de potencial patogenico ainda incerto. Os metodos diagnosticos atualmente empregados foram discutidos. Como em outros paises, as riquetsioses parecem assumir crescente importância em saude publica. Relegadas a um plano secundario por muitas decadas, o interesse por essas infeccoes tem aumentado nos dois paises, mas ainda carece de investigacao para esclarecer seu real significado em saude publica.

Chagas disease in an area of recent occupation in Cochabamba, Bolivia

INTRODUCTION A descriptive, entomological and seroepidemiological study on Chagas disease was conducted in a place of recent occupation on the outskirts of Cochabamba, Bolivia: Avaroa/Primer de Mayo (population:3,000), where the socio-economic level is low and no control measures have been made available. METHODS The immunofluorescent antibody test (IFAT) was used for IgG and IgM anti-Trypanosoma cruzi antibodies in filter paper bloodspot eluates from 128 subjects (73 females, 55 males) selected by systematic sampling. Concerning each subject age, gender, birthplace, occupation, duration of residence and building materials used in their houses were recorded. Vectors were captured both in domestic and peridomestic environments. RESULTS Seropositive, 12.5% (16/128): females, 15.1% (11/73); males, 9.1% (5/55). Average time of residence: 6.1 years for the whole population sample and 7.4 years for the seropositive subjects. Most houses had adobe walls (76. 7%, n= 30), galvanized iron rooves (86.7%) and earthen floors (53. 4%) 80% of the walls had crevices. One hundred forty seven specimens of Triatoma infestans were captured, of which 104 (70.7%) were domestic, and 1 peridomestic Triatoma sordida. Precipitin host identification: birds, 67.5%; humans, 27.8%; rodents, 11.9%; dogs, 8. 7%; cats, 1.6%. House infestation and density indices were 53.3 and 493.0 respectively. We found 21 (14.3%) specimens of T. infestans infected with trypanosomes, 18 (85.7%) of which in domestic environments. DISCUSSION The elements for the vector transmission of Chagas disease are present in Avaroa/Primer de Mayo and the ancient custom of keeping guinea pigs indoors adds to the risk of human infection. In neighboring Cochabamba, due to substandard quality control, contaminated blood transfusions are not infrequent, which further aggravates the spread of Chagas disease. Prompt action to check the transmission of this infection, involving additionally the congenital and transfusional modes of acquisition, is required.

Infective endocarditis due to Bartonella spp. and Coxiella burnetii: experience at a cardiology hospital in Sao Paulo, Brazil.

Abstract:  Bartonella spp. and Coxiella burnetii are recognized as causative agents of blood culture–negative endocarditis (BCNE) in humans and there are no studies of their occurrences in Brazil. The purpose of this study is to investigate Bartonella spp. and C. burnetii as a causative agent of culture‐negative endocarditis patients at a cardiology hospital in São Paulo, Brazil. From January 2004 to December 2004 patients with a diagnosis of endocarditis at our Institute were identified and recorded prospectively. They were considered to have possible or definite endocarditis according to the modified Duke criteria. Those with blood culture–negative were tested serologically using the indirect immunofluorescent assay (IFA) for Bartonella henselae, B. quintana, and C. burnetii. IFA‐IgG titers >800 for Bartonella spp. and C. burnetii were considered positive. A total of 61 patients with endocarditis diagnosis were evaluated, 17 (27%) were culture‐negative. Two have had IgG titer greater than 800 (≥3,200) against Bartonella spp. and one against C. burnetii (phase I and II≥6,400). Those with Bartonella‐induced endocarditis had a fatal disease. Necropsy showed calcifications and extensive destruction of the valve tissue, which is diffusely infiltrated with mononuclear inflammatory cells predominantly by foamy macrophages. The patient with C. burnetii endocarditis received specific antibiotic therapy. Reports of infective endocartitis due to Bartonella spp. and C. burnetii in Brazil reveal the importance of investigating the infectious agents in culture‐negative endocarditis.

Genetic Identification of Rickettsial Isolates from Fatal Cases of Brazilian Spotted Fever and Comparison with Rickettsia rickettsii Isolates from the American Continents

ABSTRACT Fifteen bacterial isolates from spotted fever group rickettsiosis in Brazil were genetically identified as Rickettsia rickettsii. In a phylogenetic analysis with other R. rickettsii isolates from GenBank, the Central/South American isolates showed low polymorphism and formed a clade distinct from two North American clades, with the North American clades having greater in-branch polymorphism.

