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de Melo SA, Pinto SD, Ferreira EDS, Brotas R, Marinho EPM, da Silva VA, Monte RL, Feitoza PVS, Reis MF, Almeida TVR, Ferreira LCDL, Bastos MDS. Molecular diagnosis of opportunistic infections in the central nervous system of HIV-infected adults in Manaus, Amazonas. Front Med (Lausanne) 2024; 10:1298435. [PMID: 38264048 PMCID: PMC10803427 DOI: 10.3389/fmed.2023.1298435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024] Open
Abstract
Background Opportunistic infections in the central nervous system (CNS) of people with HIV/AIDS (PLWHA) remain significant contributors to morbidity and mortality, especially in resource-limited scenarios. Diagnosing these infections can be challenging, as brain imaging is non-specific and expensive. Therefore, molecular analysis of cerebrospinal fluid (CSF) may offer a more accurate and affordable method for diagnosing pathogens. Methods We conducted extensive real-time PCR testing (qPCR) on CSF to evaluate etiological agents in PLWHA with neurological manifestations. Primers targeting DNA from specific pathogens, including cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), John Cunningham virus (JCV), Toxoplasma gondii, and human T-lymphotropic virus types 1 and 2 (HTLV-1 and HTLV-2), were used. Results Cerebrospinal fluid samples revealed 90 pathogens (36.7%). Toxoplasma gondii was the most frequently detected pathogen, found in 22 samples (30.5%). Other pathogens included Cryptococcus sp. (7.7%), EBV (5.3%), CMV, VZV, and JCV (4.0% each). Conclusion Despite antiretroviral therapy and medical follow-up, opportunistic central nervous system infections remain frequent in PLWHA. Herpesviruses are commonly detected, but T. gondii is the most prevalent opportunistic pathogen in our study population. Therefore, molecular diagnosis is a crucial tool for identifying opportunistic infections, even in patients undergoing treatment.
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Affiliation(s)
| | | | | | - Reinan Brotas
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | | | - Rossiclea Lins Monte
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | | | - Taynná V. Rocha Almeida
- Departamento de Formação em Emergências em Saúde Pública, Ministério da Saúde, Brasília, Distrito Federal, Brazil
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Marinho EPM, Ferreira EDS, Barrionuevo CCLB, Melo SA, Cordeiro JSM, Pinto SD, Monte RL, da Silva VA, Martins YF, Reis MF, Tufic-Garutti SDS, Sampaio VDS, de Castro DB, Feitoza PVS, da Rocha LA, de Lima Ferreira LC, Bastos MDS. Pediatric central nervous system infections in the Amazon: clinical and laboratory profiles. Front Public Health 2023; 11:1329091. [PMID: 38186717 PMCID: PMC10768178 DOI: 10.3389/fpubh.2023.1329091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Background Central nervous system (CNS) infections are important causes of mortality and morbidity in children, and they are related to severe problems such as hearing loss, neurological sequelae, and death. The objective was to describe clinical and laboratory exam profiles of children who were diagnosed with CNS infections. Methods We conducted a cross-sectional study based on medical records, which included pediatric patients aged from 3 months to 15 years, with a clinical suspicion of CNS infection between January 2014 to December 2019. The pathogens were confirmed in cerebrospinal fluid (CSF) samples using Gram staining, cell culture, molecular diagnostics (PCR and qPCR), and serology. Results Out of the 689 enrolled patients, 108 (15.6%) had laboratory-confirmed infections in CSF. The most common bacterial pathogens isolated from the culture were Neisseria meningitidis serogroup C in 19, Streptococcus pneumoniae in 11, and Haemophilus influenzae in seven samples. The viruses identified were Enterovirus, Cytomegalovirus, Varicella-zoster virus, Epstein-Barr virus, and arbovirus. No patient was found to be positive for Herpes simplex virus 1 and 2. Patients with viral infections showed altered levels of consciousness (p = 0.001) when compared to bacterial infections. Conclusion This study shows the presence of important vaccine-preventable pathogens, and different families of viruses causing CNS infections in the pediatric patients of Manaus.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Monique Freire Reis
- Departamento de Patologia e Medicina Legal, Universidade Federal do Amazonas, Manaus, Brazil
- Departamento de Ensino e Pesquisa, Fundação Centro de Controle de Oncologia do Amazonas, Manaus, Brazil
| | | | | | - Daniel Barros de Castro
- Universidade Federal do Amazonas, Manaus, Brazil
- Fundação de Vigilância em Saúde Dra. Rosemary Casta Pinto, Manaus, Brazil
| | | | - Lucia Alves da Rocha
- Universidade Federal do Amazonas, Manaus, Brazil
- Hospital e Pronto Socorro da Criança Zona Oeste, Manaus, Brazil
| | | | - Michele de Souza Bastos
- Universidade Federal do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
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3
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Pacheco Souza RS, Dos Reis MF, de Lima Ferreira LC, Morais MC, Lima AKS, Albuquerque Barbosa LR, de Melo GC, de Lacerda MVG. Standardization of DNA extraction from paraffinized spleen samples: molecular diagnosis of human malaria. Malar J 2023; 22:361. [PMID: 38012686 PMCID: PMC10683280 DOI: 10.1186/s12936-023-04764-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/22/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Plasmodium vivax is the main species responsible for human malaria in Brazil, and one of its manifestations is splenic malaria, though there are still challenges in its diagnosis. The present study aimed to standardize Plasmodium sp. DNA extraction from histological slices of spleen and diagnosis using real-time qPCR. METHODS This study performed a microtomy of a paraffin-embedded spleen as a positive control for P. vivax from a patient who had been previously diagnosed with the parasite. The sample was deparaffinized with xylol and ethanol, then DNA extraction was performed with two commercial kits. qPCR was carried out with the Taqman system for detection of Plasmodium sp. and was made species-specific using PvmtCOX1 gene. From 2015 to 2019, 200 spleen samples were obtained from trauma patients subjected to splenectomy in Manaus, Amazonas. All the samples were tested for cell-free human DNA (cfDNA). RESULTS The deparaffinization and the Plasmodium vivax DNA extraction method was successfully standardized, and the control sample was positive for P. vivax. Of the 200 samples, all qPCRs were negative, but they were positive for human PCR. CONCLUSION Paraffinization is practical and efficient for the preservation of samples, but the formation of bonds between proteins and DNA makes extraction difficult. Despite this, in this study, it was possible to standardize a method of DNA extraction for detecting P. vivax.
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Affiliation(s)
| | | | - Luiz Carlos de Lima Ferreira
- Amazonas State University (UEA), Manaus, Amazonas, 69040-000, Brazil
- Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, 69040-000, Brazil
| | - Manuela C Morais
- Federal University of Amazonas, Manaus, Amazonas, 69080-900, Brazil
| | | | - Laila Rowena Albuquerque Barbosa
- Amazonas State University (UEA), Manaus, Amazonas, 69040-000, Brazil
- Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, 69040-000, Brazil
| | - Gisely Cardoso de Melo
- Amazonas State University (UEA), Manaus, Amazonas, 69040-000, Brazil.
- Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, 69040-000, Brazil.
| | - Marcus Vinicius Guimaraes de Lacerda
- Leonidas & Maria Deane Institute (ILMD), Fiocruz, Manaus, Amazonas, 69057-070, Brazil
- Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, 69040-000, Brazil
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4
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Cavalcante TTA, de Souza MBS, Neves JCF, Ibiapina HNS, Barbosa FBA, Bentes KO, Alves EC, Marques HO, Colombini M, Sampaio SV, Pucca MB, da Silva IM, Ferreira LCDL, Sampaio VDS, Moura-da-Silva AM, Costa AG, Monteiro WM, Sachett JAG, Sartim MA. Inflammatory Profile Associated with Secondary Infection from Bothrops atrox Snakebites in the Brazilian Amazon. Toxins (Basel) 2023; 15:524. [PMID: 37755950 PMCID: PMC10537699 DOI: 10.3390/toxins15090524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/28/2023] Open
Abstract
Bothrops snakebite envenomation (SBE) is consider an important health problem in Brazil, where Bothrops atrox is mainly responsible in the Brazilian Amazon. Local effects represent a relevant clinical issue, in which inflammatory signs and symptoms in the bite site represent a potential risk for short and long-term disabilities. Among local complications, secondary infections (SIs) are a common clinical finding during Bothrops atrox SBE and are described by the appearance of signs such as abscess, cellulitis or necrotizing fasciitis in the affected site. However, the influence of SI in the local events is still poorly understood. Therefore, the present study describes for the first time the impact of SBE wound infection on local manifestations and inflammatory response from patients of Bothrops atrox SBE in the Brazilian Amazon. This was an observational study carried out at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (Brazil), involving victims of Bothrops SBE. Clinical and laboratorial data were collected along with blood samples for the quantification of circulating cytokines and chemokines before antivenom administrations (T0) and 24 h (T1), 48 h (T2), 72 h (T3) and 7 days after (T4). From the 94 patients included in this study, 42 presented SI (44.7%) and 52 were without SI (NSI, 55.3%). Patients classified as moderate envenoming presented an increased risk of developing SI (OR = 2.69; CI 95% = 1.08-6.66, p = 0.033), while patients with bites in hands showed a lower risk (OR = 0.20; CI 95% = 0.04-0.96, p = 0.045). During follow-up, SI patients presented a worsening of local temperature along with a sustained profile of edema and pain, while NSI patients showed a tendency to restore and were highlighted in patients where SI was diagnosed at T2. As for laboratorial parameters, leukocytes, erythrocyte sedimentation ratio, fibrinogen and C-reactive protein were found increased in patients with SI and more frequently in patients diagnosed with SI at T3. Higher levels of circulating IL-2, IL-10, IL-6, TNF, INF-γ and CXCL-10 were observed in SI patients along with marked correlations between these mediators and IL-4 and IL-17, showing a plurality in the profile with a mix of Th1/Th2/Th17 response. The present study reports for the first time the synergistic effects of local infection and envenoming on the inflammatory response represented by local manifestations, which reflected on laboratorial parameters and inflammatory mediators and thus help improve the clinical management of SI associated to Bothrops SBE.
