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Rodrigues CDS, Souza RKS, Rocha Neto CV, Otani RH, Batista DDM, Maia AKNDO, Filho KPDO, de Andrade TD, de Andrade Almeida E, Maciel LHG, Castro LDFAAP, Abtibol-Bernardino MR, Baia-da-Silva DC, Benzecry SG, Castilho MDC, Martínez-Espinosa FE, Alecrim MDGC, Santos RS, Botto-Menezes C. Clinical and Acoustic Alterations of Swallowing in Children Exposed to Zika Virus during Pregnancy in a Cohort in Amazonas, Brazil: A Case Series Study. Viruses 2023; 15:2363. [PMID: 38140604 PMCID: PMC10747239 DOI: 10.3390/v15122363] [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: 09/15/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023] Open
Abstract
Oropharyngeal dysphagia (OD) is a swallowing disorder that involves difficulty in safely passing the food bolus from the oral cavity to the stomach. OD is a common problem in children with congenital Zika virus syndrome (CZS). In this case series, we describe the clinical and acoustic alterations of swallowing in children exposed to the Zika virus during pregnancy in a cohort from Amazonas, Brazil. From July 2019 to January 2020, 22 children were evaluated, 6 with microcephaly and 16 without microcephaly. The mean age among the participants was 35 months (±4.6 months). All children with microcephaly had alterations in oral motricity, mainly in the lips and cheeks. Other alterations were in vocal quality, hard palate, and soft palate. Half of the children with microcephaly showed changes in cervical auscultation during breast milk swallowing. In children without microcephaly, the most frequently observed alteration was in lip motricity, but alterations in auscultation during the swallowing of breast milk were not observed. Regarding swallowing food of a liquid and pasty consistency, the most frequent alterations were incomplete verbal closure, increased oral transit time, inadequacy in capturing the spoon, anterior labial leakage, and increased oral transit time. Although these events are more frequent in microcephalic children, they can also be seen in non-microcephalic children, which points to the need for an indistinct evaluation of children exposed in utero to ZIKV.
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Affiliation(s)
- Cristina de Souza Rodrigues
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
| | | | - Cosmo Vieira Rocha Neto
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Rodrigo Haruo Otani
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Daniel de Medeiros Batista
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Ana Karla Nelson de Oliveira Maia
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | | | | | | | - Luiz Henrique Gonçalves Maciel
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
| | | | - Marília Rosa Abtibol-Bernardino
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Department of Maternal and Child Health, Medical School, Federal University of Amazonas, Manaus 69020-160, Brazil
| | - Djane Clarys Baia-da-Silva
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
- Faculty of Pharmacy, University Nilton Lins, Manaus 69058-030, Brazil; (K.P.d.O.F.); (T.D.d.A.)
- Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil
| | - Silvana Gomes Benzecry
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | | | - Flor Ernestina Martínez-Espinosa
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil
- Tropical Medicine Foundation Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil;
| | - Maria das Graças Costa Alecrim
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Medical Course Coordination at Manaus Metropolitan College/FAMETRO, Manaus 69050-000, Brazil
| | - Rosane Sampaio Santos
- Postgraduate Program in Communication Disorders (PPGDIC), University of Tuiuti do Paraná (UTP), Paraná 82010-210, Brazil;
| | - Camila Botto-Menezes
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
- Tropical Medicine Foundation Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil;
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Piauilino ICR, Souza RKDS, Lima MT, Rodrigues YKB, da Silva LFA, Gouveia AS, Neto AVDS, Chaves BA, Alecrim MDGC, de Menezes CHAB, Castilho MDC, Baia-da-Silva DC, Espinosa FEM. Does the Presence or a High Titer of Yellow Fever Virus Antibodies Interfere with Pregnancy Outcomes in Women with Zika Virus Infection? Viruses 2023; 15:2244. [PMID: 38005922 PMCID: PMC10675107 DOI: 10.3390/v15112244] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/28/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
Zika virus (ZIKV) and yellow fever virus (YFV) originated in Africa and expanded to the Americas, where both are co-circulated. It is hypothesized that in areas of high circulation and vaccination coverage against YFV, children of pregnant women have a lower risk of microcephaly. We evaluated the presence and titers of antibodies and outcomes in women who had ZIKV infection during pregnancy. Pregnancy outcomes were classified as severe, moderate, and without any important outcome. An outcome was defined as severe if miscarriage, stillbirth, or microcephaly occurred, and moderate if low birth weight and/or preterm delivery occurred. If none of these events were identified, the pregnancy was defined as having no adverse effects. A sample of 172 pregnant women with an acute ZIKV infection confirmed during pregnancy were collected throughout 2016. About 89% (150 of 169) of them presented immunity against YFV, including 100% (09 of 09) of those who had severe outcomes, 84% (16 of 19) of those who had moderate outcomes, and 89% (125 of 141) of those who had non-outcomes. There was no difference between groups regarding the presence of anti-YFV antibodies (p = 0.65) and YFV titers (p = 0.6). We were unable to demonstrate a protective association between the presence or titers of YFV antibodies and protection against serious adverse outcomes from exposure to ZIKV in utero.
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Affiliation(s)
- Isa Cristina Ribeiro Piauilino
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus 6904-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 6904-000, Brazil
| | | | | | - Yanka Karolinna Batista Rodrigues
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus 6904-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 6904-000, Brazil
| | - Luís Felipe Alho da Silva
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus 6904-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 6904-000, Brazil
| | - Ayrton Sena Gouveia
- Programa de Pós-graduação em Biologia Parasitária, Instituto Oswaldo Cruz, Rio de Janeiro 21040-360, Brazil
| | - Alexandre Vilhena da Silva Neto
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus 6904-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 6904-000, Brazil
| | | | - Maria das Graças Costa Alecrim
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus 6904-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 6904-000, Brazil
- Coordenação do Curso de Medicina da Faculdade Metropolitana de Manaus/FAMETRO, Manaus 69050-000, Brazil
| | - Camila Helena Aguiar Bôtto de Menezes
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus 6904-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 6904-000, Brazil
| | | | - Djane Clarys Baia-da-Silva
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus 6904-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 6904-000, Brazil
- Faculdade de Farmácia, Universidade Nilton Lins, Manaus 69058-030, Brazil
- Instituto Leônidas & Maria Deane,-ILMD/FIOCRUZ Amazônia, Manaus 69057-070, Brazil
| | - Flor Ernestina Martinez Espinosa
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus 6904-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 6904-000, Brazil
- Instituto Leônidas & Maria Deane,-ILMD/FIOCRUZ Amazônia, Manaus 69057-070, Brazil
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de Abreu-Fernandes R, Almeida-de-Oliveira NK, Gama BE, Gomes LR, De Lavigne Mello AR, Queiroz LTD, Barros JDA, Alecrim MDGC, Medeiros de Souza R, Pratt-Riccio LR, Brasil P, Daniel-Ribeiro CT, Ferreira-da-Cruz MDF. Plasmodium falciparum Chloroquine- pfcrt Resistant Haplotypes in Brazilian Endemic Areas Four Decades after CQ Withdrawn. Pathogens 2023; 12:pathogens12050731. [PMID: 37242401 DOI: 10.3390/pathogens12050731] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Malaria is a public health problem worldwide. Despite global efforts to control it, antimalarial drug resistance remains a great challenge. In 2009, our team identified, for the first time in Brazil, chloroquine (CQ)-susceptible Plasmodium falciparum parasites in isolates from the Brazilian Amazon. The present study extends those observations to include survey samples from 2010 to 2018 from the Amazonas and Acre states for the purpose of tracking pfcrt molecular changes in P. falciparum parasites. (2) Objective: to investigate SNPs in the P. falciparum gene associated with chemoresistance to CQ (pfcrt). (3) Methods: Sixty-six P. falciparum samples from the Amazonas and Acre states were collected from 2010 to 2018 in patients diagnosed at the Reference Research Center for Treatment and Diagnosis of Malaria (CPD-Mal/Fiocruz), FMT-HVD and Acre Health Units. These samples were subjected to PCR and DNA Sanger sequencing to identify mutations in pfcrt (C72S, M74I, N75E, and K76T). (4) Results: Of the 66 P. falciparum samples genotyped for pfcrt, 94% carried CQ-resistant genotypes and only 4 showed a CQ pfcrt sensitive-wild type genotype, i.e., 1 from Barcelos and 3 from Manaus. (5) Conclusion: CQ-resistant P. falciparum populations are fixed, and thus, CQ cannot be reintroduced in malaria falciparum therapy.
