Encephalitis associated with Zika virus infection and reactivation of the varicella-zoster virus in a Brazilian child

Abstract We report a case of encephalitis associated with Zika virus infection and reactivation of varicella-zoster virus in the central nervous system of a Brazilian child. This case raises the possibility that reactivation of the latent varicella-zoster virus may be a mechanism of neurological impairment induced by acquired Zika virus infection.

Potential role of dengue virus, chikungunya virus and Zika virus in neurological diseases

This study showed that laboratory markers of recent infection by dengue, Zika or chikungunya arboviruses were detected in the biological samples of approximately one-third of patients with encephalitis, myelitis, encephalomyelitis or Guillain-Barré syndrome, in a surveillance programme in Piauí state, Brazil, between 2015-2016. Fever and myalgia had been associated with these cases. Since in non-tropical countries most infections or parainfectious diseases associated with the nervous system are attributed to herpesviruses, enteroviruses, and Campylobacter jejuni, the present findings indicate that in tropical countries, arboviruses may now play a more important role and reinforce the need for their surveillance and systematic investigation in the tropics.

Persistência do baculovírus anticarsia após diferentes regimes pluviométricos / Velvet-bean nucleopolyhedrovirus persistence after different rainfall intensities

A persistência do vírus da lagarta-da-soja AgMNPV, produzido de forma bruta (maceração de lagartas) e liofilizada (produto comercial), foi avaliada após a aplicação em plantas de soja seguida de diferentes regimes pluviométricos (0; 10; 20; 30mm) na intensidade de 30mm.hora-1. Essas precipitações foram simuladas com microaspersores, em casa-de-vegetação. Após a simulação, a soja foi oferecida às lagartas zero, três, seis e nove dias após a aplicação (DAP). As plantas, durante esse período, foram mantidas em casa-de-vegetação, protegidas da chuva. O experimento foi conduzido em delineamento inteiramente casualizado em condições controladas (UR 70±10%, 25±2°C, fotofase de 14h), em esquema fatorial 4 (intensidades de precipitações pluviométricas) x 2 (formulações de vírus, bruta e liofilizada) com quatro repetições, com 30 lagartas cada. Os resultados comprovam que precipitações até 30mm, em 60 minutos, não reduzem a mortalidade das lagartas, causada por AgMNPV em ambas as formas de produção, quando a oferta das folhas às lagartas ocorre no mesmo dia da aplicação. As formas de preparo do AgMNPV influenciaram na persistência do vírus aos seis DAP. Nesta avaliação, a taxa de mortalidade foi superior a 90%, quando o produto bruto foi aplicado e inferior a 50% para o produto liofilizado. Esses resultados indicam que a eficiência de AgMNPV não é afetada por chuvas de até 30mm em uma hora, para ambas as formas de preparo do AgMNPV. Entretanto, ao longo dos dias, o método de preparo bruto apresenta-se mais eficiente, devido à maior persistência sobre a área foliar da soja após a lavagem pela água.

The persistence of the velvet-bean nucleopolyhedrovirus (AgMNPV) produced raw (macerated caterpillars) and lyophilized (commercial product) was evaluated after spraying in soybean plants followed by different simulated rainfall rates (0; 10; 20; 30mm) at 30mm hour-1 rate. Rainfall was simulated in greenhouse through micro sprinkler irrigation. After simulated rainfall, soybean leaves were offered to caterpillar in laboratory conditions at zero, three, six and nine days after spraying (DAS). Soybean plants were kept in greenhouse protected from rainfall. Trial was carried out in complete randomized design, under controlled conditions (RH 70%±10%, 25±2°C, 14h photophase) in a factorial 4 (rainfall rates) x2 (formulations, raw and lyophilized) with four replicates of 30 caterpillars. Results indicate that rainfall rates up to 30mm, in 60 minutes, do not decrease caterpillar mortality caused by AgMNPV regarding to both tested baculovirus formulations, raw and lyophilized virus, when leaves were offered to caterpillars at zero DAS. However, virus production (raw or lyophilized) impacted its persistence. Six DAS, mortality rate was higher than 90% when the virus was applied raw and lower than 50% when it was applied lyophilized. These results suggest that both raw and lyophilized AgMNPV efficacy is not impaired by 30-mm rainfalls at 30mm hour-1 rate. However, raw virus was more efficient in a long term evaluation since it had longer persistence on soybean leaves after being water washed.