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Affiliation(s)
- Távila Tatiane Amorim Cavalcante
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas-UFAM, Manaus 69080-900, Brazil
| | | | - Juliana Costa Ferreira Neves
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
| | | | | | - Karolaine Oliveira Bentes
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
| | - Eliane Campos Alves
- Instituto Federal de Educação, Ciência e Tecnologia do Amazonas-IFAM, Manaus 69025-010, Brazil
| | - Hedylamar Oliveira Marques
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas-HEMOAM, Manaus 69050-001, Brazil
| | - Monica Colombini
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo 05503-900, Brazil
| | - Suely Vilela Sampaio
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo-USP, Ribeirão Preto 14040-903, Brazil
| | - Manuela Berto Pucca
- Curso de Medicina, Universidade Federal de Roraima-UFRR, Boa Vista 69310-000, Brazil
- Departamento de Análises Clínicas, Faculdade de Ciências Farmacêuticas, Universidaed Estadual Paulista-UNESP, Araraquara 14800-903, Brazil
| | - Iran Mendonça da Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Luiz Carlos de Lima Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Vanderson de Souza Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | | | - Allyson Guimarães Costa
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas-UFAM, Manaus 69080-900, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas-HEMOAM, Manaus 69050-001, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Jacqueline Almeida Gonçalves Sachett
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Marco Aurélio Sartim
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas-UFAM, Manaus 69080-900, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Pró-Reitoria de Pesquisa e Pós-Graduação, Universidade Nilton Lins, Manaus 69058-030, Brazil
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5
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Brasileiro-Martins LM, Nascimento TP, Silva-Neto AV, Martins F, Cavalcante SA, Martins RB, Marques H, Colombini M, Martins M, Sartim MA, Wen FH, Carlos de Lima Ferreira L, de Almeida Gonçalves Sachett J, Moura-da-Silva AM, Ferreira de Aquino P, Monteiro WM. The severity of acute kidney injury correlates with plasma venom levels in Bothrops atrox envenomings. Toxicon 2022; 219:106924. [PMID: 36126694 DOI: 10.1016/j.toxicon.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/17/2022] [Accepted: 09/11/2022] [Indexed: 11/20/2022]
Abstract
The Brazilian Amazon has high rates of snakebite envenomings (SBEs), with ∼90% caused by Bothrops atrox. Envenomings by this species can trigger local and systemic effects, such as acute kidney injury (AKI). Our aim was to identify predictors of AKI in Bothrops SBEs in patients from Manaus, Western Brazilian Amazon. A total of 127 patients were enrolled, with a predominance of men between 16 and 45 years old from rural areas. Of the 127 patients, 38.6% developed AKI, with 61.2% presenting stage I, 34.7% presenting stage II and 4.1% presenting stage III severity. The age groups 0-10 years and ≥60 years presented a significantly higher frequency of AKI compared to the 11-40 years group. Moderate/severe edema in the affeccted limb was significantly associated with lower risk of AKI [p = 0.01; OR = 0.11 (95%CI 0.02-0.53)]. Nausea [p = 0.01; OR = 54.44 (95%CI = 3.26-909.27)] and high blood urea levels [p = 0.01; OR = 5.38 (95%CI = 2.12-13.66)] were risk factors for AKI. There was a significant positive correlation between circulating venom levels and the highest creatinine serum values during the hospital stay (p = 0.03) and with the difference between the maximum creatinine levels and the creatinine levels on admission (p = 0.02). A positive correlation between serum venom concentrations and creatinine levels suggests a direct or indirect dose-dependent participation of the venom toxins in the pathogenesis of AKI.
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Affiliation(s)
- Lisele Maria Brasileiro-Martins
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | - Alexandre Vilhena Silva-Neto
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | - Felipe Martins
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | | | - Hedylamar Marques
- Hemostasis Laboratory, Amazonas State Hematology and Hemotherapy Hospital Foundation, Manaus, 69050-001, Brazil
| | - Monica Colombini
- Immunopathology Laboratory, Butantan Institute, São Paulo, 05503-900, Brazil
| | - Marilaine Martins
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | - Fan Hui Wen
- Immunopathology Laboratory, Butantan Institute, São Paulo, 05503-900, Brazil
| | | | - Jacqueline de Almeida Gonçalves Sachett
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | | | - Wuelton Marcelo Monteiro
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil.
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6
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Wickenhagen A, Sugrue E, Lytras S, Kuchi S, Noerenberg M, Turnbull ML, Loney C, Herder V, Allan J, Jarmson I, Cameron-Ruiz N, Varjak M, Pinto RM, Lee JY, Iselin L, Palmalux N, Stewart DG, Swingler S, Greenwood EJD, Crozier TWM, Gu Q, Davies EL, Clohisey S, Wang B, Trindade Maranhão Costa F, Freire Santana M, de Lima Ferreira LC, Murphy L, Fawkes A, Meynert A, Grimes G, Da Silva Filho JL, Marti M, Hughes J, Stanton RJ, Wang ECY, Ho A, Davis I, Jarrett RF, Castello A, Robertson DL, Semple MG, Openshaw PJM, Palmarini M, Lehner PJ, Baillie JK, Rihn SJ, Wilson SJ. A prenylated dsRNA sensor protects against severe COVID-19. Science 2021; 374:eabj3624. [PMID: 34581622 PMCID: PMC7612834 DOI: 10.1126/science.abj3624] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/23/2021] [Indexed: 12/11/2022]
Abstract
Inherited genetic factors can influence the severity of COVID-19, but the molecular explanation underpinning a genetic association is often unclear. Intracellular antiviral defenses can inhibit the replication of viruses and reduce disease severity. To better understand the antiviral defenses relevant to COVID-19, we used interferon-stimulated gene (ISG) expression screening to reveal that 2′-5′-oligoadenylate synthetase 1 (OAS1), through ribonuclease L, potently inhibits severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We show that a common splice-acceptor single-nucleotide polymorphism (Rs10774671) governs whether patients express prenylated OAS1 isoforms that are membrane-associated and sense-specific regions of SARS-CoV-2 RNAs or if they only express cytosolic, nonprenylated OAS1 that does not efficiently detect SARS-CoV-2. In hospitalized patients, expression of prenylated OAS1 was associated with protection from severe COVID-19, suggesting that this antiviral defense is a major component of a protective antiviral response.
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Affiliation(s)
- Arthur Wickenhagen
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Elena Sugrue
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Spyros Lytras
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Srikeerthana Kuchi
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Marko Noerenberg
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Matthew L. Turnbull
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Colin Loney
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Vanessa Herder
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Jay Allan
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Innes Jarmson
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Natalia Cameron-Ruiz
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Margus Varjak
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Rute M. Pinto
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Jeffrey Y. Lee
- Department of Biochemistry, University of Oxford, Oxford, UK
| | - Louisa Iselin
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
- Department of Biochemistry, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Natasha Palmalux
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Douglas G. Stewart
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Simon Swingler
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Edward J. D. Greenwood
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
| | - Thomas W. M. Crozier
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
| | - Quan Gu
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Emma L. Davies
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Sara Clohisey
- Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Bo Wang
- Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Fabio Trindade Maranhão Costa
- Laboratory of Tropical Diseases, Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, Sao Paolo, Brazil
| | - Monique Freire Santana
- Department of Education and Research, Oncology Control Centre of Amazonas State (FCECON), Manaus, Amazonas, Brazil
| | - Luiz Carlos de Lima Ferreira
- Postgraduate Program in Tropical Medicine, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Lee Murphy
- Edinburgh Clinical Research Facility, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Angie Fawkes
- Edinburgh Clinical Research Facility, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Alison Meynert
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Graeme Grimes
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - ISARIC4C Investigators
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
- Department of Biochemistry, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
- Roslin Institute, University of Edinburgh, Edinburgh, UK
- Laboratory of Tropical Diseases, Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, Sao Paolo, Brazil
- Department of Education and Research, Oncology Control Centre of Amazonas State (FCECON), Manaus, Amazonas, Brazil
- Postgraduate Program in Tropical Medicine, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Edinburgh Clinical Research Facility, University of Edinburgh, Western General Hospital, Edinburgh, UK
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
- Wellcome Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- Division of Infection & Immunity, Cardiff University, Cardiff, UK
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children’s Hospital, Liverpool, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Imperial College Healthcare, National Health Service Trust London, London, UK
- Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Joao Luiz Da Silva Filho
- Wellcome Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Matthias Marti
- Wellcome Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Joseph Hughes
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | | | - Eddie C. Y. Wang
- Division of Infection & Immunity, Cardiff University, Cardiff, UK
| | - Antonia Ho
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Ilan Davis
- Department of Biochemistry, University of Oxford, Oxford, UK
| | - Ruth F. Jarrett
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Alfredo Castello
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - David L. Robertson
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Malcolm G. Semple
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children’s Hospital, Liverpool, UK
| | - Peter J. M. Openshaw
- National Heart and Lung Institute, Imperial College London, London, UK
- Imperial College Healthcare, National Health Service Trust London, London, UK
| | - Massimo Palmarini
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Paul J. Lehner
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
| | - J. Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, UK
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
- Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Suzannah J. Rihn
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Sam J. Wilson
- Medical Research Council–University of Glasgow Centre for Virus Research (CVR), Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
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7
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Santana MF, Frank CHM, Almeida TVR, Jeronimo CMP, de Araújo Pinto RA, Martins YF, de Farias MEL, Dutra BG, Brito-Sousa JD, Baía-da-Silva DC, Xavier MS, Lacerda MVG, Almeida Val FF, Monteiro GC, Sampaio VDS, Monteiro WM, Ferreira LCDL. Hemorrhagic and thrombotic manifestations in the central nervous system in COVID-19: A large observational study in the Brazilian Amazon with a complete autopsy series. PLoS One 2021; 16:e0255950. [PMID: 34506501 PMCID: PMC8432786 DOI: 10.1371/journal.pone.0255950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 07/27/2021] [Indexed: 12/25/2022] Open
Abstract
SARS-CoV-2 affects mainly the lungs, however, other manifestations, including neurological manifestations, have also been described during the disease. Some of the neurological findings have involved intracerebral or subarachnoid hemorrhage, strokes, and other thrombotic/hemorrhagic conditions. Nevertheless, the gross pathology of hemorrhagic lesions in the central nervous system has not been previously described in Brazilian autopsy cases. This study aimed to describe gross and microscopic central nervous system (CNS) pathology findings from the autopsies and correlate them with the clinical and laboratory characteristics of forty-five patients with COVID-19 from Manaus, Amazonas, Brazil. Forty-four patients were autopsied of which thirty-eight of these (86.36%) were positive by RT-PCR for COVID-19, and six (13.3%) were positive by the serological rapid test. Clinical and radiological findings were compatible with the infection. The patients were classified in two groups: presence (those who had hemorrhagic and/or thrombotic manifestations in the CNS) and absence (those who did not present hemorrhagic and/or thrombotic manifestations in the CNS). For risk assessment, relative risk and respective confidence intervals were estimated. Macroscopic or microscopic hemorrhages were found in twenty-three cases (52,27%). The postmortem gross examination of the brain revealed a broad spectrum of hemorrhages, from spots to large and confluent areas and, under microscopy, we observed mainly perivascular discharge. The association analyses showed that the use of corticosteroid, anticoagulant and antibiotic had no statistical significance with a risk of nervous system hemorrhagic manifestations. However, it is possible to infer a statistical tendency that indicates that individuals with diabetes had a higher risk for the same outcome (RR = 1.320, 95% CI = 0.7375 to 2.416, p = 0.3743), which was not observed in relation to other comorbidities. It is unknown whether the new variants of the virus can cause different clinical manifestations, such as those observed or indeed others. As a result, more studies are necessary to define clinical and radiologic monitoring protocols and strategic interventions for patients at risk of adverse and fatal events, such as the extensive hemorrhaging described here. It is imperative that clinicians must be aware of comorbidities and the drugs used to treat patients with COVID-19 to prevent CNS hemorrhagic and thrombotic events.