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Affiliation(s)
- Rebecca de Abreu-Fernandes
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21041-361, Brazil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Reference Laboratory for Malaria in the Extra-Amazonian Region for the Brazilian Ministry of Health, Secretaria de Vigilância Sanitária & Fiocruz, Rio de Janeiro 21041-361, Brazil
| | - Natália Ketrin Almeida-de-Oliveira
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21041-361, Brazil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Reference Laboratory for Malaria in the Extra-Amazonian Region for the Brazilian Ministry of Health, Secretaria de Vigilância Sanitária & Fiocruz, Rio de Janeiro 21041-361, Brazil
| | - Bianca Ervatti Gama
- Centro de Transplante de Medula Óssea Laboratório de Oncovirologia, Instituto Nacional do Câncer, Rio de Janeiro 20230-130, Brazil
| | - Larissa Rodrigues Gomes
- Laboratório de Bioquímica e Proteínas de Peptídeos, CDTS Centro de Desenvolvimento Tecnológico em Saúde, Fiocruz, Rio de Janeiro 21041-361, Brazil
| | - Aline Rosa De Lavigne Mello
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21041-361, Brazil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Reference Laboratory for Malaria in the Extra-Amazonian Region for the Brazilian Ministry of Health, Secretaria de Vigilância Sanitária & Fiocruz, Rio de Janeiro 21041-361, Brazil
| | - Lucas Tavares de Queiroz
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21041-361, Brazil
| | - Jacqueline de Aguiar Barros
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21041-361, Brazil
- Núcleo de Controle da Malária/Departamento de Vigilância Epidemiológica/Coordenação Geral de Vigilância em Saúde/SESAU-RR, Boa Vista 69305-080, Brazil
| | | | - Rodrigo Medeiros de Souza
- Centro de Pesquisa em Doenças Infecciosas, Universidade Federal do Acre, Rio Branco 69920-900, Brazil
| | - Lilian Rose Pratt-Riccio
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21041-361, Brazil
| | - Patrícia Brasil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Reference Laboratory for Malaria in the Extra-Amazonian Region for the Brazilian Ministry of Health, Secretaria de Vigilância Sanitária & Fiocruz, Rio de Janeiro 21041-361, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro 21040-361, Brazil
| | - Cláudio Tadeu Daniel-Ribeiro
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21041-361, Brazil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Reference Laboratory for Malaria in the Extra-Amazonian Region for the Brazilian Ministry of Health, Secretaria de Vigilância Sanitária & Fiocruz, Rio de Janeiro 21041-361, Brazil
| | - Maria de Fátima Ferreira-da-Cruz
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21041-361, Brazil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Reference Laboratory for Malaria in the Extra-Amazonian Region for the Brazilian Ministry of Health, Secretaria de Vigilância Sanitária & Fiocruz, Rio de Janeiro 21041-361, Brazil
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Arraes de Alencar Ximenes R, de Barros Miranda-Filho D, Brickley EB, Barreto de Araújo TV, Montarroyos UR, Abtibol-Bernardino MR, Mussi-Pinhata MM, Duarte G, Coutinho CM, Biason de Moura Negrini SF, Alecrim MDGC, Albuquerque de Almeida Peixoto LDF, Lopes Moreira ME, Zin A, Pereira Júnior JP, Nielsen-Saines K, Turchi Martelli CM, Rodrigues LC, Vieira de Souza W, Ventura LO, Silva de Oliveira C, de Matos H, Furtado Serra EM, Souza Gomes LT, Nogueira ML, Estofolete C, Vaz-Oliani DC, Passos SD, Moron A, Duarte Rodrigues MM, Pereira Sarmento SG, Turchi MD, Pela Rosado LE, de Sene Amâncio Zara AL, Franco Gomes MB, Schuler-Faccini L, Herrero-Silva J, Amorim MM, Melo AO, Ledo Alves da Cunha AJ, Prata-Barbosa A, Amim J, Rezende-Filho J, Calcagno JI, Júnior Alcântara LC, Lima de Almeida B, Hofer CB, Machado ES, de Siqueira IC, Martinez-Espinosa FE, Brasil P. Risk of adverse outcomes in offspring with RT-PCR confirmed prenatal Zika virus exposure: An individual participant data meta-analysis of 13 cohorts in the Zika Brazilian Cohorts Consortium. Lancet Reg Health Am 2023; 17:100395. [PMID: 36714276 PMCID: PMC9880800 DOI: 10.1016/j.lana.2022.100395] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Knowledge regarding the risks associated with Zika virus (ZIKV) infections in pregnancy has relied on individual studies with relatively small sample sizes and variable risk estimates of adverse outcomes, or on surveillance or routinely collected data. Using data from the Zika Brazilian Cohorts Consortium, this study aims, to estimate the risk of adverse outcomes among offspring of women with RT-PCR-confirmed ZIKV infection during pregnancy and to explore heterogeneity between studies. Methods We performed an individual participant data meta-analysis of the offspring of 1548 pregnant women from 13 studies, using one and two-stage meta-analyses to estimate the absolute risks. Findings Of the 1548 ZIKV-exposed pregnancies, the risk of miscarriage was 0.9%, while the risk of stillbirth was 0.3%. Among the pregnancies with liveborn children, the risk of prematurity was 10,5%, the risk of low birth weight was 7.7, and the risk of small for gestational age (SGA) was 16.2%. For other abnormalities, the absolute risks were: 2.6% for microcephaly at birth or first evaluation, 4.0% for microcephaly at any time during follow-up, 7.9% for neuroimaging abnormalities, 18.7% for functional neurological abnormalities, 4.0% for ophthalmic abnormalities, 6.4% for auditory abnormalities, 0.6% for arthrogryposis, and 1.5% for dysphagia. This risk was similar in all sites studied and in different socioeconomic conditions, indicating that there are not likely to be other factors modifying this association. Interpretation This study based on prospectively collected data generates the most robust evidence to date on the risks of congenital ZIKV infections over the early life course. Overall, approximately one-third of liveborn children with prenatal ZIKV exposure presented with at least one abnormality compatible with congenital infection, while the risk to present with at least two abnormalities in combination was less than 1.0%.
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Affiliation(s)
- Ricardo Arraes de Alencar Ximenes
- Postgraduate Program in Tropical Medicine, Federal University of Pernambuco, Recife, PE, Brazil,Post-Graduation in Health Sciences, University of Pernambuco, Recife, PE, Brazil,Corresponding author. Professional address: Postgraduate Program in Tropical Medicine, Federal University of Pernambuco, Av. Prof. Moraes Rego, s/n., Cidade Universitária, Recife, PE 50670-901, Brazil; University of Pernambuco, Rua Arnóbio Marques, n. 310, Santo Amaro, Recife, PE 50100-130, Brazil.
| | | | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Marília Rosa Abtibol-Bernardino
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus, AM, Brazil,Postgraduate Program in Tropical Medicine, Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | | | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, Ribeirão Preto, SP, Brazil
| | - Conrado Milani Coutinho
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, Ribeirão Preto, SP, Brazil
| | | | - Maria das Graças Costa Alecrim
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus, AM, Brazil,Postgraduate Program in Tropical Medicine, Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Lucíola de Fátima Albuquerque de Almeida Peixoto
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus, AM, Brazil,Postgraduate Program in Tropical Medicine, Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | | | - Andrea Zin
- Clinical Research Unit, Instituto Fernandes Figueira, Oswaldo Cruz Foundation, Fiocruz, Rio de Janeiro, RJ, Brazil
| | | | - Karin Nielsen-Saines
- Department of Pediatrics, David Geffen University of California at Los Angeles School of Medicine, LA, United States
| | | | - Laura Cunha Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Liana O. Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, PE, Brazil,Pernambuco Eyes Hospital, Recife, PE, Brazil
| | | | - Haroldo de Matos
- Department of Epidemiology, Evandro Chagas Institute, Ananindeua, PA, Brazil
| | | | - Luna Thais Souza Gomes
- Department of Arbovirology and Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua, PA, Brazil
| | - Maurício L. Nogueira
- Department of Infectious Disease, Medicine School of São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Cassia Estofolete
- Department of Infectious Disease, Medicine School of São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Denise Cristina Vaz-Oliani
- Department of Gynecology and Obstetrics, Medicine School of São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Saulo Duarte Passos
- Infectious Pediatric Laboratory, Medicine School of Jundiaí, Jundiaí, SP, Brazil
| | - Antonio Moron
- Department of Fetal Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Marília Dalva Turchi
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, GO, Brazil
| | | | | | | | - Lavínia Schuler-Faccini
- Departamento de Genética, Hospital das Clinicas de Porto Alegre, Universidade Federal do Rio Grandedo Sul, Porto Alegre, RS, Brazil
| | - Juliana Herrero-Silva
- City Hall of Tangará da Serra, Municipal Health Department, Tangará da Serra, MT, Brazil
| | - Melania M. Amorim
- Medical Academic Unit, Federal University of Campina Grande, Campina Grande, PB, Brazil
| | - Adriana Oliveira Melo
- Medical Academic Unit, Federal University of Campina Grande, Campina Grande, PB, Brazil
| | | | - Arnaldo Prata-Barbosa
- Department of Pediatrics, D’Or Institute for Research & Education, Rio de Janeiro, RJ, Brazil
| | - Joffre Amim
- Department of Obstectrics, Federal University of Rio de Janeiro Maternity School, Rio de Janeiro, RJ, Brazil
| | - Jorge Rezende-Filho
- Department of Obstectrics, Federal University of Rio de Janeiro Maternity School, Rio de Janeiro, RJ, Brazil
| | - Juan Ignacio Calcagno
- Reference Maternity Prof. José Maria de Magalhães Netto, Bahia Health Department, Salvador, BA, Brazil
| | | | | | - Cristina Barroso Hofer
- Department of Infecitous Diseases, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Elizabeth S. Machado
- Department of Infecitous Diseases, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Flor Ernestina Martinez-Espinosa
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus, AM, Brazil,Postgraduate Program in Tropical Medicine, Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil,Leonidas and Maria Deane Institute, Fiocruz, Manaus, AM, Brazil
| | - Patrícia Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Fiocruz, Rio de Janeiro, Brazil
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Abtibol-Bernardino MR, Peixoto LDFADA, Castilho MDC, Bôtto-Menezes CHA, Benzecry SG, Otani RH, Rodrigues GRI, Chaves BCS, de Oliveira GA, Rodrigues CDS, Martinez-Espinosa FE, Alecrim MDGC. Would Zika virus Infection in Pregnancy Be a Sentence of Poor Neurological Prognosis for Exposed Children? Neurodevelopmental Outcomes in a Cohort from Brazilian Amazon. Viruses 2022; 14:v14122659. [PMID: 36560662 PMCID: PMC9782914 DOI: 10.3390/v14122659] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/15/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Infections with Flavivirus in pregnant women are not associated with vertical transmission. However, in 2015, severe cases of congenital infection were reported during the Zika virus outbreak in Brazil. More subtle infections in children born to mothers with ZIKV still remain uncertain and the spectrum of this new congenital syndrome is still under construction. This study describes outcomes regarding neurodevelopment and neurological examination in the first years of life, of a cohort of 77 children born to pregnant women with ZIKV infection in Manaus, Brazil, from 2017 to 2020. In the group of normocephalic children (92.2%), most showed satisfactory performance in neuropsychomotor development, with a delay in 29.6% and changes in neurological examination in 27.1%, with two children showing muscle-strength deficits. All microcephalic children (5.2%) evolved with severe neuropsychomotor-development delay, spastic tetraparesis, and alterations in the imaging exam. In this cohort, 10.5% of the children had macrocephaly at birth, but only 2.6% remained in this classification. Although microcephaly has been considered as the main marker of congenital-Zika-virus syndrome in previous studies, its absence does not exclude the possibility of the syndrome. This highlights the importance of clinical follow-up, regardless of the classification of head circumference at birth.
