Comparative analysis of Respiratory Syncytial Virus frequency rates and viral load in different patient cohorts in a University Hospital in São Paulo, Brazil, over an eight-year period (2005-2013)

Abstract Respiratory Syncytial Virus (RSV) poses a global health concern, particularly affecting young children, the elderly, and immunosuppressed individuals. RSV viral load is essential for understanding transmission, disease severity, prevention, and treatment. This retrospective study aimed to analyze the frequency rates and viral loads of RSV infections in different patient cohorts and age groups over an eight-year period in a university hospital in São Paulo, Brazil. This study analyzed 1380 Immunocompetent (IC) and Immunosuppressed (IS) patients with acute respiratory tract infections. IC included patients with chronic Heart Disease (HD), Primary Care service recipients (PC), and a subgroup suspected of having Severe Acute Respiratory Syndrome caused by Influenza A (H1N1)pdm09 virus (SARS H1N1). IS comprised transplant patients and those with HIV infection. Respiratory samples were collected between February 2005 and October 2013, with RSV detection and viral load quantification (Log10 copies of RNA/mL) using RT-qPCR. Overall RSV infection rate was 17.3 %, with higher rates in children (23.9 %) than in adults (12.9 %), particularly in children under two years of age (28.2 %). Children in the SARS H1N1 and PC subgroups had higher infection rates (16.4 % and 34.9 %, respectively), with the highest rate in PC children aged 1 to < 2 years (45.45 %). Adults with HD had a significantly higher frequency rate (27.83 %) than those in the SARS H1N1 (2.65 %) and IS (15.16 %) subgroups and higher hospitalization rate among adults under 65 years. RSV viral load ranged from 2.43 to 10.15 Log10 RNA copies/mL (mean ± SD 5.82 ± 2.19), with hospitalized patients exhibiting significantly higher viral loads (7.34 ± 1.9) than outpatients (4.38 ± 1.89). Elderly bone marrow transplant patients also had significantly higher viral loads (7.57 ± 2.41) than younger adults (5.12 ± 1.87). This study provides insights into the RSV infection patterns in different patient cohorts in Brazil. Further investigations are needed to understand susceptibility and risk factors associated with RSV infection. In conclusion, high RSV viral load among hospitalized patients could serve as a surrogate marker of disease severity. Additionally, patients with chronic heart disease deserve greater attention regarding complications associated with RSV infection.

Níveis séricos de vitamina D e alterações hepáticas em pacientes com malária na região Amazônica / Serum levels of vitamin d and hepatic changes in patients with malaria in the Amazon region / Niveles séricos de vitamina d y alteraciones hepáticas en pacientes con malaria en la Amazonia

Vários estudos sugerem a importância da vitamina D ­ 25(OH)D ­ na evolução clínica dos pacientes com malária. Entretanto, a prevalência de deficiência de 25(OH)D na população amazônica é pouco conhecida, havendo também poucos estudos com pacientes diagnosticados com malária. Assim, o objetivo deste estudo foi avaliar os níveis séricos de 25(OH)D em pacientes com malária e sua relação com dados epidemiológicos, parasitológico e provas de função hepática. Para tanto, foi realizado um estudo transversal analítico com um grupo de pacientes com malária e um grupo controle no município de Itaituba (PA), Brasil, no período de janeiro de 2018 a outubro de 2019. Elaborou-se um protocolo para avaliação dos dados sociodemográficos, parasitológicos e laboratoriais, adotando-se o nível de significância de 5%. A prevalência de deficiência de 25(OH)D foi observada nos pacientes com malária (28,5%) e no grupo controle (24,6%), sem diferença estatística; porém, entre os residentes no garimpo, os níveis séricos foram estatisticamente menores nos pacientes com malária. Os níveis séricos de transaminase glutâmico-pirúvica (TGP) apresentaram correlação inversa com os de 25(OH)D. As provas de função hepática foram significativamente maiores no grupo com malária. Dessa forma, este estudo evidenciou a deficiência de 25(OH)D em Itaituba. Alterações hepáticas pela infecção plasmodial podem ter contribuído para a correlação inversa observada entre os níveis de TGP e 25(OH)D.

Several studies suggest the importance of vitamin D ­ 25(OH)D ­ in the clinical evolution of patients with malaria. However, the prevalence of 25(OH)D deficiency in the Amazonian population is little known, and studies with patients diagnosed with malaria are scarce. Thus the objective of this study is to evaluate the serum levels of 25(OH)D in patients with malaria and its relationship with epidemiological and parasitological data and liver function tests. To that end, an analytical cross-sectional study was carried out with a group of patients with malaria and a control group in the municipality of Itaituba (PA), Brazil, from January 2018 to October 2019. A protocol was elaborated for the evaluation of sociodemographic, parasitological, and laboratory data, adopting a significance level of 5%. Results: The prevalence of 25(OH)D deficiency was observed in patients with malaria (28.5%) and in the control group (24.6%), with no statistical difference; however, among residents in the mining, serum levels were statistically lower in patients with malaria. The glutamic-pyruvic transaminase (GPT) serum levels showed an inverse correlation with 25(OH)D levels. Liver function tests were significantly higher in the malaria group. Thus, this study evidenced 25(OH)D deficiency in Itaituba. Hepatic changes due to plasmodial infection may have contributed to the inverse correlation observed between GPT and 25(OH)D levels.

