Norovírus no município de São Paulo, 2010-2016: estudo transversal sobre a principal causa de gastroenterite infantil / Norovirus en el Municipio de São Paulo, Brasil, 2010-2016: estudio transversal sobre la principal causa de gastroenteritis infantil / Norovirus in São Paulo city, Brazil, 2010-2016: a cross-sectional study of the leading cause of gastroenteritis in children

Objetivo: descrever casos de doença diarreica aguda por norovírus em crianças menores de 5 anos do município de São Paulo, Brasil. Métodos: estudo transversal com dados provenientes da Vigilância Epidemiológica das Gastroenterites Causadas por Rotavírus; foi definido como caso o paciente internado em unidade sentinela por doença diarreica aguda e identificação laboratorial do norovírus como agente etiológico, entre os anos de 2010 e 2016. Resultados: durante o período estudado, a proporção de casos de norovírus em menores de 5 anos de idade ultrapassou a proporção de casos de rotavírus, agente considerado predominante na infância; o norovírus foi associado a 28,4% do total de casos notificados, ocorrendo o ano todo, principalmente nos meses mais quentes. Conclusão: norovírus foi o principal agente etiológico identificado em crianças menores de 5 anos com doença diarreica aguda no município de São Paulo.

Objetivo: describir casos de enfermedad diarreica aguda por Norovirus en niños menores de 5 años provenientes del Municipio de São Paulo, Brasil. Métodos: Estudio transversal con datos de la Vigilancia Epidemiológica de las Gastroenteritis causadas por Rotavirus. Se definió como caso el paciente internado en unidad centinela por enfermedad diarreica aguda e identificación de laboratorio del Norovirus como agente etiológico entre los años de 2010 y 2016. Resultados: Durante el período estudiado, la proporción de casos de Norovirus en menores de 5 años superó la proporción de casos de Rotavirus, agente considerado predominante en la infancia. El Norovirus fue asociado al 28,4% del total de los casos notificados, ocurriendo todo el año, principalmente en los meses más cálidos. Conclusión: el Norovirus fue el principal agente etiológico identificado en niños menores de 5 años con enfermedad diarreica aguda en el Municipio de São Paulo.

Objective: to describe cases of acute diarrheal disease caused by norovirus in children under 5 years old in São Paulo city, Brazil. Methods: this was a cross-sectional study using data from Epidemiological Surveillance of Gastroenteritis due to Rotavirus; cases were defined as patients hospitalized in a sentinel unit because of acute diarrheal disease and laboratory identification of norovirus as the etiological agent between 2010 and 2016. Results: during the study period, the proportion of norovirus cases in children under 5 years old exceeded the proportion of Rotavirus, an agent considered predominant in childhood; norovirus was associated with 28.4% of total reported cases, occurring all year round, especially in warmer months. Conclusion: norovirus was the leading etiological agent identified in children under 5 years old with acute diarrheal disease in São Paulo city.

Change in physical and chemical characteristics related to the binomial time-temperature used in sous pasteurization see Tambaqui (Colossoma macropomum) / Variação das características físico-químicas relacionadas ao binômio tempo-temperatura utilizado na pasteurização de sous vide de tambaqui (Colossoma macropomum)

The goal of this study was to evaluate sous vide fish and assess the influence of time and temperature on the pasteurization process through quality parameters. The raw material (tambaqui fillets) and the sous vide underwent physical, physicochemical, and microbiological analyses. A sauce was prepared containing soy sauce, water, horseradish and garlic flakes. The product's pasteurization parameters of time and temperature were defined according to a 22 central composite rotatable design (CCRD), and the dependent variables were water holding capacity (WHC) and instrumental texture aiming at obtaining high WHC values for the product to maintain the desired juiciness. The microbiological analysis required by legislation have indicated that the fish fillets and sous vide were within de standard. The values of total coliforms found in the samples (fillets and sous vide) analyzed were below the critical level of 10² CFU/g. The counts of sulphite-reducing clostridia and psychrotrophic and mesophilic bacteria on plates in the samples were <1x10 CFU/g. In conclusion, temperature was the most important factor in the pasteurization process, significantly contributing to the quality of the final product. The mathematical models proposed were considered predictive for each response.