Identificação do gene EBER1 e EBNA1 do vírus de Epstein Barr (EBV) em tecidos de pacientes com doença de Hodgkin na região Norte do Brasil / Identification of gene EBER1 and EBNA 1 of Epstein Barr virus (EBV) in tissues of patients with Hodgkin’s disease in Northern Brazil

O vírus de Epstein Barr (EBV) é o agente causador da mononucle¬ose infecciosa e está associado a várias desordens proliferativas malignas tais como: linfoma de Burkitt, linfoma de Hodgkin e lin¬fomas não Hodgkin. Objetivo: detectar o genoma do EBV mediante a identificação dos genes EBER1 e EBNA1 em casos de doença de Hodgkin. Métodos: um total de 65 casos de linfomas diagnosti¬cados no Hospital Ophir Loyola no período de 1996 e 2005 foram analisados no Instituto Evandro Chagas, Ananindeua, Brasil. Todos os espécimes parafinizados foram analisados por hibridização in situ (gene EBER1) e PCR em tempo real (EBNA1). Resultados: do total, 64,6% (42/65) dos pacientes eram do sexo masculino e 35,4% (23/65) do sexo feminino. O EBV foi identificado por HIS nas células Reed Sternberg e variantes em 76,9% (50/65) dos casos com idade média de 28,3 anos (variação 2-84 anos). Os subtipos histológicos de casos EBV-positivos foram os seguintes: esclerose nodular em 50% (25/50), celularidade mista em 28% (14/50), depleção linfocitária em 14% (7/50) e predominância linfocitária em 8% (4/50). O DNA do EBV foi detectado em 53% (26/49) dos casos de doença de Hodgkin com um coeficiente de regressão para a curva padrão de 0,99. Conclusão: este estudo foi a primeira descrição do vírus de Epstein Barr em casos de linfoma de Hodgkin na Amazônia Brasileira, reforçando a hipótese de que o EBV seja um co-fator no processo de transformação neoplásica em conjunto com a predisposição genética e imunidade do paciente

Introduction: EBV is the causative agent of infectious mononucleosis and is associated with several malignant proliferative disorders such as Burkitt’s lymphoma, Hodgkin’s lymphoma, some B and T cell non-Hodgkin’s lymphomas. Objective: The main objective of the study was to determine the prevalence of EBER 1 gene and EBNA1 gene in cases of Hodgkin’s disease. Material and Methods: A total of 65 cases of lymphomas diagnosed between 1996 and 2005 were obtained from “Instituto Ofir Loyola” and analyzed at the “Instituto Evandro Chagas” Ananindeua, Brazil. The EBV antigens using EBER 1 probe in situ hybridization (HIS) and real time quantitative PCR. Results: From the total obtained, 64.6% (42/65) were male and 35.4% (23/65) female. EBV was identified in the Reed- Sternberg cells and variants in 76.9% (50/65) of Hodgkin’s disease cases, the median age were 28.3 years (range 2-84). The histologic subtypes of EBV-positive cases were as follows: nodular sclerosis in 50% (25/50), mixed cellularity in 28% (14/50), lymphocyte depletion in 14% (7/50) and lymphocyte predominance in 8% (4/50). We detected EBV DNA in 53% (26/49) with a coefficient of regression for the standard curve of a minimum of 0.99. Conclusion: These results were the first demonstration of the role of Epstein Barr virus in cases of Hodgkin diseases in northern Brazil and are consistent with the hypothesis that the presence of EBV during neoplasic transformation could be an additional cofactor acting together with both genetic predisposition and immunity of the patient

Segurança, imunogenicidade e eficácia protetora de duas doses da vacina RIX4414 contendo rotavírus atenuado de origem humana / Safety, immunogenicity, and protective efficacy of two doses of RIX4414 live attenuated human rotavirus vaccine in healthy Brazilian infants

