Roberto Martinez

Paracoccidioidomycosis epidemiological features of a 1,000-cases series from a hyperendemic area on the southeast of Brazil.

Paracoccidioidomycosis has been known for over 100 years, and until now, there were only few estimates of the diseases incidence. We aim to analyze 1,000 cases treated between 1960 and 1999 at Ribeirão Preto city, São Paulo, Brazil, where the diseases incidence range detected was 1.6 to 3.7 cases per 100,000 habitants per year (mean = 2.7 cases/year). We observed a male to female ratio of 6:1 and an age distribution from 3 to 85 years. The acute/subacute form of the disease accounted for 25.4% of cases. Most of the patients (93.5%) had lived or worked in rural areas before the disease development. Smoking and alcoholism were reported by 64.7% and 37.2% of patients, respectively. Comorbidities identified included tuberculosis (8.3%), Chagas disease (8.6%), and human immunodeficiency virus/acquired immunodeficiency syndrome (4.2%). The present study revealed an area in Brazil where paracoccidioidomycosis is hyperendemic (has the highest reported incidence of this disease); this endemic area is probably caused by geological and climatic conditions as well as intensive agriculture.

Expansion and Evolution of a Virulent, Extensively Drug-Resistant (Polymyxin B-Resistant), QnrS1-, CTX-M-2- and KPC-2-producing Klebsiella pneumoniae ST11 International High-risk Clone

ABSTRACT In this study, we report the early expansion, evolution, and characterization of a multiresistant Klebsiella pneumoniae clone that was isolated with increasing frequency from inpatients in a tertiary-care university hospital in Brazil. Seven carbapenem- and quinolone-resistant and polymyxin B-susceptible or -resistant K. pneumoniae isolates isolated between December 2012 and February 2013 were investigated. Beta-lactamase- and plasmid-mediated quinolone resistance (PMQR)-encoding genes and the genetic environment were investigated using PCR, sequencing, and restriction fragment length polymorphism (RFLP). Clonal relatedness was established using XbaI–pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and phylogenetic group characterization. Plasmid analyses included PCR-based replicon typing (PBRT) and hybridization of the S1-PFGE product, plasmid MLST, and conjugation experiments. Virulence potential was assessed by PCR by searching for 10 virulence factor-encoding genes (ureA, fimH, kfuBC, uge, wabG, magA, mrkD, allS, rmpA, and cf29a) and by phenotypic tests to analyze the hypermucoviscous phenotype. The genetic context of a multidrug-resistant and extensively drug-resistant K. pneumoniae ST11-KpI clone harboring IncFIIk-Tn4401a-bla KPC-2, qnrS1, and bla CTX-M-2 was found. Moreover, three isolates displayed high resistance to polymyxin B (MICs = 32, 32, and 128 mg/liter) as well as mucous and hypermucoviscous phenotypes. These bacteria also harbored ureA, fimH, uge, wabG, and mrkD, which code for virulence factors associated with binding, biofilm formation, and the ability to colonize and escape from phagocytosis. Our study describes the association of important coresistance and virulence factors in the K. pneumoniae ST11 international high-risk clone, which makes this pathogen successful at infections and points to the quick expansion and evolution of this multiresistant and virulent clone, leading to a pandrug-resistant phenotype and persistent bacteria in a Brazilian hospital.

Consenso em criptococose: 2008

Divisao de Clinica de Molestias Infecciosas Hospital das Clinicas Universidade de Sao Paulo, Sao Paulo, SP

Neutralizing antibodies in Brazilian sera against three strains of human immunodeficiency virus type 1 (HIV-1)

The MN strain of HIV-1 is known to be more prevalent in Brazil, the BRU strain is more prevalent in Europe, and the NDK strain in Africa. It has been suggested in the literature to include different strains in the same vaccine against HIV-1. To contribute to the studies for the development of a universal vaccine, the occurrence of antibodies (Ab) against three HIV-1 strains (MN, BRU and NDK) was determined in serum samples from 85 HIV-1-positive patients, adult volunteers seen at the University Hospital of the Faculty of Medicine of Ribeirão Preto-USP. One-hundred tissue culture infective unit (TCIU) of the viruses reacted with serial dilutions of the sera (2x) and with MT4 cells added at a final concentration of 0.3 x 10(6) cells/ml, and a cytopathic effect was observed on the 7th and 11th days of incubation. Titres of less than 1/50 were considered to be negative. In 129 tests, the sera were negative for one of the three strains: 40 for MN, 29 for BRU and 60 for NDK. There was a predominance of strains MN and BRU, most of them presenting titres from 1/50 to 1/200. Titres for NDK were detected in 25 sera. We conclude that there seems to be a predominance of strains MN and BRU among the individuals from the region tested; however, the detection of sera with positive NKD titres indicates the need for further studies of this strain in other populations and regions of Brazil.

PESQUISA DE ROTAVIRUS EM FEZES DE DEZ PACIENTES COM SÍNDROME DA IMUNODEFICIÊNCIA ADQUIRIDA (SIDA)

Disturbios gastrointestinais, entre eles a diarreia, sao frequentemente encontrados em individuos portadores do virus da imunodeficiencia humana (HIV) ou com a sindrome da imunodeficiencia adquirida (SIDA)5 6 78.A diarreia cronica e relatada em cerca de 50% de pacientes com SIDA2.Em muitos casos, a diarreia pode ser atribuida a infeccao por um ou mais agentes comuns, como

Ocorrência de falso positivo em testes com peptídeos sintéticos para pesquisa de anticorpos contra o vírus da imunodeficiência humana tipo 2 (HIV-2) em pacientes brasileiros infectados pelo vírus da imunodeficiência humana tipo 1 (HIV-1)

At the present time two distinct viruses are known to cause AIDS the HIV-1 type virus and the HIV-2 type virus. The former was primarily isolated in Europe and the latter was initially restricted to western Africa. In Brazil data on infections caused by HIV-2 are conflicting having been derived from metropolitan and port-city populations. Some authors deny the existence of HIV-2 in the country. In the interior in the city of Ribeirao Preto with a population of 500000 the rate of HIV incidence was 273.5/100000 population during the period 1980-95. Most seropositive patients and AIDS patients are cared for at the Hospital of Clinics of the Medical School of Ribeirao Preto where routine HIV-2 antibody tests are not administered. Therefore the presence of HIV-2 was investigated in 88 patients (72 men and 16 women) carrying HIV-1 during March-April 1992. The HIV-2 antibody test utilized the recombinant antigens of HIV-1 and HIV-2 containing latex particles the Recombigen HIV-1/HIV-2 Rapid Test Device (Cambridge Biotech Corp.). 26 of the 88 sera analyzed were positive for both HIV-1 and HIV-2 yielding a 29.5% (26/88) positivity for both viruses. Subsequently the 88 sera were processed by the Pepti-Lav 1-2 test (Diagnostics Pasteur) which is an immunoenzymatic test detecting reactivity against gp41 and gp36. The result was 88 positive findings for HIV-1 and 2 positive HIV-2 antibody findings for both HIV-1 and HIV-2 yielding a 2.3% positivity for the sample analyzed. Discrepancies between different tests are not rare. The Recombigen use instructions warn that if protein recombinants are used a 25-30% rate of false positives can occur. The Pepti-Lav which detects more specific proteins is more sensitive and specific. The 2 positive HIV-2 sera were also examined by PCR (partition chromatography?) which did not show positivity. This indicates that caution should be exercised when interpreting test results.