Alta prevalência do genótipo 1 em portadores de hepatite C crônica em Belo Horizonte, MG

O vírus da hepatite C é caracterizado pela significativa heterogeneidade genética e é atualmente classificado em seis genótipos principais e diversos subtipos. A determinação do genótipo do vírus tem importância na prática clínica para orientar o tratamento dos pacientes portadores de hepatite C crônica. A prevalência dos diferentes genótipos e subtipos do vírus da hepatite C não tem sido amplamente estudada em algumas regiões do Brasil. Neste estudo foram analisadas 788 amostras de pacientes portadores de hepatite C crônica atendidos nos Centros de Referência em Hepatites Virais de Belo Horizonte, entre 2002 e 2006. A genotipagem do vírus foi realizada por seqüenciamento direto da região 5’ UTR. Adicionalmente, foi realizada análise filogenética incluindo todas as variantes genotípicas obtidas. Observou-se alta prevalência do genótipo 1 (78,4%; 1b [40,4%], 1a [37,5%] e 1a/b [0,5 %]), seguida pelo genótipo 3a (17,9%) e pelo 2b (3,1%). Foram identificadas três amostras (0,4%) com o genótipo 2a/c e duas amostras (0,2%) com o genótipo 4. A análise filogenética mostrou a segregação esperada das seqüências obtidas junto às seqüências de referência para os genótipos 1, 2, 3 e 4, exceto em duas amostras do genótipo 1a. A alta prevalência do genótipo 1 (78,4%), encontrada na população de Belo Horizonte é semelhante à previamente descrita em outras cidades, como Rio de Janeiro, mas superior à encontrada em São Paulo e no Sul do país. A presença de raras seqüências atípicas da região 5’UTR sugere a presença de variantes do vírus da hepatite C nesta população.

Gender influence on treatment of chronic hepatitis C genotype 1

INTRODUCTION: Although various studies have been published regarding the treatment of chronic hepatitis C (CHC) with peginterferon (Peg-IFN) and ribavirin, little is known regarding the real impact of gender on the characteristics that influence the effectiveness and safety of antiviral treatment for CHC patients. The objective of this study was to evaluate the influence of gender on HCV treatment outcomes. METHODS: A retrospective analytical study was conducted among selected carriers of CHC genotype 1, who were treated with Peg-IFN α-2b at a dose of 1.5 μg/kg or Peg-IFN α-2a at a dose of 180 μg/week plus a ribavirin dose of 1,000-1,250 mg/day, according to weight, between 2001 and 2007. RESULTS: Among 181 patients undergoing treatment, the mean age was 46.4 ± 11.0 years and 46% were women. At baseline, 32% of the patients had advanced fibrosis (F3-F4 Scheuer), and 83% of the subjects had viral load > 400,000 IU/ml, without significant difference between the genders (p = 0.428 and p = 0.452, respectively). When compared with men, women had higher incidence of many adverse events such as anemia (p < 0.001) and higher need for dose reduction, for both Peg-IFN (p = 0.004) and ribavirin (p = 0.006). However, the rate of sustained virological response (SVR) did not differ between the genders: 45% (female) vs 41% (male); p=0.464. CONCLUSIONS: This study suggests that women and men react differently to combined therapy, especially in relation to the incidence of adverse events and the need for dose modification. Nevertheless, these differences do not influence the SVR rate.

Antimicrobial resistance and investigation of the molecular epidemiology of Listeria monocytogenes in dairy products

INTRODUCTION: Listeria monocytogenes is a ubiquitous microorganism in nature and is responsible for listeriosis, an infectious disease caused by consumption of contaminated food. METHODS: Molecular characterization was performed on 19 strains of Listeria monocytogenes (serovars 1/2a, 1/2b, 4b and 4c), isolated from dairy products in Rio Grande do Sul, Brazil. The molecular techniques applied were random amplification of polymorphic DNA and restriction enzyme analysis. In addition to the molecular analysis, the antimicrobial resistance profile was determined. RESULTS: The strains studied showed a low degree of diversity. In relation to the antimicrobial resistance profile of those microorganisms from the samples analyzed, all of them were susceptible to the antimicrobials tested. CONCLUSIONS: The molecular techniques that were used presented good discriminatory power for the strains studied. Furthermore, all of the samples that were analyzed were susceptible to the antimicrobials tested.

