José Adail Fonseca de Castro

Genotypes of Cryptococcus neoformans and Cryptococcus gattii as agents of endemic cryptococcosis in Teresina, Piauí (northeastern Brazil)

Throughout Brazil, Cryptococcus neoformans is the cause of cryptococcosis, whereas Cryptococcus gattii is endemic to the northern and northeastern states. In this study, the molecular types of 63 cryptococcal isolates recovered from the cerebrospinal fluid of meningitis patients diagnosed between 2008-2010 in Teresina, Piauí, Brazil, were analysed. Out of the 63 patients, 37 (58.7%) were human immunodeficiency virus (HIV)-positive and 26 (41.3%) were HIV-negative. URA5-restriction fragment length polymorphism analysis identified 37/63 (58.7%) isolates as the C. neoformans VNI genotype, predominantly in HIV-positive patients (32/37, 86.5%), and 24/63 (38.1%) as the C. gattii VGII genotype, mostly in HIV-negative patients (21/26, 80.8%). The occurrence of C. gattii VGII in six apparently healthy children and in seven adolescents/young adults in this region reaffirms the endemic occurrence of C. gattii VGII-induced primary cryptococcosis and early cryptococcal infection. Lethality occurred in 18/37 (48.6%) of the HIV-positive subjects and in 13/26 (50%) of the HIV-negative patients. Our results provide new information on the molecular epidemiology of C. neoformans and C. gattii in Brazilian endemic areas.

Soroprevalência da infecção chagásica no Estado do Piauí, 2002

To evaluate the epidemiological situation of Chagas disease infection in the State of Piauí, Brazil, and its relationships with age, gender, blood transfusion and spontaneous abortion, a serological survey was performed. A random sample of 36,399 inhabitants of rural zones was examined between August and December 2002. Chagas disease infection was defined by the indirect immunofluorescence test, with identification of anti-Trypanosoma cruzi antibodies in blood samples collected on filter paper. The total seroprevalence was 1.9%, ranging from 0.1% in children less than five years old to 6.6% in adults over 79 years old. The seroprevalence was significantly higher in women (2.1%), illiterates (4.1%), individuals receiving blood (3.3%) and women with a history of spontaneous abortion (5.4%). Comparison with the national serological survey (1975-1980) showed that there had been a significant reduction in the seroprevalence of Chagas disease infection in the State of Piauí (4.0% to 1.9%), which was indicative of the efficacy of the vector control measures implemented between 1975 and 2002.

Immunoproteomics and immunoinformatics analysis of Cryptococcus gattii: novel candidate antigens for diagnosis

AIM To identify immunoreactive proteins of Cryptococcus gattii genotype VGII and their B-cell epitopes. MATERIALS & METHODS We combined 2D gel electrophoresis, immunoblotting and mass spectrometry to identify immunoreactive proteins from four strains of C. gattii genotype VGII (CG01, CG02, CG03 and R265). Next, we screened the identified proteins to map B-cell epitopes. RESULTS Sixty-eight immunoreactive proteins were identified. The strains and the number of proteins we found were: CG01 (12), CG02 (12), CG03 (18) and R265 (26). In addition, we mapped 374 peptides potentially targeted by B cells. CONCLUSION Both immunoreactive proteins and B-cell epitopes of C. gattii genotype VGII that were potentially targeted by a host humoral response were identified. Considering the evolutionary relevance of the identified proteins, we may speculate that they could be used as the initial targets for recombinant protein and peptide synthesis aimed at the development of immunodiagnostic tools for cryptococcosis.

EpHLA: An innovative and user-friendly software automating the HLAMatchmaker algorithm for antibody analysis