OBJETIVO: Determinar a segurança, imunogenicidade e eficácia de duas doses da vacina contra o rotavírus em lactentes brasileiros saudáveis. MÉTODOS: Foi realizado um estudo randomizado, multicêntrico, duplo-cego e controlado por placebo no Brasil, México e Venezuela. Os lactentes receberam duas doses orais de vacina ou placebo aos 2 e 4 meses de idade, juntamente com as imunizações de rotina, exceto a vacina oral contra poliomielite (VOP). O presente estudo relata apenas os resultados obtidos em Belém, Brasil, onde o número de indivíduos por grupo e os títulos da vacina viral foram os seguintes: 194 (104,7 unidades formadoras de focos - UFF), 196 (10(5,2) UFF), 194 (10(5,8) UFF) e 194 (placebo). A resposta de anticorpos anti-rotavírus (anti-RV) foi avaliada em 307 indivíduos. A gravidade clínica dos episódios de gastroenterite (GE) foi determinada através de um escore com 20 pontos, onde um valor > 11 foi considerado como GE grave. RESULTADOS: As taxas de sintomas gerais solicitados foram semelhantes tanto nos indivíduos que receberam a vacina como naqueles a quem se administrou placebo. Aos 2 meses após a segunda dose, ocorreu resposta em termos de IgA sérica para RV em 54,7 a 74,4 por cento dos vacinados. Não houve interferência na imunogenicidade das vacinas de rotina. A eficácia da vacina contra qualquer gastroenterite por rotavírus (GERV) foi de 63,5 por cento (IC95 por cento 20,8-84,4) para a maior concentração (10(5,8) UFF). A eficácia foi de 81,5 por cento (IC95 por cento 44,5-95,4) contra GERV grave. Em sua maior concentração (10(5,8) UFF), a RIX4414 conferiu uma proteção de 79,8 por cento (IC95 por cento 26,4-96,3) contra GERV grave causada pela amostra G9. CONCLUSÕES: A RIX4414 foi altamente imunogênica com baixa reatogenicidade, e não interferiu na resposta sérica à difteria, tétano, coqueluche, hepatite B e antígenos Hib. Duas doses da RIX4414 conferiram proteção significativa contra a GE grave causada pelo RV.

OBJECTIVE: To determine the safety, immunogenicity and efficacy of two doses of rotavirus vaccine in healthy Brazilian infants. METHODS: A randomized, multicenter, double-blind, placebo-controlled trial was conducted in Brazil, Mexico and Venezuela. Infants received two oral doses of vaccine or placebo at 2 and 4 months of age, concurrently with routine immunizations, except for oral poliomyelitis vaccine (OPV). This paper reports results from Belém, Brazil, where the number of subjects per group and the viral vaccine titers were: 194 (10(4.7) focus forming units - FFU), 196 (10(5.2) FFU), 194 (10(5.8) FFU) and 194 (placebo). Anti-rotavirus (anti-RV) antibody response was assessed in 307 subjects. Clinical severity of gastroenteritis episodes was measured using a 20-point scoring system with a score of > 11 defined as severe GE. RESULTS: The rates of solicited general symptoms were similar in vaccine and placebo recipients. At 2 months after the second dose, a serum IgA response to RV occurred in 54.7 to 74.4 percent of vaccinees. No interference was seen in the immunogenicity of routine vaccines. Vaccine efficacy against any rotavirus gastroenteritis (RVGE) was 63.5 percent (95 percentCI 20.8-84.4) for the highest concentration (10(5.8) FFU). Efficacy was 81.5 percent (95 percentCI 44.5-95.4) against severe RVGE. At its highest concentration (10(5.8) FFU), RIX4414 provided 79.8 percent (95 percentCI 26.4-96.3) protection against severe RVGE by G9 strain. CONCLUSIONS: RIX4414 was highly immunogenic with a low reactogenicity profile and did not interfere with seroresponse to diptheria, tetanus, pertussis, hepatitis B and Hib antigens. Two doses of RIX4414 provided significant protection against severe GE caused by RV.

Prevalência de IgG do vírus varicela-zoster (VVZ) em indígenas da tribo Araweté, em altamira, Pará, de janeiro-fevereiro de 2001 / Prevalence of IgG of the varicela zoster vírus (VZV)

