Clinical characteristics of neonates infected with the Omicron variant of SARS-CoV-2: a multicenter cross-sectional survey / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical characteristics of neonates infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).@*METHODS@#A cross-sectional survey was conducted on 542 hospitalized neonates with confirmed coronavirus disease 2019 (COVID-19) in 27 hospitals in Shenzhen from December 7, 2022, to January 12, 2023 (during the Omicron variant epidemic period). The neonates were divided into two groups: asymptomatic infection and symptomatic infection. The clinical characteristics, results of laboratory examination, chest X-ray findings, and outcome were compared between the two groups.@*RESULTS@#Among the 542 neonates, there were 285 males and 257 females. Among them, 515 (95.0%) were full-term infants, and 27 (5.0%) were preterm infants. The asymptomatic infection group had 60 cases, and the symptomatic infection group had 482 cases. Among them, 336 cases (69.7%) were mild, 125 cases (25.9%) were moderate, 15 cases (3.1%) were severe, and 6 cases (1.2%) were critical. Fever was the most common symptom (434 cases, 90.0%), followed by cough and/or spitting (183 cases, 38.0%), nasal congestion and/or runny nose (131 cases, 27.2%), shortness of breath (36 cases, 7.5%), and feeding intolerance (30 cases, 6.2%). Among the 325 cases who underwent chest X-ray examination, 136 cases (41.8%) had patchy or consolidative shadows in the lungs, 2 cases (0.6%) had pneumothorax, 2 cases (0.6%) had decreased lung transparency, and 185 cases (57.0%) showed no abnormality. Among the 396 cases (73.1%) who received treatment, 341 cases (86.1%) received symptomatic treatment, 137 cases (34.6%) received antibiotic treatment, 4 cases (1.0%) received immunoglobulin treatment, and 23 cases (5.8%) received respiratory support treatment. All 542 neonates were discharged from the hospital after their clinical symptoms were relieved, and the median hospital stay was 5 days. The white blood cell count, neutrophil count, hemoglobin, and procalcitonin were lower in the symptomatic infection group than those in the asymptomatic infection group (P<0.05), while the platelet count and blood glucose levels were higher in the symptomatic infection group than those in the asymptomatic infection group (P<0.05). The proportions of neonates with decreased neutrophil count, increased platelet count, and decreased hemoglobin concentration were higher in the symptomatic infection group than those in the asymptomatic group (P<0.05).@*CONCLUSIONS@#Most neonates with COVID-19 caused by the Omicron variant of SARS-CoV-2 are mild, with fever as the predominant symptom. Symptomatic neonates with COVID-19 are often accompanied by decreased neutrophil count, increased platelet count, and decreased hemoglobin level. Symptomatic treatment is the main treatment, and the prognosis is good.

Clinical and epidemiological characteristics of children with SARS-CoV-2 infection: a case series in Sinaloa / Características clínicas y epidemiológicas de la infección por SARS-CoV-2 en niños: serie de casos en Sinaloa

Abstract Background: The SARS-CoV-2 virus may affect both adults and children. Although COVID-19 has a lower prevalence in infancy and has been described as mild, the clinical characteristics may vary, and there is a possibility of complications. The objectives of this study were to describe the clinical and epidemiological aspects of confirmed COVID-19 pediatric cases in the state of Sinaloa, Mexico, during the first 3 months of the pandemic, and children admitted with COVID-19 to a secondary hospital. Methods: This case series includes all patients with SARS-CoV-2 infection confirmed by PCR (polymerase chain reaction) test, identified in the state epidemiological surveillance system (SISVER) between March 1 and May 31, 2020. Confirmed patients admitted to the Sinaloa Pediatric Hospital (HPS) in the same period are also described. Results: Fifty-one children with SARS-CoV-2 were included, of which ten were admitted to the HPS. The median age was 10 years. The more frequent symptoms were fever (78%), cough (67%), and headache (57%). Most cases were mild or asymptomatic. Three patients with comorbidities died. Only four of ten patients identified in HPS were admitted with the diagnosis of possible COVID-19. Conclusions: SARS-CoV-2 infection in children was mostly mild or asymptomatic, and the clinical presentation varied. There is a possibility of complications, especially in children with comorbidities.

Resumen Introducción: El SARS-CoV-2 puede afectar tanto a adultos como a niños. Aunque la COVID-19 presenta menor prevalencia en la infancia y se ha descrito como leve, las características clínicas pueden ser variables y existe la posibilidad de complicaciones. Los objetivos de este estudio fueron describir las características clínicas y epidemiológicas de los casos pediátricos confirmados en el Estado de Sinaloa, México, durante los primeros 3 meses de la pandemia, y de los niños con COVID-19 internados en un hospital de segundo nivel. Métodos: Esta serie de casos incluyó pacientes con infección por SARS-CoV-2 confirmados por prueba de reacción en cadena de la polimerasa (PCR), identificados en el Sistema de Vigilancia Epidemiológica de Enfermedades Respiratorias (SISVER) del 1 de marzo al 31 de mayo de 2020. Se describen también las características de todos los niños confirmados en el Hospital Pediátrico de Sinaloa (HPS) en las mismas fechas. Resultados: Se incluyeron 51 niños con infección por SARS-CoV-2, de los cuales 10 fueron internados en el HPS. La mediana de edad fue de 10 años. Los síntomas más frecuentes fueron fiebre (78%), tos (67%) y cefalea (57%). La mayoría de los casos fueron leves o asintomáticos. Tres pacientes con comorbilidad fallecieron. Solo cuatro de diez pacientes identificados en el HPS ingresaron bajo sospecha de COVID-19. Conclusiones: La infección por SARS-CoV-2 en los niños fue, en su mayoría, asintomática o leve, y la presentación fue variable. Existe la posibilidad de que se produzcan complicaciones, principalmente en niños con comorbilidad.

