Prevalence and associated factors of TB/HIV co-infection among HIV Infected patients in Amhara region, Ethiopia.

Background: Tuberculosis is one of the world’s most common causes of death in the era of Human immunodeficiency virus. The purpose of this study was to determine the prevalence and associated factors of TB/HIV co-infection. Methods: Hospital based retrospective studies were conducted among adult HIV-positive patients. Logistic regression method and Chi square test were applied. Results: A total of 571 HIV positive study participants were enrolled. Of these, 158 (27.7%) were found to have pulmonary tuberculosis. Lower baseline CD4 count<200cell/μl, patients who drunk alcohol, patients who were ambulatory at the initiation of ART, patients whose marital status was single were significant predictors for increased risk of tuberculosis in PLWHIV (P <0.05). Non smoker patients, patients in WHO clinical stage I, patients in WHO clinical stage II and ownership of the house had significant protective benefit against risk of TB (P <0.05). Conclusion: The prevalence of TB/HIV co-infection in adults on ART in our study was moderately high. Having advanced clinical status and presence of risk factors were found to be the predicting factors for co-infection. The health office should open TB/HIV co-infection units in the hospitals and health workers should be cautious when a patient has an advanced disease.

Cynomolgus monkeys ( Macaca fascicularis ) experimentally infected with B19V and hepatitis A virus: no evidence of the co-infection as a cause of acute liver failure

This study was conducted to analyse the course and the outcome of the liver disease in the co-infected animals in order to evaluate a possible synergic effect of human parvovirus B19 (B19V) and hepatitis A virus (HAV) co-infection. Nine adult cynomolgus monkeys were inoculated with serum obtained from a fatal case of B19V infection and/or a faecal suspension of acute HAV. The presence of specific antibodies to HAV and B19V, liver enzyme levels, viraemia, haematological changes, and necroinflammatory liver lesions were used for monitoring the infections. Seroconversion was confirmed in all infected groups. A similar pattern of B19V infection to human disease was observed, which was characterised by high and persistent viraemia in association with reticulocytopenia and mild to moderate anaemia during the period of investigation (59 days). Additionally, the intranuclear inclusion bodies were observed in pro-erythroblast cell from an infected cynomolgus and B19V Ag in hepatocytes. The erythroid hypoplasia and decrease in lymphocyte counts were more evident in the co-infected group. The present results demonstrated, for the first time, the susceptibility of cynomolgus to B19V infection, but it did not show a worsening of liver histopathology in the co-infected group.

High Rates of Detection of Respiratory Viruses in Tonsillar Tissues from Children with Chronic Adenotonsillar Disease

Chronic tonsillar diseases are an important health problem, leading to large numbers of surgical procedures worldwide. Little is known about pathogenesis of these diseases. In order to investigate the role of respiratory viruses in chronic adenotonsillar diseases, we developed a cross-sectional study to determine the rates of viral detections of common respiratory viruses detected by TaqMan real time PCR (qPCR) in nasopharyngeal secretions, tonsillar tissues and peripheral blood from 121 children with chronic tonsillar diseases, without symptoms of acute respiratory infections. At least one respiratory virus was detected in 97.5% of patients. The viral co-infection rate was 69.5%. The most frequently detected viruses were human adenovirus in 47.1%, human enterovirus in 40.5%, human rhinovirus in 38%, human bocavirus in 29.8%, human metapneumovirus in 17.4% and human respiratory syncytial virus in 15.7%. Results of qPCR varied widely between sample sites: human adenovirus, human bocavirus and human enterovirus were predominantly detected in tissues, while human rhinovirus was more frequently detected in secretions. Rates of virus detection were remarkably high in tonsil tissues: over 85% in adenoids and close to 70% in palatine tonsils. In addition, overall virus detection rates were higher in more hypertrophic than in smaller adenoids (p = 0.05), and in the particular case of human enteroviruses, they were detected more frequently (p = 0.05) in larger palatine tonsils than in smaller ones. While persistence/latency of DNA viruses in tonsillar tissues has been documented, such is not the case of RNA viruses. Respiratory viruses are highly prevalent in adenoids and palatine tonsils of patients with chronic tonsillar diseases, and persistence of these viruses in tonsils may stimulate chronic inflammation and play a role in the pathogenesis of these diseases.