UNLABELLED The global challenge for solid organ transplantation programs is to distribute organs to the highly sensitized recipients. The purpose of this work is to describe and test the functionality of the EpHLA software, a program that automates the analysis of acceptable and unacceptable HLA epitopes on the basis of the HLAMatchmaker algorithm. HLAMatchmaker considers small configurations of polymorphic residues referred to as eplets as essential components of HLA-epitopes. Currently, the analyses require the creation of temporary files and the manual cut and paste of laboratory tests results between electronic spreadsheets, which is time-consuming and prone to administrative errors. RESULTS The EpHLA software was developed in Object Pascal programming language and uses the HLAMatchmaker algorithm to generate histocompatibility reports. The automated generation of reports requires the integration of files containing the results of laboratory tests (HLA typing, anti-HLA antibody signature) and public data banks (NMDP, IMGT). The integration and the access to this data were accomplished by means of the framework called eDAFramework. The eDAFramework was developed in Object Pascal and PHP and it provides data access functionalities for software developed in these languages. The tool functionality was successfully tested in comparison to actual, manually derived reports of patients from a renal transplantation program with related donors. CONCLUSIONS We successfully developed software, which enables the automated definition of the epitope specificities of HLA antibodies. This new tool will benefit the management of recipient/donor pairs selection for highly sensitized patients.

Estudo soroepidemiológico da cisticercose humana em um município do Estado do Piauí, Região Nordeste do Brasil

As part of parasitological studies in the area surrounding the Serra da Capivara National Park, Piaui State, Northeast Brazil, from 1999 to 2001, the current study aimed to evaluate the epidemiological profile of human cysticercosis in the Municipality of Joao Costa. Clinical and epidemiological data were obtained, and blood samples were drawn for immunoenzymatic serological tests (ELISA and Western blot), using Taenia crassiceps as the antigen. The first stage, in 1999, investigated 169 individuals with a confirmed history or suspicion of infection/disease involving the teniasis/cysticercosis complex, along with the family members. Some 13.6% of the individuals were seroreactive for cysticercosis by the ELISA method. The second stage, in 2001, evaluated 92 serum samples of individuals who had been detected as reactive for cysticercosis in the first stage, along with their family members; 24% of the samples were reactive to cysticercosis by ELISA and 29% by Western blot. During this same stage a coprological survey was performed with 701 individuals, including volunteers. Prevalence of intestinal parasites was 51%, with a higher prevalence of protozoans (95%) than helminths (5%). The results indicate the endemicity of cysticercosis in the area, in addition to the high frequency of intestinal protozoan infections.

Prevalência de aneurismas do ventrículo esquerdo em pacientes chagásicos crônicos de duas áreas do Estado do Piauí

A cross-sectional study involving a cohort of 261 chronic Chagas disease patients (156 from the municipality of João Costa and 105 from São João do Piauí; 146 women and 115 men with mean age of 57.9 +/- 14.2 years) was carried out to evaluate the prevalence of left ventricle aneurysms. The cardiological evaluation was performed by means of clinical examination, resting electrocardiograms and one and two-dimensional echocardiograms. A total of 23 cases of left ventricle aneurysms (8.8%) were diagnosed: 17 (6.5%) in the apical segment, four (1.5%) in the posterior wall, one (0.4%) in the inferior wall and one (0.4%) in the interventricular septum. Five patients (1.9%) from São João do Piauí presented thrombi associated with apical aneurysms. The prevalence of left ventricle aneurysms was greater among the patients from São João do Piauí (13.3%) and among men (13.9%), with no significant difference in relation to age group. These results show that there was low prevalence of left ventricle aneurysms among patients from João Costa and high concentration of thrombi among patients from São João do Piauí.

Lysosome-associated protein 1 (LAMP-1) and lysosome-associated protein 2 (LAMP-2) in a larger family carrier of Fabry disease.

This study investigated the potential relationship between the expression levels of lysosome-associated membrane proteins (LAMP) 1 and 2 and responses to enzyme replacement therapy (ERT) in the members of a single family with Fabry disease (FD). LAMP levels were assessed by flow cytometry in leukocytes from 17 FD patients who received an eight-month course of ERT course and 101 healthy individuals. We found that phagocytic cells from the FD patients had higher expression levels of both LAMP-1 and LAMP-2, relative to the levels in phagocytes from the healthy controls (p=0.001). Furthermore, the LAMP-1 and LAMP-2 levels in phagocytes from the FD carriers continuously decreased with ERT administration to reach levels similar to those in healthy controls. We suggest that LAMP-1 and LAMP-2 could be used as additional markers with which to assess ERT effectiveness in FD.

