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1.
Rev. Soc. Bras. Med. Trop ; 55: e0265, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1360818

ABSTRACT

ABSTRACT BACKGROUND: We aimed to describe the clinical characteristics of coronavirus disease 2019 (COVID-19) among healthcare workers (HCWs) in Curitiba, Brazil. METHODS: Upper respiratory samples from 1077 HCWs were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription polymerase chain reaction from June 16, 2020 to December 9, 2020. RESULTS: Overall, 32.7% of HCWs were infected. The positivity rates in symptomatic and asymptomatic HCWs were 39.2% and 15.9%, respectively. Hospital departments categorized as high-risk for exposure had the highest number of infected HCWs. CONCLUSIONS: Early diagnosis and isolation of infected HCWs remain key in controlling SARS-CoV-2 transmission because HCWs in close contact with COVID-19 patients are more likely to be infected than those who are not.

2.
Becker, Jefferson; Ferreira, Lis Campos; Damasceno, Alfredo; Bichuetti, Denis Bernardi; Christo, Paulo Pereira; Callegaro, Dagoberto; Peixoto, Marco Aurélio Lana; Sousa, Nise Alessandra De Carvalho; Almeida, Sérgio Monteiro De; Adoni, Tarso; Santiago-Amaral, Juliana; Junqueira, Thiago; Pereira, Samira Luisa Apóstolos; Gomes, Ana Beatriz Ayroza Galvão Ribeiro; Pitombeira, Milena; Paolilo, Renata Barbosa; Grzesiuk, Anderson Kuntz; Piccolo, Ana Claudia; D´Almeida, José Arthur Costa; Gomes Neto, Antonio Pereira; Oliveira, Augusto Cesar Penalva De; Oliveira, Bianca Santos De; Tauil, Carlos Bernardo; Vasconcelos, Claudia Ferreira; Kaimen-Maciel, Damacio; Varela, Daniel; Diniz, Denise Sisterolli; Oliveira, Enedina Maria Lobato De; Malfetano, Fabiola Rachid; Borges, Fernando Elias; Figueira, Fernando Faria Andrade; Gondim, Francisco De Assis Aquino; Passos, Giordani Rodrigues Dos; Silva, Guilherme Diogo; Olival, Guilherme Sciascia Do; Santos, Gutemberg Augusto Cruz Dos; Ruocco, Heloisa Helena; Sato, Henry Koiti; Soares Neto, Herval Ribeiro; Cortoni Calia, Leandro; Gonçalves, Marcus Vinícius Magno; Vecino, Maria Cecilia Aragón De; Pimentel, Maria Lucia Vellutini; Ribeiro, Marlise De Castro; Boaventura, Mateus; Parolin, Mônica Koncke Fiuza; Melo, Renata Brant De Souza; Lázaro, Robson; Thomaz, Rodrigo Barbosa; Kleinpaul, Rodrigo; Dias, Ronaldo Maciel; Gomes, Sidney; Lucatto, Simone Abrante; Alves-Leon, Soniza Vieira; Fukuda, Thiago; Ribeiro, Taysa Alexandrino Gonsalves Jubé; Winckler, Thereza Cristina Dávila; Fragoso, Yara Dadalti; Nascimento, Osvaldo José Moreira Do; Ferreira, Maria Lucia Brito; Mendes, Maria Fernanda; Brum, Doralina Guimarães; Glehn, Felipe Von.
Arq. neuropsiquiatr ; 79(11): 1049-1061, Nov. 2021. tab
Article in English | LILACS | ID: biblio-1350135

ABSTRACT

ABSTRACT The Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) provide recommendations in this document for vaccination of the population with demyelinating diseases of the central nervous system (CNS) against infections in general and against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. We emphasize the seriousness of the current situation in view of the spread of COVID-19 in our country. Therefore, reference guides on vaccination for clinicians, patients, and public health authorities are particularly important to prevent some infectious diseases. The DCNI/ABN and BCTRIMS recommend that patients with CNS demyelinating diseases (e.g., MS and NMOSD) be continually monitored for updates to their vaccination schedule, especially at the beginning or before a change in treatment with a disease modifying drug (DMD). It is also important to note that vaccines are safe, and physicians should encourage their use in all patients. Clearly, special care should be taken when live attenuated viruses are involved. Finally, it is important for physicians to verify which DMD the patient is receiving and when the last dose was taken, as each drug may affect the induction of immune response differently.


RESUMO O DC de Neuroimunologia da ABN e o BCTRIMS trazem, nesse documento, as recomendações sobre vacinação da população com doenças desmielinizantes do sistema nervoso central (SNC) contra infecções em geral e contra o coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2), causador da COVID-19. Destaca-se a gravidade do atual momento frente ao avanço da COVID-19 em nosso País, o que torna mais evidente e importante a criação de guia de referência para orientação aos médicos, pacientes e autoridades de saúde pública quanto à vacinação, meio efetivo e seguro no controle de determinadas doenças infecciosa. O DCNI/ABN e o BCTRIMS recomendam que os pacientes com doenças desmielinizantes do SNC (ex., EM e NMOSD) sejam constantemente monitorados, quanto a atualização do seu calendário vacinal, especialmente, no início ou antes da mudança do tratamento com uma droga modificadora de doença (DMD). É importante também salientar que as vacinas são seguras e os médicos devem estimular o seu uso em todos os pacientes. Evidentemente, deve ser dada especial atenção às vacinas com vírus vivos atenuados. Por fim, é importante que os médicos verifiquem qual DMD o paciente está em uso e quando foi feita a sua última dose, pois cada fármaco pode interagir de forma diferente com a indução da resposta imune.


