Descriptive study of suspected congenital Zika syndrome cases during the 2015-2016 epidemic in Brazil

Abstract INTRODUCTION: Clinical and epidemiological data on suspected congenital Zika syndrome (CZS) cases from southern Mato Grosso (MT) in Brazil during the Zika virus (ZIKV) outbreak in 2015-2016 were evaluated. METHODS: This is a descriptive case series study of newborns whose mothers were suspected cases of ZIKV infections during their pregnancies. The medical records of all the suspected CZS cases (mothers and newborns) treated by the specialized ambulatory service from June 2015 to August 2016 were analyzed. RESULTS: Twenty suspected CZS cases were included in these analyses. They were categorized into four groups based on the clinical and laboratory findings: confirmed cases (n=1), highly probable cases (n=13), moderately probable cases (n=5), and somewhat probable cases (n=1). The mothers tested negative for STORCH (syphilis, toxoplasmosis, other infections, rubella, cytomegalovirus infection, and herpes simplex) and other important congenital infections; however, specific ZIKV tests were not performed during the study period. Microcephaly was observed in the majority of these newborns, and all the patients showed altered cranial computed tomography image findings. Extracranial abnormalities such as arthrogryposis, and otological and ophthalmological manifestations were also observed. CONCLUSIONS: Although ZIKV was not confirmed to cause the congenital malformations, this study demonstrated that the clinical and epidemiological findings associated with a STORCH exclusion strengthened the CZS diagnosis. The suspected cases in MT occurred simultaneously with the first CZS cases reported in Brazil, suggesting ZIKV circulation in the study region during the same period.

Genotypic analysis of secreted aspartyl proteinases in vaginal Candida albicans isolates / Análise genotípica de aspartil proteases secretórias em isolados vaginais de Candida albicans

ABSTRACT Introduction: Candida albicans is the most common etiologic agent of fungal vaginitis. These yeasts produce secreted aspartyl proteinases encoded by a family of 10 genes (SAP1-10). Objective: The purpose of this study was to analyze the presence of genes SAP1-7 in vulvovaginal C. albicans. Materials and method: The study included 26 C. albicans vaginal isolates. Detection of aspartyl proteases genes (SAP1-7) was performed by polymerase chain reaction (PCR). Results: The most frequent gene in C. albicans isolated from colonization was SAP6 (93.33%), and from infection, SAP7 (100%). We observed a statistical difference (p = 0.049) in SAP1 gene frequency between isolates from vulvovaginal colonization and infection. Conclusion: High frequency of SAP genes was observed in vulvovaginal C. albicans. The results suggest SAP1 participation in vulvovaginal candidiasis infection.

RESUMO Introdução: Candida albicans é o principal agente etiológico das vaginites fúngicas. Essas leveduras produzem aspartil proteases secretórias que são codificadas por uma família de 10 genes (SAP1-10). Objetivo: O objetivo deste estudo foi avaliar a presença dos genes SAP1-7 em linhagens vulvovaginais de C. albicans. Materiais e método: O estudo incluiu 26 isolados vaginais de C. albicans. Os genes de aspartil proteases (SAP1-7) foram detectados por reação em cadeia da polimerase (PCR). Resultados: O gene mais frequente em C. albicans isolado de colonização foi SAP6 (93,33%), e de infecção, SAP7 (100%). Foi observada diferença estatística (p = 0,049) na frequência do gene SAP1 entre isolados oriundos de colonização e infecção vulvovaginal. Conclusão: Constatou-se alta frequência dos genes SAP em linhagens vaginais de C. albicans. Os resultados sugerem uma participação de SAP1 no processo infeccioso da candidíase vulvovaginal.

Oral colonization by Candida species in HIV-positive patients: association and antifungal susceptibility study / Colonização oral por espécies de Candida em pacientes HIV positivo: estudo de associação e suscetibilidade antifúngica

ABSTRACT Objective To investigate antifungal susceptibility and factors associated with oral colonization by Candida species in HIV-positive patients. Methods A prospective study based on convenience sampling of subjects recruited from a pool of confirmed HIV-positive individuals seen at a specialty outpatient service in Rondonópolis, Mato Grosso, Brazil). Oral swabs were collected from 197 patients. Candida species were identified by standard microbiological techniques (phenotypic and molecular methods). Antifungal susceptibility was investigated using the broth microdilution method. Results A total of 101 (51.3%) patients were Candida spp carriers. Candida albicans was the most prevalent species (80%). Patients aged 45 to 59 years (Prevalence ratios: 1.90; 95%CI: 1.57-6.31) and 60 years or older (Prevalence ratios: 4.43; 95%CI: 1.57-34.18) were at higher risk of oral colonization by Candida species. Resistance to fluconazole and ketoconazole, or to itraconazole, corresponded to 1% and 4%, respectively. Conclusion Age (45 years or older) was the only factor associated with oral colonization by Candida . Low rates of antifungal resistance to azoles were detected in yeast isolates obtained from HIV-positive patients. Findings of this study may contribute to proper therapeutic selection for oral candidiasis in HIV-positive patients.