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Affiliation(s)
- Monique Freire Santana
- Departamento de Ensino e Pesquisa, Fundação Centro de Controle de Oncologia do Estado do Amazonas–FCECON, Manaus, AM, Brazil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
| | | | - Taynná Vernalha Rocha Almeida
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, AM, Brazil
| | | | - Rebecca Augusta de Araújo Pinto
- Departamento de Patologia e Medicina Legal, Hospital Universitário Getúlio Vargas, Universidade Federal do Amazonas, Manaus, AM, Brazil
| | - Yasmin Ferreira Martins
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, AM, Brazil
| | | | | | | | | | - Mariana Simão Xavier
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Marcus Vinicius Guimarães Lacerda
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
- Instituto de Pesquisas Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, AM, Brazil
| | - Fernando Fonseca Almeida Val
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, AM, Brazil
| | - Gisely Cardoso Monteiro
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Vanderson de Souza Sampaio
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
- Fundação de Vigilância em Saúde do Amazonas, Manaus, AM, Brazil
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Luiz Carlos de Lima Ferreira
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, AM, Brazil
- Departamento de Patologia e Medicina Legal, Hospital Universitário Getúlio Vargas, Universidade Federal do Amazonas, Manaus, AM, Brazil
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8
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Santana MF, Guerra MT, Hundt MA, Ciarleglio MM, Pinto RADA, Dutra BG, Xavier MS, Lacerda MVG, Ferreira AJ, Wanderley DC, Borges do Nascimento IJ, Araújo RFDA, Pinheiro SVB, Araújo SDA, Leite MF, Ferreira LCDL, Nathanson MH, Vieira Teixeira Vidigal P. Correlation Between Clinical and Pathological Findings of Liver Injury in 27 Patients With Lethal COVID-19 Infections in Brazil. Hepatol Commun 2021; 6:270-280. [PMID: 34520633 PMCID: PMC8652714 DOI: 10.1002/hep4.1820] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/22/2021] [Accepted: 08/15/2021] [Indexed: 12/14/2022] Open
Abstract
Liver test abnormalities are frequently observed in patients with coronavirus disease 2019 (COVID‐19) and are associated with worse prognosis. However, information is limited about pathological changes in the liver in this infection, so the mechanism of liver injury is unclear. Here we describe liver histopathology and clinical correlates of 27 patients who died of COVID‐19 in Manaus, Brazil. There was a high prevalence of liver injury (elevated alanine aminotransferase and aspartate aminotransferase in 44% and 48% of patients, respectively) in these patients. Histological analysis showed sinusoidal congestion and ischemic necrosis in more than 85% of the cases, but these appeared to be secondary to systemic rather than intrahepatic thrombotic events, as only 14% and 22% of samples were positive for CD61 (marker of platelet activation) and C4d (activated complement factor), respectively. Furthermore, the extent of these vascular findings did not correlate with the extent of transaminase elevations. Steatosis was present in 63% of patients, and portal inflammation was present in 52%. In most cases, hepatocytes expressed angiotensin‐converting enzyme 2 (ACE2), which is responsible for binding and entry of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), even though this ectoenzyme was minimally expressed on hepatocytes in normal controls. However, SARS‐CoV‐2 staining was not observed. Most hepatocytes also expressed inositol 1,4,5‐triphosphate receptor 3 (ITPR3), a calcium channel that becomes expressed in acute liver injury. Conclusion: The hepatocellular injury that commonly occurs in patients with severe COVID‐19 is not due to the vascular events that contribute to pulmonary or cardiac damage. However, new expression of ACE2 and ITPR3 with concomitant inflammation and steatosis suggests that liver injury may result from inflammation, metabolic abnormalities, and perhaps direct viral injury.
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Affiliation(s)
- Monique Freire Santana
- Departamento de Ensino e Pesquisa, Fundação Centro de Controle de Oncologia do Estado do Amazonas, Manaus, Brazil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Mateus T Guerra
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Melanie A Hundt
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Maria M Ciarleglio
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Rebecca Augusta de Araújo Pinto
- Programa de Residência Médica em Patologia, Hospital Universitário Getúlio Vargas, Universidade Federal do Amazonas, Manaus, Brazil
| | - Bruna Guimarães Dutra
- Departameto de Patologia e Medicina Legal, Universidade Federal do Amazonas, Manaus, Brazil
| | - Mariana Simão Xavier
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcus Vinicius Guimarães Lacerda
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Instituto de Pesquisas Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
| | - Anderson Jose Ferreira
- Department of Morphology, Institute of Biological Sciences, Federal Univeristy of Minas Gerais, Belo Horizonte, Brazil
| | - David Campos Wanderley
- Instituto Mineiro de Nefropatologia, Belo Horizonte, Brazil.,Center for Electron Microscopy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Israel Júnior Borges do Nascimento
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,School of Medicine and University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Stanley de Almeida Araújo
- Instituto Mineiro de Nefropatologia, Belo Horizonte, Brazil.,Center for Electron Microscopy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - M Fatima Leite
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luiz Carlos de Lima Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Residência Médica em Patologia, Hospital Universitário Getúlio Vargas, Universidade Federal do Amazonas, Manaus, Brazil.,Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, Brazil
| | - Michael H Nathanson
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Paula Vieira Teixeira Vidigal
- Department of Pathological Anatomy and Forensic Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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9
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Santana MF, Pinto RADA, Marcon BH, Medeiros LCASD, Morais TBDND, Dias LC, Souza LPD, Melo GCD, Monteiro WM, Lacerda MVG, Val FA, Lalwani PJ, Ferreira LCDL. Pathological findings and morphologic correlation of the lungs of autopsied patients with SARS-CoV-2 infection in the Brazilian Amazon using transmission electron microscopy. Rev Soc Bras Med Trop 2021; 54:e0850. [PMID: 33886821 PMCID: PMC8047700 DOI: 10.1590/0037-8682-0850-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/26/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION: Electron microscopy (EM) is a rapid and effective tool that can be used to create images of a whole spectrum of virus-host interactions and, as such, has long been used in the discovery and description of viral mechanisms. METHODS: Electron microscopy was used to evaluate the pulmonary pathologies of postmortem lung sections from three patients who died from infection with SARS-associated coronavirus 2 (SARS-CoV-2), a new member of the Coronaviridae family. RESULTS: Diffuse alveolar damage (DAD) was predominant in all three patients. The early exudative stage was characterized principally by edema and extravasation of red blood cells into the alveolar space with injury to the alveolar epithelial cells; this was followed by detachment, apoptosis, and necrosis of type I and II pneumocytes. The capillaries exhibited congestion, exposure of the basement membrane from denuded endothelial cells, platelet adhesion, fibrin thrombi, and rupture of the capillary walls. The proliferative stage was characterized by pronounced proliferation of type II alveolar pneumocytes and multinucleated giant cells. The cytopathic effect of SARS-CoV-2 was observed both in degenerated type II pneumocytes and freely circulating in the alveoli, with components from virions, macrophages, lymphocytes, and cellular debris. CONCLUSIONS: Viral particles consistent with the characteristics of SARS-CoV-2 were observed mainly in degenerated pneumocytes, in the endothelium, or freely circulating in the alveoli. In the final stage of illness, the alveolar spaces were replaced by fibrosis.
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Affiliation(s)
- Monique Freire Santana
- Fundação Centro de Controle de Oncologia do Estado do Amazonas, Departamento de Ensino e Pesquisa, Manaus, AM, Brasil.,Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil
| | | | | | | | | | - Lucas Castanhola Dias
- Instituto Nacional de Pesquisas da Amazônia, Laboratório Temático de Microscopia e Nanotecnologia, Manaus, AM, Brasil
| | | | | | | | - Marcus Vinicius Guimarães Lacerda
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil.,Fundação Oswaldo Cruz, Instituto Carlos Chagas, Curitiba, PR, Brasil
| | - Fernando Almeida Val
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Universidade Federal do Amazonas, Programa de Pós-Graduação em Ciências da Saúde, Manaus, AM, Brasil
| | | | - Luiz Carlos de Lima Ferreira
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Hospital Universitário Getúlio Vargas, Programa de Residência Médica em Patologia, Manaus, AM, Brasil.,Universidade Federal do Amazonas, Programa de Pós-Graduação em Ciências da Saúde, Manaus, AM, Brasil
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10
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de Souza Barbosa Ê, Santos Ibiapina HN, Rocha da Silva S, Costa AG, Val FF, Mendonça-da-Silva I, Carlos de Lima Ferreira L, Sartim MA, Monteiro WM, Cardoso de Melo G, de Almeida Gonçalves Sachett J. Association of cfDNA levels and bothrops envenomation. Toxicon 2021; 192:66-73. [PMID: 33497746 DOI: 10.1016/j.toxicon.2021.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/21/2020] [Accepted: 01/20/2021] [Indexed: 01/05/2023]
Abstract
In the Amazon, around 90% of snakebites are caused by the Bothrops genus. Complications arising from Bothrops envenomations result from the inflammatory and coagulotoxic activities of the venom. The aim of this study was to investigate the potential of cell-free DNA (cfDNA) as a biomarker of severity in Bothrops snakebites. Patients were treated at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, in the Brazilian Amazon. cfDNA plasma levels were measured by amplifying the human telomerase reverse transcriptase (hTERT) sequence using quantitative RT-PCR. Median levels of cfDNA were compared between envenomed and healthy volunteers and among patients presenting different complications, such as renal failure, bleeding and infection. Of the 76 patients included, 82.9% were male, with a mean age of 32.8 years, and envenomations were mainly classified as severe (39.5%). ROC curve analysis showed a good accuracy of cfDNA levels (AUROC of 0.745) in envenomation diagnosis. A correlation analysis using laboratory variables showed positive correlation with lactate dehydrogenase (p = 0.033) and platelet count (p = 0.003). When cfDNA levels were compared with clinical complications, significant statistical differences were only found among individuals with mild and severe pain (p < 0.05). In summary, our results demonstrated that cfDNA levels are sufficiently accurate for discriminating between envenomed and non-envenomed patients, but are not able to distinguish different complications and the level of severity among envenomed patients. Thus, the role of cfDNA in the pathogenesis of the snakebite envenomations needs to be further investigated.
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Affiliation(s)
- Êndila de Souza Barbosa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Hiochelson Najibe Santos Ibiapina
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | | | - Allyson Guimarães Costa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil; Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, Brazil
| | - Fernando Fonseca Val
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Iran Mendonça-da-Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Luiz Carlos de Lima Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil; Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, Brazil
| | - Marco Aurélio Sartim
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil; Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Gisely Cardoso de Melo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Jacqueline de Almeida Gonçalves Sachett
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil.
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11
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Wellmann IAM, Ibiapina HNS, Sachett JAG, Sartim MA, Silva IM, Oliveira SS, Tarragô AM, Moura-da-Silva AM, Lacerda MVG, Ferreira LCDL, Malheiro A, Monteiro WM, Costa AG. Correlating Fibrinogen Consumption and Profiles of Inflammatory Molecules in Human Envenomation's by Bothrops atrox in the Brazilian Amazon. Front Immunol 2020; 11:1874. [PMID: 32973773 PMCID: PMC7468254 DOI: 10.3389/fimmu.2020.01874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/13/2020] [Indexed: 12/11/2022] Open
Abstract
Snakebites are considered a major public health problem worldwide. In the Amazon region of Brazil, the snake Bothrops atrox (B. atrox) is responsible for 90% of the bites. These bites may cause local and systemic signs from acute inflammatory reaction and hemostatic changes, and present common hemorrhagic disorders. These alterations occur due the action of hemostatically active and immunogenic toxins which are capable of triggering a wide range of hemostatic and inflammatory events. However, the crosstalk between coagulation disorders and inflammatory reaction still has gaps in snakebites. Thus, the goal of this study was to describe the relationship between the consumption of fibrinogen and the profile of inflammatory molecules (chemokines and cytokines) in evenomations by B. atrox snakebites. A prospective study was carried out with individuals who had suffered B. atrox snakebites and presented different levels of fibrinogen consumption (normal fibrinogen [NF] and hypofibrinogenemia [HF]). Seventeen patients with NF and 55 patients with HF were eligible for the study, in addition to 50 healthy controls (CG). The molecules CXCL-8, CCL-5, CXCL-9, CCL-2, CXCL-10, IL-6, TNF, IL-2, IL-10, IFN-γ, IL-4, and IL-17A were quantified in plasma using the CBA technique at three different times (pre-antivenom therapy [T0], 24 h [T1], and 48 h [T2] after antivenom therapy). The profile of the circulating inflammatory response is different between the groups studied, with HF patients having higher concentrations of CCL-5 and lower IFN-γ. In addition, antivenom therapy seems to have a positive effect, leading to a profile of circulating inflammatory response similar in quantification of T1 and T2 on both groups. Furthermore, these results suggest that a number of interactions of CXCL-8, CXCL-9, CCL-2, IL-6, and IFN-γ in HF patients are directly affected by fibrinogen levels, which may be related to the inflammatory response and coagulation mutual relationship induced by B. atrox venom. The present study is the first report on inflammation-coagulation crosstalk involving snakebite patients and supports the better understanding of envenomation's pathophysiology mechanisms and guides in the search for novel biomarkers and prospective therapies.