Objetivo: determinar a prevalência de anticorpos IgG para o vírus da varicela-zoster (VVZ) em indivíduos da comunidade indígena Araweté, Altamira, Pará, Brasil. Método: foram testadas 357 amostras de soros de indivíduos residentes na comunidade indígena Araweté, coletadas em janeiro e fevereiro de 2001, após um surti grave causado por esse vírus. Utilizou-se o procedimento imunoenzimático (ELISA) "Kit" da "Clark LaboratorieisTM" (Jamestown-NY-EUA) na pesquisa de anticorpos IgG para o VVZ. Resultados: as 357 amostra. analisadas mostraram taxa de 83,2% (297/357) de positividade. O sexo feminino foi mais acometido que o masculino, com 88,0% (162/184) e 78,0% (135/173), respectivamente, resultando diferença estatisticamente significativa, p= 0,017. A freqüência de soropositividade até os 20 anos de idade foi de 64,0% (190/297) Conclusão: aproximadamente 17% do total de indivíduos pesquisados, ainda não apresentam imunidade contra o VVZ. Os autores recomendam a necessidade de vacinação de rotina contra varicela na população suscetível afim de conferir proteção contra doença severa em comunidades não imunes.

Objective: the aim of the study was to determine the prevalence of anti- VZV antibodies of immunoglobulin G class (lgG) among remote indian communities living in the central-west region of Pará state, in the municipality of Allamira. Method: serum samples were collected in January 2000 from the Araweté Indians group afier the notification of in outbreak of chickenpox starty with 12 cases. VZV-IgG antibodies were measured by enzyme-linked immunosorbent assay (ELISA), using a commercial kit (Clark LaboratoriesTM, Jamestown-NY-USA). Results: of the 357 tested, 297 (83%) were IgG-positive, of which 45,3% (135/297) were from male indians and 54,7% (162/297) from females individuals. Rates of seropositivity up to 20 years of age was 64,0% (190/297). In addition, frequencies of seropositivity were consistently higher in females than in males (p=0,0I7). Conclusion: about 17% of the total of searched individuals, still they do not present immunity against the VZV. The need for routine vaccination against varicella of susceptible population is recommended, in order to confer protection against severe disease among these non-immune communities.

Frequência de anticorpos para o vírus da caxumba / Frequence of antibody to mumps virus

Introdução: A caxumba é uma infecção viral aguda que ocorre principalmente em crianças e adolescentes na idade escolar. Durante a infecção os anticorpos IgG, geralmente são detectados cerca de duas a três semanas após o inicio dos sintomas, indicando imunidade adquirida. A presença de anticorpos IgM iniciam com eleva- dos títulos até as duas primeiras semanas, com posterior redução desses níveis, possibilitando o diagnóstico de infecção aguda ou recente. Objetivo: Determinar a freqüência de anticorpos das classes G (IgG) eM (IgM) para o vírus da caxumba em indivíduos assintomáticos residentes em dois bairros da área urbana de Belém, Pará, Brasil. Método: Foram coletadas 411 amostras de soro de indivíduos assintomáticos provenientes de dois bairros de Belém, Pará (Terra Firme e Guamá) no período de setembro a novembro de 1994. Todos os espécimes colhidos foram examinados pelo método imunoenzimático (ELISA) utilizado na detecção de anticorpos IgG e IgM específicos para o vírus da caxumba. Resultados: Em 63,5 por cento (261/411) das amostras de soro testadas foram detectados anticorpos da classe IgG e, em 12,9por cento (53/411), anticorpos da classe IgM para o vírus da caxumba. o sexo masculino foi mais acometido que o feminino com 81,8por cento (153/187) e 48,2por cento (108/224), respectivamente, com diferença estatística significativa de P=0,00l. Nossos resultados demonstraram que 52,4por cento (119/227) dos indivíduos investigados com idades abaixo de 15 anos foram susceptíveis à infecção pelo vírus em questão. Conclusão: Esses resultados podem ser utilizados para que sejam intensificadas medidas profiláticas capazes de reduzir o aparecimento dessa virose na população de Belém, Pará, Brasil

Nutritional status in relation to the efficacy of the rhesus-human reassortant, tetravalent rotavirus vaccine (rrv-tv) in infants from Belém, Para state, Brazil

