Mestrado em Doenças Infecciosas
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- ItemDoença pulmonar por micobactérias não-tuberculosas : vinte e cinco anos de experiência no Espírito Santo, Brasil(Universidade Federal do Espírito Santo, 2024-10-15) Miossi, Rubia; Palaci, Moises ; https://orcid.org/0000-0003-2013-6071; http://lattes.cnpq.br/2602694352713051; https://orcid.org/0000-0002-5772-3547; http://lattes.cnpq.br/1372503666293706; Silva, Erica Chimara ; https://orcid.org/0000-0001-9574-8449; http://lattes.cnpq.br/6815520434239716; Cerutti Junior, Crispim; https://orcid.org/0000-0002-9485-4191; http://lattes.cnpq.br/4257067087979999Diseases caused by Non-Tuberculous Mycobacteria (NTM) are on the rise. This retrospective and observational study analyzed 111 cases of NTM Pulmonary Disease treated at HUCAM-UFES between June 1998 and September 2023. The study revealed a significant increase in cases from 2017 onwards, with 50% of cases occurring after this period. The average age of patients was 60 years, with no gender predominance, and most had comorbidities (70.3%). Productive cough and weight loss were common symptoms, with a prolonged disease course prior to diagnosis. Chest radiographs showed patterns like tuberculosis. The most frequent species were M. abscessus (33.3%), M. kansasii (30.6%), and M. intracellulare (15.3%). The species M. kansasii were more frequent in urbanized areas. The M. abscessus group had the highest treatment failure rate (40.5%) and the most significant toxicity (56.8%). Future studies should focus on treatment and toxicity to further understand these emerging infections
- ItemAvaliação do uso de fatores de ressuscitação no sistema BACTEC MGIT 960 para detecção de Mycobacterium tuberculosis em amostras paucibacilares(Universidade Federal do Espírito Santo, 2024-10-24) Araújo, Filipe Augusto Coimbra de; Palaci, Moisés ; https://orcid.org/0000-0003-2013-6071; http://lattes.cnpq.br/2602694352713051; https://orcid.org/0000-0002-9256-7391; http://lattes.cnpq.br/3004156583114119; Ferrazoli, Lucilaine ; https://orcid.org/0000-0002-5389-7056; http://lattes.cnpq.br/8786839834967611; Tavares, Sarah Gonçalves; https://orcid.org/0000-0003-4170-4445; http://lattes.cnpq.br/1018708169217296The dormancy of Mycobacterium tuberculosis (Mtb) challenges laboratory diagnosis, as dormant subpopulations are not easily detected by conventional methods. The objective of this study was to evaluate the use of culture filtrate (CF) in the BACTEC MGIT 960 system to improve the detection of Mtb in 245 paucibacillary clinical samples from patients suspected of having tuberculosis (TB). The study compared samples inoculated in MGIT medium with and without the addition of Mtb CF. The results showed that the addition of CF increased the sensitivity of the test, particularly in extrapulmonary samples, with sensitivity and specificity for MGIT+CF being 97.50% and 97.86%, respectively. In comparison, the Xpert MTB/RIF Ultra presented a sensitivity of 60.53% and a specificity of 93.97%, while the egg-based medium showed 40% sensitivity and 91% specificity. Furthermore, the use of CF increased the frequency of contamination in liquid cultures and did not alter the time to positivity of MGIT. These findings suggest that the use of CF may be a promising tool for enhancing the accuracy of TB diagnosis in samples with low bacterial load
- ItemAnálise de aspectos de virulência, resistência aos antimicrobianos e diversidade genética de Staphylococcus aureus isolados de colonização nasal em puérperas(Universidade Federal do Espírito Santo, 2024-06-22) Nilo, Ana Paula Marques Caldeira; Co-orientador1; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador2; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador3; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador4; ID do co-orientador4; Lattes do co-orientador4; Schuenck, Ricardo Pinto ; https://orcid.org/; http://lattes.cnpq.br/; Orientador2; https://orcid.org/; http://lattes.cnpq.br/; https://orcid.org/; http://lattes.cnpq.br/; Cavalcante, Fernanda Sampaio ; https://orcid.org/; http://lattes.cnpq.br/; Palaci, Moises ; https://orcid.org/; http://lattes.cnpq.br/; 3º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 4º membro da banca; http://lattes.cnpq.br/; 5º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 6º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 7º membro da banca; https://orcid.org/; http://lattes.cnpq.br/Nasal colonization by Staphylococcus aureus in postpartum women is relevant due to the risk of colonization of newborns and of infections in both groups. This study aimed to evaluate the colonization rate, resistance, virulence, and genetic diversity of S. aureus isolated from nasal colonization in postpartum women. Nasal swabs were collected (n = 306) within 48h after birth in the maternity ward of a hospital in Brazil, between March/2018 and March/2019. Demographic data were obtained from