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Affiliation(s)
- Irmgardt Alicia María Wellmann
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Instituto de Pesquisa Clínica Carlos Borborema (IPCCB), Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Hiochelson Najibe Santos Ibiapina
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Instituto de Pesquisa Clínica Carlos Borborema (IPCCB), Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Jacqueline Almeida Gonçalves Sachett
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Instituto de Pesquisa Clínica Carlos Borborema (IPCCB), Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Marco Aurélio Sartim
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus, Brazil
| | - Iran Mendonça Silva
- Instituto de Pesquisa Clínica Carlos Borborema (IPCCB), Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Sâmella Silva Oliveira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Instituto de Pesquisa Clínica Carlos Borborema (IPCCB), Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Andréa Monteiro Tarragô
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus, Brazil.,Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, Brazil
| | - Ana Maria Moura-da-Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Laboratório de Imunopatologia, Instituto Butantan, São Paulo, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Instituto de Pesquisa Clínica Carlos Borborema (IPCCB), Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Instituto de Pesquisas Leônidas e Maria Deane, FIOCRUZ-Amazônia, Manaus, Brazil
| | - Luiz Carlos de Lima Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Instituto de Pesquisa Clínica Carlos Borborema (IPCCB), Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Adriana Malheiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus, Brazil.,Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Instituto de Pesquisa Clínica Carlos Borborema (IPCCB), Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Allyson Guimarães Costa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Instituto de Pesquisa Clínica Carlos Borborema (IPCCB), Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus, Brazil.,Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, Brazil
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12
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Sachett JA, Soares FGS, Silva IM, Alves EC, Oliveira SSI, Nascimento EF, Santos AS, de Lima Ferreira LC, Monteiro WM. Adverse reactions to antibothropic serum in a tertiary unit in the Brazilian Amazon. Toxicon 2020. [DOI: 10.1016/j.toxicon.2019.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Santana MF, Ferreira LCDL, Oliveira JGND, Francesconi F. Histopathological changes in epithelium of hair follicles and acrosyringium caused by measles in child. An Bras Dermatol 2020; 95:238-240. [PMID: 32146012 PMCID: PMC7175039 DOI: 10.1016/j.abd.2019.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/01/2019] [Indexed: 11/30/2022] Open
Abstract
Some epidermal alterations in measles has been described, such as keratinocytes apoptotic, parakeratosis, giant-cell formation, intranuclear and cytoplasmic inclusions, dyskeratosis, spongiosis, and intracellular edema. The authors report for the first time in human a case of measles with the presence of multinucleated giant cells in the hair follicle and dyskeratosis in acrosyringium.
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Affiliation(s)
- Monique Freire Santana
- Department of Teaching and Research, Fundação Centro de Controle de Oncologia do Amazonas, Manaus, AM, Brazil.
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14
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Monteiro WM, Gomes J, Fé N, Mendonça da Silva I, Lacerda M, Alencar A, Seabra de Farias A, Val F, de Souza Sampaio V, Cardoso de Melo G, Pardal P, Mota da Silva A, Bernarde PS, Carlos de Lima Ferreira L, Gutierrez JM, de Almeida Gonçalves Sachett J, Fan HW. Perspectives and recommendations towards evidence-based health care for scorpion sting envenoming in the Brazilian Amazon: A comprehensive review. Toxicon 2019; 169:68-80. [DOI: 10.1016/j.toxicon.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/26/2019] [Accepted: 09/01/2019] [Indexed: 01/01/2023]
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15
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Silva de Oliveira S, Campos Alves E, Dos Santos Santos A, Freitas Nascimento E, Tavares Pereira JP, Mendonça da Silva I, Sachett J, Dos Santos Ibiapina HN, Santos Sarraf LK, Contreras Bernal JC, Freitas de Sousa LA, Colombini M, Oliveira Marques H, Guimarães de Lacerda MV, Moura-da-Silva AM, Wen Fan H, de Lima Ferreira LC, Sigueko Sano Martins I, Monteiro WM. Bothrops snakebites in the Amazon: recovery from hemostatic disorders after Brazilian antivenom therapy. Clin Toxicol (Phila) 2019; 58:266-274. [PMID: 31264481 DOI: 10.1080/15563650.2019.1634273] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Bothrops atrox snakebites are a major public health problem in the Amazon region and also cause hemostatic disorders. In this study, we assessed the recovery from hemostatic disorders in Bothrops snakebite patients after being given antivenom therapy.Methods: This is a prospective study of Bothrops snakebite patients (n = 100) treated at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazilian Amazon, between January 2016 and December 2017. Blood samples were taken for the measurement of venom concentrations, platelets, clotting time and factors of patients on admission, 12, 24 and 48 h after antivenom therapy, and taken again on discharge. The presence of systemic bleeding was recorded during the follow-up.Results: On admission, systemic bleeding was observed in 14% of the patients. Thrombocytopenia was noted in 10% of the patients. A total of 54% of the patients presented unclottable blood with low levels of fibrinogen and alpha 2-antiplasmin, and high levels of fibrin/fibrinogen degradation product (FDP) and D-dimers. Unclottable blood and systemic bleeding were overcome in most patients 12 h after the antivenom therapy. Three patients developed systemic bleeding 48 h after antivenom therapy. Levels of fibrinogen and alpha 2-antiplasmin, FDP and D-dimer returned to normal around 48 h after the treatment or on discharge. The frequency of thrombocytopenia with high mean platelet volume increased in the first 24 h after antivenom therapy, and decreased on discharge. Bothrops venom levels in patients decreased 12 h after antivenom therapy and were not correlated with coagulation and fibrinolytic parameters. There were no deaths.Conclusion: Laboratorial parameters of coagulopathy returned to normal values within 48 h after the antivenom therapy until discharge. A few patients still presented bleeding signs within 48 h after beginning antivenom therapy. However, the Brazilian antivenom was able to overcome the hemostatic disorders in these cases of envenomation.
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Affiliation(s)
- Sâmella Silva de Oliveira
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.,College of Health Sciences, University of the State of Amazonas, Manaus, Brazil
| | - Eliane Campos Alves
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.,College of Health Sciences, University of the State of Amazonas, Manaus, Brazil
| | - Alessandra Dos Santos Santos
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil
| | - Elizandra Freitas Nascimento
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil
| | - João Pedro Tavares Pereira
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil
| | - Iran Mendonça da Silva
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.,College of Health Sciences, University of the State of Amazonas, Manaus, Brazil
| | - Jacqueline Sachett
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.,College of Health Sciences, University of the State of Amazonas, Manaus, Brazil
| | - Hiochelson Najibe Dos Santos Ibiapina
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.,College of Health Sciences, University of the State of Amazonas, Manaus, Brazil
| | - Lybia Kássia Santos Sarraf
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil
| | - Jorge Carlos Contreras Bernal
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.,College of Health Sciences, University of the State of Amazonas, Manaus, Brazil
| | | | - Mônica Colombini
- Immunopathology Laboratory, Butantan Institute, São Paulo, Brazil
| | | | | | | | - Hui Wen Fan
- Bioindustrial Division, Butantan Institute, São Paulo, Brazil
| | - Luiz Carlos de Lima Ferreira
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil
| | | | - Wuelton Marcelo Monteiro
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.,College of Health Sciences, University of the State of Amazonas, Manaus, Brazil
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16
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Santana MF, João GAP, Lacerda MVGD, Ferreira LCDL. Diabetes insipidus secondary to tuberculous meningoencephalitis with hypothalamic involvement extending to the hypophysis: a case report. Rev Soc Bras Med Trop 2019; 51:865-867. [PMID: 30517545 DOI: 10.1590/0037-8682-0455-2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 07/18/2018] [Indexed: 11/22/2022] Open
Abstract
The involvement of Mycobacterium tuberculosis in the central nervous system (CNS) is an uncommon and devastating manifestation of tuberculosis. We report a case of disseminated tuberculosis presenting as meningoencephalitis, hypothalamic involvement with extension to the hypophysis, and secondary insipidus diabetes diagnosed at autopsy.
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Affiliation(s)
- Monique Freire Santana
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Departamento de Ensino e Pesquisa, Fundação Centro de Controle de Oncologia do Amazonas, Manaus, AM, Brasil
| | | | | | - Luiz Carlos de Lima Ferreira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Departamento de Patologia e Medicina Legal, Universidade Federal do Amazonas, Manaus, AM, Brasil
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17
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da Silva Souza A, de Almeida Gonçalves Sachett J, Alcântara JA, Freire M, Alecrim MDGC, Lacerda M, de Lima Ferreira LC, Fan HW, de Souza Sampaio V, Monteiro WM. Snakebites as cause of deaths in the Western Brazilian Amazon: Why and who dies? Deaths from snakebites in the Amazon. Toxicon 2018; 145:15-24. [PMID: 29490236 DOI: 10.1016/j.toxicon.2018.02.041] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/29/2018] [Accepted: 02/22/2018] [Indexed: 01/08/2023]
Abstract
Snake envenoming represents a major burden for public health worldwide. In the Amazon, the official number of cases and deaths detected is probably underestimated because of the difficulty riverine and indigenous populations have reaching health centers in order to receive medical assistance. Thus, integrated analysis of health information systems must be used in order to improve adequate health policies. The aim of this work is to describe a series of deaths and identify risk factors for lethality from snakebites in the state of Amazonas, Brazil. All deaths from snakebites reported to the Brazilian Notifiable Diseases Surveillance System (SINAN) and to the Mortality Information System (SIM; ICD10-10th revision, X.29), from 2007 to 2015, were included. Variables were assessed by blocks with distal (ecological variables), intermediate (demographics) and proximal (clinical variables) components to identify predictors of case fatality. A total of 127 deaths from snakebites were recorded, with 58 pairs found through linkage of the SINAN and SIM databases (45.7%), 37 (29.1%) deaths found only in SINAN and 32 (25.2%) found only in the SIM. Deaths occurred mostly in males (95 cases; 74.8%) living in rural areas (78.6%). The most affected age group was the ≥61 years old (36 cases; 28.4%). Snakebites were presumably due to Bothrops snakes in 68.5% of the cases and Lachesis in 29.5% based on clinico-epidemiological diagnosis. A proportion of 26.2% of the cases received treatment over 24 h after the bite ocurred. On admission, cases were mostly classified as severe (65.6%). Overall, 28 patients (22.0%). Deceased without any medical assistance Antivenom was given to 53.5%. In the multivariate analysis, a distance from Manaus >300 km [OR = 3.40 (95%CI = 1.99-5.79); (p < 0.001)]; age ≥61 years [OR = 4.31 (95%CI = 1.22-15.21); (p = 0.023)] and Indigenous status [OR = 5.47 (95%CI = 2.37-12.66); (p < 0.001)] were independently associated with case fatality from snakebites. Severe snakebites [OR = 16.24 (95%CI = 4.37-60.39); (p < 0.001)] and a lack of antivenom administration [OR = 4.21 (95%CI = 1.30-13.19); (p = 0.014)] were also independently associated with case fatality. Respiratory failure/dyspnea, systemic bleeding, sepsis and shock were recorded only among fatal cases. In conclusion, i) death from snakebites was underreported in the mortality surveillance system; ii) older age groups living in remote municipalities and indigenous peoples were the population groups most prone to death; iii) lack or underdosage of antivenom resulted in higher case fatality and iv) systemic bleeding, circulatory shock, sepsis and acute respiratory failure were strongly associated to fatal outcome.
