Vera Magalhães

The role of adults in household outbreaks of pertussis.

OBJECTIVES This study describes the role of adults in 57 household outbreaks of pertussis. METHODS Parents/guardians of children with suspected pertussis seen at a university hospital were interviewed. Once a case of pertussis was confirmed, all household members were enrolled in the study. The US Centers for Disease Control and Prevention (CDC) definitions for pertussis were used . RESULTS Among 349 household members, 150 were adults and one in five had pertussis during the household outbreaks. Of the adult cases, 70.6% were aged 19-39 years. The secondary attack rate in adults was 12.6%. Adults were the primary case in a 21.1% of households, resulting in 43% of all secondary cases. Most adult cases had typical symptoms of pertussis, but none had been diagnosed before the investigation. CONCLUSIONS Adults, particularly those aged between 19 and 39 years, play an important role in pertussis transmission in households. Pertussis vaccination in adolescents/young adults may decrease the dissemination of pertussis in households.

Metallo-beta-lactamase producing Pseudomonas aeruginosa strains isolated in hospitals in Recife, PE, Brazil

De 24 linhagens hospitalares de Pseudomonas aeruginosa provenientes de Recife, Brasil, 15 (62%) produziram metalo-b-lactamase. Tais isolados foram resistentes as principais drogas antipseudomonas, exceto polimixina B e aztreonam. A enzima responsavel pela resistencia aos carbapanemicos pertence a classe SPM-1 e o gene envolvido, blaspm-1, provavelmente e plasmidial.

Children with pertussis inform the investigation of other pertussis cases among contacts

BackgroundThe number of reported pertussis has increased in the last two decades. However, many cases of pertussis may be underreported or not diagnosed. The World Health Organization estimates that pertussis causes 200.000 – 400.000 deaths each year, most deaths are in infants and in developing countries. Infants with pertussis can indicate an undetected source cases in the community.MethodsAt a University Hospital in Brazil individuals that had frequent contacts with a child with confirmed pertussis (the index case) and had recent history of cough were enrolled into the study. Nasopharyngeal swabs were collected from every contact that had cough within the last 21 days. Cases confirmation followed the guidelines of the Center for Disease Control and Prevention – Atlanta, U.S.A.ResultsPertussis diagnosis was confirmed in 51 children, (considered the index cases). Among the index cases, 72.5% (37/51) were under 6 months of age; culture for Bordetella pertussis was positive in 78.4% (40/51). Pertussis was confirmed in 39% (107/276) of the contacts of 51 index cases. Among these contacts identified as a pertussis case, 40.2% (43/107) were between 6 months and 111/2 years of age and 59.8% (64/107) were older than 111/2 years of age. Pertussis was confirmed by culture in 11.2% (12/107) of them and by epidemiologic linkage in 88.8% (95/107). Each index case allowed identifying two new cases of pertussis.ConclusionPublic health authorities should consider implementing early recognition of pertussis index cases and searching for pertussis cases among the contacts. Treatment of the cases and prophylaxis of the contacts is fundamental to control outbreaks in the community.

Aplicação dos critérios diagnósticos do lúpus eritematoso sistêmico em pacientes com hanseníase multibacilar

INTRODUCAO: O lupus eritematoso sistemico (LES) e uma doenca inflamatoria cronica que acomete multiplos orgaos ou sistemas, nao apresenta manifestacao clinica patognomonica ou teste laboratorial sensivel e especifico o suficiente para um diagnostico especifico. Para o diagnostico, sao utilizados os criterios propostos pelo Colegio Americano de Reumatologia (ACR), modificados em 1997. A presenca de quatro ou mais criterios tem sensibilidade e especificidade de 96%. Porem, esses criterios para o LES podem ter especificidade mais baixa em regioes endemicas para doencas infecciosas cronicas, como o Brasil, endemico para hanseniase, que pode apresentar manifestacoes clinico-laboratoriais semelhantes. METODOS: Foi realizado um estudo de prevalencia, onde foram aplicados os criterios de LES, nos pacientes com diagnostico recente de hanseniase multibacilar, que deram entrada no ambulatorio de hanseniase da Clinica Dermatologica da Universidade Federal de Pernambuco (UFPE) durante o periodo da coleta de dados, alem de calculada a especificidade e o numero de falso-positivos nesse grupo. RESULTADOS: Foram incluidos 100 pacientes. As prevalencias de alguns dos criterios de LES foram elevadas. Os criterios com maior prevalencia foram o eritema malar (44%), a artrite (23%), a fotossensibilidade (29%), a linfopenia (19%) e a presenca dos anticorpos antifosfolipides, incluidos no criterio imunologico (20%). A especificidade encontrada (84%) foi menor do que a atribuida aos criterios em 1997 pelo ACR. CONCLUSOES: Doencas presentes em nosso meio, como a hanseniase nas formas multibacilares, mimetizam o quadro clinico-laboratorial do LES, o que deve deixar o medico atento a realidade das doencas infecciosas locais antes de afirmar um diagnostico definitivo de LES.

Laboratory evaluation on pathogenic potentialities of Vibrio furnissii

Sixteen strains of Vibrio furnissii recovered from 16 Brazilian patients with diarrhea were screened for virulence-associated factors. All strains were non-invasive, non-fimbriated, and did not produce either enterotoxins or cholera-like toxin. In contrast, most were hemolytic on blood agar and their broth-culture supernatants damaged HeLa cell monolayers. These cytolysins, as accepted for other enteropathogenic members of the family Vibrionaceae, might be determinants of pathogenicity in V. furnissii-mediated enteritis.

