The epidemiology of sepsis in a Brazilian teaching hospital.

OBJECTIVES: The objective of this study was to estimate disease incidence and mortality rate of sepsis in a tertiary public hospital. METHODS: Patients admitted to the Intensive Care Unit (ICU) in 2004 and 2005 were monitored for sepsis using an observational longitudinal study design. Patients were monitored daily for diagnostic criteria of sepsis, according to ACCP/SCCM Consensus Conference criteria, until either death or hospital discharge. RESULTS: During the study, we analyzed 1,179 patients. Systemic Inflammatory Response Syndrome (SIRS) was present in 1,048 (88.9%) patients on admission, and was associated with infection in 554 (47.0%) patients. Of these, sepsis was diagnosed in 30 (2.5%) patients, while severe sepsis was diagnosed in 269 (22.8%) patients, and septic shock was diagnosed in 255 (21.6%) patients. APACHE II and SOFA scores were higher in septic patients (p < 0.001), and the ensuing mortality rates were 32.8% (IC 95%: 21.6-45.7%) for patients with sepsis, 49.9% (IC 95%: 44.5-55.2%) for severe sepsis, and 72.7% (IC 95%: 68.1-76.9%) for septic shock. CONCLUSIONS: The data from our study revealed a high incidence of sepsis among hospitalized patients. Moreover, sepsis patients had a high rate of mortality.

The epidemiology of sepsis in a Brazilian teaching hospital

OBJECTIVES: The objective of this study was to estimate disease incidence and mortality rate of sepsis in a tertiary public hospital. METHODS: Patients admitted to the Intensive Care Unit (ICU) in 2004 and 2005 were monitored for sepsis using an observational longitudinal study design. Patients were monitored daily for diagnostic criteria of sepsis, according to ACCP/SCCM Consensus Conference criteria, until either death or hospital discharge. RESULTS: During the study, we analyzed 1,179 patients. Systemic Inflammatory Response Syndrome (SIRS) was present in 1,048 (88.9 percent) patients on admission, and was associated with infection in 554 (47.0 percent) patients. Of these, sepsis was diagnosed in 30 (2.5 percent) patients, while severe sepsis was diagnosed in 269 (22.8 percent) patients, and septic shock was diagnosed in 255 (21.6 percent) patients. APACHE II and SOFA scores were higher in septic patients (p < 0.001), and the ensuing mortality rates were 32.8 percent (IC 95 percent: 21.6-45.7 percent) for patients with sepsis, 49.9 percent (IC 95 percent: 44.5-55.2 percent) for severe sepsis, and 72.7 percent (IC 95 percent: 68.1-76.9 percent) for septic shock. CONCLUSIONS: The data from our study revealed a high incidence of sepsis among hospitalized patients. Moreover, sepsis patients had a high rate of mortality.

Genetic polymorphisms in the chemokine and chemokine receptors: impact on clinical course and therapy of the human immunodeficiency virus type 1 infection (HIV-1).

The natural history and pathogenic processes of infection by the human immunodeficiency virus type 1 (HIV-1) are complex, variable, and dependent upon a multitude of viral and host factors and their interactions. The CCR5-Delta32 allele remains the most important genetic factor known to be associated with host resistance to the HIV-1 infection. However, other mutations in the CCR5, CCR2, CX(3)CR1, CXCL12 (SDF1), and CCL5 (RANTES) genes have been identified and associated with host resistance and/or susceptibility to HIV-1 infection and disease progression. Some studies have also suggested that chemokine receptor gene polymorphisms may affect response to potent antiretroviral therapy. This article reviews the polymorphisms already described in the mutant chemokine receptors or ligands and their impact on the host susceptibility to HIV-1 infection and on the clinical course of the disease, as well as the development of new anti-HIV therapies that takes into account these potential targets in the host. These genetic polymorphisms could be used as genetic markers to detect individuals at higher risk of developing either a faster disease progression or therapeutic failure. Once these individuals are identified, therapeutic strategies based on either different, more aggressive drugs or combinations of drugs can be used, either alone or in combination with shorter intervals for therapeutic monitoring. Pharmacogenetics is very likely to underlie future therapies for HIV-1 infection, and current patients with multi-resistance to the existing antiretroviral agents could also benefit from this approach. These developments also underscore the importance of continuing the investigation of new therapies targeted to the host in order to inhibit the HIV-1 entry into the host cells.