Subject(s)
Humans , COVID-19 , Multiple Sclerosis/drug therapy , Neurology , Central Nervous System , Vaccination , SARS-CoV-2
3.
Arq. neuropsiquiatr ; 78(5): 290-300, May 2020. tab, graf
Article in English | LILACS | ID: biblio-1131705

ABSTRACT

ABSTRACT Background: As the COVID-19 pandemic unfolds worldwide, different forms of reports have described its neurologic manifestations. Objective: To review the literature on neurological complications of SARS-CoV-2 infection. Methods: Literature search performed following systematic reviews guidelines, using specific keywords based on the COVID-19 neurological complications described up to May 10th, 2020. Results: A total of 43 articles were selected, including data ranging from common, non-specific symptoms, such as hyposmia and myalgia, to more complex and life-threatening conditions, such as cerebrovascular diseases, encephalopathies, and Guillain-Barré syndrome. Conclusion: Recognition of neurological manifestations of SARS-CoV-2 should be emphasized despite the obvious challenges faced by clinicians caring for critical patients who are often sedated and presenting other concurrent systemic complications.


RESUMO Introdução: À medida que a pandemia da COVID-19 se desenvolve em todo o mundo, diferentes tipos de publicações descreveram suas manifestações neurológicas. Objetivo: Revisar a literatura sobre complicações neurológicas da infecção por SARS-CoV-2. Métodos: A pesquisa bibliográfica foi realizada seguindo diretrizes de revisões sistemáticas, usando palavras-chave específicas baseadas nas complicações neurológicas da COVID-19 descritas até 10 de maio de 2020. Resultados: Foram selecionados 43 artigos, incluindo descrições que variam de sintomas comuns e inespecíficos, como hiposmia e mialgia, a condições mais complexas e com risco de vida, como doenças cerebrovasculares, encefalopatias e síndrome de Guillain-Barré. Conclusão: O reconhecimento das manifestações neurológicas da SARS-CoV-2 deve ser enfatizado apesar dos óbvios desafios enfrentados pelos clínicos que cuidam de pacientes críticos, muitas vezes sedados e apresentando outras complicações sistêmicas concomitantes.


Subject(s)
Humans , Pneumonia, Viral/complications , Coronavirus Infections/complications , Nervous System Diseases/complications , Brain Diseases/complications , Cerebrovascular Disorders/complications , Cerebrovascular Disorders/physiopathology , Coronavirus Infections , Guillain-Barre Syndrome/complications , Ageusia/complications , Pandemics , Myalgia/complications , Olfaction Disorders/complications , Nervous System Diseases/physiopathology
4.
Arq. neuropsiquiatr ; 77(2): 131-135, Feb. 2019. graf
Article in English | LILACS | ID: biblio-983894

ABSTRACT

ABSTRACT Objective: The history of Anatomical Pathology in the state of Paraná, in southern Brazil, is closely linked with the foundation of the Universidade Federal do Paraná (UFPR). This study identified the first central nervous system (CNS) clinical autopsy performed by the Department of Anatomical Pathology of the UFPR. Methods: This study reviewed the autopsy report archives of the Hospital de Clínicas-UFPR from 1951 onward. The clinical anatomy interpretations of the autopsy report and possible etiologic agents were discussed. Result: The first adult clinical autopsy with CNS study was performed on April 23, 1952 on a 45-year-old man with lobar pneumonia with abscesses complicated by bacterial meningitis. Conclusion: This case was the first CNS clinical autopsy performed in the state of Paraná and, possibly, in southern Brazil. The death was due to an infectious disease, which was the main cause of death in Brazil in the 1950s.


RESUMO Objetivo: A história da Anatomia Patológica no Estado do Paraná, sul do Brasil, está ligada com a fundação da Universidade Federal do Paraná (UFPR). Este estudo identificou a primeira autópsia clínica do sistema nervoso central (SNC) realizada pelo Departamento de Anatomia Patológica da UFPR. Métodos: Foi realizada revisão dos arquivos dos relatórios de autópsia do HC-UFPR, desde 1951. As interpretações anátomo-clínicas do laudo da autópsia e os possíveis agentes etiológicos foram discutidas. Resultado: A primeira autópsia clínica em adulto com estudo do SNC foi realizada em 23 de abril de 1952. Um homem de 45 anos com pneumonia lobar com abscessos pulmonares, complicada com meningite bacteriana. Conclusão: Este caso é a primeira autópsia clínica em adulto com estudo do SNC do estado do Paraná e possivelmente do Sul do Brasil. A causa da morte foi devido a uma doença infecciosa, as principais causas de óbito no Brasil nos anos 50.


Subject(s)
Humans , Male , Female , History, 16th Century , Autopsy/history , Central Nervous System , Brazil , Registries , Cause of Death , Neuropathology/history
5.
Arq. neuropsiquiatr ; 76(6): 373-380, June 2018. tab, graf
Article in English | LILACS | ID: biblio-950550

ABSTRACT

ABSTRACT Background During the first decade of this century, a significant increase in the incidence of syphilis was documented. Objective To study clinical and laboratory characteristics of central nervous system and ocular syphilis. Methods A retrospective case series of 13 patients with a clinical and laboratory diagnosis of neurosyphilis and/or ocular syphilis who had been admitted to the Neurology and Neuro-ophthalmology Service of the Hospital de Clínicas, Federal University of Paraná. Results Nine patients had a diagnosis of neurosyphilis and two of them also had ocular syphilis. Four patients had a diagnosis of ocular syphilis alone. Among the patients with a diagnosis of neurosyphilis, six had symptomatic syphilitic meningitis, of whom one manifested as cranial nerve palsy alone, one as cranial nerve palsy plus ocular syphilis, two as transverse myelitis (syphilitic meningomyelitis), one as meningitis worsening the patient's myasthenia gravis symptoms and one as meningitis plus ocular syphilis. Additionally, we diagnosed three patients with meningovascular neurosyphilis. In the univariate analysis, patients without ocular syphilis showed greater levels of total protein and white blood cells in the cerebrospinal fluid than patients with ocular syphilis. Conclusion This Brazilian case series of patients with neurosyphilis and ocular syphilis highlights the wide variability of this disease. A high degree of diagnostic suspicion is necessary when facing neurological and ocular symptoms for rapid diagnosis and appropriate management of patients.


