Heloisa Marceliano Nunes

Hepatitis D and B virus genotypes in chronically infected patients from the Eastern Amazon Basin

Hepatitis D virus (HDV) is a defective hepatotropic virus whose infectivity is dependent on hepatitis B virus (HBV). HDV super- or co-infection leads to an increased risk of fulminant hepatitis or progression to severe chronic liver disease in HBV infected patients. The Brazilian Amazon Basin has been reported to be endemic for HBV and HDV, especially in the Western Amazon Basin. In this region, HDV infection is frequently associated with acute fulminant hepatitis with characteristic histologic features. HDV is classified into seven major clades (HDV-1 to HDV-7) and HBV is subdivided into eight genotypes (A-H). HDV and HBV genotypes have been shown to have a distinct geographic distribution. The aim of this study was to determine the HBV and HDV genotypes harbored by chronically infected patients from the Eastern Amazon Basin, Brazil. We studied 17 serum samples from HBV and HDV chronically infected patients admitted to a large public hospital (Santa Casa de Misericórdia) at Belém, state of Pará, Brazil, between 1994 and 2002. HDV-3 and HBV genotype A (subtype adw2) have been identified in all cases, in contrast to previous studies from other regions of the Amazon, where HBV genotype F has been found co-infecting patients that harbored HDV-3. The HDV-3/HBV-A co-infection suggests that there is not a specific interaction between HBV and HDV genotypes, and co-infection might merely reflect the most frequent genotypes found in a particular geographic area. The analysis of the carboxy-terminal region of the large hepatitis D antigen (L-HDAg), which interacts with the hepatitis B surface antigen (HBsAg) and is essential for HDV assembly, showed some diversity between the different isolates from the Eastern Amazon. This diversity is not observed among HDV-3 sequences from other South American regions.

Prevalência dos marcadores sorológicos dos vírus das hepatites B e D na área indígena Apyterewa, do grupo Parakanã, Pará, Brasil

Com o objetivo de estudar a prevalencia dos virus das hepatites B (HBV) e D (HDV), nas aldeias Apyterewa e Xingu, do grupo Parakana, e avaliar o impacto da vacinacao contra a hepatite B, iniciada nessas aldeias em 1995, foram coletadas, em 2004, 258 amostras de soro para analise dos marcadores sorologicos das hepatites B e D, por tecnicas imunoenzimaticas; cujos resultados revelaram padrao de endemicidade moderada com prevalencia total de infeccao pelo HBV de 55,7%, com 5,4% de portadores do virus, na aldeia Apyterewa, e de 49,5%, com 1,1% de portadores, na Xingu; 31,4% de anti-HBs+ como marcador isolado nas duas aldeias, e nao foi detectada sorologia positiva para o HDV entre portadores do HBV. Caracterizamos, em base laboratorial, a presenca de portadores cronicos do HBV, ausencia de portadores do HDV e emergencia de perfil vacinal entre os susceptiveis, confirmando a efetividade e a necessidade de manter a vacinacao, principalmente no primeiro ano de vida, e, ainda, a necessidade de desenvolver vigilância epidemiologica efetiva para deteccao precoce da infeccao pelo HDV, entre os portadores do HBV.

Equinococose policística na Amazônia oriental brasileira: atualização da casuística

Mediante criterios epidemiologicos, clinicos e laboratoriais, foi levantada a casuistica de equinococose policistica no periodo de 1962 a 2003, no âmbito da Amazonia oriental brasileira, incluindo casos ineditos e aqueles ja publicados. Dessa forma, foram identificados 40 casos da doenca no referido periodo, compreendendo casos procedentes dos estados do Para e Amapa, Brasil. A amplitude das idades foi de 10 a 72 anos. Do total 47,5% pertenciam ao sexo masculino. O figado foi o orgao mais acometido (82,5% dos casos). O Echinococcus vogeli (Rausch e Bernstein, 1972), apresentou-se como o principal agente etiologico envolvido. A partir do reconhecimento da importância e das implicacoes do manejo da equinococose para a regiao tropical, acredita-se que devera ocorrer uma implementacao do diagnostico precoce, tratamento adequado e de um melhor registro da doenca.