A ocorrência de riquetsioses do grupo Rickettsia rickettsii

Foi realizada revisao da literatura com objetivo de atualizar as informacoes sobre a ocorrencia de riquetsioses do grupo Rickettsia rickettsii. Verificou-se que nos EUA e Europa, a incidencia da febre maculosa, vem aumentando desde 1970 ate hoje. No Brasil, foi relatado um caso presuntivo, no estado da Bahia, em 1979. Com relacao a prevencao, controle e tratamento dessa doenca e salientada a importância de informacoes relacionadas com individuos expostos a picadas de carrapatos, notificacao de novos casos, fatores ecologicos, tecnicas laboratoriais mais especificas para a identificacao do agente etiologico, e a antibioticoterapia mais eficiente. A vacinacao e ainda referida como meio mais favoravel na prevencao da doenca, devendo ser administrada aos individuos de alto risco. No Brasil, faltam informacoes precisas sobre a ocorrencia de R. rickettsii.

Brazilian spotted fever: Real-time PCR for diagnosis of fatal cases

Suspicion of Brazilian spotted fever (BSF) should occur in endemic regions upon surveillance of the acute febrile icteric hemorrhagic syndrome (AFIHS). However, limitations associated with currently available laboratory tests pose a challenge to early diagnosis, especially in fatal cases. Two real-time PCR (qPCR) protocols were evaluated to diagnose BSF in 110 fatal AFIHS cases, collected in BSF-endemic regions in 2009-2010. Of these, 24 were positive and 86 negative by indirect immunofluorescence (IFA) assay (cut-off IgG and/or IgM ≥ 128). DNA from these samples was used in the qPCR protocols: one to detect Rickettsia spp. (citrate synthase gene) and another to determine spotted fever group (SFG) Rickettsia species (OmpA gene). Of the 24 IFA-positive samples, 5 (21%) were positive for OmpA and 9 (38%) for citrate synthase. In the IFA-negative group (n=86), OmpA and citrate synthase were positive in 23 (27%) and 27 (31%), respectively. These results showed that the 2 qPCR protocols were about twice as sensitive as the IFA test alone (93% concordance). In conclusion, qPCR is a sensitive method for the diagnosis of fatal BSF cases and should be considered for routine surveillance of AFIHS in places like Brazil, where spotted fever-related lethality is high and other endemic diseases like dengue and leptospirosis can mislead diagnosis.

Vacina inativada contra gripe trivalente: estudo comparativo da resposta imunitária pelos métodos de inibição de hemaglutinação e da hemólise radial simples

A vacina inativada contra gripe, trivalente, preparada no Instituto Butantan, contendo 200 unidades hemaglutinantes de cada uma das cepas de virus Influenza A/SP/1/80 (H3N2), A/SP/1/78 (H1N1) e B/England/847/73, foi administrada em 110 voluntarios humanos adultos, sendo que 62 receberam uma dose de vacina e 48 duas doses, com intervalo de 21 dias. A resposta de anticorpos especificos para influenza foi analisada comparativamente pelos testes de Inibicao da Hemaglutinacao (IH) e Hemolise Radial Simples (HRS). Ocorreu aumento significativo do teor de anticorpos nos individuos vacinados, correspondente a um aumento de 4 vezes ou mais nos titulos obtidos pelo teste IH e a um aumento de 3,0 mm ou maior no diâmetro das zonas de hemolise pelo teste HRS. Os metodos demonstraram correlacao satisfatoria entre si.A vacina inativada contra gripe, trivalente, preparada no Instituto Butantan, contendo 200 unidades hemaglutinantes de cada uma das cepas de virus Influenza A/SP/1/80 (H3N2), A/SP/1/78 (H1N1) e B/England/847/73, foi administrada em 110 voluntarios humanos adultos, sendo que 62 receberam uma dose de vacina e 48 duas doses, com intervalo de 21 dias. A resposta de anticorpos especificos para influenza foi analisada comparativamente pelos testes de Inibicao da Hemaglutinacao (IH) e Hemolise Radial Simples (HRS). Ocorreu aumento significativo do teor de anticorpos nos individuos vacinados, correspondente a um aumento de 4 vezes ou mais nos titulos obtidos pelo teste IH e a um aumento de 3,0 mm ou maior no diâmetro das zonas de hemolise pelo teste HRS. Os metodos demonstraram correlacao satisfatoria entre si.