RESUMO Introdução Na primeira década deste século observou-se um aumento significativo da incidência de sífilis no mundo. Objetivo Estudar características clínicas e laboratoriais da sífilis no Sistema Nervoso Central e da sífilis ocular. Métodos Estudou-se, retrospectivamente, uma série de treze casos com diagnóstico clínico e laboratorial de neurossífilis e/ou sífilis ocular, admitidos aos Serviços de Neurologia ou Neuroftalmologia do Hospital de Clínicas da Universidade Federal do Paraná. Resultados Nove pacientes tiveram diagnóstico de neurosífilis e dois destes apresentaram concomitantemente sífilis ocular. Quatro pacientes tiveram somente o diagnóstico de sífilis ocular. Dos pacientes com diagnóstico de neurosífilis, seis apresentaram meningite sifilítica sintomática, dentre os quais um se apresentou com paralisia isolada de par craniano, um com paralisia de par craniano associada sífilis ocular, dois com mielite transversa (manifestação de meningomielite), um com meningite que agravou sintomas de Miastenia Gravis e um com meningite isolada associada a sífilis ocular. Houve 3 casos de neurosífilis meningovascular. Na análise univariada, pacientes sem manifestações oculares de sífilis apresentaram maiores níveis proteína total e leucócitos do que os pacientes com sífilis ocular. Conclusão Essa série brasileira de casos de pacientes com neurosífilis e sífilis ocular destaca a alta variabilidade clínica desta doença. Alto grau de suspeição diagnóstica é necessário quando em frente a sintomas neurológicos e oculares para rápido diagnóstico e adequado manejo dos pacientes.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Eye Infections, Bacterial/diagnosis , Neurosyphilis/diagnosis , Syphilis Serodiagnosis , Magnetic Resonance Imaging , Fluorescein Angiography , Eye Infections, Bacterial/complications , Eye Infections, Bacterial/cerebrospinal fluid , Retrospective Studies , Neurosyphilis/complications , Neurosyphilis/cerebrospinal fluid
7.
Arq. neuropsiquiatr ; 74(10): 810-815, Oct. 2016. tab, graf
Article in English | LILACS | ID: lil-796838

ABSTRACT

ABSTRACT The presence of hemoglobin in samples are considered an important inhibitory factor for polymerase chain reaction (PCR). The aim of this study was to examine the influence of red blood cells (RBC)s in cerebrospinal fluid (CSF) as an inhibitory factor to reverse transcription polymerase chain reaction (RT-PCR) for enteroviruses (EV). Forty-four CSF samples from patients showing characteristics of viral meningitis were assessed for EV by RT-PCR. Viral RNA extracted with guanidine isothyocianate buffer and virus detection was performed by in-house nested PCR. Positivity for EV RT-PCR was higher in CSF samples without RBCs than in samples with RBCs: 13(26%) and 36(9.2%), p = 0.001. In the group with positive EV RT-PCR, the mean + SD CSF RBC was 37 ± 183 cell/mm3; the group with negative results had 580 + 2,890 cell/mm3 (p = 0.007). The acceptable upper limit for CSF RBCs that could not influence RT-PCR was 108 cells/mm3. CSF samples with negative results for EV RT-PCR have more erythrocytes.


RESUMO A presença de hemoglobina em amostras de fluidos corporais é considerada um fator inibitório importante da reação em cadeia da polimerase (PCR). O objetivo deste estudo era examinar a influencia de hemácias no líquido cefalorraquidiano (LCR) como um fator inibitório da RT-PCR para enterovirus (EV). Quatrocentos e quarenta amostras de LCR de pacientes com características de meningite viral foram avaliados para enterovirus por RT-PCR. RNA viral foi extraído com tampão de isotiocianato de guanidina e a detecção viral foi feita com nested PCR in-house. A positividade do EV RT-PCR no LCR foi maior nas amostras de LCR sem hemácias do que as amostras com hemácias: 13 (26%) e 36 (9,2%), respectivamente (p = 0,001). No grupo com resultados EV RT-PCR positivo, a media ± DP do número de hemácias no LCR foi 37 ± 183 cell/mm3 e no grupo com resultados negativos foi 580 ± 2.890 cell/mm3 (p = 0,007). O limite superior aceitável de hemácias no LCR para não inibir o resultado do PCR foi 108 cells/mm3. As amostras de LCR com resultados negativos para RT-PCR EV tem mais eritrócitos em comparação com amostras com resultados positivos.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Cerebrospinal Fluid/cytology , Cerebrospinal Fluid/virology , Enterovirus/isolation & purification , Reverse Transcriptase Polymerase Chain Reaction/methods , Erythrocytes , Reference Values , Time Factors , DNA, Viral/cerebrospinal fluid , RNA, Viral/cerebrospinal fluid , Sensitivity and Specificity , Enterovirus Infections/cerebrospinal fluid , Enterovirus Infections/virology , Erythrocyte Count , Meningitis, Viral/virology
8.
Arq. neuropsiquiatr ; 74(10): 816-822, Oct. 2016. tab, graf
Article in English | LILACS | ID: lil-796832

ABSTRACT

ABSTRACT Objective To define how to best handle cerebrospinal fluid (CSF) specimens to obtain the highest positivity rate for the diagnosis of malignancy, comparing two different methods of cell concentration, sedimentation and cytocentrifugation. Methods A retrospective analysis of 411 CSF reports. Results This is a descriptive comparative study. The positive identification of malignant CSF cells was higher using the centrifuge than that using the Suta chamber (27.8% vs. 19.0%, respectively; p = 0.038). Centrifuge positively identified higher numbers of malignant cells in samples with a normal concentration of white blood cells (WBCs) (< 5 cells/mm3) and with more than 200 cells/mm3, although this was not statistically significant. There was no lymphocyte loss using either method. Conclusions Cytocentrifugation positively identified a greater number of malignant cells in the CSF than cytosedimentation with the Suta chamber. However, there was no difference between the methods when the WBC counts were within the normal range.