Situación de enfermería en América, frente a la pandemia Covid-19 / NursingSituacion in America, in front of the Covid -19 pandemic

INTRODUCCIÓN: en el mismo año en que se declara Año Internacional de la Enfermería y Partería, la inesperada aparición del nuevo coronavirus SARS-CoV-2,dio un giro a lo que se tenía planeado dentro de los programas de salud a nivel mundial y deja en evidencia las debilidades de los sistemas sanitarios, donde el continente más afectado por dicho virus fue América, ya que sus esfuerzos por contener la pandemia fueron insuficientes, el tiempo de reacción para establecer protocolos de salud fue tardío y la disponibilidad para dotar al personal de salud de equipos de protección fue mínimo, y aun así el accionar del personal sanitario en especial de enfermería. OBJETIVO: describir la situación de enfermería en América, frente a la pandemia Covid-19. METODOLOGÍA: la investigación se realizó mediante un diseño narrativo, de carácter documental, analítico de enfoque cualitativo y método inductivo; obteniendo la información de fuentes secundarias confiables. RESULTADOS Y CONCLUSIONES: la actual pandemia demuestra la importancia de disponer de profesionales de salud en un número adecuado según las necesidades y cuidados que requiere cada paciente; es por esta razón que se precisa que los países inviertan en mejorar las condiciones de trabajo de los profesionales de enfermería, que incluyan equipos de protección individual, apoyo al trabajo en equipo y educación continua en enfermería, lo cual llevará a importantes logros, evidenciando el profesionalismo de enfermería y su entrega absoluta, al aplicar sus cuatro roles fundamentales con el fin de proteger la salud y mejorar la vida de las personas, a pesar de los evidentes riesgos reales y potenciales a los que se enfrentan a nivel laboral.

INTRODUCTION: in the same year in which the International Year of Nursing and Midwifery is declared, the unexpected appearance of the new SARS-CoV-2 coronavirus, gave a turn to what was planned within health programs worldwide and leaves in evidence the weaknesses of the health systems, where the continent most affected by this virus was America, since their efforts to contain the pandemic were insufficient, the reaction time to establish health protocols was late and the availability to provide staff with The health ofprotective equipment was minimal, and even so, the actions of health personnel, especially nursing personnel. OBJECTIVE: to describe the nursing situation in America, in the face of the Covid-19 pandemic. METHODOLOGY: the research was carried out through a narrative, documentary, analytical design with a qualitative approach and an inductive method; obtaining the information from reliable secondary sources. RESULTS AND CONCLUSIONS: the current pandemic shows the importance of having adequate numbers of health professionals according to the needs and care that each patient requires; It is for this reason that it is necessary for countries to invest in improving the working conditions of nursing professionals, which include individual protection equipment, support for teamwork and continuing education in nursing, which will lead to important achievements, evidencing the Nursing professionalism and its absolute dedication, by applying its four fundamental roles in order to protect health and improve people's lives, despite the obvious real and potential risks they face at the work level.

La infección asintomática por el SARS-CoV-2: evidencias para un estudio poblacional en Cuba / Asymptomatic Infection by SARS-CoV-2: evidence for a Population Study in Cuba a

Introducción: La transmisión del SARS-CoV-2 entre personas asintomáticas continúa siendo motivo de debate y preocupación para la comunidad científica internacional. Objetivo: Exponer algunas consideraciones sobre la infección asintomática por SARS-CoV-2 y características de los casos notificados en Cuba entre el 11 de marzo y 17 de junio de 2020 como evidencia para un estudio poblacional de seguimiento. Métodos: Se realizó una revisión bibliográfica de la literatura sobre la infección por SARS-CoV-2 y las particularidades de las manifestaciones clínicas de la COVID-19; para ello se consultaron informaciones diarias y evidencias reportadas a través del portal web de la red Infomed. Se analizó la información contenida en la base de datos nacional de casos confirmados de la COVID-19, entre el 11 de marzo y 17 de junio de 2020. Además de la condición de asintomático al momento del diagnóstico se analizaron otras variables como grupos de edad y provincia. Se resumió la información mediante totales y tasa de incidencia acumulada. Se ajustó la línea recta y un polinomio de orden 4 a la serie de casos asintomáticos. Conclusiones: Se denota cuan comunes son las personas asintomáticas al momento del diagnóstico y parece existir consenso en el ámbito científico en cuanto a su implicación en la propagación subclínica de la enfermedad. Desde el inicio de la epidemia, la mayoría de los casos notificados en Cuba han sido asintomáticos, lo cual se ha evidenciado en la mayoría de las provincias y en los diferentes grupos etarios, exceptuando los menores de un año y el grupo entre 60 y 79 años de edad. El conocimiento incompleto sobre la magnitud de la infección asintomática en la población supuestamente sana, las peculiaridades de esos casos y su influencia en la transmisión viral, alentaron la realización de un estudio poblacional de seguimiento(AU)