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Affiliation(s)
- Marília Rosa Abtibol-Bernardino
- Postgraduate Program in Tropical Medicine (PPGMT), State University of Amazonas (UEA) in Partnership with the Tropical Medicine Foundation Dr Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil
- Department of Maternal and Child Health, Medical School, Federal University of Amazonas (UFAM), Manaus 69020-160, Brazil
- Correspondence:
| | - Lucíola de Fátima Albuquerque de Almeida Peixoto
- Postgraduate Program in Tropical Medicine (PPGMT), State University of Amazonas (UEA) in Partnership with the Tropical Medicine Foundation Dr Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil
| | - Marcia da Costa Castilho
- Department of Virology, Tropical Medicine Foundation Dr Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil
| | - Camila Helena Aguiar Bôtto-Menezes
- Postgraduate Program in Tropical Medicine (PPGMT), State University of Amazonas (UEA) in Partnership with the Tropical Medicine Foundation Dr Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil
- Department of Medicine, School of Health Sciences, State University of Amazonas (UEA), Manaus 69065-001, Brazil
- Department of Malaria, Tropical Medicine Foundation Dr Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil
| | - Silvana Gomes Benzecry
- Department of Medicine, School of Health Sciences, State University of Amazonas (UEA), Manaus 69065-001, Brazil
| | - Rodrigo Haruo Otani
- Department of Medicine, School of Health Sciences, State University of Amazonas (UEA), Manaus 69065-001, Brazil
| | - Gabriela Ribeiro Ivo Rodrigues
- Postgraduate Program in Tropical Medicine (PPGMT), State University of Amazonas (UEA) in Partnership with the Tropical Medicine Foundation Dr Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil
| | - Beatriz Caroline Soares Chaves
- Postgraduate Program in Tropical Medicine (PPGMT), State University of Amazonas (UEA) in Partnership with the Tropical Medicine Foundation Dr Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil
| | - Geruza Alfaia de Oliveira
- Postgraduate Program in Tropical Medicine (PPGMT), State University of Amazonas (UEA) in Partnership with the Tropical Medicine Foundation Dr Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil
| | - Cristina de Souza Rodrigues
- Postgraduate Program in Tropical Medicine (PPGMT), State University of Amazonas (UEA) in Partnership with the Tropical Medicine Foundation Dr Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil
| | - Flor Ernestina Martinez-Espinosa
- Postgraduate Program in Tropical Medicine (PPGMT), State University of Amazonas (UEA) in Partnership with the Tropical Medicine Foundation Dr Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil
- Department of Malaria, Tropical Medicine Foundation Dr Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil
- Postgraduate Program in Living Conditions and Health Situations in the Amazon (PPGVIDA), Leônidas & Maria Deane Institute at Fiocruz Amazonia, Manaus 69057-070, Brazil
- Laboratory of Territory Environment Health and Sustainability, Leônidas & Maria Deane Institute of Fiocruz Amazonia, Manaus 69057-070, Brazil
| | - Maria das Graças Costa Alecrim
- Postgraduate Program in Tropical Medicine (PPGMT), State University of Amazonas (UEA) in Partnership with the Tropical Medicine Foundation Dr Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil
- Department of Malaria, Tropical Medicine Foundation Dr Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil
- Medical Course Coordination at Manaus Metropolitan College/FAMETRO, Manaus 69050-000, Brazil
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Melo MM, Costa MR, Filho FS, Brito-Sousa JD, Almeida AC, Monteiro WM, Melo GC, Vieira JLF, Alecrim MDGC. Pharmacokinetics of chloroquine in patients with malaria by P. vivax from the Western Brazilian Amazon basin. Biomed Pharmacother 2022; 149:112874. [DOI: 10.1016/j.biopha.2022.112874] [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] [Received: 02/08/2022] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 11/02/2022] Open
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7
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Alecrim MDGC, de Amorim MMR, de Araújo TVB, Brasil P, Brickley EB, Castilho MDC, Coelho BP, da Cunha AJLA, Duarte G, Estofolete CF, Gurgel RQ, Herrero-Silva J, Hofer CB, Lopes ASA, Martelli CMT, Melo ASDO, Miranda-Filho DDB, Montarroyos UR, Moreira ME, Mussi-Pinhata MM, de Oliveira CS, Passos SD, Prata-Barbosa A, dos Santos DN, Schuler-Faccini L, da Silva AAM, de Siqueira IC, Sousa PDS, Turchi MD, Ximenes RADA, Zara ALDSA. Zika Brazilian Cohorts (ZBC) Consortium: Protocol for an Individual Participant Data Meta-Analysis of Congenital Zika Syndrome after Maternal Exposure during Pregnancy. Viruses 2021; 13:v13040687. [PMID: 33923434 PMCID: PMC8072625 DOI: 10.3390/v13040687] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/31/2022] Open
Abstract
Despite great advances in our knowledge of the consequences of Zika virus to human health, many questions remain unanswered, and results are often inconsistent. The small sample size of individual studies has limited inference about the spectrum of congenital Zika manifestations and the prognosis of affected children. The Brazilian Zika Cohorts Consortium addresses these limitations by bringing together and harmonizing epidemiological data from a series of prospective cohort studies of pregnant women with rash and of children with microcephaly and/or other manifestations of congenital Zika. The objective is to estimate the absolute risk of congenital Zika manifestations and to characterize the full spectrum and natural history of the manifestations of congenital Zika in children with and without microcephaly. This protocol describes the assembly of the Consortium and protocol for the Individual Participant Data Meta-analyses (IPD Meta-analyses). The findings will address knowledge gaps and inform public policies related to Zika virus. The large harmonized dataset and joint analyses will facilitate more precise estimates of the absolute risk of congenital Zika manifestations among Zika virus-infected pregnancies and more complete descriptions of its full spectrum, including rare manifestations. It will enable sensitivity analyses using different definitions of exposure and outcomes, and the investigation of the sources of heterogeneity between studies and regions.
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Affiliation(s)
| | - Melania Maria Ramos de Amorim
- Universidade Federal de Campina Grande, Campina Grande 58428-830, Brazil; (M.M.R.d.A.); (A.S.d.O.M.)
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife 50070-902, Brazil
| | | | - Patrícia Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Brazil;
| | | | - Marcia da Costa Castilho
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil; (M.d.G.C.A.); (M.d.C.C.)
| | - Bernadete Perez Coelho
- Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife 50670-901, Brazil;
| | | | - Geraldo Duarte
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14049-900, Brazil; (G.D.); (M.M.M.-P.)
| | | | | | | | - Cristina Barroso Hofer
- Departamento de Pediatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-971, Brazil; (A.J.L.A.d.C.); (C.B.H.)
| | | | | | - Adriana Suely de Oliveira Melo
- Universidade Federal de Campina Grande, Campina Grande 58428-830, Brazil; (M.M.R.d.A.); (A.S.d.O.M.)