RESUMO Objetivo Definir qual a melhor forma de concentrar amostras de LCR para obter maior porcentagem de positividade para o diagnóstico de infiltração neoplásica. comparando dois métodos diferentes de concentração de células, sedimentação e citocentrifugação. Métodos Análise retrospectiva de 411 laudos de LCR. Resultados Estudo comparativo descritivo. A identificação de células neoplásicas no LCR foi mais elevada quando usada a citocentrífuga do que a câmara de Suta (28% vs 19,0%, respectivamente; p = 0,038). Centrifugação identificou maior número de células neoplásicas em amostras com concentração de células < 5 células/mm3 e superior a 200 células/mm3, embora não significativo. Não houve perda de linfócitos usando qualquer um dos métodos. Conclusões A citocentrifugação identificou um número maior de células malignas no LCR do que a sedimentação com a câmara de Suta. No entanto, não houve diferença entre os métodos quando as contagens de leucócitos estavam dentro do intervalo normal.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Centrifugation/instrumentation , Centrifugation/methods , Central Nervous System Neoplasms/cerebrospinal fluid , Reference Standards , Reference Values , Specimen Handling/instrumentation , Specimen Handling/methods , Time Factors , Leukemia/cerebrospinal fluid , Cerebrospinal Fluid/cytology , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Leukocyte Count
9.
Arq. neuropsiquiatr ; 73(7): 624-629, 07/2015. tab
Article in English | LILACS | ID: lil-752387

ABSTRACT

The nervous system plays an important role in HIV infection. The purpose of this review is to discuss the indications for cerebrospinal fluid (CSF) analysis in HIV infection in clinical practice. CSF analysis in HIV infection is indicated for the diagnosis of opportunistic infections and co-infections, diagnosis of meningitis caused by HIV, quantification of HIV viral load, and analysis of CNS HIV compartmentalization. Although several CSF biomarkers have been investigated, none are clinically applicable. The capacity of HIV to generate genetic diversity, in association with the constitutional characteristics of the CNS, facilitates the generation of HIV quasispecies in the CNS that are distinct from HIV in the systemic circulation. CSF analysis has a well-defined and valuable role in the diagnosis of CNS infections in HIV/AIDS patients. Further research is necessary to establish a clinically applicable biomarker for the diagnosis of HIV-associated neurocognitive disorders.


O sistema nervoso representa um papel importante na infecção pelo HIV. O objetivo desta revisão é discutir as indicações para análise do líquido cefalorraquidiano (LCR) na infecção pelo HIV na prática clínica. A análise do LCR na infecção pelo HIV é indicada para o diagnóstico de infecções oportunistas e co-infecções, meningite pelo HIV, quantificação da carga viral de HIV e compartimentalização do HIV no SNC. Uma série de biomarcadores no LCR foi investigada, na literatura, porém não apresentam aplicabilidade clínica. A grande capacidade do HIV de gerar diversidade genética, associado a características constitucionais do SNC propicia o desenvolvimento quasiespécies distintas no SNC das circulantes sistemicamente. A análise do LCR na infecção pelo HIV é bem estabelecida no diagnóstico de infecções no CNS, contudo mais pesquisas é necessária para estabelecer a aplicabilidade clínica dos biomarcadores no diagnóstico de desordens cognitivas associadas ao HIV.


Subject(s)
Humans , Central Nervous System Infections/cerebrospinal fluid , HIV Infections/cerebrospinal fluid , Anti-Retroviral Agents/therapeutic use , Central Nervous System Infections/drug therapy , Central Nervous System Infections/virology , Cerebrospinal Fluid/virology , Cognition Disorders/cerebrospinal fluid , HIV Infections/complications , HIV Infections/drug therapy , Reproducibility of Results , Viral Load
10.
Arq. neuropsiquiatr ; 72(7): 506-509, 07/2014. tab, graf
Article in English | LILACS | ID: lil-714592

ABSTRACT

Blood plasma specimens are the clinical standard for HIV-1 pol gene genotyping from viral populations; however, it is not always successful, often from low viral loads or the presence of polymerase chain reaction (PCR) inhibitors. Objective To describe the successful of HIV-1 genotyping in two samples of cerebrospinal fluid (CSF), after genotype procedures failed from blood. Method Two HIV-infected patients enrolled in a neurocognitive research study were evaluated when standard HIV-1 genotyping failed from blood plasma samples. Genotyping was performed using the commercial system TRUGENE® HIV-1 Genotyping Kit and the OpenGene® DNA Sequencing System (Siemens Healthcare Diagnostics, Tarrytown, NY, USA). Results CSF genotyping was performed via the same commercial platform and was successful in both cases. Conclusion This report demonstrates that CSF could be used as an alternate clinical specimen for HIV-1 genotyping when it fails from blood. .


O plasma é a amostra clínica padrão utilizada para a genotipagem da região pol do HIV-1; entretanto, a genotipagem pode nem sempre ser bem sucedida, geralmente devido a baixas cargas virais ou à presença de inibidores da reação em cadeia da polimerase (PCR). Objetivo: Descrever o sucesso da genotipagem do HIV-1 em duas amostras de líquido cefalorraquidiano (LCR) após a falha do mesmo método em amostras de plasma dos mesmos pacientes. Método: Dois pacientes HIV+ envolvidos em um estudo neurocognitivo foram avaliados após a falha da genotipagem do HIV-1 no plasma. A genotipagem foi realizada com o sistema comercial TRUGENE® HIV-1 Genotyping e o OpenGene® DNA Sequencing (Siemens Healthcare Diagnostics, Tarrytown, NY, USA). Resultados: A genotipagem no LCR foi realizada pelo mesmo método utilizado no plasma, sendo bem sucedida para ambos os pacientes. Conclusão: Este artigo demonstra que o LCR pode ser usado como uma amostra clínica alternativa para a genotipagem do HIV-1 quando esta falha no plasma. .