Introduction: SARS-CoV-2 transmission among asymptomatic people continues to be a matter of debate and concern for the international scientific community. Objective: To present some considerations about SARS-CoV-2 asymptomatic infection and the characteristics of the cases reported in Cuba between March 11 and June 17, 2020, as evidence for a population follow-up study. Methods: We carried out a bibliographic review of the literature about SARS-CoV-2 infection and the particularities of the clinical manifestations of COVID-19, for which we consulted the daily information and the evidence reported through the web portal of the Infomed network. We analyzed the information contained in the national database of confirmed COVID-19 cases, between March 11 and June 17, 2020. In addition to the asymptomatic condition at the time of diagnosis, other variables were analyzed, such as age groups and province. The information was summarized using totals and the cumulative incidence rate. The straight line and a polynomial of order 4 were adjusted to the series of asymptomatic cases. Conclusions: It is evident how common asymptomatic people are at the time of diagnosis, while there seems to be consensus, in the scientific field, regarding their involvement in the subclinical spread of the disease. Since the beginning of the epidemic, most of the cases reported in Cuba have been asymptomatic, which has been evidenced in most of the provinces and different age groups, except those aged less than one year or 60-79 years old. Incomplete knowledge of the extent of asymptomatic infection in the supposedly healthy population, the peculiarities of these cases and its influence on viral transmission, encouraged a population "follow-up study(AU)

Evolução da prevalência de infecção por COVID-19 no Rio Grande do Sul, Brasil: inquéritos sorológicos seriados / Trends in the prevalence of COVID-19 infection in Rio Grande do Sul, Brazil: repeated serological surveys

Resumo A COVID-19 é uma doença produzida pelo vírus SARS-CoV-2. Esse vírus se espalhou rapidamente pelo mundo, o que levou a Organização Mundial da Saúde a classificar a COVID-19 como uma emergência de saúde internacional e, posteriormente, a declará-la uma pandemia. O número de casos confirmados, no dia 11 de abril de 2020, já passa de 1.700.000, porém esses dados não refletem a real prevalência de COVID-19 na população, visto que, em muitos países, os testes são quase que exclusivamente realizados em pessoas com sintomas, especialmente os mais graves. Para definir políticas de enfrentamento, é essencial dispor de dados sobre a prevalência real de infecção na população. Este estudo tem por objetivos avaliar a proporção de indivíduos já infectados pelo SARS-CoV-2 no Rio Grande do Sul, Brasil, analisar a velocidade de expansão da infecção e estimar o percentual de infectados com e sem sintomas. Serão realizados quatro inquéritos sorológicos repetidos a cada 15 dias, com amostragem probabilística de nove cidades sentinela, em todas as sub-regiões do Estado. As entrevistas e testes ocorrerão no âmbito domiciliar. Serão utilizados testes rápidos para detecção de anticorpos, validados previamente ao início da coleta de dados.

Abstract COVID-19, the disease produced by the virus SARS-CoV-2, has spread quickly throughout the world, leading the World Health Organization to first classify it as an international health emergency and, subsequently, declaring it pandemic. The number of confirmed cases, as April 11, surpassed 1,700,000, but this figure does not reflect the prevalence of COVID-19 in the population as, in many countries, tests are almost exclusively performed in people with symptoms, particularly severe cases. To properly assess the magnitude of the problem and to contribute to the design of evidence-based policies for fighting COVID-19, one must accurately estimate the population prevalence of infection. Our study is aimed at estimating the prevalence of infected individuals in the state of Rio Grande do Sul, Brazil, to document how fast the infection spreads, and to estimate the proportion of infected persons who present or presented symptoms, as well as the proportion of asymptomatic infections. Four repeated serological surveys will be conducted in probability samples of nine sentinel cities every two weeks. Tests will be performed in 4,500 participants in each survey, totaling18,000 interviews. Interviews and tests will be conducted at the participants' household. A rapid test for the detection of antibodies will be used; the test was validated prior to the beginning of the fieldwork.

Asymptomatic plasmodium infection in a residual malaria transmission area in the atlantic forest region: implications for elimination

Abstract INTRODUCTION: Elimination of malaria in areas of interrupted transmission warrants careful case assessment to avoid the reintroduction of this disease. Occasional malaria cases are reported among visitors of the Atlantic Forest area of Brazil, while data on residents of this area are scarce. METHODS: A sectional study was carried out to examine 324 individuals living in a municipality where autochthonous cases were detected. RESULTS: Asymptomatic Plasmodium infections were detected in 2.8% of the individuals by polymerase chain reaction (PCR), with one case of P. falciparum (0.3%), two cases of P. vivax (0.6%), and six cases of P. malariae (1.9%). The thick blood smears were negative in all individuals. Serological tests performed in 314 subjects were reactive in 11.1%, with 3.5% for P. falciparum and 7.7% for P. vivax. A subsample of 42 reactive individuals for any Plasmodium species showed P. malariae in 30.9% of specimens. Individuals who entered the Atlantic Forest region were 2.7 times more likely to exhibit reactive serology for P. vivax compared with individuals who did not enter this region (p<0.05). Children <15 years had a higher chance of reactive serology for P. falciparum and P. vivax than individuals ≥15 years of age (p<0.05). Individuals living in the Paraiso district had a higher chance of reactive serology for P. vivax compared to other districts (p<0.05). No associations were found between sex, past exposure to malaria, or serological response to antibodies of any Plasmodium species. CONCLUSIONS: The implications of these results for the elimination of malaria were discussed.