- Instituto Paraibano de Diagnóstico (EMBRION), Campina Grande 58400-506, Brazil
| | | | | | | | - Marisa Marcia Mussi-Pinhata
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14049-900, Brazil; (G.D.); (M.M.M.-P.)
| | | | | | | | | | | | | | | | - Patrícia da Silva Sousa
- Centro de Referência em Neurodesenvolvimento, Assistência e Reabilitação de Crianças, Secretaria de Saúde do Estado do Maranhão, São Luís 65076-820, Brazil;
| | - Marília Dalva Turchi
- Departamento de Saude Coletiva, Universidade Federal de Goiás, Goiânia 74605-050, Brazil; (M.D.T.); (A.L.d.S.A.Z.)
| | - Ricardo Arraes de Alencar Ximenes
- Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife 50100-130, Brazil;
- Departamento de Medicina Tropical da Universidade Federal de Pernambuco, Recife 50670-901, Brazil
- Correspondence:
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8
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Barbosa LRA, da Silva EL, de Almeida ACG, Salazar YEAR, Siqueira AM, Alecrim MDGC, Vieira JLF, Bassat Q, de Lacerda MVG, Monteiro WM, Melo GC. An Ultra-Sensitive Technique: Using Pv-mtCOX1 qPCR to Detect Early Recurrences of Plasmodium vivax in Patients in the Brazilian Amazon. Pathogens 2020; 10:pathogens10010019. [PMID: 33396824 PMCID: PMC7823330 DOI: 10.3390/pathogens10010019] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Early recurrence of Plasmodium vivax is a challenge for malaria control in the field, particularly because this species is associated with lower parasitemia, which hinders diagnosis and monitoring through blood smear testing. Early recurrences, defined as the persistence of parasites in the peripheral blood despite adequate drug dosages, may arise from resistance to chloroquine. The objective of the study was to estimate early recurrence of P. vivax in the Brazilian Amazon by using a highly-sensitive detection method, in this case, PCR. METHODS An ultra-sensitive qPCR that targeted mitochondrial DNA was used to compare a standard qPCR that targeted 18S rDNA to detect early recurrence of P. vivax in very low densities in samples from patients treated with chloroquine. RESULTS Out of a total of 312 cases, 29 samples (9.3%) were characterized as recurrences, from which 3.2% (10/312) were only detected through ultra-sensitive qPCR testing. CONCLUSIONS Studies that report the detection of P. vivax early recurrences using light microscopy may severely underestimate their true incidence.
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Affiliation(s)
- Laila R. A. Barbosa
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-200, AM, Brazil
| | - Emanuelle L. da Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
- UNINILTONLINS—Universidade Nilton Lins, Unicenter, Manaus 69058-030, AM, Brazil
| | - Anne C. G. de Almeida
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-200, AM, Brazil
- FAMETRO—Faculdade Metropolitana de Manaus, Campus Central, Av. Constantino Nery, Chapada, Manaus 69050-000, AM, Brazil
| | - Yanka E. A. R. Salazar
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
| | - André M. Siqueira
- Fiocruz-Manguinhos—Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro 21040-900, RJ, Brazil;
| | - Maria das Graças Costa Alecrim
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-200, AM, Brazil
| | | | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain;
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Clínic per la Recerca Biomédica, Maputo 1929, Mozambique
- Catalan Institution for Research and Advanced Studies (ICREA), Campus Clínic, Pg. Lluís Companys 23, 08010 Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, 1867 Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Marcus V. G. de Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-200, AM, Brazil
- Instituto Leônidas & Maria Deane, ILMD-Fiocruz-Fundação Oswaldo Cruz, Manaus 69057-070, AM, Brazil
| | - Wuelton M. Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-200, AM, Brazil
| | - Gisely C. Melo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-200, AM, Brazil
- Correspondence: ; Tel.: +55-92-99159-8604
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9
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Redivo EDF, Bôtto Menezes C, da Costa Castilho M, Brock M, da Silva Magno E, Gomes Saraiva MDG, Alvarez Fernandes SS, Costa Antony de Andrade AB, Costa Alecrim MDG, Martinez-Espinosa FE. Zika Virus Infection in a Cohort of Pregnant Women with Exanthematic Disease in Manaus, Brazilian Amazon. Viruses 2020; 12:v12121362. [PMID: 33260784 PMCID: PMC7760272 DOI: 10.3390/v12121362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 01/31/2023] Open
Abstract
The epidemic transmission of Zika virus (ZIKV) in Brazil has been identified as a cause of microcephaly and other neurological malformations in the babies of ZIKV-infected women. The frequency of adverse outcomes of Zika virus infection (ZIKVi) in pregnancy differs depending on the characteristics of exposure to infection, the time of recruitment of research participants, and the outcomes to be observed. This study provides a descriptive analysis—from the onset of symptoms to delivery—of a cohort registered as having maternal ZIKVi in pregnancy, from November 2015 to December 2016. Suspected cases were registered at a referral center for infectious and tropical diseases in Manaus, in the Amazonian region of Brazil. Of 834 women notified, 762 women with confirmed pregnancies were enrolled. Reverse-transcriptase polymerase chain reaction (RT-PCR) confirmed ZIKVi in 42.3% of the cohort. In 35.2% of the cohort, ZIKV was the sole infection identified. Severe adverse pregnancy outcomes (miscarriage, stillbirth, or microcephaly) were observed in both RT-PCR ZIKV-positive (5.0%) and ZIKV-negative (1.8%) cases (RR 3.1; 95% IC 1.4–7.3; p < 0.05), especially during the first trimester of pregnancy (RR 6.2, 95% IC 2.3–16.5; p < 0.001). Although other infectious rash diseases were observed in the pregnant women in the study, having confirmed maternal ZIKVi was the most important risk factor for serious adverse pregnancy events.
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Affiliation(s)
- Elijane de Fátima Redivo
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (E.d.F.R.); (C.B.M.); (S.S.A.F.); (M.d.G.C.A.)
| | - Camila Bôtto Menezes
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (E.d.F.R.); (C.B.M.); (S.S.A.F.); (M.d.G.C.A.)
- Department of Medicine, School of Health Sciences, University of Amazonas State, Manaus 69065-000, Brazil;
- Department of Malaria, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Márcia da Costa Castilho
- Department of Virology, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil;
| | - Marianna Brock
- Department of Medicine, School of Health Sciences, University of Amazonas State, Manaus 69065-000, Brazil;
| | - Evela da Silva Magno
- Department of Epidemiology and Public Health, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil; (E.d.S.M.); (M.d.G.G.S.)
| | - Maria das Graças Gomes Saraiva
- Department of Epidemiology and Public Health, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil; (E.d.S.M.); (M.d.G.G.S.)
| | - Salete Sara Alvarez Fernandes
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (E.d.F.R.); (C.B.M.); (S.S.A.F.); (M.d.G.C.A.)
| | - Anny Beatriz Costa Antony de Andrade
- Postgraduate Program in Living Conditions and Health Situations in the Amazon PPGVIDA, Leônidas & Maria Deane Institute, Manaus 69057-070, Amazonas, Brazil;
| | - Maria das Graças Costa Alecrim
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (E.d.F.R.); (C.B.M.); (S.S.A.F.); (M.d.G.C.A.)
- Department of Malaria, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Flor Ernestina Martinez-Espinosa
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (E.d.F.R.); (C.B.M.); (S.S.A.F.); (M.d.G.C.A.)
- Department of Malaria, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
- Postgraduate Program in Living Conditions and Health Situations in the Amazon PPGVIDA, Leônidas & Maria Deane Institute, Manaus 69057-070, Amazonas, Brazil;
- Laboratory of Territory, Environment, Health and Sustainability, Leônidas & Maria Deane Institute, Manaus 69057-070, Fiocruz Amazonia, Brazil
- Correspondence: ; Tel.: +55-929-8128-5890
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10
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Abtibol-Bernardino MR, de Almeida Peixoto LDFA, de Oliveira GA, de Almeida TF, Rodrigues GRI, Otani RH, Soares Chaves BC, de Souza Rodrigues C, de Andrade ABCA, de Fatima Redivo E, Fernandes SS, da Costa Castilho M, Gomes Benzecry S, Bôtto-Menezes C, Martinez-Espinosa FE, Costa Alecrim MDG. Neurological Findings in Children without Congenital Microcephaly Exposed to Zika Virus in Utero: A Case Series Study. Viruses 2020; 12:v12111335. [PMID: 33233769 PMCID: PMC7699969 DOI: 10.3390/v12111335] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023] Open
Abstract
The Zika virus can induce a disruptive sequence in the fetal brain and is manifested mainly by microcephaly. Knowledge gaps still exist as to whether the virus can cause minor disorders that are perceived later on during the first years of life in children who are exposed but are asymptomatic at birth. In this case series, we describe the outcomes related to neurodevelopment through the neurological assessment of 26 non-microcephalic children who had intrauterine exposure to Zika virus. Children were submitted for neurological examinations and Bayley Scales-III (cognition, language, and motor performance). The majority (65.4%) obtained satisfactory performance in neurodevelopment. The most impaired domain was language, with 30.7% impairment. Severe neurological disorders occurred in five children (19.2%) and these were spastic hemiparesis, epilepsy associated with congenital macrocephaly (Zika and human immunodeficiency virus), two cases of autism (one exposed to Zika and Toxoplasma gondii) and progressive sensorineural hearing loss (GJB2 mutation). We concluded that non-microcephalic children with intrauterine exposure to Zika virus, in their majority, had achieved satisfactory performance in all neurodevelopmental domains. One third of the cases had some impairment, but the predominant group had mild alterations, with low occurrence of moderate to severe disorders, similar to other studies in Brazil.
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Affiliation(s)
- Marília Rosa Abtibol-Bernardino
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
- Correspondence:
| | - Lucíola de Fátima Albuquerque de Almeida Peixoto
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
| | - Geruza Alfaia de Oliveira
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil; (G.A.d.O.); (G.R.I.R.)
| | | | | | - Rodrigo Haruo Otani
- Department of Medicine, School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (R.H.O.); (S.G.B.)
| | - Beatriz Caroline Soares Chaves
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
| | - Cristina de Souza Rodrigues
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
| | - Anny Beatriz Costa Antony de Andrade
- Postgraduate Program in Living Conditions and Health Situations in the Amazon PPGVIDA, Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil;
| | - Elijane de Fatima Redivo
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
| | - Salete Sara Fernandes
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
| | - Marcia da Costa Castilho
- Department of Virology, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil;
| | - Silvana Gomes Benzecry
- Department of Medicine, School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (R.H.O.); (S.G.B.)
| | - Camila Bôtto-Menezes
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
- Department of Medicine, School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (R.H.O.); (S.G.B.)