Subject(s)
Adult , Humans , Male , Middle Aged , Genotyping Techniques/methods , HIV Infections/cerebrospinal fluid , HIV-1 , Base Sequence , HIV Infections/blood , HIV-1 , Polymerase Chain Reaction , Reproducibility of Results , RNA, Viral/isolation & purification , Viral Load
11.
Arq. neuropsiquiatr ; 72(7): 500-505, 07/2014. tab, graf
Article in English | LILACS | ID: lil-714599

ABSTRACT

Increased plasma lactate levels can indicate the presence of metabolic disorders in HIV infected individuals. Objective: To determine whether a portable analyzer is valid for measuring cerebrospinal fluid (CSF) and plasma lactate levels in HIV infected individuals. Method: CSF and plasma were collected from 178 subjects. Samples tested by the Accutrend® portable analyzer were compared to those tested by a reference device (SYNCHRON LX® 20). Results: The portable analyzer had in plasma sensitivity of 0.95 and specificity 0.87. For CSF the specificity was 0.95; the sensitivity 0.33; the negative predictive value was 95% and the positive predictive value 33%. Conclusions: These findings support the validity of the portable analyzer in measuring lactate concentrations in CSF that fall within the normal range. The relatively poor positive predictive value indicates that a result above the reference range may represent a “false positive test”, and should be confirmed by the reference device before concluding abnormality. .


O aumento da concentração plasmática dos níveis de lactato pode indicar a presença de distúrbios metabólicos em indivíduos infectados pelo HIV. Objetivo: Determinar a validade do analisador portátil para quantificar os níveis de lactato no líquido cefalorraquidiano (LCR) e plasma em indivíduos infectados. Método: LCR e plasma foram coletados de 178 participantes. As amostras testadas com o analisador portátil Accutrend® e os resultados comparados com aqueles obtidos com o equipamento de referência (SYNCHRON LX® 20). Resultados: O analisador portátil teve, no plasma, sensibilidade de 0,95 e especificidade 0,87. No LCR a especificidade foi 0,95; a sensibilidade 0,33; o valor preditivo negativo foi de 95% e o valor preditivo positivo 33%. Conclusões: Estes dados suportam a validade dos resultados do analisador portátil em concentrações de lactato dentro da faixa normal. Os valores preditivos positivos relativamente baixos indicam que um resultado acima da faixa de referência pode representar um resultado “falso positivo”. .


Subject(s)
Adult , Female , Humans , Male , Middle Aged , HIV Infections/blood , HIV Infections/cerebrospinal fluid , Lactic Acid/blood , Lactic Acid/cerebrospinal fluid , Point-of-Care Systems , Predictive Value of Tests , Reference Values , Reproducibility of Results , Time Factors
12.
Arq. neuropsiquiatr ; 71(9B): 689-692, set. 2013.
Article in English | LILACS | ID: lil-688534

ABSTRACT

Cognitive impairment and major depressive disorder (MDD) are common HIV-1 central nervous system (CNS) complications. Their frequencies in AIDS patients are 36% and 45%, respectively. The diagnoses of HIV cognitive impairment are made by clinical criteria, no single laboratory test or biomarker establishes the diagnosis. Factors of indirect neuronal injury related with the pathophysiology of the HIV infection in the CNS, are the factors studied as biomarkers. In the present no biomarker is established to the diagnosis of HIV cognitive impairment, much still needs to be done. We review in this paper some biomarkers in cerebrospinal fluid that could be valuable to the diagnosis of HIV cognitive impairment. Diagnosing depression in the context of HIV can be challenging, to identify a biomarker that could help in the diagnosis would be very important, although MDD risks and neurobiology are still poorly understood.


A alteração cognitiva e a desordem depressiva maior (MDD) são complicações comuns da AIDS no sistema nervoso central (CNS). Suas frequências, em pacientes com AIDS são 36 % e 45 %, respectivamente. O diagnósticos de alteração cognitiva pelo HIV é feito por critérios clínicos, não há nenhum teste único de laboratório ou biomarcador que estabeleçam o diagnóstico. Os fatores inflamatórios relacionados com dano neuronal indireto e com a patofisiologia da infecção do HIV no CNS, são os fatores estudados como biomarcadores. No presente nenhum biomarcador é estabelecido para o diagnóstico de alteração cognitiva pelo HIV, muito ainda tem para ser feito. Nesta revisão abordaremos alguns biomarcadores no líquido cefalorraquidiano que podem auxiliar no diagnóstico da alteração cognitiva e HIV. Da mesma forma o diagnostico de depressão no contexto da aids pode ser desafiante, identificar um biomarcador que possa ajudar no diagnóstico seria muito importante, embora os riscos de desenvolvimento de MDD e a neurobiologia ainda sejam pobremente entendidos.