Degree of disability, pain levels, muscle strength, and electromyographic function in patients with Hansen's disease with common peroneal nerve damage

INTRODUCTION This study evaluated the degree of disability, pain levels, muscle strength, and electromyographic function (RMS) in individuals with leprosy. METHODS We assessed 29 individuals with leprosy showing common peroneal nerve damage and grade 1 or 2 disability who were referred for physiotherapeutic treatment, as well as a control group of 19 healthy participants without leprosy. All subjects underwent analyses of degree of disability, electromyographic tests, voluntary muscle force, and the Visual Analog Pain Scale. RESULTS McNemars test found higher levels of grade 2 of disability (Δ = 75.9%; p = 0.0001) among individuals with leprosy. The Mann-Whitney test showed greater pain levels (Δ = 5.0; p = 0.0001) in patients with leprosy who had less extension strength in the right and left extensor hallucis longus muscles (Δ = 1.28, p = 0.0001; Δ = 1.55, p = 0.0001, respectively) and dorsiflexion of the right and left feet (Δ = 1.24, p = 0.0001; Δ = 1.45, p = 0.0001, respectively) than control subjects. The Kruskal-Wallis test showed that the RMS score for dorsiflexion of the right (Δ = 181.66 m·s-2, p = 0.001) and left (Δ = 102.57m·s-2, p = 0.002) feet was lower in patients with leprosy than in control subjects, but intragroup comparisons showed no difference. CONCLUSIONS Leprosy had a negative influence on all of the study variables, indicating the need for immediate physiotherapeutic intervention in individuals with leprosy. This investigation opens perspectives for future studies that analyze leprosy treatment with physical therapeutic intervention.

Avaliação da dor em portadores de hanseníase submetidos à mobilização neural

Este estudo tem como objetivo avaliar o efeito da tecnica de mobilizacao neural sobre a percepcao da dor em portadores de hanseniase. A amostra de 56 individuos portadores de hanseniase foi randomizada em: grupo experimental (GMN) composto por 29 individuos submetidos ao tratamento com mobilizacao neural e grupo controle (GC) composto por 27 individuos que foram submetidos ao tratamento convencional. A percepcao da dor foi avaliada atraves da Escala Visual Analogica, indicando-se em uma extremidade a marcacao de ausencia de dor e na outra, pior dor imaginavel. O GMN foi submetido ao tratamento utilizando a tecnica de mobilizacao neural, que consistiu de dezoito atendimentos (seis semanas), tres vezes por semana. O GC foi submetido ao tratamento convencional com exercicios de flexibilidade, fortalecimento, com uso de exercitadores de tornozelo ou de recursos eletroterapicos. O GMN apresentou reducao significativa (p=0,000) na percepcao da dor ao comparar o pre e o pos-teste e na comparacao com o GC no pos-teste. O GC nao apresentou diferenca significativa (p=0,520). Conclui-se que a utilizacao da tecnica de mobilizacao neural promoveu reducao nos niveis de dor em portadores de hanseniase.

Electromyography function, disability degree, and pain in leprosy patients undergoing neural mobilization treatment

INTRODUCTION This study aimed to evaluate the effect of the neural mobilization technique on electromyography function, disability degree, and pain in patients with leprosy. METHODS A sample of 56 individuals with leprosy was randomized into an experimental group, composed of 29 individuals undergoing treatment with neural mobilization, and a control group of 27 individuals who underwent conventional treatment. In both groups, the lesions in the lower limbs were treated. In the treatment with neural mobilization, the procedure used was mobilization of the lumbosacral roots and sciatic nerve biased to the peroneal nerve that innervates the anterior tibial muscle, which was evaluated in the electromyography. RESULTS Analysis of the electromyography function showed a significant increase (p<0.05) in the experimental group in both the right (Δ%=22.1, p=0.013) and the left anterior tibial muscles (Δ%=27.7, p=0.009), compared with the control group pre- and post-test. Analysis of the strength both in the movement of horizontal extension (Δ%right=11.7, p=0.003/Δ%left=27.4, p=0.002) and in the movement of back flexion (Δ%right=31.1; p=0.000/Δ%left=34.7, p=0.000) showed a significant increase (p<0.05) in both the right and the left segments when comparing the experimental group pre- and post-test. The experimental group showed a significant reduction (p=0.000) in pain perception and disability degree when the pre- and post-test were compared and when compared with the control group in the post-test. CONCLUSIONS Leprosy patients undergoing the technique of neural mobilization had an improvement in electromyography function and muscle strength, reducing disability degree and pain.