Stromal cell-derived factor 1 (SDF1) genetic polymorphism in a sample of healthy individuals, seronegative individuals exposed to human immunodeficiency virus type 1 (HIV-1) and patients infected with HIV-1 from the Brazilian population.

The interaction of viral and host factors is believed to determine not only the risk for initial human immunodeficiency virus type 1 (HIV-1) acquisition but also the course of the infection. Genetic polymorphisms in the chemokine receptors and their ligands were related to the susceptibility and resistance to HIV-1 infection. A polymorphism in the conserved 3' untranslated region of the stromal cell-derived factor-1 (SDF1) gene, which encodes a ligand of the CXCR4 receptor, has been related either to delayed progression to AIDS or to rapid disease progression and death. Global, regional, and ethnic distributions of frequencies of SDF1 genotypes and of the SDF1-3'A allele vary significantly. Although the HIV-1 epidemic is increasing in Brazil, little information about the frequencies of host genetic mutations related to HIV/AIDS resistance in the Brazilian population has been reported. To address this question, this study was carried out in order to determine the frequencies of the SDF1 polymorphism and the SDF1-3'A allele on 1061 genomic DNA samples purified from peripheral blood cells of 136 healthy individuals (group 1), 147 HIV-1-exposed seronegative individuals (group 2), 161 HIV-1-infected asymptomatic individuals and with CD4(+) T-cells count 350 mm(-3) (group 3), and 617 HIV-1-infected individuals with AIDS and/or CD4(+) T-cells count < 350 mm(-3) (group 4). The frequencies of the SDF1-3'A homozygous mutation were 3.7%, 6.1%, 4.3%, and 5.3% among groups 1, 2, 3, and 4, respectively (P = 0.5120). The overall frequency of the SDF1-3'A allele was 0. 1984 and did not differ among the four groups (P = 0.2744). The results underscore the global distribution of the SDF1 polymorphism and the hypothesis that the SDF1-3'A allele, itself, may not be sufficient to prevent the risk of HIV-1 infection and may be not related to the progression of the disease in the Brazilian population.

[Trypanosoma cruzi infection in blood donor candidates]. / Infecção por Trypanosoma cruzi em candidatos a doador de sangue.

INTRODUCTION: Transmission of American trypanossomiasis by transfusion has been reduced by expansion of control measures of blood quality in Brazil. A research project was, therefore, undertaken to evaluate soropositivity for Trypanosoma cruzi infection on blood donors and to compare this rate with those found in 1958 and 1975 in blood banks. METHOD: A transversal study was carried out on blood donors in Londrina, Paraná, Brazil. ELISA and Immunofluorescence were the serological test techniques used in the diagnosis of Trypanosoma cruzi infection. RESULTS AND CONCLUSION: A serumprevalence rate of 1.3% was found with a tendency for positive serum findings for Trypanosoma cruzi infection on blood donors to decrease over Aime (1958, 1975, and 1995).

Seroprevalence of Trypanosoma cruzi infection in students at the seven-fourteen age range, Londrina, PR, Brazil, in 1995.

Seropositivity for Chagas disease was evaluated in 834 children aged between 7 and 14 from the Municipal Teaching System in the district of Londrina, State of Paraná. A seroprevalence rate of 0.1% was found through the use of an indirect immunofluorescent test and an enzyme-linked immunosorbent assay. This low rate of seroprevalence provides evidence that the vectorial transmission of Chagas disease has been eliminated in Londrina. The main reason for the elimination of vectorial transmission of Trypanosoma cruzi infection, as evaluated by serological tests, may be a remarkable change in the economic structure of the northern region of Paraná in the 1960's. At that time coffee production was almost completely replaced by soy beans, wheat and grazing in the rural areas. This change deeply affected the rural ecology and caused an exodus of the population from rural to urban areas as well as a decrease in the total number of the population of that region. The measures introduced for controlling the disease through the Program of Chagas Disease Control established by the Fundação Nacional de Saúde of the Brazilian Ministry of Health, certainly, had a positive impact on the reduction of American trypanosomiasis prevalence in the area under study. However, it does not seem that this was the most relevant factor responsible for the elimination of vectorial transmission of Chagas disease in Londrina.