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Affiliation(s)
- Anderson da Silva Souza
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Jacqueline de Almeida Gonçalves Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.
| | - João Arthur Alcântara
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Monique Freire
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Maria das Graças Costa Alecrim
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Marcus Lacerda
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil; Instituto de Pesquisa Leônidas & Maria Deane, FIOCRUZ, Manaus, Brazil
| | - Luiz Carlos de Lima Ferreira
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | - Vanderson de Souza Sampaio
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil; Núcleo de Sistemas de Informação, Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
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18
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Silva de Oliveira S, Freitas-de-Sousa LA, Alves EC, de Lima Ferreira LC, da Silva IM, de Lacerda MVG, Fan HW, Moura-da-Silva AM, Monteiro WM. Fatal stroke after Bothrops snakebite in the Amazonas state, Brazil: A case report. Toxicon 2017; 138:102-106. [DOI: 10.1016/j.toxicon.2017.08.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
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19
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Monteiro WM, de Oliveira SS, Pivoto G, Alves EC, de Almeida Gonçalves Sachett J, Alexandre CN, Fé NF, Barbosa Guerra MDGV, da Silva IM, Tavares AM, Ferreira LCDL, Lacerda MVG. Scorpion envenoming caused by Tityus cf. silvestris evolving with severe muscle spasms in the Brazilian Amazon. Toxicon 2016; 119:266-9. [DOI: 10.1016/j.toxicon.2016.06.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/20/2016] [Accepted: 06/23/2016] [Indexed: 11/30/2022]
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Monteiro WM, Oliveira SSD, Sachett JDAG, Silva IMD, Ferreira LCDL, Lacerda MVG. Hallux amputation after a freshwater stingray injury in the Brazilian Amazon. Rev Soc Bras Med Trop 2016; 49:389-92. [DOI: 10.1590/0037-8682-0333-2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/27/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
- Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brasil
| | - Sâmella Silva de Oliveira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brasil
| | | | - Iran Mendonça da Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brasil
| | | | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brasil; Fundação Oswaldo Cruz, Brasil
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21
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da Fonseca AJ, Galvão RS, Miranda AE, Ferreira LCDL, Chen Z. Comparison of three human papillomavirus DNA detection methods: Next generation sequencing, multiplex-PCR and nested-PCR followed by Sanger based sequencing. J Med Virol 2015; 88:888-94. [PMID: 26496186 DOI: 10.1002/jmv.24413] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 11/10/2022]
Abstract
To compare the diagnostic performance for HPV infection using three laboratorial techniques. Ninty-five cervicovaginal samples were randomly selected; each was tested for HPV DNA and genotypes using 3 methods in parallel: Multiplex-PCR, the Nested PCR followed by Sanger sequencing, and the Next_Gen Sequencing (NGS) with two assays (NGS-A1, NGS-A2). The study was approved by the Brazilian National IRB (CONEP protocol 16,800). The prevalence of HPV by the NGS assays was higher than that using the Multiplex-PCR (64.2% vs. 45.2%, respectively; P = 0.001) and the Nested-PCR (64.2% vs. 49.5%, respectively; P = 0.003). NGS also showed better performance in detecting high-risk HPV (HR-HPV) and HPV16. There was a weak interobservers agreement between the results of Multiplex-PCR and Nested-PCR in relation to NGS for the diagnosis of HPV infection, and a moderate correlation for HR-HPV detection. Both NGS assays showed a strong correlation for detection of HPVs (k = 0.86), HR-HPVs (k = 0.91), HPV16 (k = 0.92) and HPV18 (k = 0.91). NGS is more sensitive than the traditional Sanger sequencing and the Multiplex PCR to genotype HPVs, with promising ability to detect multiple infections, and may have the potential to establish an alternative method for the diagnosis and genotyping of HPV.
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Affiliation(s)
- Allex Jardim da Fonseca
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, University of State of Amazonas, Manaus, Brazil.,Center of Infectious Diseases Research, Federal University of Espírito Santo, Vitória, Brazil
| | - Renata Silva Galvão
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, University of State of Amazonas, Manaus, Brazil
| | | | | | - Zigui Chen
- Department of Microbiology & Immunology, Epidemiology & Population Health, and Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine, New York.,Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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22
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Benício E, Cordeiro M, Monteiro H, Saboia Moura MA, Oliveira C, Nunes Gadelha EP, Chrusciak-Talhari A, Talhari C, de Lima Ferreira LC, Mira MT, Lima Machado PR, Talhari S, Schriefer A. Sustained Presence of Cutaneous Leishmaniasis in Urban Manaus, the Largest Human Settlement in the Amazon. Am J Trop Med Hyg 2015; 93:1208-13. [PMID: 26483119 DOI: 10.4269/ajtmh.14-0164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/20/2015] [Indexed: 11/07/2022] Open
Abstract
The Amazon is responsible for approximately 40% of the American tegumentary leishmaniasis (ATL) in Brazil. Herein the sustained presence of ATL in Manaus, the largest settlement in the Amazon, was investigated. Records of notification of historic cases, and data from cases prospectively enrolled in the Tropical Medicine Foundation of the Amazonas State were used. Geographic coordinates of prospective patients' living sites were used to detect inner-city clusters of ATL. Infecting Leishmania species was determined by polymerase chain reaction. Among prospectively enrolled subjects, 94.8% were infected with Leishmania (Viannia) guyanensis, 76.7% were male, 30.2% were 0-20 years old, and 69.8% had an urban residence. Historic cases showed a profile similar to that of prospectively enrolled subjects. Several clusters of ATL, widely distributed within the city of Manaus, could be detected. In conclusion, there was a high frequency of disease in young age groups and cases clustered in urban neighborhoods. It cannot be determined from these data whether transmission of these cases occurred within or outside the city of Manaus.
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Affiliation(s)
- Ednelza Benício
- Fundação de Medicina Tropical do Amazonas, Manaus, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Universidade Federal da Bahia, Salvador, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
| | - Mayara Cordeiro
- Fundação de Medicina Tropical do Amazonas, Manaus, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Universidade Federal da Bahia, Salvador, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
| | - Hannah Monteiro
- Fundação de Medicina Tropical do Amazonas, Manaus, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Universidade Federal da Bahia, Salvador, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
| | - Marco Antônio Saboia Moura
- Fundação de Medicina Tropical do Amazonas, Manaus, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Universidade Federal da Bahia, Salvador, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
| | - Cintia Oliveira
- Fundação de Medicina Tropical do Amazonas, Manaus, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Universidade Federal da Bahia, Salvador, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
| | - Ellen Pricilla Nunes Gadelha
- Fundação de Medicina Tropical do Amazonas, Manaus, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Universidade Federal da Bahia, Salvador, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
| | - Anette Chrusciak-Talhari
- Fundação de Medicina Tropical do Amazonas, Manaus, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Universidade Federal da Bahia, Salvador, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
| | - Carolina Talhari
- Fundação de Medicina Tropical do Amazonas, Manaus, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Universidade Federal da Bahia, Salvador, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
| | - Luiz Carlos de Lima Ferreira
- Fundação de Medicina Tropical do Amazonas, Manaus, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Universidade Federal da Bahia, Salvador, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
| | - Marcelo Távora Mira
- Fundação de Medicina Tropical do Amazonas, Manaus, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Universidade Federal da Bahia, Salvador, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
| | - Paulo Roberto Lima Machado
- Fundação de Medicina Tropical do Amazonas, Manaus, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Universidade Federal da Bahia, Salvador, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
| | - Sinésio Talhari
- Fundação de Medicina Tropical do Amazonas, Manaus, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Universidade Federal da Bahia, Salvador, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
| | - Albert Schriefer
- Fundação de Medicina Tropical do Amazonas, Manaus, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Universidade Federal da Bahia, Salvador, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
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Abstract
In Brazil, almost 16,000 new cases of cervical cancer (CC), the type of neoplasia that claims the more lives of young women than any other, are expected in 2014. Although the vaccine against HPV has been developed, the application of this strategies to large populations is costly, and its use in Brazil is limited. Studies of the economic implications of new preventive technologies for CC may support rational and evidence-based decisions in public health. A systematic search of articles published between 2000 and 2014 was conducted using MEDLINE, EMBASE, the Cochrane Collaboration of Systematic Reviews, and LILACS. The aim of this search was the identification of original articles that evaluated the cost-effectiveness of vaccination against HPV in Brazil. A total of 6 articles are included in this review, evaluating the addition of a vaccine against HPV in comparison to population screening. Although the vaccine against HPV increases the cost of preventing cervical cancer, this new preventive technology presents favorable cost-effectiveness profiles in the case of Brazil. Failure to utilize the newly available preventative technologies against CC can lead to misguided and perverse consequences in a country in which programs based on the Papanicolaou test have been only partially successful.
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Affiliation(s)
- Allex Jardim Fonseca
- a Tropical Medicine Foundation ; Universidade do Estado do Amazonas ; Manaus , Brazil
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Feitosa ES, Sampaio V, Sachett J, Castro DBD, Noronha MDDN, Lozano JLL, Muniz E, Ferreira LCDL, Lacerda MVGD, Monteiro WM. Snakebites as a largely neglected problem in the Brazilian Amazon: highlights of the epidemiological trends in the State of Amazonas. Rev Soc Bras Med Trop 2015; 48 Suppl 1:34-41. [PMID: 26061369 DOI: 10.1590/0037-8682-0105-2013] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 05/22/2014] [Indexed: 11/21/2022] Open
Abstract
Envenoming snakebites are thought to be a particularly important threat to public health worldwide, especially in rural areas of tropical and subtropical countries. The true magnitude of the public health threat posed by snakebites is unknown, making it difficult for public health officials to optimize prevention and treatment. The objective of this work was to conduct a systematic review of the literature to gather data on snakebite epidemiology in the Amazon region and describe a case series of snakebites from epidemiological surveillance in the State of Amazonas (1974-2012). Only 11 articles regarding snakebites were found. In the State of Amazonas, information regarding incidents involving snakes is scarce. Historical trends show an increasing number of cases after the second half of the 1980s. Snakebites predominated among adults (20-39 years old; 38%), in the male gender (78.9%) and in those living in rural areas (85.6%). The predominant snake envenomation type was bothropic. The incidence reported by the epidemiological surveillance in the State of Amazonas, reaching up to 200 cases/100,000 inhabitants in some areas, is among the highest annual snakebite incidence rates of any region in the world. The majority of the cases were reported in the rainy season with a case-fatality rate of 0.6%. Snakebite envenomation is a great disease burden in the State of Amazonas, representing a challenge for future investigations, including approaches to estimating incidence under-notification and case-fatality rates as well as the factors related to severity and disabilities.
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Affiliation(s)
- Esaú Samuel Feitosa
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | | | - Jaqueline Sachett
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | | | | | | | - Emiro Muniz
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Luiz Carlos de Lima Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | | | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil
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Maia DCC, Menezes CKDS, Bastos TC, Ferreira LCDL, Francesconi F. Poorly differentiated synovial sarcoma in the wrist--case report. An Bras Dermatol 2015; 89:816-8. [PMID: 25184926 PMCID: PMC4155965 DOI: 10.1590/abd1806-4841.20143015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/30/2013] [Indexed: 11/22/2022] Open
Abstract
Synovial sarcomas are rare malignant tumors affecting mainly young adults, presenting as a slow growth mass located in deep soft tissues of extremities, near the joints. In this report a 34-year-old male patient, presented an ulcerovegetative lesion on the right wrist which was completely excised. Histopathology and immunohistochemistry confirmed synovial sarcomas with poorly differentiated cells. This patient presented 11 months later with ipsilateral axillary lymph node metastasis, which emphasizes the unfavorable prognosis of this synovial sarcoma variant. The indolent growth pattern of this sarcoma justifies the well circumscribed initial stages, which progressively infiltrate adjacent structures with lung metastasis (80%) and lymph node involvement (20%) and thus corroborates the importance of early diagnosis and proper treatment.