Hepatitis B and asymptomatic malaria coinfection in Sub-Saharan African immigrants: epidemiological and clinical features of HBV infection

Abstract INTRODUCTION: Here, we conducted an epidemiological study of hepatitis B virus (HBV) mono-infected and asymptomatic malaria/HBV coinfected immigrants and further discussed the possibility of malaria disease modifying the clinical presentation of HBV infection. METHODS: A total of 195 African immigrants were examined for HBV infection or coinfection with HBV and asymptomatic malaria. HBV infection was diagnosed using serological tests and confirmed by PCR; furthermore, we performed a pan-Plasmodium-specific-nucleic-acid-sequence-based-amplification (NASBA) assay to detect asymptomatic malaria infection. The stage/grade of the liver disease was determined using echotomography and elastometry. RESULTS: PCR-NASBA results confirmed that 62 of 195 subjects (31.8%) were positive for Plasmodium infection, whereas 41 of 195 subjects (21%) tested positive for HBV chronic hepatitis (HBV-DNA positive). Among the HBV-positive subjects, 26 (63.4%) of them were mono-infected patients (Group A), whereas 15 (36.6%) patients had HBV chronic hepatitis and asymptomatic malaria coinfections (Group B). The HBV-DNA median levels were 1.4×105IU/mL in HBV-mono-infected patients and 2.0×105IU/mL in coinfected patients. Echotomography and hepatic elastometry presented similar findings for both groups of patients. CONCLUSIONS: Coinfected patients seem to present with the same clinical symptoms of the liver disease as HBV mono-infected patients.

La prevalencia actual de infección genital por Chlamydia trachomatis en adolescentes y mujeres jóvenes chilenas asintomáticas justifica la vigilancia periódica / The current prevalence of Chlamydia trachomatis infection among teenagers and young asymptomatic Chilean women justifies the periodic surveillance

Introduction: Chlamydia trachomatis infection constitutes the most common sexual transmitted disease (STD) among young women. International studies demonstrate that prevalence changes over time and also according to places. Aims: To estimate the prevalence of this infection among asymptomatic Chilean women (15 to 24 years old) and correlating with risk factor occurrence. Methods: Transversal cohort study to identify C. trachomatis infection through a diagnostic kit designed to detect and amplify cryptic plasmid DNA by quantitative PCR from endocervical sample. Results: 181 women were screened during the period of study. The overall prevalence estimate was 5.5% and founding significant estimate variations (0% to 14.6%) between recruiting centers. There was difference in number of sexual partners (4.1 vs 2.5; p<0.05) between positive and negative women. No difference was observed in age of first coitus, STD history, the use of barrier method or socioeconomic level. However, the probability of being carrier increases as greater is the number of sexual partners, especially when the use of barrier method is low. The latest is not related to the socioeconomic level. Conclusions: One of 12 to 18 women at this age range will have asymptomatic infection. The current prevalence and its variability substantiates the C. trachomatis screening and periodic surveillance.

Introducción: La infección por Chlamydia trachomatis constituye la infección de transmisión sexual (ITS) más común en población femenina joven. Estudios internacionales demuestran que su prevalencia cambia con el tiempo y en diferentes lugares. Objetivos: Estimar la prevalencia de esta infección en mujeres jóvenes chilenas (15 a 24 años), asintomáticas, y correlacionarla con factores de riesgo. Métodos: Estudio de corte transversal para detección de C. trachomatis mediante kit diagnóstico basado en amplificación de ADN plasmidial críptico y uso de RPC cuantitativa en secreción endocervical. Resultados: En el período de estudio fueron tamizadas 181 mujeres. La prevalencia global fue 5,5%, observándose variaciones significativas (0% hasta 14,6%) entre centros. Hubo diferencia en el número de parejas (4,1 vs 2,5; p = 0,04) entre infectadas o no. No hubo diferencia en edad de inicio de actividad sexual, historia de ITS, uso de preservativo o nivel socio-económico. Sin embargo, el riesgo de infección asintomática aumenta a mayor número de parejas sexuales y cuando el uso de método de barrera es infrecuente durante el coito, independiente del nivel socio-económico. Conclusiones: Una de cada 12 a 18 mujeres a esta edad presenta infección asintomática de C. trachomatis. La prevalencia actual y su variabilidad justifican el tamizaje y la vigilancia periódica de C. trachomatis.

Asymptomatic infection with American cutaneous leishmaniasis: epidemiological and immunological studies

American cutaneous leishmaniasis (ACL) is a major public health problem caused by vector-borne protozoan intracellular parasites from the genus Leishmania, subgenera Viannia and Leishmania. Asymptomatic infection is the most common outcome after Leishmania inoculation. There is incomplete knowledge of the biological processes explaining the absence of signs or symptoms in most cases while other cases present a variety of clinical findings. Most studies of asymptomatic infection have been conducted in areas of endemic visceral leishmaniasis. In contrast, asymptomatic ACL infection has been neglected. This review is focused on the following: (1) epidemiological studies supporting the existence of asymptomatic ACL infection and (2) immunological studies conducted to understand the mechanisms responsible for controlling the parasite and avoiding tissue damage.