Infecção pelo vírus da hepatite A em área indígena da Amazônia oriental brasileira

The hepatitis A virus infection represents an important problem of public health all over the world, being related to the socioeconomic and hygienic conditions of the population. In Brazilian Amazon, seroepidemiological studies in amerindians populations have been demonstrating high endemicity related to the infection. With the objective of evaluate the prevalence of the hepatitis virus A infection in xicrin village, in the municipality district of Altamira-Pará-Brazil, whose investigation was unchained by indigenous childs obit, that clinical developed in nine days with a picture icterus-hemorrhagic, without confirmation by serologic exams, 352 samples of blood were analyzed by serologic tests of the markers of the hepatitis A, B, C and D virus, for immunoenzymatic technic, that indicated a prevalence of 98% of antibodies against the hepatitis A virus, which 30.5% with recent infection, characterizing in laboratorial basis, the outbreak of infection for the virus of the hepatitis A and raising the possibility to be associated with the obit happened in the village.

Anatomo-clinical and molecular description of liver neotropical echinococcosis caused by Echinococcus oligarthrus in human host

Since humans rarely play the role as Echinococcus oligarthrus host, there is lack of knowledge about the complex infectious process. Only three cases have been reported to occur in humans in the neotropics until now. We present the anatomo-clinical and molecular findings describing a new case of infection by E. oligarthrus in a man. The muscular or subcutaneous tissues tropism described for this species in the previously reported cases was not present, but a liver tropism was observed. Additionally, the larval stage rostellar hooks morphometry differed from E. oligarthrus in the other human cases.

Capillaria hepatica (Bancroft, 1893) (Nematoda) entre populações indígenas e mamíferos silvestres no noroeste do Estado do Mato Grosso, Brasil, 2000

Capillaria hepatica is a hepatotropic nematode that infects rodents and other mammals. In 2000, eggs of this helminth were identified in stool samples from the indigenous population in Northwestern Mato Grosso, Brazil. A parasitological survey was conducted in stool samples from 477 (76.6%) out of 622 Indians from six villages (Mamaindé, Kithãulu, Camararé, Negatoré, Nambiquara and Wassussu) located in the valleys of the Guaporé and Nambiquara rivers. Liver samples from wild animals were used by these Indians as a food source and were collected for histopathological and parasitological assessment. The results revealed the presence of C. hepatica eggs in the stool samples from 8.6% (41/477) of the individuals and revealed enteric parasitic protozoa and other helminths. Eggs of C. hepatica were also found in the livers of Tayassu pecari (white-lipped peccary) and Ateles paniscus (black spider monkey). The fecal elimination of C. hepatica eggs that was found among the Indians represented a spurious infection and was associated with the consumption of the viscera of wild animals that are considered to be reservoirs of C. hepatica in the investigated area. Additional clinical and epidemiological studies must be performed in this area because of the zoonotic potential of C. hepatica to cause hepatic capillariasis. Keyword: Capillaria hepatica; Nematoda; Helminths; protozoan; Indigenous Population. Capillaria hepatica (Bancroft, 1893) (Nematodo) entre poblaciones indígenas y mamíferos silvestres en el noroeste del Estado de Mato Grosso, Brasil, 2000 RESUMEN Capillaria hepatica es un nematodo hepatotrópico capaz de infectar roedores y otros mamíferos. En virtud de la identificación de huevos de este helminto en muestras de heces de indígenas del noroeste de Mato Grosso, el año 2000, se realizó una investigación coproparasitaria en las heces de 477 (76,6%) de los 622 indígenas de seis aldeas (Mamaindé, Kithãulu, Camararé, Negatoré, Nambiquara y Wassussu) situadas en los valles de los ríos Guaporé y Nambiquara, noroeste del Estado de Mato Grosso. También se colectaron muestras, para evaluación histopatológica y parasitaria, de hígados de animales silvestres utilizados como fuente alimentar por estos indígenas. Los resultados indicaron la presencia de huevos de C. hepatica en las heces de 8,6% (41/477) de los indígenas y de protozoarios y otros helmintos enteroparásitos entre las muestras analizadas. Huevos de C. hepatica también fueron identificados en el hígado de Tayassu pecari (pecarí barbiblanco) y Ateles paniscus (mono araña). La eliminación fecal de huevos de C. hepatica entre los indígenas representó infecciones espurias y fue asociada al consumo de vísceras de animales silvestres, considerados como reservorios del helminto en el área. Estudios clínico-epidemiológicos complementarios deben ser desarrollados en la región, en virtud del potencial zoonótico del parásito en causar infecciones genuinas de capilariasis hepática. Palabras clave: Capillaria hepatica; Nematodo; helmintos; protozoarios; población indígena.