Diversos estudios sugieren la importancia de la vitamina D ­[25(OH)D]­ en la evolución clínica de pacientes con malaria. Sin embargo, la prevalencia de la deficiencia de 25(OH)D en la población amazónica es poco conocida y existen pocos estudios en pacientes con malaria. Ante esto, el objetivo de este estudio fue evaluar los niveles séricos de 25(OH)D en pacientes con malaria y su relación con datos epidemiológicos, parasitológicos y pruebas de función hepática. Para ello, se realizó un estudio transversal analítico en el grupo de pacientes con malaria y en un grupo control en el municipio de Itaituba (PA), Brasil, de enero de 2018 a octubre de 2019. Se elaboró un protocolo para la evaluación de datos sociodemográficos, parasitológicos y de laboratorio, adoptando un nivel de significancia del 5%. La prevalencia de deficiencia de 25(OH)D se observó en pacientes con malaria (28,5%) y en el grupo control (24,6%), sin diferencia estadística; sin embargo, entre los residentes en la minería, los niveles séricos fueron estadísticamente inferiores en pacientes con malaria. Los niveles séricos de transaminasa glutámico pirúvica (TGP) mostraron una correlación inversa con los niveles de 25(OH)D. Las pruebas de función hepática fueron significativamente más altas en el grupo de malaria. De esta manera, se evidenció deficiencia de 25(OH)D en la población de Itaituba. Los cambios hepáticos debido a la infección plasmodial pueden haber contribuido a la correlación inversa observada entre los niveles de TGP y 25(OH)D.

Análise clínico-epidemiológica dos atendimentos em um centro de referência em imunobiológicos especiais na amazônia / Análisis clínico-epidemiológico de la atención en un centro de referencia em inmunobiológicos especiales em la amazonia / Clinical-epidemiological analysis of the care services at a special immunobiological reference center in the amazon

RESUMO Objetivo: descrever o perfil clínico-epidemiológico do atendimento no Centro de Referência em Imunobiológicos Especiais de Hospital na Amazônia. Método: descritivo de abordagem quantitativa e analisado por meio da estatística descritiva e inferencial. O Sistema de Informação do Centro de Referência para Imunobiológicos Especiais (antigo) e Sistema de Informação do Programa Nacional de Imunização (atual) foram as bases utilizadas, entre 2006 e 2016. Resultados: foram administradas 77.077 doses de imunobiológicos; 25,2% corresponderam à vacina influenza inativada; insuficiência renal crônica foi a principal indicação (19%). O sistema atual registrou 18.267 doses de imunobiológicos administrados entre os anos de 2014 a 2016; sendo 37,8% correspondente à vacina influenza inativada; não foram informadas 42,5% das indicações, sendo HIV/AIDS 18,2%. Infectologia foi a especialidade que mais encaminhou para vacinação (18,3%). Conclusão: a acurácia dos dados foi comprometida pela falta de completude nos sistemas de informação. Observou-se subutilização do serviço pela população local.

RESUMEN: Objetivo: describir el perfil clínico-epidemiológico de la atención brindada por el Centro de Referencia para Inmunobiológicos Especiales de un Hospital de la Amazonía. Método: descriptivo con enfoque cuantitativo y analizado mediante estadística descriptiva e inferencial. El Sistema de Información del Centro de Referencia para Inmunobiológicos Especiales (antiguo) y el Sistema de Información del Programa Nacional de Inmunización (actual) se utilizaron como base de datos entre 2006 y 2016. Resultados: se administraron 77,077 dosis de inmunobiológicos; el 25,2% correspondió a la vacuna inactivada contra la influenza; La insuficiencia renal crónica fue la indicación principal (19%). El sistema actual registró 18.267 dosis de inmunobiológicos administradas entre los años 2014 y 2016; siendo que el 37,8% correspondió a la vacuna inactivada contra la influenza; El 42,5% de las indicaciones no fueron informadas, y el porcentaje informado de VIH / SIDA fue de 18,2%. La especialidad que más derivaciones realizó para vacunación fue la de infectología (18,3%). Conclusión: la precisión de los datos se vio comprometida por la falta de integridad en los sistemas de información. Se observó la subutilización del servicio por la población local.