- Department of Malaria, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Flor Ernestina Martinez-Espinosa
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
- Postgraduate Program in Living Conditions and Health Situations in the Amazon PPGVIDA, Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil;
- Department of Malaria, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
- Laboratory of Territory, Environment, Health and Sustainability, Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil
| | - Maria das Graças Costa Alecrim
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
- Department of Malaria, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
- Medical Course Coordination, Manaus Metropolitan College/FAMETRO, Manaus 69050-000, Brazil
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11
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Baia-da-Silva DC, Brito-Sousa JD, Rodovalho SR, Peterka C, Moresco G, Lapouble OMM, Melo GCD, Sampaio VDS, Alecrim MDGC, Pimenta P, Lima JBP, Lacerda MVGD, Monteiro WM. Current vector control challenges in the fight against malaria in Brazil. Rev Soc Bras Med Trop 2019; 52:e20180542. [PMID: 30843971 DOI: 10.1590/0037-8682-0542-2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 02/20/2019] [Indexed: 11/22/2022] Open
Abstract
In Brazil, malaria is an important public health problem first reported in 1560. Historically, fluctuations in malaria cases in Brazil are attributed to waves of economic development; construction of railroads, highways, and hydroelectric dams; and population displacement and land occupation policies. Vector control measures have been widely used with an important role in reducing malaria cases. In this review article, we reviewed the vector control measures established in the Brazilian territory and aspects associated with such measures for malaria. Although some vector control measures are routinely used in Brazil, many entomological and effectiveness information still need better evidence in endemic areas where Plasmodium vivax predominates. Herein, we outlined some of the needs and priorities for future research: a) update of the cartography of malaria vectors in Brazil, adding molecular techniques for the correct identification of species and complexes of species; b) evaluation of vector competence of anophelines in Brazil; c) strengthening of local entomology teams to perform vector control measures and interpret results; d) evaluation of vector control measures, especially use of insecticide-treated nets and long-lasting insecticidal nets, estimating their effectiveness, cost-benefit, and population acceptance; e) establishment of colonies of malaria vectors in Brazil, i.e., Anopheles darlingi, to understand parasite-vector interactions better; f) study of new vector control strategies with impacts on non-endophilic vectors; g) estimation of the impact of insecticide resistance in different geographical areas; and h) identification of the relative contribution of natural and artificial breeding sites in different epidemiological contexts for transmission.
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Affiliation(s)
- Djane Clarys Baia-da-Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - José Diego Brito-Sousa
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Sheila Rodrigues Rodovalho
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil.,Organização Pan-Americana de Saúde, Brasília, DF, Brasil
| | - Cassio Peterka
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil.,Programa Nacional de Controle da Malária, Ministério da Saúde, Brasília, DF, Brasil
| | - Gilberto Moresco
- Programa Nacional de Controle da Malária, Ministério da Saúde, Brasília, DF, Brasil
| | - Oscar Martín Mesones Lapouble
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil.,Organização Pan-Americana de Saúde, Brasília, DF, Brasil
| | - Gisely Cardoso de Melo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Vanderson de Souza Sampaio
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil.,Fundação de Vigilância em Saúde, Manaus, AM, Brasil
| | - Maria das Graças Costa Alecrim
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Paulo Pimenta
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil.,Instituto de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brasil
| | | | - Marcus Vinícius Guimarães de Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil.,Instituto de Pesquisas Leônidas and Maria Deane, Fundação Oswaldo Cruz, Manaus, AM, Brasil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil
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12
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Costa MRF, Barcelos ALR, Camargo MAD, Melo GCD, Almeida AC, Costa AGD, Sousa JDDB, Melo MMD, Alecrim MDGC, Lacerda MVGD, Monteiro WM. Performance of an immuno-rapid malaria Pf/Pv rapid diagnostic test for malaria diagnosis in the Western Brazilian Amazon. Rev Soc Bras Med Trop 2019; 52:e20170450. [PMID: 30652783 DOI: 10.1590/0037-8682-0450-2017] [Citation(s) in RCA: 2] [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: 11/21/2017] [Accepted: 06/21/2018] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION Rapid diagnostic tests (RDTs) for detecting Plasmodium antigens have become increasingly common worldwide. We aimed to evaluate the accuracy of the Immuno-Rapid Malaria Pf/Pv RDT in detecting Plasmodium vivax infection compared to standard thick blood smear (TBS) under microscopy. METHODS Hundred and eighty-one febrile patients from the hospital's regular admissions were assessed using TBS and RDT in a blinded experiment. RESULTS RDT showed a sensitivity of 98.9%, specificity of 100%, and accuracy of 99.5% for P. vivax infection when compared to TBS. CONCLUSIONS The RDT is highly accurate, making it a valuable diagnostic tool for P. vivax infection.
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Affiliation(s)
- Monica Regina Farias Costa
- Instituto de Pesquisas Clínicas Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil
| | | | | | - Gisely Cardoso de Melo
- Instituto de Pesquisas Clínicas Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Anne Cristine Almeida
- Instituto de Pesquisas Clínicas Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Allyson Guimarães da Costa
- Instituto de Pesquisas Clínicas Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Jose Diego de Brito Sousa
- Instituto de Pesquisas Clínicas Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Marly Marques de Melo
- Instituto de Pesquisas Clínicas Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Maria das Graças Costa Alecrim
- Instituto de Pesquisas Clínicas Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Marcus Vinicius Guimarães de Lacerda
- Instituto de Pesquisas Clínicas Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Pesquisa e Desenvolvimento, Wama Diagnóstica, São Carlos, SP, Brasil.,Instituto de Pesquisas Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, AM, Brasil
| | - Wuelton Marcelo Monteiro
- Instituto de Pesquisas Clínicas Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brasil
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13
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Pinto RDM, Sampaio VDS, de Melo GC, Alecrim MDGC, Mattos K, Perdomo RT, Cordeiro SDC, Parente AFA, de Carvalho LR, Mendes RP, Lacerda MVG, Monteiro WM, Weber SS. Overview of artemisinin effectiveness during outset years of its implementation in the western Brazilian Amazon. Mem Inst Oswaldo Cruz 2019; 114:e190075. [PMID: 31038549 PMCID: PMC6489370 DOI: 10.1590/0074-02760190075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/23/2019] [Accepted: 03/27/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND METHODS FINDINGS MAIN CONCLUSIONS
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Affiliation(s)
| | - Vanderson de Souza Sampaio
- Fundação de Vigilância em Saúde, Brasil; Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brazil
| | - Gisely Cardoso de Melo
- Universidade do Estado do Amazonas, Brazil; Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brazil
| | | | | | | | | | | | | | | | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brazil; Fundação Oswaldo Cruz-Fiocruz, Brazil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brazil
| | - Simone Schneider Weber
- Universidade Federal de Mato Grosso do Sul, Brazil; Universidade Federal do Amazonas, Brazil
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14
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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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15
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Francesconi VA, Francesconi F, Ramasawmy R, Romero GAS, Alecrim MDGC. Failure of fluconazole in treating cutaneous leishmaniasis caused by Leishmania guyanensis in the Brazilian Amazon: An open, nonrandomized phase 2 trial. PLoS Negl Trop Dis 2018; 12:e0006225. [PMID: 29481560 PMCID: PMC5854414 DOI: 10.1371/journal.pntd.0006225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 03/15/2018] [Accepted: 01/09/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The treatment of Leishmaniasis caused by Leishmania (Viannia) guyanensis is based on a weak strength of evidence from very few clinical trials and some case series reports. Current treatment guidelines recommend pentamidine isethionate or meglumine antimoniate (Glucantime) as the first-line choices. Both are parenteral drugs with a low therapeutic indexes leading to a high risk of undesired effects. Imidazole derivatives interfere with the production of leishmanial ergosterol, an essential component of their membrane structure. One drug that has been studied in different clinical presentations of Leishmania is fluconazole, a hydrophilic bis-triazole, which is easily absorbed through the oral route with a low toxicity profile and is considered safe for children. This drug is readily available in poor countries with a reasonable cost making it a potential option for treating leishmaniasis. METHODS AND FINDINGS An adaptive nonrandomized clinical trial with sequential groups with dose escalation of oral fluconazole was designed to treat adult men with localized cutaneous leishmaniasis (LCL) in Manaus, Brazil. Eligible participants were patients with LCL with confirmed Leishmania guyanensis infection. RESULTS Twenty adult male patients were treated with 450 mg of fluconazole daily for 30 days. One patient (5%) was cured within 30 days of treatment. Of the 19 failures (95%), 13 developed a worsening of ulcers and six evolved lymphatic spreading of the disease. Planned dose escalation was suspended after the disappointing failure rate during the first stage of the trial. CONCLUSION/SIGNIFICANCE Oral fluconazole, at the dose of 450mg per day, was not efficacious against LCL caused by Leishmania guyanensis in adult men. TRIAL REGISTRATION Brazilian Clinical Trial Registration (ReBec)-RBR-8w292w; UTN number-1158-2421.