Subject(s)
Humans , Cognition Disorders/cerebrospinal fluid , Depressive Disorder, Major/cerebrospinal fluid , HIV Infections/cerebrospinal fluid , Biomarkers/cerebrospinal fluid , Chemokines/cerebrospinal fluid , Cognition Disorders/etiology , Depressive Disorder, Major/etiology , HIV Infections/complications , HIV-1 , Matrix Metalloproteinases/cerebrospinal fluid , Viral Load , /cerebrospinal fluid
13.
Arq. neuropsiquiatr ; 70(5): 366-372, May 2012. ilus, tab
Article in English | LILACS | ID: lil-622576

ABSTRACT

Pneumococcal meningitis is a life-threatening disease characterized by an acute purulent infection affecting piamater, arachnoid and the subarachnoid space. The intense inflammatory host's response is potentially fatal and contributes to the neurological sequelae. Streptococcus pneumoniae colonizes the nasopharynx, followed by bacteremia, microbial invasion and blood-brain barrier traversal. S. pneumoniae is recognized by antigen-presenting cells through the binding of Toll-like receptors inducing the activation of factor nuclear kappa B or mitogen-activated protein kinase pathways and subsequent up-regulation of lymphocyte populations and expression of numerous proteins involved in inflammation and immune response. Many brain cells can produce cytokines, chemokines and others pro-inflammatory molecules in response to bacteria stimuli, as consequence, polymorphonuclear are attracted, activated and released in large amounts of superoxide anion and nitric oxide, leading to the peroxynitrite formation, generating oxidative stress. This cascade leads to lipid peroxidation, mitochondrial damage, blood-brain barrier breakdown contributing to cell injury during pneumococcal meningitis.


A meningite pneumocócica é doença potencialmente fatal caracterizada por infecção aguda purulenta que afeta a pia-máter, a aracnoide e o espaço subaracnoide. A resposta inflamatória do hospedeiro é potencialmente fatal e contribui para as sequelas neurológicas. O processo inicia-se com a colonização da nasofaringe pelo Streptococcus pneumoniae, seguida de invasão, bacteremia e passagem através da barreira hematoencefálica. O S. pneumoniae é reconhecido por células apresentadoras de antígenos através da ligação aos receptores Toll-like. Isto induz a ativação do fator nuclear kappa B ou proteína quinase ativada por mitógenos. Muitas células cerebrais também podem produzir citocinas, quimiocinas e outras moléculas pró-inflamatórias em resposta aos estímulos bacterianos. Como consequência, são atraídos polimorfonucleares, ocorrendo a liberação de grandes quantidades de ânion superóxido e óxido nítrico, o que leva à formação de peroxinitrito e ocasiona o estresse oxidativo. Esta cascata pró-inflamatória leva à peroxidação lipídica, a danos mitocondriais e à ruptura da barreira hematoencefálica, contribuindo para o dano celular em meningite pneumocócica.


Subject(s)
Humans , Meningitis, Pneumococcal , Acute Disease , Adrenal Cortex Hormones/therapeutic use , Cytokines/metabolism , Matrix Metalloproteinases/metabolism , Meningitis, Pneumococcal/drug therapy , Meningitis, Pneumococcal/immunology , Meningitis, Pneumococcal/microbiology , Meningitis, Pneumococcal/physiopathology , Nose/microbiology , Oxidative Stress/physiology , Streptococcus pneumoniae
14.
Arq. neuropsiquiatr ; 69(6): 964-972, Dec. 2011. ilus, tab
Article in English | LILACS | ID: lil-612642

ABSTRACT

The central nervous system (CNS) and the immune system are considered major target organs for HIV infection. The neurological manifestations directly related to HIV are acute viral meningitis, chronic meningitis, HIV associated dementia, vacuolar myelopathy and involvement of the peripheral nervous system. Changes in diagnosis and clinical management have changed the aspect of HIV infection so that it is no longer a fatal disease, and has become a chronic disease requiring sustained medical management. After HAART the incidence of most opportunistic infections, including those affecting the CNS, has dropped markedly. Some studies suggest that neurological involvement of infected patient occur with different frequency, depending on HIV subtype involved in the infection. Subtype C may have reduced neuroinvasive capacity, possibly due to its different primary conformation of HIV transactivating regulatory protein (Tat), involved in monocyte chemotaxis. This review focus on physiopathologic aspects of HIV infection in CNS and its correlation with HIV clades.


O sistema nervoso central (SNC) e o sistema imunológico são considerados os principais órgãos alvo na infecção pelo HIV. As manifestações neurológicas diretamente relacionadas ao HIV são meningites virais aguda e crônica, demência associada ao HIV, mielopatia vacuolar e envolvimento do sistema nervoso periférico. Mudanças no diagnóstico e sobrevida têm mudado o aspecto da infecção pelo HIV, não mais considerada uma doença fatal e sim crônica. Após HAART, a incidência da maioria das doenças oportunistas, incluindo aquelas que afetam o SNC, reduziu-se significativamente. Alguns estudos sugerem que o envolvimento de pacientes infectados ocorre com frequência diferente, dependendo do subtipo de HIV. O subtipo C apresenta uma capacidade reduzida de neuroinvasão, possivelmente devido a conformação primária da sua proteína reguladora da transativação (Tat), que perde sua capacidade quimiotáxica. Esta revisão aborda aspectos fisiopatológicos da infecção do HIV no SNC e subtipos de HIV.


Subject(s)
Humans , AIDS Dementia Complex/virology , AIDS-Related Opportunistic Infections/virology , Genetic Variation , HIV-1 , HIV-2 , AIDS Dementia Complex/physiopathology , AIDS-Related Opportunistic Infections/physiopathology , Genotype , HIV-1 , HIV-2
15.
Braz. j. infect. dis ; 15(3): 215-219, May-June 2011. ilus
Article in English | LILACS | ID: lil-589951

ABSTRACT

BACKGROUND AND OBJECTIVES: Rotavirus (RV) is the main etiological agent of diarrhea in childhood; its laboratory diagnosis is crucial to guide the clinical management and prevention of its spread. RV immunization was introduced in Brazilian 6-month-old children in 2006. The present study was aimed to evaluate three methodologies used for human RV detection in stool samples obtained from patients hospitalized due to gastroenteritis in a teaching hospital and report the impact of RV immunization in hospitalization by diarrhea. METHODS: 293 stool samples collected in the 2001-2008 period were analyzed by enzyme immunoassay (EIA), latex agglutination (LA) and polyacrylamide gel electrophoresis (PAGE). RESULTS: Rotavirus was detected in 34.8 percent of samples by LA assay, 28.3 percent of samples by EIA assay and in 25.6 percent of samples by PAGE assay. Considering the PAGE method as gold standard, the sensitivity, specificity and accuracy of EIA were 94.6 percent, 94.4 percent and 94.5 percent, and to LA were 82.6 percent, 81.6 percent and 81.9 percent, respectively. CONCLUSION: These results indicate that antigen detection by EIA is a rapid, sensitive and specific method, and could be used in large-scale applications for screening stool samples suspected of RV infection. This study showed decreased incidence of RV infection in hospitalized children prior to the implementation of the national immunization program against RV.