Severe lower respiratory tract infection in infants and toddlers from a non-affluent population: viral etiology and co-detection as risk factors

Abstract Background Lower respiratory tract infection (LRTI) is a major cause of pediatric morbidity and mortality, especially among non-affluent communities. In this study we determine the impact of respiratory viruses and how viral co-detections/infections can affect clinical LRTI severity in children in a hospital setting. Methods Patients younger than 3 years of age admitted to a tertiary hospital in Brazil during the months of high prevalence of respiratory viruses had samples collected from nasopharyngeal aspiration. These samples were tested for 13 different respiratory viruses through real-time PCR (rt-PCR). Patients were followed during hospitalization, and clinical data and population characteristics were collected during that period and at discharge to evaluate severity markers, especially length of hospital stay and oxygen use. Univariate regression analyses identified potential risk factors and multivariate logistic regressions were used to determine the impact of specific viral detections as well as viral co-detections in relation to clinical outcomes. Results We analyzed 260 episodes of LRTI with a viral detection rate of 85% (n = 222). Co-detection was observed in 65% of all virus-positive episodes. The most prevalent virus was Respiratory Syncytial Virus (RSV) (54%), followed by Human Metapneumovirus (hMPV) (32%) and Human Rhinovirus (HRV) (21%). In the multivariate models, infants with co-detection of HRV + RSV stayed 4.5 extra days (p = 0.004), when compared to infants without the co-detection. The same trends were observed for the outcome of days of supplemental oxygen use. Conclusions Although RSV remains as the main cause of LRTI in infants our study indicates an increase in the length of hospital stay and oxygen use in infants with HRV detected by RT-PCR compared to those without HRV. Moreover, one can speculate that when HRV is detected simultaneously with RSV there is an additive effect that may be reflected in more severe clinical outcome. Also, our study identified a significant number of children infected by recently identified viruses, such as hMPV and Human Bocavirus (HBov), and this is a novel finding for poor communities from developing countries.

Estudo das alterações linfocitárias CD4/CD8 e carga viral em pacientes co-infectados HIV/Mycobacterium tuberculosis associadas a frequência de mutações na região Pol do HIV-1

Pós-graduação em Biociências e Biotecnologia Aplicadas à Farmácia - FCFAR

Clinical Characteristics of Children with Viral Single- and Co-Infections and a Petechial Rash

BACKGROUND:: Children with petechial rash are more likely to undergo invasive diagnostics, to be treated with antibiotics for potential bacterial infection and to be hospitalized. However, viruses have also been associated with petechial rash. Nonetheless, a systematic analysis of viral infections with modern available techniques as quantitative real time polymerase chain reaction (q-PCR) in the context of petechial rash is lacking. The purpose of this pediatric study was to prospectively uncover viral pathogens that may promote the emergence of petechiae and to analyze the correlation with the clinical characteristics and course. METHODS:: We conducted a prospective study in children (0 to 18 years) presenting with petechiae and signs or symptoms of infection at the emergency department between November 2009 and March 2012. In nasopharyngeal aspirates the following viruses were analyzed by q-PCR: Cytomegalovirus, Epstein-Barr virus, parvovirus B19, Influenza A and B, parainfluenza viruses, human respiratory syncytial virus A and B, human metapneumovirus, rhinovirus, enterovirus, adenovirus, human coronavirus OC43, 229E, NL63 and human bocavirus. RESULTS:: A viral pathogen was identified in 67% of the analyzed 58 cases with petechial rash. Virus positive patients showed a significantly higher incidence of lower respiratory tract infections. Forty-one percent were viral co-infections, which were significantly younger than virus negative patients, had a higher leukocyte count and were hospitalized for a longer time. CONCLUSIONS:: A petechial rash is frequently associated viral single- and co-infections and can rapidly be identified via q-PCR.

Sole infection by human metapneumovirus among children with radiographically diagnosed community-acquired pneumonia in a tropical region

Background Limited information is available on the role of human metapneumovirus (HMPV) as the unique pathogen among children hospitalized for community-acquired pneumonia (CAP) in a tropical region. Objective We aimed to describe HMPV infection among children with CAP investigating bacterial and viral co-infections. Patients and methods A prospective study was carried out in Salvador, North-East Brazil. Overall, 268 children aged <5 years hospitalized for CAP were enrolled. Human metapneumovirus RNA was detected in nasopharyngeal aspirates (NPA) by reverse transcription polymerase chain reaction. Sixteen other bacterial and viral pathogens were investigated by an expanded panel of laboratory methods. Chest X-ray taken on admission was read by an independent paediatric radiologist unaware of clinical information or the established aetiology. Results Human metapneumovirus RNA was detected in NPAs of 11 (4.1%) children, of which 4 (36%) had sole HMPV infection. The disease was significantly shorter among patients with sole HMPV infection in comparison with patients with mixed infection (4 +/- 1 versus 7 +/- 2 days, P = 0.03). Three of those four patients had alveolar infiltrates. Conclusion Sole HMPV infection was detected in children with CAP in Salvador, North-East Brazil. HMPV may play a role in the childhood CAP burden.

Paracoccidioidomycosis: an unusual presentation in a young girl disclosing an unnoted HIV-infection

The association of paracoccidioidomycosis with AIDS is apparently less frequent than expected. The authors present an unusual case of paracoccidioidomycosis in a 13-year-old female student which was later found to be the first opportunistic infection in the course of the patient's HIV-infection. The clinical presentation followed an accidental incised wound on the palmar region initially described as a 'sporotrichotic-chancre'. After good response under sulfamethoxazole-trimethoprin, the patient relapsed and presented an associated oral candidiasis. HIV-infection was documented and additional investigation showed CD4(+) T-cells=22/mm(3), CD8(+)=280 cell/mm(3) and viral load=4,043 log. This case report presents an uncommon dermatological-clinical picture in the youngest patient in which such association has been reported to date.

