Evidência de alterações de permeabilidade vascular na dengue: quando a dosagem de albumina sérica define o quadro? / Plasma leakage detection in severe dengue: when serum albumin quantification plays a role?

Evidência de extravasamento vascular decorrente do aumento da permeabilidade capilar caracteriza e diferencia febre hemorrágica da dengue. Este artigo avalia o valor de albumina sérica na detecção de alterações de permeabilidade vascular em casos de dengue. Quatorze pacientes diagnosticados com febre hemorrágica da dengue em dois hospitais privados em Recife, Brasil, entre janeiro e maio de 2002 foram seguidos com dosagens diárias de hematócrito e albumina sérica. Ultra-son e Raio X de tórax foram realizados. Oito (57 por cento) casos apresentaram hemoconcentração de 20 por cento ou mais. Hipoalbuminemia foi detectado em dez (71 por cento) pacientes. Dosagem de albumina sérica aumentou a detecção de alterações de permeabilidade em seis (43 por cento) casos na qual a hemoconcentração foi inferior a 20 por cento e os sintomas foram compatíveis com um a resposta imune exacerbada. Raio-X foi normal em todos os casos. A utilização, portanto, de dosagem de albumina sérica aumenta a sensibilidade de detecção de casos de febre hemorrágica da dengue.

Evidence of vascular leakage due to increased capillary permeability characterizes and differentiates dengue hemorrhagic fever. This article assesses the value of serum albumin for detecting vascular permeability abnormalities in dengue cases. Fourteen patients diagnosed with dengue hemorrhagic fever at two private hospitals in Recife, Brazil, between January and May 2002 were followed up with daily hematocrit and serum albumin assays. Ultrasound scans and chest X-rays were also performed. Eight (57 percent) of the cases presented hemoconcentration of 20 percent or more. Hypoalbuminemia was detected in ten patients (71 percent). Serum albumin assays increased the detection of permeability abnormalities in six cases (43 percent) in which the hemoconcentration was less than 20 percent and the symptoms were compatible with an exacerbated immune response. The X-rays were normal in all cases. Thus, the use serum albumin quantification increased the sensitivity of dengue hemorrhagic fever detection.

Acute disseminated encephalomyelitis in classic dengue

Neurological manifestation is uncommon in dengue infection. The pathogenesis of central nervous system involvement is controversial. We report a rare case of acute disseminated encephalomyelitis in classic dengue, with isolation of serotype 3 in liquor. This condition was associated with significant structural damage detected by magnetic resonance.

Manifestação neurológica é incomum em dengue. A patogênese do acometimento do sistema nervosa central é controversa. Nós relatamos um raro caso de encefalomielite disseminada aguda em dengue clássica, com isolamento do sorotipo 3 em líquor. O quadro estava associado a significativo dano estrutural detectado pela ressonância magnética.

Prevalence of cagA and vacA genes in isolates from patients with Helicobacter pylori-associated gastroduodenal diseases in Recife, Pernambuco, Brazil

Geographical differences in the prevalence of Helicobacter pylori genes and their association with disease severity have been identified. This study analyzes the prevalences of the cagA gene and alleles of the vacA gene in H. pylori-associated gastroduodenal diseases in isolates from Recife, PE, Brazil. Gastric biopsy of 61 H. pylori-positive patients were submitted to DNA extraction and gene amplification by polymerase chain reaction. Among the 61 patients, 21 suffered from duodenal ulcer (DU) and 40 from gastritis (GT). The prevalence of H. pylori strains harbouring the cagA gene was higher in the DU group (90.5 percent) than in the GT group (60 percent) (p = 0.02). The vacA gene was amplified in 56 out of 61 biopsies, of which 43 (76.8 percent) contained bacteria carrying the s1 allele and 13 (23.2 percent) the s2. However, the prevalence of the vacA s1 genotying was the same in either DU or GT group. The majority of the s1-typed strains, 39 (90.7 percent) out of 43, were subtype s1b. In resume there was a strong association between the H. pylori cagA+ gene and DU. However, there were no differences between the DU and GT groups in relation to the vacA s1 and s2 alleles distribution, albeit the subtype s1b was predominat