[Outbreak of acute toxoplasmosis transmitted thru the ingestion of ovine raw meat]. / Surto de toxoplasmose aguda transmitida através da ingestão de carne crua de gado ovino.

The authors present 17 cases of symptomatic acute toxoplasmosis acquired by the ingestion of raw mutton offered during a party in September 1993. The incubation period carried from 6 to 13 days (10.9 +/- 7.0). Sixteen (94.5%) patients presented fever, headache, myalgia, arthralgia, and adenopathy (cervical or cervical/axilar). Hepatomegaly was found in 6 patients, splenomegaly in 4 and rash in 2. One patient presented clinical picture of chorioretinitis confirmed by ophthalmological exam. All patients showed increased serum levels of specific antibodies (IgG and IgM) on indirect immunofuorescence assay evidencing acute phase of toxoplasmosis. The patients were treated with specific drugs for toxoplasmosis and presented satisfactory clinical and laboratory response.

[Congenital ChagasDisease: epidemiology, laboratorial diagnosis, prognosis and treatment]. / Doença de Chagas congênita: epidemiologia, diagnóstico laboratorial, prognóstico e tratamento.

The authors review studies about epidemiology, clinical aspects and methods used in laboratorial diagnosis of congenital Chagas'disease, emphasizing the limitations in their specificity and sensibility, and suggest alternative methods to improve the accuracy and the quality of the laboratorial diagnosis of congenital Chagasdisease, essential to an efficient treatment.

[Neurocysticercosis with initial clinical picture of acute meningitis]. / Neurocisticercose com quadro clínico inicial de meningite aguda.

Twenty seven cases of neurocysticercosis, with clinical picture of acute meningitis, are described. Twenty (74.1%) patients are male; the age was 4 to 42 years (23.6 +/- 11.7 years). The etiologic diagnosis was defined by the complement fixation test (Weinberg) and/or enzyme-linked immunosorbent assay (ELISA) for cysticercosis in the cerebrospinal fluid (c. s. f.). Six patients that realized cranial computerized tomographic scan resembling neurocysticercosis. Twenty one (77.8%) have predominance of lymphomononuclear cells in the c. s. f. obtained in the admission to the hospital; in 6 (22.2%) there were predominance of polymorphonuclear neutrophils. In this c. s. f. lymphomononuclear pleocytosis and in three that have c. s. f. neutrophil pleocytosis, suggesting the diagnosis of neurocysticercosis. The treatment of acute neurocysticercosis was made with dexamethasone. All the patients survived and were transferred to the ambulatory of Neurology for follow-up and complementary treatment.

[The positivity index of the immunoenzyme reaction (ELISA) for cysticercosis in the cerebrospinal fluid (CSF) and in the serum of epilepsy patients]. / Indice de positividade da reação imunoenzimática (ELISA) para cisticercose no líquido cefalorraquidiano (LCR) e no soro de pacientes com epilepsia.

Fifty patients with epilepsy seen in three Londrina Neurological Services, in Paraná, were studied. The positivity prevalence of the enzyme-linked immunosorbent assay (ELISA) for cysticercosis in the cerebrospinal fluid (CSF) and in the serum of these patients was 34.0% and 20.0%, respectively. There was statistically significant difference when these two rates were compared with the reaction positivity in the CSF and the serum in the control group, formed by individuals without neurological diseases. There was no association between the type of seizure (generalized or partial) and the positivity index of ELISA for cysticercosis in the CSF. A greater number of patients with positive ELISA for cysticercosis in the rural area dwellers was found, in relation with the urban area dwellers. From the obtained results in our study we came to the following conclusions: 1. The high positivity ELISA rates for cysticercosis in the CSF and in the patients serum with epilepsy indicate that neurocysticercosis is an important seizure cause in Londrina, PR. 2. The positivity prevalence of ELISA for cysticercosis in CSF was greater in epileptic patients from the rural area than the ones from the urban area. 3. There was no association between the type seizure (generalized or partial) and the ELISA cysticercosis positivity rate in the CSF. 4. The high positivity prevalence of ELISA in the CSF and in the epileptic patients serum in Londrina indicates the priority of performing epidemiologic inquiry to establish the real cysticercosis prevalence in the city. ELISA may be used with this finality due to its high sensibility, its low cost and its simple performance.