Resposta virológica sustentada em pacientes com co-infecção pelos genótipos 1 e 2 do vírus da hepatite C, com apenas nove semanas de terapêutica antiviral: relato de caso

Relata-se um paciente do sexo masculino com 67 anos e sorologia positiva para o vírus da hepatite C (HCV). Exames moleculares revelaram a presença do RNA do HCV, com carga viral de 2.000 cópias/mL e genótipos 1 e 2. O tratamento foi com alfapeginterferon-2a, 180mcg/semana e ribavirina, 1.000mg/dia. Na quarta semana de tratamento, a carga viral para o HCV era indetectável. Na nona semana, o paciente apresentou hematêmese, piora do quadro de astenia, inapetência e comprometimento do estado geral, quando o tratamento foi descontinuado. O PCR foi negativo após 6 meses e permaneceu assim após um ano. O paciente encontra-se assintomático.

Antimicrobial susceptibilities of Listeria monocytogenes human strains isolated from 1970 to 2008 in Brazil

INTRODUCTION: Listeria monocytogenes is the causative agent of listeriosis, a foodborne illness that affects mainly pregnant women, the elderly and immunocompromised patients. The primary treatment is a combination of ampicillin with an aminoglycoside, in addition to a second-choice drug represented by chloramphenicol, erythromycin, tetracycline and rifampicin. The aim of this study was to analyze the antimicrobial susceptibility profile of strains isolated from human sources in the last four decades. METHODS: Sixty-eight strains were selected from the culture collection of the Laboratory of Bacterial Zoonoses/LABZOO/FIOCRUZ isolated in different regions of Brazil from 1970 to 2008 and primarily isolated from cerebrospinal fluid and blood culture. Susceptibility tests to antimicrobials drugs were evaluated using the criteria established by Soussy using the Kirby-Bauer method and E-Test strips were used to determine the minimum inhibitory concentration (MIC). RESULTS: Among the strains tested, serovar L4b (60.3%) was the most prevalent, followed by serovar 1/2a (20.6%), 1/2b (13.2%) and the more uncommon serovars 1/2c, 3b and 4ab (5.9%). All strains were susceptible to ampicillin, cephalothin, erythromycin, gentamicin, teicoplanin and vancomycin. Only one strain (1.5%) showed resistance to rifampin, and two (3%) were resistant to trimethoprim-sulfamethoxazole. MICs with values up to 2μg/ml reinforce the need for microbiological surveillance. CONCLUSIONS: The study demonstrated low prevalence of strains resistant to the antimicrobial drugs indicated in the treatment of human listeriosis. Monitoring antimicrobial resistance profile is still very important to determine adequate treatment, especially in immunocompromised patients.

Evaluation of the therapeutic response of hepatitis C in coinfected patients (HIV/HCV): a study of cases from a hospital for chronic liver diseases in the Eastern Brazilian Amazon

INTRODUCTION: The aim of this study was to evaluate the therapeutic response of hepatitis C in patients coinfected with human immunodeficiency virus (HIV-1). METHODS: A retrospective study of 20 patients coinfected with HIV-1/HCV who were treated in the outpatient liver clinic at the Sacred House of Mercy Foundation Hospital of Pará (Fundação Santa Casa de Misericórdia do Pará - FSCMPA) from April 2004 to June 2009. Patients were treated with 180µg PEG interferon-α2a in combination with ribavirin (1,000 to 1,250mg/day) for 48 weeks. The end point was the sustained virological response (SVR) rate (HCV RNA negative 24 weeks after completing treatment). RESULTS: The mean age of the patients was 40±9.5 years, of which 89% (n=17) were male, and the HCV genotypes were genotype 1 (55%, n=11/20), genotype 2 (10%, n=2/20) and genotype 3 (35%, n=7/20). The mean CD4+ lymphocyte count was 507.8, and the liver fibrosis stages were (METAVIR) F1 (25%), F2 (55%), F3 (10%) and F4 (10%). The early virological response (EVR) was 60%, the end-of-treatment virological response (EOTVR) was 45% and the SVR was 45%. CONCLUSIONS: The median HCV viral load was high, and in 85% of cases in which highly active antiretroviral therapy (HAART) was used, none of the patients with F3-F4 fibrosis responded to treatment. Of the twenty patients treated, 45% achieved SVR and 45% achieved EOTVR. Studies that include cases from a wider region are needed to better evaluate these findings.

