Soroprevalência de citomegalovírus em gestantes brasileiras de classe socioeconômica favorecida / Seroprevalence of cytomegalovirus infection in pregnant woman of socioeconomically advantaged class from Brazil

Introdução: a citomegalovirose congênita é a infecção intrauterina mais comum em todo o mundo e a principal causa infecciosa de malformação do sistema nervoso central, surdez e dificuldade de aprendizado na infância. Entretanto, apesar da importância e das repercussões desta infecção, poucos estudos foram publicados no Brasil e na America Latina. Objetivo: estabelecer a soroprevalência para citomegalovírus em gestantes de classe socioeconômica favorecida e conhecer melhor o perfi l desta infecção na população brasileira. Métodos: estudo descritivo onde foram incluídas todas as gestantes que procuraram a empresa Cryopraxis Criobiologia Ltda. para armazenamento de sangue de cordão umbilical no período de 1o de janeiro de 2005 a 31 de dezembro de 2006. Todas as gestantes foram submetidas à coleta de sangue para detecção de anticorpos das classes IgG e IgM contra citomegalovírus pelos métodos de ensaio imunoenzimático e quimioluminescência. Resultados: foram obtidas 4.620 amostras de soro, 1.966 (42%) procedentes do estado do Rio de Janeiro, 1.695 (37%) do estado de São Paulo e 959 (21%) de outros estados. Destas, 3.894 (84%) apresentaram reatividade para anticorpos da classe IgG contracitomegalovírus, evidenciando alta prevalência desta infecção. Apenas 64 (1,4%) gestantes apresentaram resultados sugestivos de infecção aguda (IgMpositiva). Conclusão: embora a infecção por CMV seja com frequência associada à condição socioeconômica menos favorecida, os resultados encontrados neste trabalho mostram uma elevada prevalência da infecção também em mulheres brasileiras de classe média a alta. Adicionalmente, de acordo com os resultados sorológicos, boa parte das gestantes mostrou-se ainda sujeita a primoinfecção, o que alerta para o risco de transmissão materno-fetal nesta população. Como não há tratamento específico para mulheres grávidas, conhecer a sorologia materna permite adequada orientação e consequente redução do risco de infecção congênita.

Introduction: congenital cytomegalovirus is the most common intrauterine infection in the world, causing central nervous malformation, deafness andpoor acquaintance of knowledge. Notwithstanding, few studies are addressed studying this infection in Brazilian and Latin America pregnat women.Objective: the aim of this study was to establish the seroprevalence of cytomegalovirus in advantaged socioeconomic class pregnants in Brazil.Methods: we search the seroprevalence of cytomegalovirus in high socioeconomic pregnant women in Brazil and the profile of the infection in ourcountry. Our study was observational/transversal, with pregnant women attended at Cryopraxis Criobiology Ltda. Blood from umbilical cord was collected from January 2005 until December 2006 with analyzing IgM and IgG antibodies for cytomegalovirus (immunoassay and chemiluminescence). Results: we obtained 4,620 samples, 1966 (42%) from Rio de Janeiro, 1,695 (37%) from São Paulo State and 959 (21%) from other states. 3894 (84%) were IgG positivity to cytomegalovirus, with high prevalence. Only 64 (1,4%) of the pregnants were suggestively acute infection (IgM positive). Conclusion:although cytomegalovirus infection is frequently associated with lower socioeconomic class, the seropositivity of IgG is high in pregnant women of high socioeconomic class in Brazil. In many cases, previous contact with viruses was not evident, which warns about the maternal susceptibility to infection and consequent risk of fetal transmission in this population. There is no specific treatment of the disease. Then, serology is important for adequate attendance, reducing the risk of congenital infection.

Immune reconstitution syndrome in patients treated for HIV and tuberculosis in Rio de Janeiro

We made a retrospective longitudinal study from January 2000 to January 2003 to examine cases of immune reconstitution syndrome (IRS) and its incidence rate in tuberculosis (TB)-human immunodeficiency virus (HIV) co-infected patients. The incidence rate (IR) was calculated using a Poisson regression. The confidence interval (CI) that was stipulated was 95 percent. IRS occurred in 10/84 HIV and TB-positive patients; nine of them were on highly active anti-retroviral therapy (HAART) during a mean of 61.7 (±59) days following the introduction of antiretrovirals. Lymph-node enlargement was the sole clinical manifestation. CD4 counts were <100 cells/mm³in 50 percent of the patients, at the time of TB diagnosis. All but two patients were treated with prednisone, and recovered from TB within a mean of 91 days (±30 days). One relapse of TB was observed, but there were no IRS-related deaths. The incidence rate was higher (IR=11.18; CI, 1.41-88.76) in patients that had superficial lymph node enlargement at the moment of TB diagnosis (not associated with TB), extrapulmonary TB (IR=1.97; CI, 0.44-8.79), were antiretroviral naive (IR=1.85; CI, 0.48-7.16), and CD4 counts <100 cells/mm³ (IR=1.50; CI, 0.40-5.59), although with a wide CI. IRS was frequent in our sample, occurred more frequently in HIV-naive patients with lymph-node enlargement and extrapulmonary TB. No cases of new pulmonary lesions or worsening of pulmonary infiltrates were observed.