medical records. Antimicrobial susceptibility was determined by the disk diffusion test and Minimum Inhibitory Concentrations (MICs) were obtained by broth microdilution. Biofilm production was evaluated using a polystyrene microplate test. Polymerase Chain Reaction (PCR) was used to perform SCCmec typing and detect the following adhesin and toxin genes: fnbB, clfA, clfB, cna, bbp, hla, hld, hlg, hlg-2, lukSF-PV, lukED, eta, etb, sea, seb, sec, sed, see and tsst-1. Genetic diversity was assessed by Random Amplified Polymorphic DNA (RAPD). The rate of S. aureus nasal colonization was 14.7% (45/306), with seven (15.6%) MRSA. The overall MRSA rate was 2.3% (7/306). Demographic data demonstrated an average age of 30 years, and high rates of unemployment (66.7%), multiparity (83.3%), and comorbidities (85.7%). High resistance rates to penicillin (88.9%) and erythromycin (53.3%) were observed. All MRSA isolates carried SCCmec type IVa and one was characterized as oxacilin-susceptible methicilin-resistant S. aureus (OS-MRSA). Most isolates (84.4%) were classified as strong biofilm producers. Several virulence genes were detected and the most prevalent were hld (93.3%), hla and eta (48.9%), and sea (42.2%). RAPD analysis identified 14 profiles. Profile J grouped 11 isolates (among them, five MRSA, one OS-MRSA, and one MSSA-MDR) and was the second with the greatest diversity of virulence genes (n = 14). The study highlights the high rates of toxin genes among nasal isolates of S. aureus in postpartum women, with emphasis on the genes for exfoliative toxin A and enterotoxin A. These toxins are relevant in puerperal mastitis and severe neonatal infections. This is the first report of an OS-MRSA isolate colonizing the anterior nares of postpartum women
- ItemAnálise espaço-temporal dos casos de chikungunya no Espírito Santo entre 2018 e 2020: um estudo dos fatores associados(Universidade Federal do Espírito Santo, 2023-10-24) Clipes, Marcus Vinícius Salvador; Cerutti Junior, Crispim; https://orcid.org/0000000294854191; http://lattes.cnpq.br/4257067087979999; https://orcid.org/0009-0005-6925-0272; http://lattes.cnpq.br/2449228239599129; Teixeira, Carlos Graeff; https://orcid.org/0000000327250061; http://lattes.cnpq.br/0464152494769261; Jabor, Pablo Medeiros; http://lattes.cnpq.br/1542876666875683Introdução: Chikungunya (CHIK) is a febrile illness caused by the Chikungunya virus (CHIKV), a global-wide distributed Alphavirus. The transmission of CHIKV occurs by the bites of female Aedes vector mosquitoes. CHIK was first evidenced and identified in 1953 in Tanzania. In Brazil, there have been autochthonous cases reported since 2014. Clinically, CHIK manifests itself by intense and sudden fever, followed by fatigue, headache, skin rash, and arthralgia, which can last for weeks to months, with consequences regarding public health and the quality of life for those affected. Although mortality is low, there are substantial morbid effects related to the disease. An understanding of the social and environmental determinants related to CHIK is crucial to establish disease control and mitigation strategies. Objective: This study aims to describe the social and demographic characteristics of individuals affected by Chikungunya (CHIK) in Espírito Santo state, evaluating their association with the disease incidence. Methods: We performed a cross-sectional study to describe temporal, spatial, and sociodemographic data of individuals with a confirmed diagnosis of CHIK in Espírito Santo state, Brazil, from 2018 to 2020. The analysis included monthly incidence calculation. The data processing regarding the annual spatial distribution resulted in the construction of maps disclosing the relative risks by each municipality and the distribution of clusters. Statistical analysis through the chi-square test indicated associations between sex, race, education, and age with the disease occurrence. Results: During the period and through the area analyzed, a CHIK epidemic occurred in 2020, with 2,198.2 cases per million inhabitants incidence. Southern and central regions harbored a risk five times higher than the others in the epidemic region. Women (odds ratio - OR 1.65; 95% Confidence Interval - CI 1.58- 1.72), afro descendants (OR 1.22; 95% CI 1.13-1.33), individuals with less than 11 years of education (OR 1.48; 95% CI 1.37-1.61), and elders (OR 7.49; 95% CI 6.53- 8.59) had the highest risk for the disease occurrence, a difference statistically significant. Conclusion: CHIK stands as an emerging public health problem in Brazil since its introduction in 2014. The population susceptibility and the broad vector distribution facilitate the virus dispersion through the country’s territory. Espírito Santo suffered a substantial epidemic in 2020, possibly related to outbreaks in neighboring 12 states. The population under risk should be prioritized in health care, considering the morbidity potential of the disease.