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Affiliation(s)
- Valeska Albuquerque Francesconi
- Department of Dermatology, Academic and Research Division at the Tropical Medicine Foundation - Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Fabio Francesconi
- Department of Dermatology, Academic and Research Division at the Tropical Medicine Foundation - Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Rajendranath Ramasawmy
- Department of Molecular Biology, Division of Immunogenetics, at the Tropical Medicine Foundation - Dr Heitor Vieira Dourado and Universidade Nilton Lins, Manaus, Amazonas, Brazil
| | | | - Maria das Graças Costa Alecrim
- Department of Infectology, Division of Malaria and Neglected Tropical Diseases at the Tropical Medicine Foundation - Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
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16
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Andrade SDD, Andrade MGFS, Santos PJ, Galvão MDL, Barros MMD, Ramasawmy R, Safe IP, Monteiro WM, Sabidó M, Alecrim MDGC. Acute disseminated encephalomyelitis following inactivated influenza vaccination in the Brazilian Amazon: a case report. Rev Soc Bras Med Trop 2015; 48:498-500. [DOI: 10.1590/0037-8682-0314-2014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/29/2015] [Indexed: 11/22/2022] Open
Affiliation(s)
- Solange Dourado de Andrade
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Brazil; Centro de Referência para Imunobiológicos Especiais, Brazil
| | | | | | | | | | - Rajendranath Ramasawmy
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Brazil; Universidade do Estado do Amazonas, Brazil
| | | | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Brazil; Universidade do Estado do Amazonas, Brazil
| | - Meritxell Sabidó
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Brazil; Universitat de Girona, Spain
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17
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Sampaio VS, Siqueira AM, Alecrim MDGC, Mourão MPG, Marchesini PB, Albuquerque BC, Nascimento J, Figueira ÉAG, Alecrim WD, Monteiro WM, Lacerda MVG. Malaria in the State of Amazonas: a typical Brazilian tropical disease influenced by waves of economic development. Rev Soc Bras Med Trop 2015; 48 Suppl 1:4-11. [DOI: 10.1590/0037-8682-0275-2014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/03/2015] [Indexed: 11/22/2022] Open
Affiliation(s)
- Vanderson Souza Sampaio
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brazil; Universidade do Estado do Amazonas, Brazil; Fundação de Vigilância em Saúde do Amazonas, Brazil
| | | | | | - Maria Paula Gomes Mourão
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brazil; Universidade do Estado do Amazonas, Brazil
| | | | | | - Joabi Nascimento
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brazil; Universidade do Estado do Amazonas, Brazil
| | | | | | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brazil; Universidade do Estado do Amazonas, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brazil; Universidade do Estado do Amazonas, Brazil; Fundação Oswaldo Cruz, Brazil
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18
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Alexandre MAA, Benzecry SG, Siqueira AM, Vitor-Silva S, Melo GC, Monteiro WM, Leite HP, Lacerda MVG, Alecrim MDGC. The association between nutritional status and malaria in children from a rural community in the Amazonian region: a longitudinal study. PLoS Negl Trop Dis 2015; 9:e0003743. [PMID: 25928774 PMCID: PMC4415998 DOI: 10.1371/journal.pntd.0003743] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 04/06/2015] [Indexed: 11/18/2022] Open
Abstract
Background The relationship between malaria and undernutrition is controversial and complex. Synergistic associations between malnutrition and malaria morbidity and mortality have been suggested, as well as undernutrition being protective against infection, while other studies found no association. We sought to evaluate the relationship between the number of malaria episodes and nutritional statuses in a cohort of children below 15 years of age living in a rural community in the Brazilian Amazon. Methodology/Principal Findings Following a baseline survey of clinical, malaria and nutritional assessment including anthropometry measurements and hemoglobin concentration, 202 children ranging from 1 month to 14 years of age were followed for one year through passive case detection for malaria episodes. After follow-up, all children were assessed again in order to detect changes in nutritional indicators associated with malaria infection. We also examined the risk of presenting malaria episodes during follow-up according to presence of stunting at baseline. Children who suffered malaria episodes during follow-up presented worse anthropometric parameters values during this period. The main change was a reduction of the linear growth velocity, associated with both the number of episodes and how close the last or only malaria episode and the second anthropometric assessment were. Changes were also observed for indices associated with chronic changes, such as weight-for-age and BMI-for-age, which conversely, were more frequently observed in children with the last or only episode occurring between 6 and 12 months preceding the second nutritional assessment survey. Children with inadequate height-for-age at baseline (Z-score < -2) presented lower risk of suffering malaria episodes during follow-up as assessed by both the log-rank test (p =0.057) and the multivariable Cox-proportional hazards regression (Hazard Ratio = 0.31, 95%CI [0.10; 0.99] p=0.049). Conclusions Malaria was associated with impaired nutritional status amongst children in an endemic area of the Western Brazilian Amazon where P. vivax predominates. Our data all supports that the association presents differential effects for each age group, suggesting distinct pathophysiology pathways. We were also able to demonstrate that undernourishment at baseline was protective to malaria during follow-up. These findings support an intriguing interaction between these conditions in the rural Amazon and the need for a more integrative approach by health systems in endemic areas. Malaria is one of the most serious public health problems in the world, with 3.3 billion people at risk of contracting the disease and almost one million deaths annually, primarily in children younger than five years of age. Undernutrition is also a morbidity of importance to the public worldwide and primarily affects children in tropical regions. In the present study, we sought to analyze the relationship between malaria and undernutrition in children living in a rural Amazonian community where malaria is endemic. Children from 1 month to 14 years of age were followed-up for 12 months through passive case detection (i.e., the presence of malarial parasites in peripheral blood in case of fever). Anthropometric and hemoglobin measurements and active malaria case detection tests (to detect asymptomatic parasitaemia) were conducted at the beginning and end of the follow-up period of 12 months. Children who had at least one episode of malaria during this period presented lower mean anthropometric index scores compared to children who did not have malaria. We concluded that malaria had a negative impact on the nutritional status of children living in an endemic area at the Western Brazilian Amazon, where Plasmodium vivax predominates.
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Affiliation(s)
- Márcia Almeida Araújo Alexandre
- Gerência de Malaria, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Silvana Gomes Benzecry
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Department of Pediatrics, Discipline of Nutrition and Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Andre Machado Siqueira
- Gerência de Malaria, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sheila Vitor-Silva
- Gerência de Malaria, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Gisely Cardoso Melo
- Gerência de Malaria, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- Gerência de Malaria, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Heitor Pons Leite
- Department of Pediatrics, Discipline of Nutrition and Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Gerência de Malaria, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Centro de Pesquisas Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
- * E-mail:
| | - Maria das Graças Costa Alecrim
- Gerência de Malaria, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
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Silva LFRE, Lima ES, Vasconcellos MCD, Aranha ESP, Costa DS, Mustafa EV, Morais SKRD, Alecrim MDGC, Nunomura SM, Struwe L, de Andrade-Neto VF, Pohlit AM. In vitro and in vivo antimalarial activity and cytotoxicity of extracts, fractions and a substance isolated from the Amazonian plant Tachia grandiflora (Gentianaceae). Mem Inst Oswaldo Cruz 2014; 108:501-7. [PMID: 23827996 DOI: 10.1590/s0074-02762013000400017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 03/26/2013] [Indexed: 11/22/2022] Open
Abstract
Tachia sp. are used as antimalarials in the Amazon Region and in vivo antimalarial activity of a Tachia sp. has been previously reported. Tachia grandiflora Maguire and Weaver is an Amazonian antimalarial plant and herein its cytotoxicity and antimalarial activity were investigated. Spectral analysis of the tetraoxygenated xanthone decussatin and the iridoid aglyone amplexine isolated, respectively, from the chloroform fractions of root methanol and leaf ethanol extracts was performed. In vitro inhibition of the growth of Plasmodium falciparum Welch was evaluated using optical microscopy on blood smears. Crude extracts of leaves and roots were inactive in vitro. However, chloroform fractions of the root and leaf extracts [half-maximal inhibitory concentration (IC50) = 10.5 and 35.8 µg/mL, respectively] and amplexine (IC50= 7.1 µg/mL) were active in vitro. Extracts and fractions were not toxic to type MRC-5 human fibroblasts (IC50> 50 µg/mL). Water extracts of the roots of T. grandiflora administered by mouth were the most active extracts in the Peters 4-day suppression test in Plasmodium berghei-infected mice. At 500 mg/kg/day, these extracts exhibited 45-59% inhibition five to seven days after infection. T. grandiflora infusions, fractions and isolated substance have potential as antimalarials.