The rhesus-human reassortant, tetravalent rotavirus vaccine (RRV-TV) was licensed for routine use in the United States of America but it was recently withdrawn from the market because of its possible association with intussusception as an adverse event. The protective efficacy of 3 doses of RRV-TV, in its lower-titer (4 x 10(4) pfu/dose) formulation, was evaluated according to the nutritional status of infants who participated in a phase III trial in Belém, Northern Brazil. A moderate protection conferred by RRV-TV was related to weight-for-age Z-scores (WAZ) greater than -1 only, with rates of 38 percent (p = 0.04) and 40 percent (p = 0.04) for all- and- pure rotavirus diarrhoeal cases, respectively. In addition, there was a trend for greater efficacy (43 percent, p = 0.05) among infants reaching an height-for-age Z-score (HAZ) of > -1. Taking WAZ, HAZ and weight-for-height Z-score (WHZ) indices <= -1 together, there was no significant protection (p > 0.05) if both placebo and vaccine groups are compared. There was no significant difference if rates of mixed and pure rotavirus diarrhoeal cases are compared in relation to HAZ, WAZ and weight-for-height Z-score (WHZ) indices. Although a low number of malnourished infants could be identified in the present study, our data show some evidence that malnutrition may interfere with the efficacy of rotavirus vaccines in developing countries

Association between human parvovirus B19 and arthropathy in Belém, Pará, North Brazil

A total of 220 patients with arthropathy were selected in Belém, Pará between January 1994 and December 2000, and screened for the presence of human parvovirus B19 IgM and IgG antibodies by enzyme-linked immunosorbent assay (ELISA). A subgroup (n = 132) of patients with high levels of antibodies (either IgM+/IgG+ or IgM-/IgG+) were examined for the presence of DNA by polymerase chain reaction/nested PCR. Recent/active infection (detection of IgM and/or IgG-specific antibodies and presence of viral DNA) was identified in 47.7 percent of the 132 individuals with arthropathy. In our study, women were significantly more affected (59.7 percent) than men (35.4 percent) (P = 0.0006). The age group of 11-20 years (84.6 percent), among female patients, and 21-30 years (42.1 percent), among male, were those with the highest incidence rates. The analysis of the temporal distribution of B19-associated arthropaties showed a cyclic pattern, with peak incidence rates occuring at 3-5 year intervals. Significant diference (P = 0.01) was observed when comparing both the highest (39.0 percent) and the lowest (11.0 percent) seropositivity rates for the years of 1995 and 2000, respectively. The interfalangial joints of hands and feet were mostly affected, with 50.0 percent and 48.0 percent of cases among both women and men, respectively. In a smaller proportion, other joints such as those of knee, ankle, pulse and shoulder were affected. As for the duration, symptoms lasted 1 to 5 days in 54.0 percent of the individuals, whereas in 46.0 percent of them the disease lasted 6-10 days, if considered the subgroup (n = 63) of patients with recent/active infection by parvovirus B19. In our study, joint clinical manifestations occurred symmetrically. Our results indicate that B19 may be an important agent of arthropathies in our region, and this underscores the need for specific laboratory diagnosis when treating patients suffering from acute arthropathy, mainly pregnant women

Outbreaks of human-herpes virus 6 (HHV-6) infection in day-care centers in Belém, Pará, Brazil

A total of 730 children aged less than 7 years, attending 8 day-care centers (DCCs) in Belém, Brazil were followed-up from January to December 1997 to investigate the occurrence of human-herpes virus 6 (HHV-6) infection in these institutional settings. Between October and December 1997 there have been outbreaks of a febrile- and -exanthematous disease, affecting at least 15-20 percent of children in each of the DCCs. Both serum- and- plasma samples were obtained from 401 (55 percent) of the 730 participating children for the detection of HHV-6 antibodies by enzyme-linked immunosorbent assay (ELISA), and viral DNA amplification through the nested-PCR. Recent HHV-6 infection was diagnosed in 63.8 percent (256/401) of them, as defined by the presence of both IgM and IgG-specific antibodies (IgM+/IgG+); of these, 114 (44.5 percent) were symptomatic and 142 (55.5 percent) had no symptoms (p = 0.03). A subgroup of 123 (30.7 percent) children were found to be IgM-/IgG+, whereas the remaining 22 (5.5 percent) children had neither IgM nor IgG HHV-6- antibodies (IgM-/IgG-). Of the 118 children reacting strongly IgM-positive ( > or = 30 PANBIO units), 26 (22.0 percent) were found to harbour the HHV-6 DNA, as demonstrated by nested-PCR. Taken the ELISA-IgM- and- nested PCR-positive results together, HHV-6 infection was shown to have occurred in 5 of the 8 DCCs under follow-up. Serological evidence of recent infections by Epstein-Barr virus (EBV) and parvovirus B19 were identified in 2.0 percent (8/401) and 1.5 percent (6/401) of the children, respectively. Our data provide strong evidence that HHV-6 is a common cause of outbreaks of febrile/exanthematous diseases among children attending DCCs in the Belém area