- ItemFATORES ASSOCIADOS À HOSPITALIZAÇÃO NA FEBRE DE CHIKUNGUNYA Vitória - ES 2022(Universidade Federal do Espírito Santo, 2022-12-15) Lopes, Danielle Torres dos Santos; Vicente, Creuza Rachel; https://orcid.org/0000-0003-0182-7969; http://lattes.cnpq.br/0530544422426629; https://orcid.org/; http://lattes.cnpq.br/; Miranda, Angelica Espinosa Barbosa; https://orcid.org/0000-0002-5556-8379; http://lattes.cnpq.br/5842271060162462Introduction: Chikungunya is a disease caused by the RNA virus Chikungunya (CHIKV), of the genus Alphavirus, family Togaviridae, transmitted to humans through the bite of infected female mosquitoes of the species Aedes aegypti and Aedes albopictus. It manifests itself in an acute febrile form, with symptoms similar to those of other arboviruses. Autochthonous transmission of CHIKV has already been reported in 114 countries and the annual estimate of cases ranges from 52,774 to 328,943. Hospitalization is uncommon in cases of Chikungunya and there are gaps in knowledge about the factors associated with this outcome. Objective: The present study evaluated factors associated with hospitalization in patients with acute CHIKV infection. Method: A cross-sectional study was carried out, including data from cases of the acute form of Chikungunya fever with laboratory confirmation in residents of the municipality of Vitória, state of Espírito Santo, Brazil, which occurred between 2016 and 2020, and accessed through the databases of the Notifiable Diseases Information System and eSUS Health Surveillance. Results: 2,868 patients were included, of which 1.42% (n = 41) were hospitalized. There was a difference in terms of age between hospitalized and non-hospitalized patients, which was smaller in hospitalized patients (median = 26 years, interquartile range = 12 - 61) than in non-hospitalized patients (median = 47 years, interquartile range = 34 - 59) (p -value = 0.001). Pregnancy was significantly longer in hospitalized patients (n = 2, 10.5%) than in nonhospitalized patients (n = 36, 2.0%) (p-value = 0.010). As for clinical manifestations, some symptoms were significantly less frequent among hospitalized patients, such as myalgia (pvalue = 0.006), headache (p-value < 0.001), nausea (p-value = 0.009), back pain (p-value < 0.001), arthritis (p-value = 0.014), arthralgia (p-value < 0.001) and retro-orbital pain (p-value < 0.001). There was no statistically significant difference between the groups in terms of gender, with greater involvement of women among hospitalized (n = 26) and non-hospitalized (n = 1,910) (p-value = 0.573), in addition to pre-existing diseases, and time disease evolution (p-value = 0.102). Back pain (OR = 0.134; 95% CI = 0.044 - 0.409) and arthralgia (OR = 0.226; 95% CI = 0.083 - 0.613) were protective predictors of hospitalization. Conclusion: The study demonstrated that milder clinical manifestations in the acute phase of Chikungunya fever were identified among hospitalized patients, and some signs and symptoms were protective predictors of hospitalization. Therefore, understanding the correlation between sociodemographic characteristics, comorbidities and symptoms presented by individuals affected by the disease allows the development of measures for effective prevention, control and management of the disease, reducing hospitalizations.