O papel dos parceiros sexuais sintomáticos e assintomáticos nas vulvovaginites recorrentes / The role of the symptomatic and asymptomatic sexual partners in the recurrent vulvovaginitis

OBJETIVO: Identificar as espécies predominantes e o papel dos parceiros sexuais na manutenção das vulvovaginites recorrentes por Candida spp. MÉTODOS: Entre agosto de 2007 e março de 2012, foi efetuado estudo prospectivo de 830 pacientes com idades variáveis entre 18 e 65 anos e vaginites fúngicas. Foram excluídos pacientes com diabetes mellitus, síndrome da imunodeficiência adquirida (AIDS), em uso de corticoterapia, antibioticoterapia, hormonoterapia, imunossupressão, duchas vaginais, dispositivos intrauterinos (DIUs) ou espermicidas. A identificação das espécies de Candida foi feita por métodos fenotípicos e genotípicos. O teste do χ2 foi usado para correlacionar a Candida spp. nos parceiros masculinos e a recorrência nas vaginites. RESULTADOS: O agente fúngico foi isolado em um total de 40 mulheres, sendo 24 com vaginites recorrentes, e em 15 dos seus parceiros sexuais, dos quais 10 eram assintomáticos, e 5, sintomáticos. Houve concordância das espécies encontradas no casal em 100% das recorrências. C. albicans (62,4 e 60%), C. glabrata (29,1 e 33,3%) e C. guilliermondii foram as espécies identificadas. Candida tropicalis (4,1%) foi isolada de apenas uma paciente. Nas 16 mulheres restantes que tinham vaginites não complicadas, C. albicans foi isolada em todas. C. glabrata foi isolada em apenas dois de seus parceiros assintomáticos. CONCLUSÃO: Houve predominância de C. albicans; parceiros sintomáticos ou assintomáticos podem ter papel importante como reservatório e fonte de transmissão de leveduras, principalmente nos quadros de vulvovaginites recorrentes. .

PURPOSE: To identify the predominant species and the role of sexual partners in the maintenance of recurrent vulvovaginitis by Candida spp. METHODS: A prospective study of 830 patients aged 18 to 65 years with yeast vaginitis was performed between August 2007 and March 2012. Patients with diabetes mellitus, AIDS or taking corticosteroids, antibiotics or hormone therapy and immunosuppressed patients, patients using vaginal douches, spermicides or intrauterine devices were excluded from the study. Candida species were identified by phenotypic and genotypic methods. The chi-square test was used to correlate the presence of Candida spp. in male partners with the recurrence of vaginitis. RESULTS: The fungal agent was isolated from a total of 40 women, 24 with recurrent vaginitis and from 15 of their sexual partners, 10 of whom were asymptomatic while 5 were symptomatic. There was agreement of the species found in the couple in 100% of recurrences. C. albicans (62.4 and 60%), C. glabrata (29.1 and 33.3%) and C. guilliermondii species were identified. Candida tropicalis (4.1%) was isolated from only one patient. Candida albicans was isolated from the remaining 16 women who had uncomplicated vaginitis. C. glabrata was isolated from only two of the asymptomatic partners. CONCLUSION: There was a predominance of C. albicans and symptomatic or asymptomatic partners can play an important role as a reservoir and source of transmission of yeast, especially in cases of recurrent vulvovaginitis. .

Occult hepatitis B virus infection in liver transplant patients in a Brazilian referral center

Estimates of occult hepatitis B virus (HBV) infection prevalence varies among different studies depending on the prevalence of HBV infection in the study population and on the sensitivity of the assay used to detect HBV DNA. We investigated the prevalence of occult HBV infection in cirrhotic patients undergoing liver transplantation in a Brazilian referral center. Frozen liver samples from 68 adults were analyzed using a nested polymerase chain reaction assay for HBV DNA. The specificity of the amplified HBV sequences was confirmed by direct sequencing of the amplicons. The patient population comprised 49 (72.1%) males and 19 (27.9%) females with a median age of 53 years (range=18-67 years). Occult HBV infection was diagnosed in three (4.4%) patients. The etiologies of the underlying chronic liver disease in these cases were alcohol abuse, HBV infection, and cryptogenic cirrhosis. Two of the patients with cryptic HBV infection also presented hepatocellular carcinoma. Markers of previous HBV infection were available in two patients with occult HBV infection and were negative in both. In conclusion, using a sensitive nested polymerase chain reaction assay to detect HBV DNA in frozen liver tissue, we found a low prevalence of occult HBV infection in cirrhotic patients undergoing liver transplant, probably due to the low prevalence of HBV infection in our population.

Molecular detection of Mayaro virus during a dengue outbreak in the state of Mato Grosso, Central-West Brazil

Mayaro virus (MAYV) is frequently reported in Pan-Amazonia. The aim of this study was to investigate the circulation of alphaviruses during a dengue outbreak in the state of Mato Grosso, Brazil. Serum samples from dengue-suspected patients were subjected to multiplex semi-nested reverse transcriptase polymerase chain reaction for 11 flaviviruses and five alphaviruses, to nucleotide sequencing and to viral isolation. MAYV was detected in 15 (2.5%) of 604 patients. Twelve were co-infected with dengue virus 4, which was isolated from 10 patients. The molecular detection of MAYV in dengue-suspected patients suggests that other arboviruses may be silently circulating during dengue outbreaks in Brazil.