Registro de 24 horas da pressão arterial em tabagistas e não-tabagistas

OBJETIVO: Avaliar o efeito do tabagismo sobre o comportamento da pressão arterial durante 24 horas, mediante análise dos parâmetros da monitorização ambulatorial da pressão arterial (MAPA). MÉTODOS: Foram estudados 289 exames de MAPA de pacientes classificados como fumantes ou não-fumantes. Os parâmetros analisados foram: médias pressóricas sistólica e diastólica durante 24 horas, na vigília e no sono, descenso noturno sistólico e diastólico e cargas pressóricas. De acordo com o uso ou não de medicação anti-hipertensiva, foram subdivididos em quatro grupos: 1A - com medicação, não-tabagistas; 1B - com medicação, tabagistas; 2A - sem medicação, não-tabagistas; e 2B - sem medicação, tabagistas. Foram descritas as variáveis por valores mínimo, máximo, mediana, média e desvio-padrão e foi feita a análise univariada, com comparação dos grupos de fumantes e não-fumantes. A análise multivariada selecionou as variáveis significativamente diferentes entre os grupos e o nível de significância adotado foi de 5%. RESULTADOS: As médias pressóricas sistólica e diastólica na vigília foram significativamente mais elevadas nos tabagistas, que usavam ou não medicação anti-hipertensiva. As médias pressóricas noturnas foram semelhantes entre tabagistas e não-tabagistas. As médias pressóricas sistólicas nas 24 horas foram significativamente mais elevadas nos tabagistas em uso ou não de medicação. O descenso noturno não diferiu entre os grupos. As cargas pressóricas foram significativamente mais elevadas nos tabagistas em todos os períodos, independentemente do uso de medicação. CONCLUSÃO: Tabagistas apresentam, durante a vigília, médias pressóricas, sistólicas e diastólicas maiores que os não-tabagistas, independentemente do uso de medicação anti-hipertensiva. Não há diferença no descenso noturno entre tabagistas e não-tabagistas.

Classificação do diabete melito

A correta classificação do diabete melito (DM) permite o tratamento mais adequado e compreende quatro categorias: DM tipo 1; DM tipo 2; Outros tipos e Diabete Gestacional. Em alguns casos, pode ocorrer sobreposição de quadros, principalmente no DM que inicia no adulto jovem ou que se apresenta inicialmente com cetoacidose, intermediários ao DM 1 e DM 2. Assim, acréscimos ao sistema de classificação clássico têm sido propostos, avaliando a presença de autoimunidade (anticorpos) e a função de célula β (peptídeo-C) para definir mais precisamente os subtipos. O objetivo desta revisão foi de analisar o desempenho desses índices diagnósticos para a classificação do DM e descrever os subtipos em detalhe. Os anticorpos contra o pâncreas evidenciam a autoimunidade, sendo o anticorpo contra insulina o mais acurado antes dos 5 anos de idade e o anti-descarboxilase do ácido glutâmico para início da doença acima dos 20 anos, é esse o teste que permanece positivo por mais tempo. Já a medida do peptídeo-C avalia a reserva pancreática de insulina, e os métodos de estímulo mais usados são a medida após refeição ou após glucagon endovenoso. Valores de peptídeo-C < 1,5 ng/ml definem o paciente com função pancreática ausente, e acima desse valor, com função preservada. Combinando-se a presença de anticorpos (A+) dirigidos ao pâncreas e a sua capacidade secretória de insulina (β+), pode-se subdividir a classificação do DM em tipo 1A (A+β-) e 1B (A+ β-); e o DM tipo 2 em subgrupos de DM 2A (A+β+) e DM 2B (A-β+), o que permite uma classificação e tratamento mais precisos, além de abrir os horizontes para o entendimento da patogênese do DM.