O objetivo deste estudo foi avaliar a influência do tempo e da temperatura no processo de pasteurização do sous vide de peixe por meio dos parâmetros de qualidade. Foram realizadas análises físicas, físico-químicas e microbiológicas na matéria-prima (filé de tambaqui) e no sous vide. Foi preparado um molho contendo molho de soja, água, raiz forte e flocos de alho. Parâmetros de pasteurização do produto (tempo x temperatura) foram definidos de acordo com um projeto de 2x2 rotativo composto central (DRCC), e as variáveis dependentes foram capacidade de retenção de água (CRA) e textura instrumental, visando à obtenção de altos valores de CRA para que o produto obtivesse a suculência desejada. As análises microbiológicas exigidas na legislação indicaram que a matéria-prima e o sous vide encontravam-se dentro dos padrões estabelecidos. Os valores de coliformes totais encontrados nas amostras (filés e sous vide) analisadas foram inferiores ao nível crítico de 10² UFC/g. As contagens de clostrídios sulfitorredutores e bactérias psicrotróficas e mesófilas em placas nas amostras foram <1x10 UFC/g. Concluiu-se que a temperatura foi o fator mais importante no processo de pasteurização, contribuindo de forma significativa para a qualidade do produto final. Os modelos matemáticos propostos foram preditivos para cada resposta.

Norovírus: uma visão geral / Norovirus: an overview

Os norovírus (NoV) foram os primeiros agentes virais ligados à doença gastrointestinal, entretanto, eles foram, por muito tempo, considerados como causa secundária de gastroenterite, após os rotavírus. O desenvolvimento de técnicas moleculares voltadas ao diagnóstico dos NoV forneceu dados mais claros sobre o impacto epidemiológico desses vírus, os quais são, atualmente, reconhecidos não apenas como principal causa de surtos de gastroenterite não bacteriana, mas também como causa importante de gastroenterite esporádica em crianças e adultos. Esta revisão enfoca os conhecimentos necessários para compreender a sua morfologia, genética, transmissão, patogênese e controle. Uma vez que não há vacina disponível, a prevenção da infecção por NoV depende principalmente de medidas de higiene da comunidade e pessoais.

Although noroviruses (NoVs) were the first viral agents linked to gastrointestinal disease, for a long time they have been considered secondary cause of gastroenteritis, second to rotaviruses as etiologic agents. The development of molecular techniques in diagnosing NoV provided a clearer insight into the epidemiological impact of these viruses, which are currently recognized not only as the leading cause of non-bacterial gastroenteritis outbreaks, but also as a major cause of sporadic gastroenteritis in both children and adults. This review focuses on the required knowledge to understand their morphology, genetics, transmission, pathogenesis, and control. Since no vaccine is available, prevention of NoV infection relies mainly on strict community and personal hygiene measures.

Enteritis virales en adultos inmunocompetentes, agentes clásicos y emergentes / Viral enteritis in immunocompetent adults: classic and emergent agents

Objetivo: Revisar aspectos epidemiológicos y clínicos de las enteritis de etiología viral en pacientes adultos inmunocompetentes. Resumen: La diarrea aguda infecciosa (enteritis) es una patología relevante en todo el mundo y aún es responsable de una alta mortalidad en niños y elevada morbilidad en adultos. En pacientes adultos inmunocompetentes la etiología viral es frecuentemente subestimada aunque la mayoría de las enteritis agudas son causadas por virus. Los agentes virales más frecuentemente identificados son el Norovirus, Rotavirus, Astrovirus, y Adenovirus. Su principal vía de contagio es la ruta fecal-oral y el cuadro clínico suele ser en su gran mayoría leve y autolimitado, con manifestaciones clínicas similares e inespecíficas: diarrea acuosa, náuseas, vómitos y dolor abdominal. Adultos mayores y pacientes inmunosuprimidos pueden presentar cuadros más severos y prolongados. El tratamiento es fundamentalmente sintomático. La prevención se basa en tomar medidas sanitarias y limitar el contagio de persona a persona. Virus respiratorios emergentes como SARS e InfluenzaA-H1N1, con frecuencia comprometen el tracto gastrointestinal y en períodos de epidemia deben ser considerados en el diagnóstico diferencial de enteritis aguda.