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Affiliation(s)
| | | | - Thales Costa Bastos
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
| | | | - Fabio Francesconi
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
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Soeiro CMDO, Miranda AE, Saraceni V, Santos MCD, Talhari S, Ferreira LCDL. Syphilis in pregnancy and congenital syphilis in Amazonas State, Brazil: an evaluation using database linkage. CAD SAUDE PUBLICA 2014; 30:715-23. [PMID: 24896047 DOI: 10.1590/0102-311x00156312] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 10/10/2013] [Indexed: 11/22/2022] Open
Abstract
This study analyzes notification of syphilis in pregnancy and congenital syphilis in Amazo- nas State, Brazil, from 2007 to 2009 and verifies underreporting in databases in the National Information System on Diseases of Notification (SINAN) and the occurrence of perinatal deaths associated with congenital syphilis and not reported in the Mortality Information System (SIM). This was a cross-sectional study with probabilistic record linkage between the SINAN and SIM. There were 666 reports of syphilis in pregnant women, including 224 in 2007 (3.8/1,000), 244(4.5/1,000) in 2008, and 198(4.0/1,000) in 2009. The study found 486 cases of congenital syphilis, of which 153 in 2007 (2.1/1,000), 193 in 2008 (2.6/1,000), and 140 in 2009 (2.0/1,000). After linkage of the SINAN databases, 237 pregnant women (35.6%) had cases of congenital syphilis reported. The SIM recorded 4,905 perinatal deaths, of which 57.8% were stillbirths. Probabilistic record linkage between SIM and SINAN-Congenital Syphilis yielded 13 matched records. The use of SINAN and SIM may not reflect the total magnitude of syphilis, but provide the basis for monitoring and analyzing this health problem, with a view towards planning and management.
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da Fonseca AJ, Murari RSW, Moraes IS, Rocha RF, Ferreira LCDL. [Validity of cervicovaginal cytology in a Brazilian State with high incidence rate of cervical cancer]. Rev Bras Ginecol Obstet 2014; 36:347-52. [PMID: 25184347 DOI: 10.1590/so100-720320140005061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/07/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the validity of cervicovaginal cytology performed at LAPER, the main Laboratory of Pathology of the State of Roraima, Brazil, by interrater agreement (external monitoring) and agreement with histopathologic results. METHODS One hundred women were included, a population-based convenience sample. Their cervical cytological exams were evaluated by the laboratory staff and reviewed by expert medical pathologists, external to the laboratory. Cohen's Kappa index, sensitivity and specificity were evaluated. The study was approved by LAPER coordination and Federal University of Roraima Research Ethics Commitee. RESULTS Regarding the prevalence of human papillomavirus-related atypical, there was no concordance between the results issued by LAPER and by the external pathologists (k=0.21). A low sensitivity (28.5%) and specificity (89,2%) was detected for the diagnostic performance of LAPER, with a high proportion of false positive and false negative results. The cytological reports of the external pathologists showed higher sensitivity and specificity (71.4 and 98.9%, respectively), ruling out the possibility that errors related to collection methods and staining would explain the low performance of the laboratory. CONCLUSION A low diagnostic accuracy of cervicovaginal cytology can be a barrier against the control of cervical cancer in Roraima. We emphasize the need for professional training and internal and external monitoring in Brazilian states with a high incidence of cervical cancer.
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Affiliation(s)
| | | | - Iane Santana Moraes
- Centro de Ciências da Saúde, Universidade Federal de Roraima, Boa Vista, RO, Brasil
| | - Robledo Fonseca Rocha
- Departamento de Patologia, Centro de Ciências da Saúde, Universidade Federal de Roraima, Boa Vista, RO, Brasil
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Jalkh AP, Miranda AE, Hurtado-Guerreiro JC, Ramos LAC, Figliuolo G, Maia J, Costa CM, Ramasawmy R, de Lima Ferreira LC. Chlamydia trachomatis in human immunodeficiency virus-infected men treated at a referral hospital for sexually transmitted diseases in the Amazonas, Brazil. Braz J Infect Dis 2013; 18:158-63. [PMID: 24216156 PMCID: PMC9427454 DOI: 10.1016/j.bjid.2013.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/12/2013] [Accepted: 06/19/2013] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES The aim of the present study was to determine the Chlamydia trachomatis prevalence and to identify the demographic, behavioural and clinical factors associated with C. trachomatis in human immunodeficiency virus infected men. STUDY This was a cross-sectional study of C. trachomatis prevalence among human immunodeficiency virus-infected men enrolled at the Outpatient clinic of acquired immunodeficiency syndrome of the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado in Manaus, Amazonas, Brazil. C. trachomatis deoxyribonucleic acid from urethral samples was purified and submitted to real time polymerase chain reaction to identify the presence of C. trachomatis. RESULTS A total of 276 human immunodeficiency virus-infected men were included in the study. The prevalence of C. trachomatis infection was 12% (95% confidence interval 8.1%-15.7%). The mean age of the participants was 34.63 (standard deviation 10.80) years. Of the 276 human immunodeficiency virus-infected men, 93 (56.2%) had more than one sexual partner in the past year and 105 (38.0%) reported having their first sexual intercourse under the age of 15 years. Men having sex with men and bisexuals amounted to 61.2% of the studied population. A total of 71.7% had received human immunodeficiency virus diagnosis in the last three years and 55.1% were using antiretroviral therapy. Factors associated with C. trachomatis infection in the logistic model were being single (p<0.034), men having sex with men (p<0.021), and having previous sexually transmitted diseases (p<0.001). CONCLUSION The high prevalence of C. trachomatis infection among human immunodeficiency virus-infected men highlights that screening human immunodeficiency virus-infected men for C. trachomatis, especially among men having sex with men, is paramount to control the spread of C. trachomatis infection.
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Affiliation(s)
- Alex Panizza Jalkh
- Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
| | - Angelica Espinosa Miranda
- Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil; Infectious Diseases Unit, Federal University of Espírito Santo, Vitória, ES, Brazil
| | | | | | - Guiseppe Figliuolo
- Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Jussimara Maia
- Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Cintia Mara Costa
- Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Rajendranath Ramasawmy
- Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil; Universidade Nilton Lins, Manaus, AM, Brazil
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Fonseca AJD, Ferreira LCDL, Neto GB. Cost-effectiveness of the vaccine against human papillomavirus in the Brazilian Amazon region. Rev Assoc Med Bras (1992) 2013; 59:442-51. [PMID: 24041909 DOI: 10.1016/j.ramb.2013.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 02/25/2013] [Accepted: 03/23/2013] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To assess the cost-utility of the human papillomavirus (HPV) vaccination on the prevention of cervical cancer in the Brazilian Amazon region. METHODS A Markov cohort model was developed to simulate the natural evolution of HPV and its progress to cervical cancer, considering the current preventive programs and treatment costs. The one-year transition probabilities were mainly based on empirical data of local and national studies. The model evaluated the addition of the vaccine to three cervical cancer-screening scenarios (0, 3 or 10 exams throughout life). RESULTS The scenario of three Pap tests resulted in satisfactory calibration (base case). The addition of HPV vaccination would reduce by 35% the incidence of cervical cancer (70% vaccination coverage). The incremental cost-effectiveness ratio was US$ 825 for each quality-adjusted life year gained. The sensitivity analysis confirms the robustness of this result, and duration of immunity was the parameter with greater variation in incremental cost-effectiveness ratio. CONCLUSION Vaccination has a favorable profile in terms of cost-utility, and its inclusion in the immunization schedule would result in a substantial reduction in incidence and mortality of invasive cervical cancer in the Brazilian Amazon region.
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Affiliation(s)
- Allex Jardim da Fonseca
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil; Post-Graduate Program in Economics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Schettini DA, Schettini APM, Sardinha JCG, Ferreira LCDL, Vasques F, Xerez L. Assessment of completion of forms requesting skin biopsies. An Bras Dermatol 2012; 87:115-8. [PMID: 22481659 DOI: 10.1590/s0365-05962012000100014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 09/21/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Information contained in request forms for histopathological examinations is essential for interpreting tissue changes observed in microscopy. OBJECTIVE To determine the adequacy of information provided on forms requesting skin biopsies. METHOD Assessment, in two health institutions, of 647 forms requesting skin biopsies in order to determine the completeness on the forms of the clinical details/items considered necessary for undertaking skin biopsies. RESULTS Of the total 18 items on the forms, 7 were found to relay complete information in under 10% of the forms and only 9 items were correctly completed in over 80% of the requests. CONCLUSION We concluded that information on many of the essential items required for a correct interpretation of the anatomopathologic examination was missing from the request forms.
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Andrade RVD, Massone C, Lucena MNBD, Talhari AC, Talhari S, Guerra JADO, Ferreira LCDL. The use of polymerase chain reaction to confirm diagnosis in skin biopsies consistent with American tegumentary leishmaniasis at histopathology: a study of 90 cases. An Bras Dermatol 2012; 86:892-6. [PMID: 22147028 DOI: 10.1590/s0365-05962011000500005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 11/22/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cutaneous leishmaniasis is a chronic, infectious disease caused by protozoa of the genus leishmania. The incidence of this disease is high in Brazil, with 19,746 new cases having been detected in 2008. The presence of amastigotes in the cytoplasm of histiocytes constitutes diagnosis of the disease; however, their presence is rarely found in late lesions, making histological diagnosis difficult. Polymerase chain reaction has been shown to represent a highly sensitive and specific technique for the diagnosis of cutaneous leishmaniasis. OBJECTIVES To use polymerase chain reaction to evaluate paraffin-embedded skin biopsies with histopathological features consistent with cutaneous leishmaniasis. MATERIAL AND METHODS Polymerase chain reaction amplification of a 120-base-pair fragment of Leishmania kinetoplast DNA (kDNA) minicircles was performed on 90 skin biopsies. The male/female ratio was 75/15. Mean age was 32.36 years, with a median of 31 years, range 4-72 years. Samples were histologically compatible with cutaneous leishmaniasis but a definitive diagnosis could not be made since amastigotes were not found. All cases were histologically classified according to the patterns described by de Magalhães. RESULTS According to the de Magalhães classification, the most common histological pattern was type IV (exudative granulomatous reaction), which was found in 65.6% of cases (56/90), followed by type I (exudative cellular reaction) in 21.1% of cases (19/90) and type III (exudative and necrotic granulomatous reaction) in 12.2% of cases (11/90). Leishmania DNA was found in 96.7% of the biopsies (87/90). CONCLUSION Polymerase chain reaction performed by amplifying kDNA is able to confirm a diagnosis of cutaneous leishmaniasis with a high degree of sensitivity in cases in which histopathology is consistent with a diagnosis of cutaneous leishmaniasis but not definitive.
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Monteiro WM, Magalhães LKC, Oliveira JC, Guerra JADO, Silveira H, Ferreira LCDL, Toledo MJDO, Barbosa MDGV. Biological behavior of Trypanosoma cruzi stocks obtained from the State of Amazonas, Western Brazilian Amazon, in mice. Rev Soc Bras Med Trop 2012; 45:209-14. [PMID: 22534994 DOI: 10.1590/s0037-86822012000200014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 09/19/2011] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION The biological diversity of circulating Trypanosoma cruzi stocks in the Amazon region most likely plays an important role in the peculiar clinic-epidemiological features of Chagas disease in this area. METHODS Seven stocks of T. cruzi were recently isolated in the State of Amazonas, Brazil, from humans, wild mammals, and triatomines. They belonged to the TcI and Z3 genotypes and were biologically characterized in Swiss mice. Parasitological and histopathological parameters were determined. RESULTS Four stocks did not promote patent parasitemia in mice. Three stocks produced low parasitemia, long pre-patent periods, and a patent period of 1 day or oscillating parasitemia. Maximum parasitemia ranged from 1,400 to 2,800 trypomastigotes/0.1 mL blood. Mice inoculated with the T. cruzi stocks studied showed low positivity during fresh blood examinations, ranging from 0% to 28.6%. In hemoculture, positivity ranged from 0% to 100%. Heart tissue parasitism was observed in mice inoculated with stocks AM49 and AM61. Stock AM49 triggered a moderate inflammatory process in heart tissue. A mild inflammatory process was observed in heart tissue for stocks AM28, AM38, AM61, and AM69. An inflammatory process was frequently observed in skeletal muscle. Examinations of brain tissue revealed inflammatory foci and gliosis in mice inoculated with stock AM49. CONCLUSIONS Biological and histopathological characterization allowed us to demonstrate the low infectivity and virulence of T. cruzi stocks isolated from the State of Amazonas.