Imunidade para varicela entre habitantes de Belém, PA, Brasil / Chickenpox immunity among Belém (PA) Brazil inhabitants

Objetivo: Conhecer o estado imunitário para a varicela em indivíduos de diversas faixas etárias da Cidade de Belém, no Estado do Pará, norte do Brasil, para a tomada de decisäo quanto à indicaçäo de vacinaçäo. Método: Os soros de 525 indivíduos residentes na Cidade de Belém, separados aleatoriamente da soroteca de dois laboratórios privados de análise clínicas e do Instituto Evandro Chagas, foram testados pelo método imunoenzimático (ELISA). Resultados: Dos 525 soros testados 22,2 por cento, 5l,7 por cento , 72,9 por cento e 92,5 por cento foram positivos nas faixas etárias de 0-4, 5-14, 15-24 e > e igual 25 anos, respectivamente. Conclusöes: Näo obstante a grande concentraçäo da varicela nos primeiros dez anos de vida, cerca da metade dos adolescentes e adultos jovens persistem sem imunidade. Este achado sugere que há indicaçäo da vacinaçäo contra a varicela para as crianças, mas também, e principalmente, para os adolescentese adultos jovens, sem história consistente de doença correlata, uma vez que nesses grupos de faixas etárias maiores, a infecçäo pode evoluir com doença mais grave, com risco de complicaçöes e óbito.

Characterization of rotavirus P genotypes circulating among paediatric inpatients in northern Brazil

De novembro de 1992 a agosto de 1993, 28 amostras fecais positivas para rotavirus, obtidas de pacientes pediatricos hospitalizados em Belem, Brasil, com idades inferiores a 4 anos, foram testadas por RT-PCR visando a determinacao dos genotipos P. Com excecao de 7 criancas nao diarreicas, todos os pacientes apresentavam diarreia a admissao ou a desenvolviam enquanto internados no hospital. Cepas de rotavirus com especifidades antigenicas P correspondentes aos genotipos P1B[4] e P1A[8]...

Papilomavírus humano associado a lesöes de cérvice uterina / Human papillomavirus associated to uterine cervix lesions

Estudou-se a prevalência do papilomavírus humano (HPV) em 228 mulheres portadoras de lesöes em cérvice uterina, atendidas no lnstituto Ofir Loiola, em Belém, Pará, no período de março de 1992 a maio de 1996. As pacientes foram submetidas à biópsia de colo uterino, sendo o material encaminhado para histopatologia e pesquisa de HPV por PCR e hibridizaçäo por dot-blot. Distribuíram-se as participantes em três grupos, conforme diagnóstico histopatológico. O grupo A constituiu-se de 155 mulheres com carcinoma epidermóide invasor ou com adenocarcinoma, o grupo B de 54 portadoras de neoplasia intraepitelial cervical grau II ou III, e o grupo C de 19 pacientes com cervicite crônica. Observaram-se prevalências de HPV em 70,3 por cento, 63,0 por cento e 36,8 por cento das mulheres dos grupamentos A, B e C, respectivamente, sendo o HPV 16 registrado em 60,4 por cento das amostras positivas do grupo A e 54,5 por cento daquelas do grupo B. Os tipos 16, 18 e 33 representaram 71,4 por cento dos detectados no grupo C

Mononucleose infecciosa em crianças e adolescentes de Belém, Pará, Brasil: abordagem clínica e soroepidemiológica / Infection mononucleosis among children and adolescent living in Belem-PA Brasil