O tratamento de pré-emergência com o 2, 4-D no milho

In order to study the action of herbicides - sodium salt, amine salt and ester of 2,4-D, TCA and 2,4,5-T a preliminary experiment for pre-emergence weed control was corried out, and the corresponding results are given in table I and II. The corn used in the experiments was of the flint type 1A 3531. The loam soil on which the experiment has been carried out is called "terra roxa". All treatments were highly significant when compared with the check plots, except the 2B one in the control of broad leaf weeds, and 4B in the control of grass weeds. Among these treatments there are no significant differences. But we note the following: (table I). a) treatments of higher concentrations were superior to lower ones. b) the treatments which gave the best control for broad leaf weeds were in the following decreasing order: 1A, 5A and 3A. For grass weeds, they were 5A, 1A and 3A. c) the amine 2,4-D (600 grs. per hectare) supplied very good control when we get into consideration that on the acid basis, it was in very low concentration. d) TCA in high concentration affected the germination, growth and yield, in the lower one it did not show good control of weeds, especially of grasses. It is not suitable for pre-emergence control in corn. e) 2,4,5-T was not better than the 2,4-D products. As it is much more expensive than the others, economically its use in pre-emergence weed control in corn is not praticable. f) all the products used controled grass weeds as well as broad leaf ones; this show the superiority of the pre-emergence treatment method over that of post-emergence. g) Even a dose as strong as the treatment 1A (3.400g. of 2,4-D acid per hectare) did not damage corn production (table II). h) the superiority noted in the production of all the treatments with the exception of 2A, which damaged the plants, we atribute to the lack of competion between corn and weeds; all chek-plots suffered this competition, because they were not Probably, there was, also, hormonial effect of 2,4-D on the corn plant. Not withstanding the fact that the present experiment has been successful, we think that new researches are necessary, especially with the purpose of studying factors as climate and soil which in other countries, interferred with the success of the pre-emergence weed control.

Pesquisa de Listeria monocytogenes em solos

Foi investigada a presençaa de L. monocytogenes em 20 amostras de solos da superficie, oriundas de diferentes áreas ecológicas do Estado do Rio de Janeiro (perímetro urbano, pasto, mata e horta). A análise bacteriológica evidenciou 32 amostras do microrganismo, revelando maior incidencia no solo não cultivado (mata) que representou 56,25% dos isolamentos, ficando em segundo plano a area urbana com 25%. No levantamento, destacam-se os sorotipos L1/2b (46,87%), L4b (25%) e L1/2a (18,75%) como os mais frequentes, embora incidindo de mameira heterogenea em relação as áreas analisadas. Entre os vários aspectos estudados, salienta-se que 50% das amostras se comportaram como patogenicas, em decorrencia da producao de ceratoconjuntivite em cobaia, detalhe este intimamente relacionado com a atividade hemolitica "in vitro". Confirma-se que tanto as formas virulenta e avirulenta de L. monocytogenes sobrevivem as condicoes impostas pelo solo, sendo provavelmente a causa primária desta contaminação os dejetos eliminados por diferentes espécies de animais portadores, corroborada pela presença de coliformes fecais nas áreas analisadas.

Species and serovars of the genus Listeria lsolated from different sources in Brazil from 1971 to 1997

Using phenotype techniques, characterization was made to species and serovar of 3,112 strains of Listeria, isolated from different sources of infection such as human (247-7.9%) and animals (239-7.6%), as well as from various routes of infection, including food (2,330-74.8%) and environmental constituents (296-9.5%), all coming from different regions of the country and collected during the period 1971-1997. The following species were recovered in the cultures analysed: L. monocytogenes (774-24.8%), L. innocua (2,269-72.9%), L. seeligeri (37-1.1%), L. welshimeri (22-0.7%), L. grayi (9-0.2%), and L. ivanovii (1-0.03%). L. monocytogenes was represented by ten serovars, the most prevalent being 4b (352-11.3%), 1/2a (162-5.2%), and 1/2b (148-4.7%). The predominant serovar in L. innocua was 6a (2,093-67.2%). Considerations about laboratory methods for diagnosis and epidemiological aspects are presented on the basis of the results obtained.

Prevalence and genotypes of GB Virus C/Hepatitis G virus among blood donors in Central Brazil

A survey was conducted in a blood donor population of Central Brazil aiming to investigate the prevalence of GB virus C (GBV-C)/hepatitis G virus (HGV) infection and also to analyze the virus genotypes distribution. A total of 241 voluntary blood donors were interviewed at the State Blood Bank in Goiânia, State of Goiás, Brazil. Blood samples were collected and serum samples tested for GBV-C/HGV RNA by polymerase chain reaction. Genotypes were determined by restriction fragment length polymorphism (RFLP) analysis. Seventeen samples were GBV-C/HGV RNA-positive, resulting in a prevalence of 7.1% (95% CI: 4.2-11.1). A significant trend of GBV-C/HGV RNA positivity in relation to age was observed, with the highest prevalence in donors between 29-39 years old. Ten infected individuals were characterized by reporting parenteral (30%), sexual (18%), both (6%) and intrafamiliar (6%) transmission. However, 7 (40%) GBV-C/HGV RNA-positive donors did not mention any potential transmission route. RFLP analysis revealed the presence of genotypes 1 and 2 of GBV-C/HGV; more precisely, 10 (58.9%) samples were found belonging to the 2b subtype, 4 (23.5%) to the 2a subtype, and 3 (17.6%) to genotype 1. The present data indicate an intermediate endemicity of GBV-C/HGV infection among this blood donor population, and a predominant circulation of genotype 2 (subtype 2b) in Central Brazil.