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Affiliation(s)
- Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, AM.
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Nogueira LMC, Santos M, Ferreira LCDL, Talhari C, Rodrigues RR, Talhari S. AIDS-associated paracoccidioidomycosis in a patient with a CD4+ T-cell count of 4 cells/mm³. An Bras Dermatol 2012; 86:S129-32. [PMID: 22068792 DOI: 10.1590/s0365-05962011000700034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 12/14/2010] [Indexed: 11/21/2022] Open
Abstract
We describe a case of a patient presenting with HIV and paracoccidioidomycosis co-infection. At the time of diagnosis total CD4+ T-cell count was 4 cells/mm3. Histopathology revealed tuberculoid granulomas, scarce CD4+ T cells, a moderate number of CD8+ cells and the absence of Foxp3+ cells. Most of the cutaneous lesions healed after two weeks of treatment with amphotericin B. After 14 months the patient is still under antiretroviral therapy and no clinical evidence of recurrence of the mycosis has been observed.
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Guimarães AGDP, Araujo JRD, Andrade RVD, Costa CMD, Galvão RDS, Hada AL, Ferreira LCDL. Coinfection of Epstein-Barr virus, cytomegalovirus, herpes simplex virus, human papillomavirus and anal intraepithelial neoplasia in HIV patients in Amazon, Brazil. ACTA ACUST UNITED AC 2012. [DOI: 10.1590/s2237-93632012000100003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Soeiro CMDO, Miranda AE, Saraceni V, Lucena NOD, Talhari S, Ferreira LCDL. Mother-to-child transmission of HIV infection in Manaus, State of Amazonas, Brazil. Rev Soc Bras Med Trop 2012; 44:537-41. [PMID: 22031068 DOI: 10.1590/s0037-86822011000500001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 06/07/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Reduction in the vertical transmission of HIV is possible when prophylactic measures are implemented. Our objective was to determine demographic characteristics of HIV-infected pregnant women and the rate of mother-to-child transmission of HIV in Manaus, Amazonas, Brazil. METHODS A descriptive study was conducted using notification, and investigating data from the Notifiable Diseases Data System in the Brazilian State of Amazonas, between 2007 and 2009. RESULTS During the study period, notification was received of 509 HIV-positive pregnant women. The vertical transmission was 9.9% (95% CI: 7.2-12.6%). The mean age of women was 27 years (SD: 5.7), and the majority (54.8%) had not completed elementary school (eighth grade). Diagnosis of HIV seropositivity was made prior to pregnancy in 115 (22.6%) women, during prenatal care in 302 (59.3%), during delivery in 70 (13.8%), and following delivery in 22 (4.3%). Four hundred four of these women (79.4%) had had prenatal care, with 79.4% of patients receiving antiretroviral during pregnancy and 61.9% of the newborn infants receiving prophylaxis. In the final multivariate logistic regression model, living in urban area [OR = 0.7 (95% CI: 0.35-0.89)] and having had prenatal care [OR = 0.1 (95% CI: 0.04-0.24)] remained as protective factors against vertical HIV transmission in this population. CONCLUSIONS The relevance of adequate compliance with the measures already established as being effective in guaranteeing a reduction in HIV transmission within the maternal and infant population should be emphasized.
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Sardinha JFJ, Tarlé RG, Fava VM, Francio AS, Ramos GB, Ferreira LCDL, Schriefer NAB, Mira MT, Talhari S. Genetic risk factors for human susceptibility to infections of relevance in dermatology. An Bras Dermatol 2012; 86:708-15. [PMID: 21987137 DOI: 10.1590/s0365-05962011000400013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 11/18/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the pre-microbiological era, it was widely accepted that diseases, today known to be infectious, were hereditary. With the discovery of microorganisms and their role in the pathogenesis of several diseases, it was suggested that exposure to the pathogen was enough to explain infection. Nowadays, it is clear that infection is the result of a complex interplay between pathogen and host, therefore dependant on the genetic make-up of the two organisms. Dermatology offers several examples of infectious diseases in different stages of understanding of their molecular basis. In this review, we summarize the main advances towards dissecting the genetic component controlling human susceptibility to infectious diseases of interest in dermatology. Widely investigated diseases such as leprosy and leishmaniasis are discussed from the genetic perspective of both host and pathogen. Others, such as rare mycobacterioses, fungal infections and syphilis, are presented as good opportunities for research in the field of genetics of infection.
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Soeiro CMDO, Miranda AE, Saraceni V, Talhari S, Ferreira LCDL. Clinical aspects of pediatric AIDS cases notified in the state of Amazonas, 1991-2009. Braz J Infect Dis 2012; 15:411-2. [PMID: 21861022 DOI: 10.1590/s1413-86702011000400025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Guimarães AGDP, Silva Junior RMD, Costa OTFD, Silva ITDCE, Gimenez FS, Araujo JRD, Andrade RVD, Lopes EJDS, Pinheiro JP, Ferreira JRD, Malheiro A, Ferreira LCDL. Morphometric analysis of dendritic cells from anal mucosa of HIV-positive patients and the relation to intraepithelial lesions and cancer seen at a tertiary health institution in Brazil. Acta Cir Bras 2011; 26:521-9. [DOI: 10.1590/s0102-86502011000600019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 07/22/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To morphometrically quantify CD1a+ dentritic cells and DC-SIGN+ dendritic cells in HIV-positive patients with anal squamous intraepithelial neoplasia and to evaluate the effects of HIV infection, antiretroviral therapy and HPV infection on epithelial and subepithelial dendritic cells. METHODS: A prospective study was performed to morphometrically analyze the relative volume of the dendritic cells and the relationship between anal intraepithelial neoplasia and cancer in HIV-positive patients from the Tropical Medicine Foundation of Amazonas, Brazil. All patients were submitted to biopsies of anorectal mucosa to perform a classic histopathological and immunohistochemical analysis, employing antibodies against CD1a and DC-SIGN for the morphometric quantification of dendritic cells. RESULTS: HIV-negative patients displayed a CD1a DC density significantly higher than that of HIV-positives patients (3.75 versus 2.54) (p=0.018), and in patients with severe anal intraepithelial neoplasia had correlated between DC CD1a density with levels of CD4 + cells (p: 0.04) as well as the viral load of HIV-1 (p: 0.035). A not significant rise in the median density of CD1a+ DC was observed in the HIV positive/ HAART positive subgroup compared to the HIV positive/ HAART negative subgroup. The CD1a+ DC were also significantly increased in HIV-negative patients with anorectal condyloma (2.33 to 3.53; p=0.05), with an opposite effect in HIV-positive patients. CONCLUSIONS: Our data support an enhancement of the synergistic action caused by HIV-HPV co-infection on the anal epithelium, weakening the DC for its major role in immune surveillance. Notoriously in patients with severe anal intraepithelial neoplasia, the density of CD1a+ epithelial dendritic cells was influenced by the viral load of HIV-1. Our study describes for the first time the density of subepithelial DC-SIGN+ dendritic cells in patients with anal severe anal intraepithelial neoplasia and points to the possibility that a specific therapy for HIV induces the recovery of the density of epithelial DC.
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Neves LO, Talhari AC, Gadelha EPN, Silva Júnior RMD, Guerra JADO, Ferreira LCDL, Talhari S. Estudo clínico randomizado comparando antimoniato de meglumina, pentamidina e anfotericina B para o tratamento da leishmaniose cutânea ocasionada por Leishmania guyanensis. An Bras Dermatol 2011; 86:1092-101. [DOI: 10.1590/s0365-05962011000600005] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 12/03/2010] [Indexed: 11/22/2022] Open
Abstract
FUNDAMENTOS: O tratamento da leishmaniose tegumentar americana (LTA) ainda constitui desafio, pois a maioria dos medicamentos é injetável e têm-se poucos ensaios clínicos randomizados comparando a eficácia das drogas. Além disso, é provável que as espécies de Leishmania tenham influência nas respostas terapêuticas. OBJETIVOS: Avaliar e comparar a eficácia e a segurança dos esquemas de tratamento na LTA, ocasionada por Leishmania (Viannia) guyanensis. MÉTODOS: 185 pacientes foram selecionados, conforme critérios de elegibilidade, e distribuídos, aleatoriamente, em 3 grupos - 2 com 74 enfermos e outro com 37 - que receberam, respectivamente, antimoniato de meglumina, isotionato de pentamidina e anfotericina B em doses, períodos e vias de administração padronizados. Os enfermos foram reexaminados um, dois e seis meses após o final dos tratamentos. RESULTADOS: Não houve diferença entre os grupos terapêuticos em relação ao sexo, idade, número ou local das lesões. A análise por intenção de tratar (ITT) mostrou eficácias de 58,1% para a pentamidina e 55,5% para o antimoniato (p=0,857). O grupo da anfotericina B foi analisado separadamente, pois 28 (75,7%) pacientes negaram-se a continuar no estudo após a randomização. Eventos adversos leves ou moderados foram relatados por 74 (40%) pacientes, principalmente artralgia (20,3%), para o grupo do antimoniato, e dor (35,1%) ou enduração (10,8%) no local das injeções para a pentamidina. CONCLUSÕES: A pentamidina tem eficácia similar ao antimonial pentavalente para o tratamento da LTA ocasionada por L. guyanensis. Face aos baixos resultados de eficácia apresentados por ambas as drogas, necessita-se, com urgência, investigar novas opções terapêuticas para esta enfermidade.
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Orsi AT, Nogueira L, Chrusciak-Talhari A, Santos M, Ferreira LCDL, Talhari S, Talhari C. Coinfecção histoplasmose e Aids. An Bras Dermatol 2011; 86:1025-6. [DOI: 10.1590/s0365-05962011000500028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Accepted: 07/16/2010] [Indexed: 11/22/2022] Open
Abstract
Apresenta-se um caso de coinfecção histoplasmose e Aids, com lesões cutâneas predominantemente papulosas e comprometimento sistêmico. O exame histopatológico e micológico de lesão cutânea confirmou o diagnóstico. Em doentes com Aids, a histoplasmose surge, principalmente, quando a contagem de células T-CD4-positivas é inferior a 50 células/mm³. Nesses casos, a histoplasmose pode ser grave e, se não tratada adequadamente, levar ao êxito letal, como no paciente relatado.