Polimorfismos do gene NRAMP1 em indivíduos com reações hansênicas, atendidos em dois Centros de Referência no Recife, nordeste do Brasil

INTRODUCTION: To investigate susceptibility to leprosy reactions, three polymorphisms of the natural resistance-associated macrophage protein (NRAMP1) gene were determined in 201 individuals who were attended at two reference centers in Recife, between 2007 and 2008. Of these, 100 were paucibacillary and 101 were multibacillary. METHODS: The 274C/T, D543N and 1729+55del4 polymorphisms of the NRAMP1 gene were determined using the technique of restriction fragment polymorphism on DNA extracted from peripheral blood. Allelic and genotypic frequencies were estimated by direct counting. RESULTS: The predominant genotypes were: CC (51.8%) for 274C/T; GG (86.6%) for D543N; and +-TGTG (59.9%) for 1729+55del4. The mutant genotype 274 TT predominated in negativity of the reverse reaction (p = 0.03) and in positivity of erythema nodosum leprosum (p = 0.04). CONCLUSIONS: Our results suggest that 274 C/T polymorphism of the NRAMP1 gene may aid in determining the susceptibility to type II reactions among leprosy patients.

Vibrio metschnikovii among diarrheal patients during cholera epidemic in Recife Brazil

Although known since the last century, Vibrio metschnikovii was only appropriately described and recognized as a new species within the genus Vibrio in 1978. Rarely is the organism linked to human disease. Only once has V. metschnikovii been incriminated as responsible for human diarrhea, and affecting an old woman who suffered from diabetes and had a hepatoma. During the first two years of the present cholera epidemic, which reached Recife in March, 1992, we screened for vibrio nearly 4000 diarrheal fecal specimens submitted to a private clinical laboratory for detection of enteropathogenic microorganisms. Now, we report six cases of diarrhea associated with V. metschnikovii affecting individuals not suffering of any apparent underlying systemic illness.

Hyperglycemia increases the complicated infection and mortality rates during induction therapy in adult acute leukemia patients

Objective To determine the prevalence of hyperglycemia during induction therapy in adult patients with acute leukemia and its effect on complicated infections and mortality during the first 30 days of treatment. Methods An analysis was performed in a retrospective cohort of 280 adult patients aged 18 to 60 years with previously untreated acute leukemia who received induction chemotherapy from January 2000 to December 2009 at the Hemocentro de Pernambuco (HEMOPE), Brazil. Hyperglycemia was defined as the finding of at least one fasting glucose measurement > 100 mg/dL observed one week prior to induction therapy until 30 days after. The association between hyperglycemia and complicated infections, mortality and complete remission was evaluated using the Chi-square or Fishers exact tests by the Statistical Package for Social Sciences (SPSS) in the R software package version 2.9.0. Results One hundred and eighty-eight patients (67.1%) presented hyperglycemia at some moment during induction therapy. Eighty-two patients (29.3%) developed complicated infections. Infection-related mortality during the neutropenia period was 20.7% (58 patients). Mortality from other causes during the first 30 days after induction was 2.8%. Hyperglycemia increased the risk of complicated infections (OR 3.97; 95% confidence interval: 2.08 - 7.57; p-value < 0.001) and death (OR 3.55; 95% confidence interval: 1.77-7.12; p-value < 0.001) but did not increase the risk of fungal infections or decrease the probability of achieving complete remission. Conclusion This study demonstrates an association between the presence of hyperglycemia and the development of complicated infections and death in adult patients during induction therapy for acute leukemia.

Diagnosing visceral leishmaniasis and HIV/AIDS co-infection: a case series study in Pernambuco, Brazil

HIV/AIDS-associated visceral leishmaniasis may display the characteristics of an aggressive disease or without specific symptoms at all, thus making diagnosis difficult. The present study describes the results of diagnostic tests applied to a series of suspected VL cases in HIV-infected/AIDS patients admitted in referral hospitals in Pernambuco, Brazil. From a total of 14 eligible patients with cytopenias and/or fever of an unknown etiology, and indication of bone marrow aspirate, 10 patients were selected for inclusion in the study. Diagnosis was confirmed by the following examinations: Leishmania detection in bone marrow aspirate, direct agglutination test, indirect immunofluorescence, rK39 dipstick test, polymerase chain reaction and latex agglutination test. Five out of the ten patients were diagnosed with co-infection. A positive direct agglutination test was recorded for all five co-infected patients, the Leishmania detection and latex agglutination tests were positive in four patients, the rK39 dipstick test in three, the indirect immunofluorescence in two and a positive polymerase chain reaction was recorded for one patient. This series of cases was the first to be conducted in Brazil using this set of tests in order to detect co-infection. However, no consensus has thus far been reached regarding the most appropriate examination for the screening and monitoring of this group of patients.

Investigation of Propionibacterium acnes in progressive macular hypomelanosis using real‐time PCR and culture

Background  Progressive macular hypomelanosis (PMH) is a dermatosis of unknown etiology. It has been concluded that it involves the presence of Propionibacterium acnes, a saprophyte of the pilosebaceous follicles. In our study, we investigated the presence of P. acnes in lesional and non‐lesional skin of patients with PMH through quantitative real‐time polymerase chain reaction (PCR) and bacterial culture from a skin fragment.