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Affiliation(s)
- Luiz Francisco Rocha e Silva
- Laboratório de Princípios Ativos da Amazônia, Coordenação de Tecnologia e Inovação, Instituto Nacional de Pesquisas da Amazônia, Manaus, AM, Brasil
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20
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Rawlinson T, Siqueira AM, Fontes G, Beltrão RPL, Monteiro WM, Martins M, Silva-Júnior EF, Mourão MPG, Albuquerque B, Alecrim MDGC, Lacerda MVG. From Haiti to the Amazon: public health issues related to the recent immigration of Haitians to Brazil. PLoS Negl Trop Dis 2014; 8:e2685. [PMID: 24809971 PMCID: PMC4014393 DOI: 10.1371/journal.pntd.0002685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - André Machado Siqueira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Amazonas, Brazil
| | - Gilberto Fontes
- Universidade Federal de São João Del Rei, Campus Centro Oeste, Divinópolis, Minas Gerais, Brazil
| | | | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Amazonas, Brazil
| | - Marilaine Martins
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Amazonas, Brazil
| | - Edson Fidelis Silva-Júnior
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Amazonas, Brazil
| | - Maria Paula Gomes Mourão
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Amazonas, Brazil
| | | | - Maria das Graças Costa Alecrim
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Amazonas, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Amazonas, Brazil
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21
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Silva LFRE, Lima ES, de Vasconcellos MC, Aranha ESP, Costa DS, Mustafa EV, de Morais SKR, Alecrim MDGC, Nunomura SM, Struwe L, de Andrade-Neto VF, Pohlit AM. In vitro and in vivo antimalarial activity and cytotoxicity of extracts, fractions and a substance isolated from the Amazonian plant Tachia grandiflora (Gentianaceae). Mem Inst Oswaldo Cruz 2013. [PMID: 23827996 PMCID: PMC3970616 DOI: 10.1590/0074-0276108042013017] [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] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tachia sp. are used as antimalarials in the Amazon Region and in vivo antimalarial activity of a Tachia sp. has been previously reported. Tachia grandiflora Maguire and Weaver is an Amazonian antimalarial plant and herein its cytotoxicity and antimalarial activity were investigated. Spectral analysis of the tetraoxygenated xanthone decussatin and the iridoid aglyone amplexine isolated, respectively, from the chloroform fractions of root methanol and leaf ethanol extracts was performed. In vitro inhibition of the growth of Plasmodium falciparum Welch was evaluated using optical microscopy on blood smears. Crude extracts of leaves and roots were inactive in vitro. However, chloroform fractions of the root and leaf extracts [half-maximal inhibitory concentration (IC50) = 10.5 and 35.8 µg/mL, respectively] and amplexine (IC50= 7.1 µg/mL) were active in vitro. Extracts and fractions were not toxic to type MRC-5 human fibroblasts (IC50> 50 µg/mL). Water extracts of the roots of T. grandiflora administered by mouth were the most active extracts in the Peters 4-day suppression test in Plasmodium berghei-infected mice. At 500 mg/kg/day, these extracts exhibited 45-59% inhibition five to seven days after infection. T. grandiflora infusions, fractions and isolated substance have potential as antimalarials.
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Affiliation(s)
- Luiz Francisco Rocha e Silva
- Laboratório de Princípios Ativos da Amazônia, Coordenação de
Tecnologia e Inovação, Instituto Nacional de Pesquisas da Amazônia, Manaus, AM,
Brasil,Universidade Federal do Amazonas, Manaus, AM, Brasil,Centro Universitário do Norte, Manaus, AM, Brasil
| | | | | | | | - David Siqueira Costa
- Laboratório de Princípios Ativos da Amazônia, Coordenação de
Tecnologia e Inovação, Instituto Nacional de Pesquisas da Amazônia, Manaus, AM,
Brasil,Centro Universitário do Norte, Manaus, AM, Brasil
| | - Elba Vieira Mustafa
- Laboratório de Princípios Ativos da Amazônia, Coordenação de
Tecnologia e Inovação, Instituto Nacional de Pesquisas da Amazônia, Manaus, AM,
Brasil,Universidade Federal do Amazonas, Manaus, AM, Brasil
| | - Sabrina Kelly Reis de Morais
- Laboratório de Princípios Ativos da Amazônia, Coordenação de
Tecnologia e Inovação, Instituto Nacional de Pesquisas da Amazônia, Manaus, AM,
Brasil,Universidade Federal do Amazonas, Manaus, AM, Brasil
| | | | - Sergio Massayoshi Nunomura
- Laboratório de Princípios Ativos da Amazônia, Coordenação de
Tecnologia e Inovação, Instituto Nacional de Pesquisas da Amazônia, Manaus, AM,
Brasil
| | - Lena Struwe
- Rutgers, The State University of New Jersey, New Brunswick, NJ,
USA
| | | | - Adrian Martin Pohlit
- Laboratório de Princípios Ativos da Amazônia, Coordenação de
Tecnologia e Inovação, Instituto Nacional de Pesquisas da Amazônia, Manaus, AM,
Brasil,Corresponding author:
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22
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Silva LFRE, Magalhães PMD, Costa MRF, Alecrim MDGC, Chaves FCM, Hidalgo ADF, Pohlit AM, Vieira PPR. In vitro susceptibility of Plasmodium falciparum Welch field isolates to infusions prepared from Artemisia annua L. cultivated in the Brazilian Amazon. Mem Inst Oswaldo Cruz 2012; 107:859-66. [DOI: 10.1590/s0074-02762012000700004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 08/08/2012] [Indexed: 11/22/2022] Open
Affiliation(s)
- Luiz Francisco Rocha e Silva
- Instituto Nacional de Pesquisas da Amazônia, Brasil; Universidade do Estado do Amazonas, Brasil; Centro Universitário do Norte, Brasil
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23
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Lucena NOD, Pereira FR, Barros FSD, Silva NBD, Alexandre MADA, Castilho MDC, Alecrim MDGC. [HIV-1 infection after occupational accidents in the State of Amazonas: first reported case]. Rev Soc Bras Med Trop 2011; 44:646-7. [PMID: 22031087 DOI: 10.1590/s0037-86822011000500027] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 02/17/2011] [Indexed: 11/22/2022] Open
Abstract
The medical care of occupational accidents in Tropical Medicine Foundation Dr. Heitor Dourado (FMT-HVD), involving blood and body fluids, started routinely in 1999. The objective of this report is to emphasize the importance of the measures used for the control of accidents with biological material. This study is carried out after a detailed epidemiological investigation confirmed one case of human immunodeficiency virus (HIV) seroconversion after an occupational accident involving bodily fluids and sharp instruments.
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24
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Ferreira WA, Ferreira CM, Naveca FG, Almeida NCODS, Vasconcelos WDS, Gomes JDS, Silva MDFPD, Alecrim MDGC. Genotyping of two Neisseria gonorrhoeae fluroquinolone-resistant strains in the Brazilian Amazon Region. Mem Inst Oswaldo Cruz 2011; 106:629-31. [DOI: 10.1590/s0074-02762011000500018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 06/06/2011] [Indexed: 11/22/2022] Open
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25
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Rocha E Silva LF, Silva Pinto AC, Pohlit AM, Quignard ELJ, Vieira PPR, Tadei WP, Chaves FCM, Samonek JF, Lima CAJ, Costa MRF, Alecrim MDGC, Andrade-Neto VF. In vivo and in vitro antimalarial activity of 4-nerolidylcatechol. Phytother Res 2011; 25:1181-8. [PMID: 21302338 DOI: 10.1002/ptr.3424] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 01/03/2011] [Accepted: 01/05/2011] [Indexed: 11/10/2022]
Abstract
4-Nerolidylcatechol (4-NC) isolated from Piper peltatum L. (Piperaceae) was evaluated for in vitro antiplasmodial activity against Plasmodium falciparum (cultures of both standard CQR (K1) and CQS (3D7) strains and two Amazonian field isolates) and for in vivo antimalarial activity using the Plasmodium berghei-murine model. 4-NC exhibits significant in vitro and moderate in vivo antiplasmodial activity. 4-NC administered orally and subcutaneously at doses of 200, 400 and 600 mg/kg/day suppressed the growth of P. berghei by up to 63% after four daily treatments (days 1-4). Also, 4-NC exhibited important in vitro antiplasmodial activity against both standard and field P. falciparum strains in which 50% inhibition of parasite growth (IC(50) ) was produced at concentrations of 0.05-2.11 μg/mL and depended upon the parasite strain. Interestingly, healthy (non-infected) mice that received 4-NC orally presented (denatured) blood plasma which exhibited significant in vitro activity against P. falciparum. This is evidence that mouse metabolism allows 4-NC or active metabolites to enter the blood. Further chemical and pharmacological studies are necessary to confirm the potential of 4-NC as a new antimalarial prototype.
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26
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Melo GC, Reyes-Lecca RC, Vitor-Silva S, Monteiro WM, Martins M, Benzecry SG, Alecrim MDGC, Lacerda MVG. Concurrent helminthic infection protects schoolchildren with Plasmodium vivax from anemia. PLoS One 2010; 5:e11206. [PMID: 20574512 PMCID: PMC2888569 DOI: 10.1371/journal.pone.0011206] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 05/18/2010] [Indexed: 01/11/2023] Open
Abstract
Background Plasmodium vivax is responsible for a significant portion of malaria cases worldwide, especially in Asia and Latin America, where geo-helminthiasis have a high prevalence. Impact of the interaction between vivax malaria and intestinal helminthes has been poorly explored. The objective of this study was to evaluate the influence of intestinal helminthiasis on the concentration of hemoglobin in children with Plasmodium vivax malaria in rural areas in the municipality of Careiro, in the Western Brazilian Amazon. Methodology/Principal Findings A cohort study was conducted from April to November 2008, enrolling children from 5 to 14 years old in two rural areas endemic for malaria. A cross-sectional evaluation was performed in April to actively detect cases of malaria and document baseline hemoglobin and nutritional status. Children were followed-up for six months through passive case detection of malaria based on light microscopy. Throughout the follow-up interval, hemoglobin value and stool examination (three samples on alternate days) were performed on children who developed P. vivax malaria. For 54 schoolchildren with a single infection by P. vivax, hemoglobin during the malaria episode was similar to the baseline hemoglobin for children co-infected with Ascaris lumbricoides (n = 18), hookworm (n = 11) and Trichuris trichiura (n = 9). In children without intestinal helminthes, a significant decrease in the hemoglobin during the malarial attack was seen as compared to the baseline concentration. In the survival analysis, no difference was seen in the time (in days) from the baseline cross-sectional to the first malarial infection, between parasitized and non-parasitized children. Conclusion/Significance For the first time, a cohort study showed that intestinal helminthes protect against hemoglobin decrease during an acute malarial attack by P. vivax.