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Passos L, Talhari C, Santos M, Ribeiro-Rodrigues R, Ferreira LCDL, Talhari S. Síndrome de restauração imune associada à histoplasmose. An Bras Dermatol 2011; 86:S168-72. [DOI: 10.1590/s0365-05962011000700044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 11/25/2010] [Indexed: 11/21/2022] Open
Abstract
Paciente masculino, 27 anos, portador de HIV, com quadro de histoplasmose cutânea disseminada. Terapia antirretroviral oral e anfotericina B por via EV (dose total acumulada 0,5g) foram introduzidas, verificando-se rápida cicatrização das lesões após duas semanas. A anfotericina B foi substituída por itraconazol (200mg/dia). O paciente interrompeu voluntariamente os tratamentos. A terapia antirretroviral foi reintroduzida, havendo aumento da contagem de células T CD4-positivas (No restante do texto, a autora usa o símbolo "+" (T CD4+) ao invés da palavra "positiva". O que fazer neste caso? Seguimos o padrão do restante do texto ou acatamos essa opção da autora no resumo?!). Neste momento, diagnosticou-se histoplasmose ganglionar. O aumento da contagem de células T CD4-positivas (de novo aqui), associado à redução da carga viral a níveis inferiores ao limite de detecção após a reintrodução da terapia antirretroviral, sugere que essa piora clínica paradoxal seja uma síndrome de restauração imune
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Affiliation(s)
- Leny Passos
- Fundação de Hematologia e Hemoterapia do Amazonas, Brasil
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de Oliveira Soeiro CM, Miranda AE, Saraceni V, Talhari S, de Lima Ferreira LC. Clinical aspects of pediatric AIDS cases notified in the state of Amazonas, 1991–2009. Braz J Infect Dis 2011. [DOI: 10.1016/s1413-8670(11)70220-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Tramujas da Costa E Silva I, Coelho Ribeiro M, Santos Gimenez F, Dutra Ferreira JR, Galvao RS, Vasco Hargreaves PE, Gonçalves Daumas Pinheiro Guimaraes A, de Lima Ferreira LC. Performance of p16INK4a immunocytochemistry as a marker of anal squamous intraepithelial lesions. Cancer Cytopathol 2011; 119:167-76. [PMID: 21365778 DOI: 10.1002/cncy.20143] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Revised: 01/19/2011] [Accepted: 01/20/2011] [Indexed: 01/25/2023]
Abstract
BACKGROUND Protein p16(INK4a) immunocytochemistry (ICCp16) has the potential to reveal lesions at risk of progression to anal cancer. This study examined measures of diagnostic validity of ICCp16 in HIV-positive patients treated at the Tropical Medicine Foundation of Amazonas in the coloproctology outpatient clinic. METHODS One hundred ninety HIV-positive patients were consecutively enrolled in 2007 and 2008. All patients underwent anal cytologic sampling to perform ICCp16 in conventional and GluCyte (Synermed International, Westfield, Indiana and S¸ao Paulo, Brazil) smears and also for genotyping of human papillomavirus (HPV). Patients were then subjected to anal biopsies monitored by high-resolution anoscopy. Hematoxylin-eosin and immunoperoxidase p16 (clone 6H12) stains were performed in slides with biopsied and cytological specimens, respectively. HPV genotyping on anal scrapings was performed by a polymerase-chain reaction (PCR)-based method. The immunochemical findings were compared with histopathological and PCR results in contingency tables and analyzed by nonparametric tests. Measures of diagnostic validity of ICCp16 were calculated. Statistical significance was set at P ≤ .5. RESULTS There was no statistically significant association between the immunochemical results (conventional or GluCyte smears) and histopathological or HPV genotyping findings (P > .05). In the best scenario, ICCp16 presented 31% sensitivity and 81% specificity for the diagnosis of anal squamous intraepithelial lesion (ASIL) and 30% and 66%, respectively, for the diagnosis of infection with high-risk HPV. CONCLUSIONS There was no association between ICCp16 results and histopathological findings nor between ICCp16 and HPV genotyping. ICCp16 showed poor sensitivity and moderate specificity for the diagnosis of ASIL or high-risk HPV.
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Affiliation(s)
- Ivan Tramujas da Costa E Silva
- Postgraduation Program of Tropical Medicine Foundation of Amazonas / University of the State of Amazonas, Manaus, Brazil, Department of Surgery, School of Medicine, Federal University of Amazonas, Manaus, Brazil.
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Silva ITDCE, Araújo JDR, Andrade RVD, Cabral CRB, Gimenez FS, Guimarães AGDP, Martins TC, Lopes LR, Ferreira LCDL. Anal cancer precursor lesions in HIV-positive and HIV-negative patients seen at a tertiary health institution in Brazil. Acta Cir Bras 2011; 26:64-71. [DOI: 10.1590/s0102-86502011000100012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 10/19/2010] [Indexed: 11/22/2022] Open
Abstract
Purpose: To investigate the prevalence of anal squamous intraepithelial lesions (ASIL) or anal cancer in patients attended at the Tropical Medicine Foundation of Amazonas. Methods: 344 patients consecutively attended at the institution, in 2007/2008, were distributed in the following strata according to presence/abscense of at risk conditions for anal cancer: Group 1 _ HIV-positive men-who-have-sex-with-men (101); Group 2 _ HIV-positive females (49); Group 3 _ patients without any at risk condition for anal cancer (53); Group 4 _ HIV-positive heterosexual men (38); Group 5 _ HIV-negative patients, without anoreceptive sexual habits, but with other at risk conditions for anal cancer (45); Group 6 _ HIV-negative men-who-have-sex-with-men (26); and Group 7 _ HIV-negative anoreceptive females (32). The histopathological results of biopsies guided by high-resolution anoscopy were analyzed by frequentist and bayesian statistics in order to calculate the point-prevalence of ASIL/cancer and observe any eventual preponderance of one group over the other. Results: The point-prevalence of ASIL for all the patients studied was 93/344 (27%), the difference between HIV-positive and negative patients being statistically significant (38.3% versus 13.5%; p < 0.0001). The prevalence of ASIL for each one of the groups studied was: Group 1 = 49.5%, Group 2 = 28.6%, Group 3 = 3.8%, Group 4 = 21.1%, Group 5 = 11.1%, Group 6 = 30.8% and Group 7 = 18.8%. Standard residual analysis demonstrated that ASIL was significantly prevalent in patients of Group 1 and high-grade ASIL in patients of Group 2. The odds for ASIL of Group 1 was significantly higher in comparison to Groups 2, 3, 4, 5 and 7 (p < 0.03). The odds for ASIL of Groups 2, 4 and 6 were significantly higher in comparison to Group 3 (p < 0.03). Conclusions: In the patients studied, ASIL (low and/or high-grade) tended to be significantly more prevalent in HIV-positive patients. Nonetheless, HIV-negative anoreceptive patients also presented great probability to have anal cancer precursor lesions, mainly those of the male gender.
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Alencar AAFD, Alencar Filho ACD, Ferreira LCDL, Alencar Neto ACD. Cisto coloide no terceiro ventrículo e morte súbita em jovem. J Bras Patol Med Lab 2010. [DOI: 10.1590/s1676-24442010000600010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Santos M, Talhari C, Nogueira L, Rabelo RF, Ferreira LCDL, Talhari S. Case for diagnosis. An Bras Dermatol 2010; 85:564-6. [PMID: 20944923 DOI: 10.1590/s0365-05962010000400024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Indexed: 11/22/2022] Open
Abstract
Since the first reports and descriptions of AIDS in the early 1980s, herpetic infection has been considered as one of the most prevalent and opportunistic aids related infections in patients with retroviral diseases Infection by Herpes simplex type 2 (HSV-2), the etiologic agent responsible for 60% to 90% of the cases of genital herpes, is very common among patients suffering from AIDS. Herpes simplex type 2 infection may cause severe and prolonged (over a period of time of one month) mucocutaneous onset of the disease, being characterized as an aids defining clinical condition.
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Talhari S, de Souza Santos MN, Talhari C, de Lima Ferreira LC, Silva RM, Zelger B, Massone C, Ribeiro-Rodrigues R. Borrelia Burgdorferi "sensu lato" in Brazil: Occurrence confirmed by immunohistochemistry and focus floating microscopy. Acta Trop 2010; 115:200-4. [PMID: 20211144 DOI: 10.1016/j.actatropica.2010.02.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 02/19/2010] [Accepted: 02/28/2010] [Indexed: 11/26/2022]
Abstract
In the present study, we report the occurrence of Lyme's borreliosis in patients from the Brazilian Amazon Region. Borreliosis was investigated by immunohistochemistry and focus floating microscopy for Borrelia burgdorferi in skin biopsy samples from 22 patients with both clinical and histopathology evidences compatible with Erythema Migrans. Spirochetes were detected by specific immunohistochemistry and focus floating microscopy for B. burgdorferi in samples from five patients. Clinical cure of the cutaneous lesions was observed in all the patients after treatment with doxycycline regimen as proposed by the Center Disease Control guidelines. A limitation of our study was the fact that we were not able to isolate and culture these organisms. These are the first known Brazilian cases of borreliosis to have Focus Floating Microscopy confirmation.
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Ferreira da Silva LC, Espinosa Miranda A, de Lima Ferreira LC, Moreira da Silva R, Távora Mira M, Talhari C, Talhari S. Post-ART Epidermodysplasia Verruciformis in a Patient With AIDS. ACTA ACUST UNITED AC 2010; 9:10-4. [DOI: 10.1177/1545109709355709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Epidermodysplasia verruciformis (EV) is a rare disorder characterized by persistent human papillomavirus (HPV) infection. Here, we describe a 48-year-old, black, married male with AIDS, presenting a 1-year history of asymptomatic hypopigmented lesions that appeared 3 years after antiretroviral therapy (ART) initiation. Pre-ART, the initial CD4 count was 32 cells/mm3 and the skin lesions appeared when the CD4 count reached 122 cells/mm3. Dermatological examination demonstrated thin, scaly, slightly verrucous hypopigmented macules and papules, isolated or presenting with a linear aspect (Köbner phenomenon) in some areas, distributed on the neck, trunk, and superior and inferior members. Skin biopsy of a macular lesion revealed epidermal acanthosis with vacuolated keratinocytes presenting blue-gray pallor, arranged in clusters at the granular and upper spinous layer. Immunohistochemistry revealed expression of p16 INK4a with diffuse positivity in the upper third of the epithelium, corresponding to the vacuolated keratinocytes. Polymerase chain reaction (PCR) was positive for type 12 HPV, and a diagnosis of EV-like associated to AIDS was made. EV-like is a rare disease and in this patent might be a manifestation of immune reconstitution inflammatory syndrome.
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Affiliation(s)
- Leila Cristina Ferreira da Silva
- Enfermeira do Serviço de Assistência Especializada em DST/AIDS, Gerência de Dermatologia e DST/AIDS, Fundação de Medicina Tropical do Amazonas (FMTAM), Amazonas, Brazil
| | | | | | | | - Marcelo Távora Mira
- Centro de Ciências da Saúde e Biológicas, Universidade Pontifícia Católica. Amazonas, Brazil
| | - Carolina Talhari
- Serviço de Assistência Especializada em DST/AIDS, Gerência de Dermatologia e DST/AIDS, FMTAM, Amazonas, Brazil
| | - Sinésio Talhari
- Serviço de Assistência Especializada em DST/AIDS, Gerência de Dermatologia e DST/AIDS, FMTAM, Amazonas, Brazil,
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Talhari C, Ferreira LCDL, Araújo JR, Talhari AC, Talhari S. Immune reconstitution inflammatory syndrome or upgrading type 1 reaction? Report of two AIDS patients presenting a shifting from borderline lepromatous leprosy to borderline tuberculoid leprosy. LEPROSY REV 2008; 79:429-435. [PMID: 19274990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Carolina Talhari
- Department of Dermatology, Institute of Tropical Medicine of Amazonas, Manaus, Brazil
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Souza SLSD, Feitoza PVS, Araújo JRD, Andrade RVD, Ferreira LCDL. Causas de óbito em pacientes com síndrome da imunodeficiência adquirida, necropsiados na Fundação de Medicina Tropical do Amazonas. Rev Soc Bras Med Trop 2008; 41:247-51. [DOI: 10.1590/s0037-86822008000300005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 06/13/2008] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste estudo foi verificar em 129 pacientes com AIDS, necropsiados na Fundação de Medicina Tropical do Amazonas de 1996 a 2003, as causas do óbito, observando o grau de concordância entre os diagnósticos necroscópicos com os diagnósticos clínicos. A doença mais freqüente que causou o óbito foi tuberculose 28%, seguida de pneumonia bacteriana 17%, histoplasmose 13%, toxoplasmose 10%, pneumocistose 8%, criptococose 5%, sepse bacteriana 4% e 15% outras causas. A concordância entre o diagnóstico clínico antemortem e a necropsia foi de 51,9%. O principal órgão acometido foi o pulmão 82,2%. O tempo de sobrevivência após o diagnóstico laboratorial até o óbito variou entre um mês e 120 meses. A média de sobrevivência foi 15 dias e 56% morreram menos de um mês após o diagnóstico, 15 pacientes morreram na mesma data do diagnóstico. Esses resultados demonstram a importância da necropsia na causa mortis em pacientes com AIDS.
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