Neotropical echinococcosis: Second report of Echinococcus vogeli natural infection in its main definitive host, the bush dog (Speothos venaticus)

The bush dog (Speothos venaticus) acts as the natural definitive host in the life cycle of Echinococcus vogeli, the causative agent of polycystic hydatid disease, a zoonotic neglected disease in the South America. We report a case of natural infection by Echinococcus vogeli in a bush dog from the Brazilian Amazon, confirmed by the morphological and morphometric examination of adult parasites and their hooks obtained from the small intestine of the canid. Additionally, mitochondrial DNA sequence analysis corroborated these findings. This is the second report of natural infection by E. vogeli in a bush dog.

Etiology of cutaneous leishmaniasis and anthropophilic vectors in Juruti, Pará State, Brazil

In a preliminary study in Juruti, a mining municipality in western Pará State, Brazil, 12 out of 21 patients suspected of presenting cutaneous leishmaniasis showed positive PCR (SSUrDNA and G6PD): Leishmania (Viannia) braziliensis (9/12; 75%) and L. (V.) sp. (3/12; 25%). Entomological studies in the same location revealed the presence of 12 different phlebotomine species (n =105). One of the most common species was Lutzomyia (Psychodopygus) complexa (17%) which is both highly anthropophilic and a known vector of L. (V.) braziliensis in other regions of Pará. These preliminary findings should serve to guide future epidemiological surveillance in Juruti.

Prevalence of hepatitis A, B, C and D infections in the Juruti municipal hospital, western Pará, Brazil

The Juruti Municipality, located to the west of the Pará State, possesses major bauxite reserves, the exploration of which started in 2005. The appearance of some diseases and the increased frequency of others have been influenced by this exploration, particularly in relation to viral hepatitis. These epidemiological trends are different from those observed anywhere else worldwide. To define the prevalence of the infections by the hepatitis A, B, C and D viruses in the Juruti municipal hospital between February 2007 and April 2008, serum samples were collected from patients and analyzed for serological markers of hepatitis A (HAV), B (HBV), C (HCV) and D (HDV) by immunoenzymatic techniques. In samples positive for the hepatitis B and C viruses, assays were performed for the detection of HBV-DNA and HCV-RNA by PCR and RT-PCR, respectively. Among the 1,630 samples collected, the prevalence of total anti-HAV was 85.6%; HBsAg was 0.7%; + + anti-HBc/anti-HBs was 9.1% and isolated anti-HBs were 31.4%. Among the HBsAg , 9.1% were HBeAg ; 63.6% were anti+ + HBe and 72.7% were HBV-DNA . Anti-HCV was positive in 0.1% of the samples and positive serologies were not detected for HDV. Laboratory-based characterization revealed a high prevalence of infection by HAV, detected chronic HBV carriers and those susceptible to HBV, identified an HCV carrier and revealed the absence of HDV carriers. Local, community-based epidemiological studies are recommended for comparison to the hospital data presented here.

Prevalência de infecção pelos vírus das hepatites A, B, C e D na demanda de um hospital no Município de Juruti, oeste do Estado do Pará, Brasil

The Juruti Municipality, located to the west of the Pará State, possesses major bauxite reserves, the exploration of which started in 2005. The appearance of some diseases and the increased frequency of others have been influenced by this exploration, particularly in relation to viral hepatitis. These epidemiological trends are different from those observed anywhere else worldwide. To define the prevalence of the infections by the hepatitis A, B, C and D viruses in the Juruti municipal hospital between February 2007 and April 2008, serum samples were collected from patients and analyzed for serological markers of hepatitis A (HAV), B (HBV), C (HCV) and D (HDV) by immunoenzymatic techniques. In samples positive for the hepatitis B and C viruses, assays were performed for the detection of HBV-DNA and HCV-RNA by PCR and RT-PCR, respectively. Among the 1,630 samples collected, the prevalence of total anti-HAV was 85.6%; HBsAg was 0.7%; + + anti-HBc/anti-HBs was 9.1% and isolated anti-HBs were 31.4%. Among the HBsAg , 9.1% were HBeAg ; 63.6% were anti+ + HBe and 72.7% were HBV-DNA . Anti-HCV was positive in 0.1% of the samples and positive serologies were not detected for HDV. Laboratory-based characterization revealed a high prevalence of infection by HAV, detected chronic HBV carriers and those susceptible to HBV, identified an HCV carrier and revealed the absence of HDV carriers. Local, community-based epidemiological studies are recommended for comparison to the hospital data presented here.