Subject(s)
Child , Humans , Diarrhea/virology , Feces/virology , Gastroenteritis/virology , Rotavirus , Rotavirus Infections/diagnosis , Rotavirus Vaccines/immunology , Brazil/epidemiology , Diarrhea/epidemiology , Electrophoresis, Polyacrylamide Gel , Gastroenteritis/epidemiology , Hospitalization , Immunization Programs , Immunoenzyme Techniques , Incidence , Latex Fixation Tests , Program Evaluation , Rotavirus Infections/epidemiology , Rotavirus Infections/prevention & control , Rotavirus/immunology , Rotavirus/isolation & purification
16.
Arq. neuropsiquiatr ; 69(3): 475-481, June 2011. ilus, tab
Article in English | LILACS | ID: lil-592506

ABSTRACT

Viral meningitis is a common infectious disease of the central nervous system (CNS) that occurs worldwide. The aim of this study was to identify the etiologic agent of lymphomonocytary meningitis in Curitiba, PR, Brazil. During the period of July 2005 to December 2006, 460 cerebrospinal fluid (CSF) samples with lymphomonocytary meningitis were analyzed by PCR methodologies. Fifty nine (12.8 percent) samples were positive. Enteroviruses was present in 49 (83 percent) samples and herpes virus family in 10 (17 percent), of these 6 (10 percent) herpes simplex virus, 1 (2 percent) Epstein Barr virus, 2 (3 percent) human herpes virus type 6 and 1 (2 percent) mixed infection of enterovirus and Epstein Barr virus. As conclusion enterovirus was the most frequent virus, with circulation during summer and was observed with higher frequency between 4 to 17 years of age. PCR methodology is an important method for rapid detection of RNA enterovirus and DNA herpesvirus in CSF.


A meningite viral é uma síndrome infecciosa comum do sistema nervoso central (SNC), que ocorre no mundo inteiro. O objetivo deste estudo foi identificar o agente etiológico de meningite linfomonocitária em Curitiba, PR, Brasil. Durante o período de julho de 2005 a dezembro de 2006, 460 amostras com meningite linfomonocitária foram analisadas por metodologias de PCR. Cinquenta e nove (12,8 por cento) amostras foram positivas. Enterovirus estava presente em 49 (83 por cento) amostras e herpes vírus em 10 (17 por cento), destas 6 (10 por cento) HSV, 1 (2 por cento) EBV, 2 (3 por cento) HHV- 6 e 1 (2 por cento) infecção mista de enterovírus e EBV. Conclui-se que o enterovirus foi o vírus mais frequente, com a circulação durante o verão. Houve maior número de amostras positivas entre 4 a 17 anos. A metodologia de PCR é um importante método para a detecção rápida de RNA de enterovirus e DNA do herpesvirus no LCR.


Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Young Adult , Enterovirus Infections/virology , Enterovirus/genetics , Herpesviridae Infections/virology , Herpesviridae/genetics , Meningitis, Viral/virology , Brazil , DNA, Viral/cerebrospinal fluid , Enterovirus Infections/diagnosis , Herpesviridae Infections/diagnosis , /genetics , /genetics , Meningitis, Viral/diagnosis , Polymerase Chain Reaction , RNA, Viral/cerebrospinal fluid , Simplexvirus/genetics
17.
Mem. Inst. Oswaldo Cruz ; 105(8): 1044-1049, Dec. 2010. ilus, graf, mapas, tab
Article in English | LILACS | ID: lil-570677

ABSTRACT

Human immunodeficiency virus (HIV) clades B and C account for more than 60 percent of the HIV-1 infections worldwide. In this paper, we describe the profiles of patients infected with subtypes of HIV-1 from the state of Paraná, Southern Brazil, and correlate them with demographic and epidemiological findings. A retrospective analysis of HIV cases reported from 1999-2007 was also performed. Data from 293 patients were reviewed and 245 were older than 13 (58 percent female). The distribution of clades was as follows: B 140 (57 percent), C 67 (23 percent), F 24 (10 percent) and mosaic or unique recombinant forms (URFs) 24 (10 percent). Of the 48 patients younger than 13 years of age (62.5 percent male), vertical transmission occurred in 46 and the distribution of clades was as follows: B 14 (29 percent), C 24 (50 percent), F 7 (15 percent) and URFs 6 (13 percent). There was no significant difference in mortality between HIV-1 subtypes. In both groups, patients infected with clade C tended to have higher rates of injection drug use exposure risk.