GB virus C/hepatitis G virus infection in dialysis patients and kidney transplant recipients in central Brazil

In order to investigate the prevalence of GB virus C (GBV-C)/hepatitis G virus (HGV) infection in dialysis patients and kidney transplant recipients in Central Brazil and also to analyze the virus genotypes distribution, a total of 123 patients including 98 on hemodialysis, 13 on continuous ambulatory peritoneal dialysis treatment, and 12 who received kidney transplantation were interviewed in one unit of dialysis treatment in Goiânia city. Blood samples were collected and serum samples tested for GBV-C/HGV RNA by polymerase chain reaction. Genotypes were determined by restriction fragment length polymorphism (RFLP) analysis. Eighteen samples were GBV-C/HGV RNA-positive, resulting in an overall prevalence of 14.6% (95% CI: 9.2-21.7). A high positivity for GBV-C/HGV RNA was observed in patients who had received kidney transplant (16.7%), followed by those on hemodialysis (15.3%), and peritoneal dialysis (7.7%). RFLP analysis revealed the presence of genotypes 1, 2, and 3 of GBV-C/HGV; more precisely, 9 (50%) samples were found belonging to the 2b subtype, 4 (22%) to the 2a subtype, 3 (17%) to genotype 1, and 2 (11%) to genotype 3. The present data indicate an intermediate prevalence of GBV-C/HGV infection among dialysis patients and kidney transplant recipients in Central Brazil. Genotype 2 (subtype 2b) seems to be the most prevalent GBV-C/HGV genotype in our region.

Frequency of serovars and antimicrobial resistance in Shigella spp. from Brazil

A total of 296 Shigella spp. were received from State Public Health Laboratories, during the period from 1999 to 2004, by National Reference Laboratory for Cholera and Enteric Diseases (NRLCED) - IOC/Fiocruz, Rio de Janeiro, Brazil. The frequency of Shigella spp. was: S. flexneri (52.7%), S. sonnei (44.2%), S. boydii (2.3%), and S. dysenteriae (0.6%). The most frequent S. flexneri serovars were 2a and 1b. The highest incidence rates of Shigella isolation were observed in the Southeast (39%) and Northeast (34%) regions and the lowest rate in the South (3%) of Brazil. Strains were further analyzed for antimicrobial susceptibility by disk diffusion method as part of a surveillance program on antimicrobial resistance. The highest rates of antimicrobial resistance were to trimethoprim-sulfamethozaxole (90%), tetracycline (88%), ampicillin (56%), and chloramphenicol (35%). The patterns of antimicrobial resistance among Shigella isolates pose a major difficulty in the determination of an appropriate drug for shigellosis treatment. Continuous monitoring of antimicrobial susceptibilities of Shigella spp. through a surveillance system is thus essential for effective therapy and control measures against shigellosis.

Hepatitis A virus subgenotypes dissemination during a community outbreak in a surrounding region of Rio de Janeiro

From December 1999 to December 2001, many cases of hepatitis A were notified in the county of Belford Roxo involving individuals aged 0 to 79 years. Serum samples were collected to evaluate the prevalence of anti-hepatitis A virus (HAV) antibodies, to detect HAV-RNA and to correlate with possible risk factors of HAV infection. Serum samples were screened by commercial IgM and total anti-HAV antibody ELISA and HAV-RNA was isolated and subsequently amplified by reverse transcription-polymerase chain reaction (RT-PCR) at VP1/2A region, sequenced and analyzed. Total anti-HAV prevalence was 87.9% (203/231) and IgM anti-HAV prevalence was 38.7% (89/231). Multivariate analysis showed that individuals under 20 years old are risks groups to acquire the infection suggesting that hygienic habits of young subjects are the principal factor of transmission and so they could be the target for vaccine programs. HAV-RNA was amplified from 29 (32.5%) IgM anti-HAV positive patients and 26 samples were sequenced and classified into subgenotypes IB (8 isolates) and IA (18 isolates). Isolates classified into subgenotype IB were identical representing one distinct strain. We could observe both subgenotypes circulating during the study which suggests different sources of infection. Prophylactic measures as vaccination strategies added to improvements in hygienic and sanitary conditions would be highly effective to reduction of infection.