Um total de 234 crianças e adolescentes, menores de 16 anos (média de idade = ñ 5,8 anos), com suspeita clínica de mononucleose infecciosa, foi atendido no "Serviço de Virologia Geral" do "Instituto Evandro Chagas (IEC)", no período de junho a dezembro de 1995. As amostras de soro foram testadas quanto à presença de anticorpos das classes IgG e IgM anti-Epstein Barr (EBV), através do procedimento imunoenzimático (ELISA), especificamente contra o antígeno do capsídeo viral (anti-VCA). Para tanto se utilizou o Kit da Clark Laboratories(tm) (Jamestown - NY - EUA). O objetivo deste trabalho foi de estabelecer a frequência de infecçäo primária pelo EBV, avaliando as características clínicas em crianças e adolescentes. Dentre as 234 amostras analisadas a soropositividade em termos de IgG foi de 56 por cento (131/234), sendo que 55 por cento (72/131) e 45 por cento (59/131) eram do sexo masculino e feminino, respectivamente. Em 10,6 por cento (25/234) das crianças e adolescentes com mononucleose infecciosa ativa (presença de anticorpos IgM-EBV), registramos os seguintes achados clínicos: linfadonopatias (76 por cento), febre (68 por cento), erupçäo cutânea (12 por cento) e hepatomegalia (12 por cento). Os resultados indicam que, já aos seis anos de idade, metade das crianças já foram infectadas pelo EBV

Rotaviruses as a cause of nosocomial, infantile diarrhoea in northern Brazil: pilot study

Faecal samples were obtained from 190 children, aged 0 to 5 years, admitted to a public hospital in Belém, Pará, Brazil. These patients were placed in a pediatric ward with 40 beds distributed in six rooms. Case were classified into three groups: (a) nosocomial: children who developed gastroenteritis 72 hr or later after admission; (b) community-acquired: patients admitted either with diarrhoea or who had diarrhoea within 72 hr following admission; (c) non-diarrhoeic: those children who had no diarrhoea three days before and three days after collection of formed faecal sample. Specimens were routinely processed for the presence of rotaviruses, bacteria and parasites. Rotaviruses were detected through enzyme-linked immunosorbent assay (ELISA) and subsequently serotyped/electrophoretyped. Rotaviruses were the most prevalent enteropathogens among nosocomial cases, accounting for 39 porcento (9/23) of diarrhoeal episodes; on the other hand, rotaviruses ocurred in 8.3 por cento (11/133) and 9 por cento (3/34) of community-acquired and non-diarrhoeic categories, respectively. Mixed infections involving rotavirus and Giardia intestinalis and rotavirus plus G. intestinalis and Entamoeba histolytica were detected in frequencies of 8.6 and 4.3 por cento, respectively, in the nosocomial group. The absence of bacterial pathogens in this category, and the unusual low prevalence of these agents in the other two groups may reflect the early and routine administration of antibiotics following admission to this hospital. Rotavirus serotype 2 prevailed over the other types, accounting for 77.8 por cento of isolates from nosocomial diarrhoeal episodes. In addition, at least five different genomic profiles could be observed, of which one displayed an unusual five-segment first RNA cluster. Dehydration was recorded in all cases of hospital-acquired, rotavirus-associated diarrhoea, whereas in only 57 por cento of nosocomial cases of other aetiology. It was also noted that nosocomial, rotavirus-associated diarrhoeal episodes ocurr earlier (7 days), following admission, if compared with those hospital-acquired cases of other aetiology (14 days).

Epidemiology of rotavirus gastroenteritis in the Amazon region and the need for a specific vaccine

In the Amazon region, rotaviruses account for at least 30 per cent of all episodes of acute gastroenteritis among hospitalized children and are associated with nearly 1O per cent of cases of infantile acute diarrhea at community level. All four rotavirus serotypes are shown to infect children in our region, serotype l being predominant (about 50 per cent). Sequential infections in the same child, caused by different serotypes, are commonly noted. No clear seasonal variation on the occurrence of rotavirus diarrhea has been recorded, as cases are readily detected throughout the year. Rotavirus diarrhea cases have been found to be, in general, more severe than those of other aetiology. On the other hand, it has been noted that early (children less than 4 months of age) rotavirus infections are more likely to be asymptomatic (p = 0.021). Occurrence of rotavirus infections among Amazonian Indian populations seems to be very common. An explosive outbreak of rotavirus diarrhea affected possibly 88 per cent of both children and adults of the Tiryió population, Northern Pará State. In addition, rotavirus antibody was detected in 54.7 per cent of 1,299 sera collected from Amerinds belonging to 13 relatively isolated communities in the Amazon region. In the light of the above mentioned findings it was suggested that our region would be suitable for a field trial with a rotavirus-candidate vaccine. A study is therefore underway aiming to compare safety, immunogenicity and efficacy of a rhesus-human reassortant rotavirus (RRV-tetravalent) vaccine and placebo in 500 healthy infants living in the peripheral area of Belém.