RESUMO Objetivo Investigar a suscetibilidade a antifúngicos e os fatores associados à colonização oral por espécies de Candida isoladas de pacientes HIV positivo. Métodos Estudo prospectivo realizado com amostragem por conveniência de indivíduos HIV positivo, acompanhados por um serviço de atendimento especializado da cidade de Rondonópolis, Mato Grosso, Brasil. Foram coletados swabs orais de 197 pacientes. As espécies de Candida foram identificadas por técnicas microbiológicas fenotípicas padrão e por método molecular. A suscetibilidade antifúngica foi determinada pelo método de microdiluição em caldo. Resultados Cento e um (51,3%) pacientes foram colonizados por Candida spp. Candida albicans foi a espécie mais prevalente (80%). Identificou-se um maior risco de colonização oral por espécies de Candida em pacientes com idade entre 45 e 59 anos (razão de prevalência: 1,90; IC95%: 1,57-6,31) e 60 anos ou mais (razão de prevalência: 4,43; IC95%: 1,57-34,18). A resistência ao fluconazol e ao cetoconazol foi de 1% cada e de 4% ao itraconazol. Conclusão O único fator associado à colonização oral por espécies de Candida foi ter 45 anos ou mais. Identificamos baixa taxa de resistência antifúngica aos azóis entre as leveduras isoladas de pacientes HIV positivo. Estes achados podem contribuir para selecionar o tratamento da candidíase oral em pacientes HIV positivos.

Dengue epidemiological profile in southern Mato Grosso, Brazil (2008-2012)

Dengue is an arboviral disease that is a serious public health concern, especially due to its increasing incidence in the past decades. This study aimed to characterize the epidemiological incidence of dengue in 2008­2012 in Southern Mato Grosso, Brazil. This is an epidemiological and descriptive study of dengue in the 19 municipalities of the Rondonópolis Regional Health Office using data obtained from the Information System of Diseases Notification. An analysis of the number of confirmed cases of dengue, according to year, age, and gender was performed. Data was associated with the rainfall of the region as well. There were 13,580 reported dengue cases; 2010 had the highest number of cases, with 7,244 dengue cases. In 2011, the number fell dramatically to only 236 notified cases. With regard to age, the most often affected were young adults (20-39 years of age); no difference was noted regarding gender. As expected, dengue cases were higher during the rainy season. In 2009 and 2010, in Southern Mato Grosso, there was a significant increase in the proportion of dengue cases compared with other years during the period evaluated. However, a rapid decline in the subsequent year was noted, possibly because of the intensification of preventive actions in vector control. Interestingly, 2012 presented an increasing number of dengue cases. This fact highlights the importance of actively combating dengue in order to prevent future epidemics.

Características clínicas e citogenéticas da síndrome de Turner na região Centro-Oeste do Brasil / Clinical and cytogenetic aspects of the Turner syndrome in the Brazilian Western region

OBJETIVO: examinar a associação entre características citogenéticas e alterações clínicas em pacientes com síndrome de Turner (ST). MÉTODOS: Foram incluídas 42 pacientes. Os dados clínicos foram colhidos e registrados em formulário padronizado com entrevista do responsável e, quando possível, com a própria paciente, seguido de exame físico detalhado. A associação entre cariótipo e intercorrências clínicas foram examinadas pelo teste do χ2. RESULTADOS: Das pacientes, 64 por cento tinham cariótipo 45,X; 26,2 por cento 45,X/46,X; 7 por cento 45,X/46Xi(Xq) e 2,3 por cento 45,X/46,X,Del(Xq). Independentemente do cariótipo, 100 por cento das pacientes apresentaram baixa estatura. A implantação baixa dos cabelos foi mais frequente nas pacientes com cariótipo 45,X (p=0,03). Anomalias cardiovasculares (45 por cento), otites (43 por cento), disfunção da tireoide (33 por cento) e hipertensão arterial (26,6 por cento) foram as alterações clínicas mais frequentes e não mostraram correlação com o cariótipo. A avaliação de medidas antropométricas revelou correlação positiva entre a idade e o diâmetro da cintura e quadril (r=0,9; p=0,01). Trinta e uma pacientes (74 por cento) faziam ou tinham feito uso de medicamentos, sendo que hormônio de crescimento (43 por cento), esteroides sexuais (30 por cento), tiroxina (11,9 por cento) e oxandrolona (9,5 por cento) foram os mais utilizados. A comparação da idade da gestação no momento em que ocorreu o parto com dificuldade no aprendizado mostrou razão de prevalência de 1,71 (p>0,05). CONCLUSÃO: a implantação baixa dos cabelos é o estigma mais prevalente nas pacientes com cariótipo 45,X e as alterações clínicas mais comuns são as cardiovasculares, otites, hipertensão arterial e disfunções tireoidianas, porém não apresentam correlação com o cariótipo.

PURPOSE: to examine the association between cytogenetic characteristics and clinical and epidemiological changes in patients with Turner syndrome (TS). METHODS: Forty-two patients were included. Data were collected using a standardized questionnaire in interviews conducted with the responsible person and, when possible, with the patient. A detailed physical examination was performed. The association between karyotype, stigmata and clinical disorders were examined using the χ2 test. RESULTS: Sixty-four percent of TS patients were 45,X; 26,2 percent 45,X/46,X;7 percent 45,X/46Xi(Xq), and 2,3 percent 45,X/46,X,Del(Xq). Regardless of the karyotype, all patients had short stature. Low hair implantation was more frequent in patients with 45,X (p=0.03). Cardiovascular abnormalities (45 percent), otitis (43 percent), thyroid dysfunction (33 percent) and hypertension (26.6 percent) were the most frequent clinical disorders, but without correlation with the karyotype. Anthropometric measurements revealed a positive linear correlation of waist and hip circumference with age (r=0.9, p=0.01). Thirty-one patients (74 percent) were using or had previously used growth hormone (43 percent), sex steroids (30 percent), thyroxine (11.9 percent) or oxandrolone (9.5 percent). Comparison between gestational age at birth and learning difficulties showed a prevalence ratio of 1.71 (p>0.05). CONCLUSION: Low hair implantation is the most prevalent stigma in patients with a 45,X karyotype and the most common clinical changes were cardiovascular problems, otitis, thyroid dysfunction and hypertension; however, they did not show any correlation with the karyotype.