High prevalence of occult hepatitis B virus genotype H infection among children with clinical hepatitis in west Mexico

Studies on the prevalence of infection with hepatitis B virus (HBV) among children are scarce in Latin American countries, especially in Mexico. This study was aimed to investigate the prevalence of HBV infection, occult hepatitis B infection (OBI) and HBV genotypes among children with clinical hepatitis. In total, 215 children with clinical hepatitis were evaluated for HBV infection. HBV serological markers and HBV DNA were analysed. OBI diagnosis and HBV genotyping was performed. HBV infection was found in 11.2% of children with clinical hepatitis. Among these HBV DNA positive-infected children, OBI was identified in 87.5% (n = 21/24) of the cases and 12.5% (n = 3/24) were positive for both HBV DNA and hepatitis B surface antigen. OBI was more frequent among children who had not been vaccinated against hepatitis B (p < 0.05) than in those who had been vaccinated. HBV genotype H was prevalent in 71% of the children followed by genotype G (8%) and genotype A (4%). In conclusion, OBI is common among Mexican children with clinical hepatitis and is associated with HBV genotype H. The results show the importance of the molecular diagnosis of HBV infection in Mexican paediatric patients with clinical hepatitis and emphasise the necessity of reinforcing hepatitis B vaccination in children.

Características clínicas de pacientes con déficit selectivo de IgA en el hospital infantil municipal de Córdoba, periodo 2010-2013 / Clinical features of patients with selective Iga deficiency In municipal hospital children of Córdoba, period 2010-2013

Introducción: el déficit selectivo de IgA (DsIgA) es la inmunodeficiencia primaria más frecuente, caracterizada por nivelesséricos de inmunoglobulina A (IgA) menores a 7 mg/dl en pacientes mayores a 4 años con niveles normales de otros isotipos de inmunoglobulinas. Aunque la mayoría de los individuos sona sintomáticos, cerca de un tercio padecen infecciones recurrentes, alergia o autoinmunidad. Objetivo: Principal: determinar características clínicas asociadas al DsIgA. Secundario: analizar los valores de inmunoglobulina G (IgG) e inmunoglobulina M (IgM) de los pacientes.Materiales y métodos: Se revisaron en forma retrospectiva registros de laboratorio e historias clínicas de 24 pacientes que cumplieron con los criterios diagnósticos de DsIgA. Resultados: Se observó que 17 pacientes (71%) presentaban fenó-menos alérgicos, 13 pacientes (54%) enfermedades autoinmunes y 7 pacientes (29%) infecciones recurrentes al momento de diagnóstico del DsIgA. Además se pudo ver un aumento de IgG e IgMen un 38% y 46% de los pacientes, respectivamente. Conclusión: Observamos que la principal manifestación clínica fue la alergia, y que un grupo de pacientes tenía elevadas sus inmunoglobulinas séricas.

Introduction: selective IgA deficiency (IgAD) is considered as the most common primary immunodeficiency, is defined as a serum IgA of less than 7mg/dl, with normal serum IgG and IgM levels in patients older than 4 years with other wise normal immune system. Although the majority of affected individuals are asymptomatic, a third of patients are symptomatic and suffer from recurrent infections, allergies and autoimmune diseases. Aim: To investigate the clinical characteristics of children with IgAD and analyse the levels of IgG and IgM of the patients. Materials and methods: The clinical and laboratory information from medical records of 24 children with IgAD were studied retrospectively. Results: 17 (71%) patients had allergic disorders, 13 (54%) patients had autoimmune disorders and 7 (29%) patients had infectious diseases at the moment of the diagnosis of IgAD. Serum IgG and IgM levels were increased in 38 % and 46 % of patients, respectively. Conclusions: we found that allergic disorders were the most common clinical manifestation and group of patients had increased levels of serum immunoglobulins.

Variation in haematological parameters in children less than five years of age with asymptomatic Plasmodium infection: implication for malaria field studies

During the season of high malaria transmission, most children are infected by Plasmodium, which targets red blood cells (RBCs), affecting haematological parameters. To describe these variations, we examined the haematological profiles of two groups of children living in a malaria-endemic area. A cross-sectional survey was conducted at the peak of the malaria transmission season in a rural area of Burkina Faso. After informed consent and clinical examination, blood samples were obtained from the participants for malaria diagnosis and a full blood count. Of the 414 children included in the analysis, 192 were not infected with Plasmodium, whereas 222 were asymptomatic carriers of Plasmodium infection. The mean age of the infected children was 41.8 months (range of 26.4-57.2) compared to 38.8 months (range of 22.4-55.2) for the control group (p = 0.06). The asymptomatic infected children tended to have a significantly lower mean haemoglobin level (10.8 g/dL vs. 10.4 g/dL; p < 0.001), mean lymphocyte count (4592/µL vs. 5141/µL; p = 0.004), mean platelet count (266 x 103/µL vs. 385 x 103/µL; p < 0.001) and mean RBC count (4.388 x 106/µL vs. 4.158 x 106/µL; p < 0.001) and a higher mean monocyte count (1403/µL vs. 1192/µL; p < 0.001) compared to the control group. Special attention should be applied when interpreting haematological parameters and evaluating immune responses in asymptomatic infected children living in malaria-endemic areas and enrolled in vaccine trials.