Subject(s)
Adolescent , Adult , Female , Humans , Male , HIV Infections , HIV-1 , Brazil , Cross-Sectional Studies , Genotype , HIV Infections , HIV-1 , Retrospective Studies , Risk Factors
18.
Arq. neuropsiquiatr ; 68(1): 76-80, Feb. 2010. graf, tab
Article in English | LILACS | ID: lil-541193

ABSTRACT

Neurocysticercosis (NCC) is a common central nervous system infection caused by Taenia solium metacestodes. Objective: To investigate the occurrence of depression in patients with calcified NCC form. The study group consisted of 114 patients subdivided in four groups: NCC with epilepsy, NCC without epilepsy, epilepsy without NCC and chronic headache. Method: Depression was evaluated and quantified by the Hamilton Rating Scale for Depression (HRSD-21). Results: Percentage of patients with depression was as follows: group 1 (83 percent); group 2 (88 percent); group 3 (92 percent); group 4 (100 percent). The majority of patients had moderate depression. Conclusion: Incidence of depression in all groups was higher than in the general population. It is possible that, in a general way, patients with chronic diseases would have depression with similar intensity. NCC is associated with the presence of depression.


Neurocysticercose (NCC) é uma infecção do sistema nervoso central comum causada por metacestodes da Taenia solium. Objetivo: investigar a ocorrência de depressão nos pacientes com NCC forma calcificada. O grupo de estudo é formado por 114 pacientes subdivididos em quatro grupos: NCC com epilepsia, NCC sem epilepsia, epilepsia sem NCC e cefaléia crônica. Método: A presença de depressão foi determinada e quantificada pela Escala de Depressão de Hamilton (HRSD-21). Resultados: A porcentagem de pacientes com depressão foi: grupo 1 (83 por cento); grupo 2 (88 por cento); grupo 3 (92 por cento); grupo 4 (100 por cento). A maioria dos pacientes apresentou depressão moderada. Conclusão: A incidência da depressão em todos os grupos foi mais elevada do que na população geral, contudo não houve diferença entre os grupos estudados. É possível que, de uma maneira geral, os pacientes portadores de doença crônica apresentarem a depressão em intensidade similar. NCC está associada com a presença de depressão.


Subject(s)
Female , Humans , Male , Depression/etiology , Epilepsy/etiology , Neurocysticercosis/psychology , Case-Control Studies , Chronic Disease , Psychiatric Status Rating Scales
19.
Braz. j. infect. dis ; 13(2): 142-146, Apr. 2009. tab, graf
Article in English | LILACS | ID: lil-538221

ABSTRACT

We compared the pp65 antigen detection by an in house method (immunoperoxidase assay) and by a commercial kit (immunofluorescence assay) available for cytomegalovirus infection diagnosis in immunocompromised patients. Sixty-four blood samples were analyzed in duplicate for both techniques. Eight-six percent of the samples had concordant qualitative results. The discordant results occurred more frequently in samples with low quantity of positive cells. There were no significant differences with qualitative and quantitative results of the methods.


Subject(s)
Adult , Female , Humans , Male , Pregnancy , Cytomegalovirus Infections/diagnosis , Cytomegalovirus/immunology , Immunocompromised Host/immunology , Phosphoproteins/analysis , Viral Matrix Proteins/analysis , Cytomegalovirus/physiology , Fluorescent Antibody Technique , Immunoenzyme Techniques , Sensitivity and Specificity , Virus Replication
20.
Arq. neuropsiquiatr ; 66(3a): 509-515, set. 2008. graf, tab
Article in English | LILACS | ID: lil-492572

ABSTRACT

The main objectives of this study are to evaluate the resistance rates of Streptococcus pneumonia to penicillin G, ceftriaxone and vancomycin in patients with meningitis; to analyze possible risk factors to the antimicrobian resistance; to describe the serotypes detected and to suggest an initial empirical treatment for meningitis. The sensitiveness and serotypes of all isolated S. pneumoniae of patients with acute bacterial meningitis received by the Paraná State Central Laboratory from April 2001 to august 2002 have been evaluated. One hundred S. pneumoniae have been isolated, of which 15 percent were resistant to penicillin, 1 percent to cephalosporin and 0 percent to vancomycin. The serotypes most found were 14 (19 percent), 3 and 23F (10 percent each). When only the resistant serotypes were analyzed, the most prevalent was the 14 with 44 percent. The risk factors found in relation to the S. pneumoniae resistance were: age under one year old (p=0.01) and previous use of antibiotic (p=0.046). The resistance rates found, which were moderate to penicillin, low to cephalosporin and neutral to vancomycin, suggest the isolated use of a 3rd generation cephalosporin as an initial empirical therapy for the treatment of acute bacterial meningitis with a communitarian background.


Este estudo teve como objetivo avaliar as taxas de resistência de Streptococcus pneumoniae, isolados de pacientes com meningite, à penicilina G, ceftriaxona e vancomicina; avaliar possíveis fatores de risco para resistência antimicrobiana; descrever os sorotipos encontrados e sugerir a terapêutica empírica inicial para meningite. Foram isoladas 100 amostras de S. pneumoniae, encontrando-se 15 por cento de resistência à penicilina, 1 por cento à cefalosporina e 0 por cento à vancomicina. Os sorotipos mais encontrados foram 14 (19 por cento), 3 e 23F (10 por cento cada). Analisando-se os resistentes, o sorotipo 14 (44 por cento) também foi o mais freqüente. Os fatores de risco para resistência de S. pneumoniae encontrados foram: idade menor que um ano (p=0,01) e o uso prévio de antibiótico (p=0,046). As taxas de resistência encontradas, moderada a penicilina, baixa para cefalosporina e nula para vancomicina, sugerem como terapêutica empírica inicial para tratamento da meningite bacteriana aguda de origem comunitária, a cefalosporina de terceira geração isoladamente.


Subject(s)
Adolescent , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Multiple, Bacterial , Meningitis, Pneumococcal/drug therapy , Streptococcus pneumoniae/drug effects , Acute Disease , Brazil , Chi-Square Distribution , Cephalosporins/therapeutic use , Meningitis, Pneumococcal/cerebrospinal fluid , Penicillins/therapeutic use , Risk Factors , Serotyping , Statistics, Nonparametric , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/isolation & purification , Vancomycin/therapeutic use , Young Adult
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