Objective: To review epidemiological and clinical aspects of viral enteritis in immunocompetent adult patients. Abstract: Acute infectious diarrhea (enteritis) is a worldwide important disease and it still accounts for high mortality among children and high morbidity among adults. In immunocompetent adult patients the viral etiology is frequently underestimated, although the most common cause of acute enteritis is avirus. The mos frequently identified viral agents are Norovirus, Rotavirus, Astrovirus, and Adenovirus. The main mechanism of spread of the disease is fecal-oral transmission and the clinical setting is commonly mild and self-limited, with clinical manifestations that are similar and unspecific: aqueous diarrhea, nausea, vomiting and abdominal pain. Elderly and immunosupressed patients may show more severe and prolonged episodes. Treatment is mainly symptomatic. Prevention is based on taking sanitary measures and reducing person-to-person transmission. Emerging respiratory viruses as SARS and A-H1N1 influenza frequently compromise the gastrointestinal tract and during epidemic periods these viruses should be considered in differential diagnosis of acute enteritis.

Infecciones virales intestinales en pediatría / Intestinal viral infections in pediatrics

Los virus que causan diarrea en humanos generalmente muestran gran trofismo por las células epiteliales del intestino delgado. El mecanismo tradicionalmente aceptado es que estos agentes causan enfermedad destruyendo gran cantidad de entericitos maduros, (sea por lisis directa o induciendo la apoptosis) los que son reemplazados por células inmaduras provenientes de las criptas. Esto lleva a una absorción inadecuada de agua, electrolitos y nutrientes, con capacidad conservada de secretar cloro y agua. A diferencia de lo que ocurre frente a patógenos bacterianos invasores, la respuesta inflamatoria del huésped es leve y no contribuye significativamente en el mecanismo de la diarrea viral. Estudios posteriores han llevado a postular mecanismos adicionales, que no serían autoexcluyentes. Se ha descrito que algunas proteínas virales no estructurales actuarían como enterotoxina. Además, jugaría un rol la alteración de las uniones estrechas con aumento del flujo paracelular de agua y electrolitos, el aumento de la secreción intestinal mediada por neurotransmisores, y la microisquemia vellositaria. El impacto de la enteritis viral es mayor y la recuperación más lenta en niños previamente desnutridos. Se ha demostrado en animales de experimentación desnutridos un notorio retraso en la recuperación de la capacidad enzimática y absortiva de la mucosa intestinal frente a una enteritis viral, lo que refuerza la necesidad de una temprana y efectiva rehabilitación nutricional durante los episodios agudos de diarrea. Es ampliamente conocido que la lactancia materna, disminuye la incidencia y severidad de las diarreas virales en niños, los primeros meses de vida.

Viruses that cause diarrhea in humans generally show great tropism due to epithelial cells of the small intestine. The traditionally accepted mechanism is that these agents cause illness by destroying large number of mature enterocytes (via direct lysis or by inducing apoptosis), which are replaced by immature cells coming from the crypts. This leads to an inadequate absorption of water, electrolytes and nutritients with conserved chloride and water secretion. In contrast to invasive bacterial pathogens, the host infl amatory response is mild and it does not contribute significantly to the mechanism of viral diarrhea. Subsequent studies have leaded to postulate additional mechanisms that would not exclude each other. It has been described that some non-structural viral proteins may act as enterotoxin. In addition, the alteration of the tight junctions with an enhanced paracellular flow of water and electrolytes, the increase of neurotransmitter mediated intestinal secretion, and the micro-ischemia of villi would also play a role. The impact of viral enteritis is larger and the recovery slower in previously undernourished children. Studies carried out on undernourished experimentation animals have demonstrated a notorious delay in the recovery of the enzymaticand absorptive capacity of intestinal mucosa after viral enteritis, which reinforces the need for early and effective nutritional rehabilitation during episodes of acute diarrhea. It is well-known that the breastfeeding reduces the incidence and severity of viral diarrheas in children during the first months of life.