ABSTRACT Objective: to describe the clinical-epidemiological profile of the care service at the Reference Center for Special Immunobiologicals of Hospital in the Amazon. Method: a descriptive study, of a quantitative approach and analyzed by means of the descriptive and inferential statistics. The Information System of the Reference Center for Special Immunobiologicals (former) and the Information System of the National Immunization Program (current) were the databases used, between 2006 and 2016. Results: 77,077 doses of immunobiological vaccines were administered; 25.2% corresponded to the inactivated influenza vaccine; chronic renal failure was the main indication (19%). The current system recorded 18,267 doses of immunobiological vaccines administered between the years 2014 to 2016; 37.8% of which were inactivated influenza vaccines; 42.5% of the indications were not reported, with HIV/AIDS being 18.2%. Infectologia foi a especialidade que mais encaminhou para vacinação (18,3%). Conclusion: the data accuracy has been compromised by the incompleteness in the information systems. We observed underutilization of the service by the local population.

Basic sanitation, socioeconomic conditions, and degree of risk for the presence and maintenance of malaria in a low-transmission area in the Brazilian Amazon

ABSTRACTINTRODUCTION:This study aimed to evaluate basic sanitation and socioeconomic indicators, reported cases of malaria, and risk of contracting malaria in the Ananindeua municipality, State of Pará.METHODS:Data on basic sanitation and socioeconomic dimensions were taken from the Brazilian Institute of Geography and Statistics [ Instituto Brasileiro de Geografia e Estatística (IBGE)] 2010 census. Epidemiological malaria information was taken from the Epidemiological Malaria Surveillance Information System [ Sistema de Informação de Vigilância Epidemiológica de Malária (SIVEP/Malaria)], between 2003 and 2013 of the Ministry of Health and from the SIVEP/Malaria forms of the municipality's Endemic Diseases Unit for 2,013 cases.RESULTS:Our data do not confirm the correlation among indicators of basic sanitation, socioeconomic conditions, and water supply with malaria cases. Of the 1,557 cases evaluated, most were caused by Plasmodium vivax , with rare cases of Plasmodium falciparum and mixed infections. There were 756 notifications in 2003. The number of reported cases was sharply reduced between 2006 and 2012, but a 142-case outbreak occurred in 2013. Ananindeua municipality's Annual Parasite Index indicated low risk in 2003 and no risk in other years, and the 2,013 cases were predominantly male individuals aged ≥40 years.CONCLUSIONS:Our data confirm the non-endemicity of malaria in the Ananindeua municipality, as the Annual Parasite Indices described for the years 2004-2013 classify it as a risk-free area. However, the 2013 outbreak indicates the need to strengthen prevention, surveillance, and control activities to reduce the risk of new outbreaks and consequent economic and social impacts on the population.

Myocarditis associated with Plasmodium vivax malaria: a case report

Malaria remains a major public health problem in Brazil where Plasmodium vivax is the predominant species, responsible for 82% of registered cases in 2013. Though benign, P. vivax infection may sometimes evolve with complications and a fatal outcome. Here, we report a severe case of P. vivax malaria in a 35-year-old Brazilian man from a malaria endemic area, who presented with reversible myocarditis.

Vacinação dos viajantes: experiência do Ambulatório dos Viajantes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo / Travelers' vaccinations: experience from the Travelers' Clinic of Hospital das Clínicas, University of São Paulo School of Medicine

O perfil dos indivíduos, a situação vacinal e as vacinas recomendadas aos viajantes que procuram o serviço médico de orientação pré-viagem do Ambulatório dos Viajantes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo foram analisados no presente estudo. Dos 445 viajantes estudados, 51 por cento eram mulheres; a mediana de idade foi de 33,5 anos; 51 por cento viajavam a trabalho e 39,5 por cento por lazer. Destinos mais procurados: África (47 por cento); Ásia (31,7 por cento); América do Sul (21,4 por cento). Trezentos e oitenta e cinco (86,5 por cento) viajantes tiveram indicação de vacinação para viagem. Principais vacinas recomendadas: febre tifóide (55,7 por cento), difteria-tétano (54,1 por cento), hepatite A (46,1 por cento), hepatite B (44,2 por cento), febre amarela (24,7 por cento). A orientação pré-viagem mostrou-se importante não só para indicar as vacinas recomendadas para a viagem, mas também como oportunidade para atualização das vacinas de rotina.

TThe profile and vaccination status of travelers seeking pre-travel medical advice at the Travelers' Clinic of Hospital das Clínicas, University of São Paulo School of Medicine, and the vaccines recommended for them, were analyzed in the present study. Among the 445 travelers who were studied, 51 percent were women, the median age was 33.5 years, 51 percent were traveling on business and 39.5 percent were traveling for leisure purposes. The destinations most sought were Africa (47 percent), Asia (31.7 percent) and South America (21.4 percent). Vaccination before traveling was recommended for 385 (86.5 percent) of the travelers. The main vaccines recommended were against typhoid fever (55.7 percent), diphtheria-tetanus (54.1 percent), hepatitis A (46.1 percent), hepatitis B (44.2 percent) and yellow fever (24.7 percent). The pre-travel guidance was shown to be important not only for indicating the vaccines recommended for the trip, but also as an opportunity to update routine vaccinations.