Leishmaniose felina e sua associação com imunodeficiência viral e toxoplasmose em gatos provenientes de área endêmica para leishmaniose visceral

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Aplicação da técnica de RT-PCR in situ na detecção da co-infecção pelo Coronavírus grupo 3 (TCoV) e Astrovírus (TAstV-2) em perus com quadro agudo de enterite

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Co-infecção vírus da imunodeficiência humana e vírus da hepatite C (HIV/HCV): aspectos epidemiológicos, clínicos e laboratoriais de uma população atendida em um serviço de hepatopatias na cidade de Belém-Pará

A infecção pelo Vírus da imunodeficiência humana 1 (HIV -1) em associação com a do Vírus da hepatite C (HCV) representa, atualmente, uma comorbidade que pode interferir principalmente na história natural da hepatite C. Este trabalho tem como objetivo descrever aspectos demográfico, clínico e laboratorial, incluindo exame histopatológico de pacientes coinfectados HIV/RCV. No período de agosto de 2004 a dezembro de 2006, 36 pacientes coinfectados, foram selecionados para o estudo. Noventa e dois por cento desses pacientes eram procedentes de Belém, com média de idade de 42 anos. Entre as principais informações demográficas da população estudada, foram identificados 72,52% solteiros, 83,5% do sexo masculino e 61,1% relataram ser heterossexuais. Entre os fatores de risco para o HCV o uso de drogas ilícitas injetáveis foi identificado em 41,7% dos casos, o uso de cocaína intranasal foi relatado por 38,9% dos pacientes, e o compartilhamento de seringas e material pessoal, em 38,9% dos casos. A história de etilismo em 77,8% e o uso de TARV foram os possíveis fatores agravantes mais frequentes para a doença hepática. Apenas um paciente apresentou sinais clínicos de insuficiência hepática crônica. Entre os testes bioquímicos hepáticos, a mediana de ALT e AST foi de 68UI/L e 61UI/L, respectivamente. Os níveis de linfócitos T CD4+ apresentaram mediana de 327 células/mm³, a carga viral do HIV com mediana de 2,53 logl0 cópias/mL (ep=0,34), carga viral do HCV com mediana de 5,9 log10UI/mL. O genótipo 1 do HCV foi o mais frequente (58,82%). Cinqüenta e sete por cento dos pacientes submetidos à biópsia hepática apresentavam fibrose de moderada a severa, e 11% não apresentaram fibrose pela classificação MET AVIR. Houve associação entre níveis de linfócitos T CD4+ e níveis de ALT e de AST (p=0,0009 e p=0,0002, respectivamente), assim como associação entre genótipo 1 do HCV e HCV-RNA maior ou igual a 6 log10 UI/mL (p=0.0039). Foi observada também associação entre HCV-RNA e HIV-RNA (p=0,039). Os pacientes apresentam estado geral bom, imunologicamente estáveis, sem sinais de descompensação hepática, mas com alterações estruturais hepáticas importantes, sendo portanto bons candidatos à terapia antiviral para o HCV. Futuros estudos, talvez de caso controle, com casuística maior são necessários para melhor entendimento da co-infecção HIV/HCV.

Prevalência da co-infecção Leishmania/HIV em pacientes atendidos em unidades de referência do município de Belém

Com o objetivo de investigar a prevalência da co-infecção Leishmania/HIV em pacientes sorologicamente positivos para o HIV, sem histórico da co-infecção, foi realizado um estudo transversal através de análise de ficha clínico-epidemiológica aplicada aos pacientes registrados nas unidades de referência para aids em belém: CASA DIA e URE - DIPE, no período de julho a outubro de 2008. Foram coletadas amostras de sangue de 377 pacientes que concordaram em participar da pesquisa, por análise de IFI e PCR e em 55 deles foi realizada a IDRM. A média de idade foi de 38,2 anos e 59% dos pacientes era do sexo feminino. A carga viral média entre os 249 pacientes que apresentaram informações completas a respeito desta variável, foi de 30952,2. A IFI foi positiva em 08 pacientes e a PCR foi positiva em 22. Um total de 214 pacientes encontrva-se em tratamento com TARV. Foram registrados 218 pacientes com episódios de doenças associados à condição HIV positivos. Cinco pacientes relataram episódio de co-infecção M. leprae/HIV, e nenhum deles apresentou resultado positivo para Leishmania pela PCR. O uso de drogas intravenosas foi relatado por 27 pacientes, porém apenas um apresentou PCR positivo, indicando que a transmissão não foi do tipo inter-humana. Dentre os pacientes que foram submetidos à IDRM, nenhum apresentou reação positiva. No presente trabalho, a técnica de PCR foi mais sensível que a reação de IFI, 6% e 2%, respectivamente.