Prevalencia de norovirus en muestras de heces procedenes del laboratotio del Hospital José Gregorio Hernández / The prebalence of the norovirus in fecal samples which originated at the laboratory of the Hospital José Gregorio Hernandez. Catia, Caracas

La gastroenteritis en Venezuela es la principal causa de muerte y morbilidad en la población infantil. La falta de adecuadas metodologías diagnósticas en el laboratorio de rutina impide identificar todos los posibles microorganismos causantes de gastroenteritis enfocando el diagnóstico al estudio de parásitos protozoarios o helmintos, bacterias aeróbicas y en menos grado virus y hongos. Basado en esto, decidimos determinar si el norovirus es el agente causal de gastroenteritis en nuestro país, determinar las condiciones ambientales y sanitarias en la comunidad en estudio y analizar los esquemas y técnicas diagnósticas actualmente utilizadas en los centros de salud. Se evaluaron 173 muestras de heces de pacientes que asistieron al laboratorio del Hospital Magallanes de Catia. Se utilizó un kit de inmunoensayo enzimático, ELISA RIDASCREEN norovirus de r-biopharm AG, alemania, el cual permite el diagnóstico in vitro e identificación cualitativa de los norovirus genogrupo I y II en muestras de heces. De las 173 muestras de heces analizadas 29 (16,76%) resultaron positivas, 144 (83,32%) fueron negativas. Cuando se evaluaron por grupo etario, el grupo de niños de 6-13 años se obtuvo el mayor número de muestras positivas (8) seguido del grupo de niños 0 - 5 años con 7 muestras positivas. Se encontró mayor frecuencia de norovirus en muestras con aspecto heterogéneo, color marrón y verde de consistencia blanda y alcalina, así mismo 19,08% de las muestras fueron positivas para algún parásito (Protozoario o Helmintos) visibles en el examen microscópico directo. Se demostró que 16,76% de las diarreas en le grupo evaluado fueron por norovirus, siendo importante su determinación para el diagnóstico de gastroenteritis.

Gastroenteritis is the main cause of death and morbidity among children in Venezuela. The lack of adequate diagnostic methodologies in the laboratory reduce the identification of all possible microorganisms that cause gastroenteritis, since they focus the diagnosis on the study of parasites, protozoa or helminthes, aerobic bacteria and, to a lesser degree, on viruses and fungi. Based on this, we decided to determine if the norovirus is the causal agent of gastroenteritis in our country; to determine the environmental and sanitary conditions in the community under study; and, to analyze the diagnostic framework and techniques currently used in healthcare centers. 173 fecal samples of patients that visited the laboratory of the Hospital Magallanes in Catia were evaluated. An enzymatic immunoassay kit, ELISA RIDASCREEN norovirus of r-biopharm AG, Germany, was used since it permits the in vitro diagnosis and the qualitative identification of the norovirus genogroups I and II in fecal samples. Of the 173 stool samples analyzed, 29 (16.76%) tested positive, 144 (83.32%) tested negative. When evaluated by age group, the group of children between 6-13 years old presented the greatest number of positive samples (8), followed by the group of children between 0-5 with 7 positive samples. The highest frequency of norovirus was found in samples of heterogeneous appearance, brown-green color, soft and alkaline consistency; also, 19.08% of the samples tested positive for some type of parasite (Protozoa or Helminthes), visible with direct microscopic examination. So, we can conclude that it was shown that 16.76% of the diarrheas in the evaluation group were due to norovirus, its determination being important for the diagnosis of gastroenteritis.