High rates of undiagnosed leprosy and subclinical infection amongst school children in the Amazon Region

Leprosy in children is correlated with community-level factors, including the recent presence of disease and active foci of transmission in the community. We performed clinical and serological examinations of 1,592 randomly selected school children (SC) in a cross-sectional study of eight hyperendemic municipalities in the Brazilian Amazon Region. Sixty-three (4%) SC, with a mean age of 13.3 years (standard deviation = 2.6), were diagnosed with leprosy and 777 (48.8%) were seropositive for anti-phenolic glycolipid-I (PGL-I). Additionally, we evaluated 256 house-hold contacts (HHCs) of the students diagnosed with leprosy; 24 (9.4%) HHC were also diagnosed with leprosy and 107 (41.8%) were seropositive. The seroprevalence of anti-PGL-I was significantly higher amongst girls, students from urban areas and students from public schools (p < 0.0001). Forty-five (71.4%) new cases detected amongst SC were classified as paucibacillary and 59 (93.6%) patients did not demonstrate any degree of physical disability at diagnosis. The results of this study suggest that there is a high rate of undiagnosed leprosy and subclinical infection amongst children in the Amazon Region. The advantages of school surveys in hyperendemic areas include identifying leprosy patients at an early stage when they show no physical disabilities, preventing the spread of the infection in the community and breaking the chain of transmission.

Asymptomatic infection with Plasmodium falciparum and Plasmodium vivax in the Brazilian Amazon Basin: to treat or not to treat?

In this study, we determined whether the treatment of asymptomatic parasites carriers (APCs), which are frequently found in the riverside localities of the Brazilian Amazon that are highly endemic for malaria, would decrease the local malaria incidence by decreasing the overall pool of parasites available to infect mosquitoes. In one village, the treatment of the 19 Plasmodium falciparum-infected APCs identified among the 270 residents led to a clear reduction (Z = -2.39, p = 0.017) in the incidence of clinical cases, suggesting that treatment of APCs is useful for controlling falciparum malaria. For vivax malaria, 120 APCs were identified among the 716 residents living in five villages. Comparing the monthly incidence of vivax malaria in two villages where the APCs were treated with the incidence in two villages where APCs were not treated yielded contradictory results and no clear differences in the incidence were observed (Z = -0.09, p = 0.933). Interestingly, a follow-up study showed that the frequency of clinical relapse in both the treated and untreated APCs was similar to the frequency seen in patients treated for primary clinical infections, thus indicating that vivax clinical immunity in the population is not species specific but only strain specific.

The burden of dengue: Jundiaí, Brazil - January 2010

OBJECTIVE: To study the antibody prevalence against dengue in the municipality of Jundiaí, São Paulo, Brazil, due to the low number of official confirmed autochthonous cases. METHODS: A serological study on dengue infection was conducted during January 2010 and previous reports on dengue and entomological surveillance during that period were reviewed. RESULTS: A prevalence of 7.8% IgG positive (68:876) was found. Furthermore, based on the detection of IgM antibodies in five samples, it was observed that the incidence of dengue in the city at the time of the survey contrasts with the absence of notifications by local health authorities over the same period of time. CONCLUSION: These results highlight the discrepancies between the actual and the detected number of dengue infections, possibly due to significant numbers of asymptomatic infections aggravated by difficulties with dengue clinical diagnosis.

Intestinal parasitism prevalence amongst children from six indigenous communities residing in Cali, Colombia / Prevalencia de parasitismo intestinal en menores de seis comunidades indígenas residentes en Cali, Colombia

Objective Establishing the prevalence of intestinal parasitism in children aged 5 to 14 years of age from six indigenous communities residing in the city of Cali. Methodology A cross-sectional, descriptive epidemiological study was carried out in six indigenous communities residing in the city of Cali; it consisted of making a direct serial and concentration coproparasitological examination of a randomly selected sample of fifty-seven 5 to 14 year-old children. Results Of the 57 samples obtained, 84 % of the children were infected with parasites; protozoa (98 %) predominated over helminths (16.7 %) and mixed parasitemia was found in 14.6 % of the samples. Monoparasitism appeared in children over 10 years of age and biparasitism (10.4 %) and polyparasitism (52.1 %) in children under 10 years of age. Regarding occult blood determination, 6 % were observed to be positive in all the samples analysed; 4 % of these results were associated with E. histolyticaldispar. The simple parasitism index (SPI) reflected a high degree of infestation amongst the children included in the study. Conclusions The prevalence of intestinal parasitism in indigenous infants was higher than that reported nationally in the overall adolescent and school-aged children population in the same age group. Mono- and polyparasitism prevailed in the positive samples. The infestation load was not randomly distributed amongst the communities.