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Affiliation(s)
| | | | | | | | - Marilaine Martins
- Tropical Medicine Foundation of Amazonas, Manaus, Amazonas, Brazil
- University of the State of Amazonas, Manaus, Amazonas, Brazil
| | | | | | - Marcus Vinícius Guimarães Lacerda
- Tropical Medicine Foundation of Amazonas, Manaus, Amazonas, Brazil
- University of the State of Amazonas, Manaus, Amazonas, Brazil
- Nilton Lins Universitary Center, Manaus, Amazonas, Brazil
- * E-mail:
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dos Santos MC, de Albuquerque BC, Pinto RC, Aguiar GP, Lescano AG, Santos JHA, Alecrim MDGC. Outbreak of Haff disease in the Brazilian Amazon. Rev Panam Salud Publica 2010; 26:469-70. [PMID: 20107699 DOI: 10.1590/s1020-49892009001100012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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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28
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Santos MCD, de Albuquerque BC, Monte RL, Filho GG, Alecrim MDGC. Outbreak of chemical meningitis following spinal anesthesia caused by chemically related bupivacaine. Infect Control Hosp Epidemiol 2009; 30:922-4. [PMID: 19653822 DOI: 10.1086/599358] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lacerda MVGD, Mourão MPG, Santos PJTD, Alecrim MDGC. [Algid malaria: a syndromic diagnosis]. Rev Soc Bras Med Trop 2009; 42:79-81. [PMID: 19287942 DOI: 10.1590/s0037-86822009000100017] [Citation(s) in RCA: 4] [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: 10/13/2008] [Accepted: 01/19/2009] [Indexed: 11/21/2022] Open
Abstract
Two patients with malaria due to Plasmodium falciparum who progressed to shock syndrome are reported. They received hemodynamic support in an intensive care unit without using antibiotics and presented improvements. Algid malaria should be a syndromic diagnosis of varying etiology (dehydration, bacterial infection, bleeding and/or adrenal insufficiency).
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30
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Costa MRF, Vieira PPR, Ferreira CDO, Lacerda MVGD, Alecrim WD, Alecrim MDGC. Diagnóstico molecular da malária em uma unidade de atenção terciária na Amazônia Brasileira. Rev Soc Bras Med Trop 2008; 41:381-5. [DOI: 10.1590/s0037-86822008000400011] [Citation(s) in RCA: 7] [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: 05/14/2007] [Accepted: 07/02/2008] [Indexed: 11/21/2022] Open
Abstract
O exame de rotina para o diagnóstico da malária continua sendo a gota espessa, apesar da comprovada diminuição da sensibilidade e especificidade em situações de densidade parasitária baixa e infecções mistas. A reação em cadeia da polimerase vem sendo cada vez mais utilizada para a detecção molecular e identificação das espécies de plasmódio, por apresentar maior sensibilidade e especificidade. Foi realizada a nested-PCR em amostras de sangue total de 344 pacientes com síndrome febril aguda que se apresentaram para o diagnóstico de malária, em uma unidade terciária de saúde, em Manaus (Amazonas). Nenhum caso de malária por Plasmodium malariae foi diagnosticado à gota espessa ou PCR. Observou-se co-positividade de 96,7%, co-negatividade de 62,2% e coeficiente kappa de 0,44 entre PCR e gota espessa para Plasmodium falciparum. Para Plasmodium vivax, co-positividade de 100%, co-negatividade de 78,1% e coeficiente kappa de 0,56. Na detecção da malária mista, co-positividade de 100%, co-negatividade de 84,9% e coeficiente kappa de 0,26. A reação em cadeia da polimerase detectou alto número de infecções mistas nas amostras analisadas, mas seu uso rotineiro no diagnóstico da malária merece ainda ampla discussão.
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Filho FSDS, Arcanjo ARDL, Chehuan YM, Costa MR, Martinez-Espinosa FE, Vieira JL, Barbosa MDGV, Alecrim WD, Alecrim MDGC. Chloroquine-resistant Plasmodium vivax, Brazilian Amazon. Emerg Infect Dis 2008; 13:1125-6. [PMID: 18214203 PMCID: PMC2878224 DOI: 10.3201/eid1307.061386] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | | | - Flor Ernestina Martinez-Espinosa
- Foundation for Tropical Medicine of Amazonas, Manaus, Amazonas, Brazil
- Foundation for Research Support of Amazonas, Manaus, Amazonas, Brazil
| | | | - Maria das Graças Vale Barbosa
- Foundation for Tropical Medicine of Amazonas, Manaus, Amazonas, Brazil
- Amazonas State University, Manaus, Amazonas, Brazil
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Santana MS, da Rocha MAF, Arcanjo ARL, Sardinha JFJ, Alecrim WD, Alecrim MDGC. [Association of methemoglobinemia and glucose-6-phosphate dehydrogenase deficiency in malaria patients treated with primaquine]. Rev Soc Bras Med Trop 2008; 40:533-6. [PMID: 17992408 DOI: 10.1590/s0037-86822007000500008] [Citation(s) in RCA: 15] [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: 04/24/2007] [Accepted: 08/20/2007] [Indexed: 01/09/2023] Open
Abstract
This study had the aim of investigating occurrences of methemoglobinemia among individuals with glucose-6-phosphate dehydrogenase deficiency during treatment for malaria infection using primaquine. Patients with a diagnosis of malaria caused by Plasmodium vivax or the V+F mixture (Plasmodium vivax + Plasmodium falciparum) were selected. Group 1 consisted of 74 individuals with a clinical diagnosis of methemoglobinemia and Group 2 consisted of 161 individuals without a clinical diagnosis of methemoglobinemia. The glucose-6-phosphate dehydrogenase deficiency rates (numbers of enzymopenic individuals) in Groups 1 and 2 were 51.3% (38) and 8.7% (14) respectively. These data demonstrated a statistically significant association with methemoglobinemia only among the individuals in Group 1 (p<0.05). Investigation of the relationship between methemoglobinemia and glucose-6-phosphate dehydrogenase deficiency showed that there was a possible association such that enzymopenic individuals may develop methemoglobinemia more frequently.
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Affiliation(s)
- Marli Stela Santana
- Gerência de Malária, Fundação de Medicina Tropical do Amazonas, Avenida Pedro Teixeira 25, Bairro D. Pedro I, Manaus, AM.
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Arcanjo ARL, de Lacerda MVG, Alecrim WD, Alecrim MDGC. [Evaluation of the Optimal-IT and ICT P.f./P.v. rapid dipstick tests for diagnosing malaria within primary healthcare in the municipality of Manaus, Amazonas]. Rev Soc Bras Med Trop 2007; 40:88-90. [PMID: 17486264 DOI: 10.1590/s0037-86822007000100020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Accepted: 01/19/2007] [Indexed: 11/22/2022] Open
Abstract
Malaria is routinely diagnosed using the thick blood smear test. However, this technique requires the training of microscopists and may be time-consuming. A concordance study was conducted on two dipstick tests (Optimal-IT and ICT P.f./P.v.) and the thick blood smear test, within primary healthcare in Manaus.
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Alecrim MDGC, de Lacerda MVG, Mourão MPG, Alecrim WD, Padilha A, Cardoso B, Boulos M. First Brazilian experience with the use of artemether-lumefantrine (Coartem) a fixed-dosed ACT combination. Am J Trop Med Hyg 2006; 75:187. [PMID: 16896116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
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Alecrim MDGC, Carvalho LM, Andrade SD, Arcanjo ARL, Alexandre MA, Alecrim WD. [Treatment of children with malaria Plasmodium falciparum with derivatives artemisinin]. Rev Soc Bras Med Trop 2003; 36:223-6. [PMID: 12806458 DOI: 10.1590/s0037-86822003000200005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
From January 1996 to December 1998, artemisinin derivatives were prescribed to 108 children infected with Plasmodium falciparum. The therapeutic effect was evaluated. Only children with moderate or severe malaria were included. Group I (intravenous artesunate; n = 62): 50.8% with moderate malaria and 49.2% with severe malaria; 53.2% with mild parasitemia, 22.6% with moderate parasitemia and 24.2% with high parasitemia; Group II (intramuscular artemether [Paluter ]; n = 46): 67.4% with moderate malaria and 32.6% with severe malaria; 52.2% with mild parasitemia, 36.2% with moderate parasitemia and 15.2% with high parasitemia; clinical amelioration and clearance of parasitemia showed no statistical difference between the groups. All patients cleared the parasitemia at the seventh day of follow-up (D7). In order to avoid recrudescence, mefloquine or clindamycin was used.
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Abstract
As características clínicas da malária falciparum foram estudadas em 61 crianças com idade de 0 a 14 anos, atendidas em centro de referência em Manaus, entre outubro e dezembro de 1997. Os sintomas encontrados foram febre (98,4%), cefaléia (80,3%), calafrios (68,9%), sudorese (65,6%), mialgia (59%), náuseas (54,1%), lombalgia (49,2%), vômitos (49,2%), tosse (45,9%), artralgia (31,1%), diarréia (34,4%), dispnéia (8,2%), convulsões (8,2%) e tonturas (4,9%). Palidez cutâneo-mucosa e anemia foram observadas mais freqüentemente nas crianças menores de 5 anos. A anemia esteve asssociada aos maiores níveis de parasitemia. Cinqüenta e oito (91,5%) pacientes apresentaram malária não complicada, 3 (4,9%) malária grave e a letalidade foi 1,6%.
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