Objetivo Establecer la prevalencia de parasitismo intestinal en menores de 5 a 14 años de seis comunidades indígenas residentes en la ciudad de Cali. Metodología Se llevó a cabo un estudio epidemiológico transversal en seis comunidades indígenas residentes en la ciudad de Cali, que consistió en realizar un examen seriado coproparasitológico a una muestra de menores entre 5 y 14 años elegida al azar. Resultados De las 57 muestras, un total de 84 % estaban infectados con parásitos; en los cuales predominaron los protozoarios (98 %) sobre los helmintos (16,7 %) y la presencia de enfermedades parasitarias intestinales mixtas fue del 14,6 %. El monoparasitismo se observe en los mayores de 10 años; en niños por debajo de los 10 años se observó el biparasitismo (10,4 %) y poliparasitismo (52,1 %). Con relación a la determinación de sangre oculta, un 6 % de las muestras fueron positivas, 4 % de esos resultados estaban asociados con E. histolyticaldispar. El índice de parasitismo simple refleja un alto grado de infestación en los menores incluidos en este estudio. Conclusiones La prevalencia de parasitismo intestinal en menores de ascendencia indígena es mayor a la reportada en el orden nacional en menores escolares y adolescentes. Sobresalieron el mono y poliparasitismo en las muestras positivas. La carga de infestación no se distribuyó al azar entre las comunidades.

Preditores clínicos de bacteriúria assintomática na gestação / Clinical predictors of asymptomatic bacteriuria during pregnancy

OBJETIVOS: Estimar a prevalência de bacteriúria assintomática (BAS) entre gestantes atendidas em pré-natal de Serviço Universitário e identificar prováveis preditores clínicos. MÉTODOS: Estudo prospectivo de corte transversal, envolvendo 260 gestantes matriculadas em serviço de pré-natal de baixo risco entre agosto de 2008 e outubro de 2009, sem sintomas de infecção do trato urinário. Foram excluídas aquelas com febre, disúria, tenesmo vesical, dor lombar, presença de sangramento genital, perda de líquido amniótico, uso de antimicrobianos nos últimos 30 dias e aquelas que não desejaram participar do projeto. A presença de colonização bacteriana ≥10(5) UFC/mL de único patógeno, na amostra urinária obtida do jato médio, foi considerada como a variável dependente. As variáveis estudadas foram: idade, raça, estado civil, nível de instrução, história obstétrica, idade gestacional, anemia, traço falciforme, colpite, passado de infecção do trato urinário, polaciúria, urgência miccional e incontinência urinária. Dados do sumário de urina também foram analisados, como a presença de leucocitúria, flora bacteriana aumentada, hematúria, proteinúria e nitrito. A análise estatística foi realizada com o programa Statistical Package for the Social Sciences (SPSS) 13.0 e a significância estatística foi previamente definida por valor p<0,05. As prevalências foram expressas por percentual e intervalo de confiança considerado foi de 95 por cento. RESULTADOS: A prevalência de foi de 12,3 por cento (IC95 por cento=8,3-16,3). O agente etiológico mais frequente foi a E. coli (59,4 por cento). A regressão logística indicou que a urgência miccional (OR=5,9; IC95 por cento=2,2-16,3; p<0,001), a leucocitúria (OR=2,8; IC95 por cento=1,0-7,8; p=0,04) e a flora bacteriana aumentada (OR=10,6; IC95 por cento=3,9-28,5; p<0,001), são preditores independentes de BAS durante a gestação. CONCLUSÃO: A prevalência de bacteriúria assintomática na população estudada é alta. O escore preditor criado com o modelo final de regressão logística possui uma acurácia de 91,9 por cento para bacteriúria.

PURPOSE: To estimate the prevalence of asymptomatic bacteriuria among pregnant women attended at our university prenatal care clinic and to identify probable clinical predictors. METHODS: Across-sectional study was carried out from August 2008 to October 2009 at the Bahiana School of Medicine involving 260 pregnant women without symptoms of urinary tract infection. The following exclusion criteria were considered: presence of clinical signs such as fever, dysuria, vesical tenesmus, lumbar pain, history of active genital bleeding or loss of amniotic fluid, use of antimicrobial agents in the 30 days prior to sample collection, and refusal to participate in the project. The presence of single pathogen bacterial colonization ≥10(5) CFU/mL in the urine sample obtained from the middle jet was considered to be a dependent variable. The predictive factors evaluated were as follows: age, race, marital status, schooling, gestational age, hypertension, anemia, vaginal infection, sickle cell trait and previous history of urinary tract infection, urinary symptoms related to the lower urinary tract (frequency, urgency and nocturia) and data obtained from the urine summary (leukocyturia, increased bacterial flora, hematuria, proteinuria, and presence of nitrite). Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) software version 13.0 and the level of significance was set at p<0.05. Prevalences were expressed as percentage, and the confidence interval considered was 95 percent (95 percentCI). RESULTS: The prevalence of asymptomatic bacteriuria was 12.3 percent (95 percentCI=8.3-16.3). E. coli was the most frequent etiologic agent (59.4 percent). Logistic regression indicated that urgency to void (OR=5.99; 95 percentCI=2.20-16.31; p<0.001); leukocyturia (OR=2.85; 95 percentCI=1.04-7.83; p=0.042) and increased bacterial flora (OR=10.62; 95 percentCI=3.95-28.56; p<0.001) were independent predictors of asymptomatic bacteriuria. CONCLUSION: The prevalence of asymptomatic bacteriuria in the studied population was high. The prediction score created for the final logistic regression model has an accuracy of 91.9 percent for bacteriuria.