Tuberculosis in adolescence: an integrative review focusing on patient-centered care / Tuberculose na adolescência: uma revisão integrativa com foco no cuidado centrado no paciente

ABSTRACT Objective: To identify how patient-centered care has been addressed in tuberculosis studies with adolescents. Data source: We searched for articles published in Portuguese, Spanish and English in the Virtual Health Library (LILACS), PubMed (MedLine), and Scopus (Elsevier) databases, from 2000 to 2020, using descriptors (DeCS, MeSH) in Portuguese and English. Data synthesis: 1,322 studies were identified, of which 18 were selected. The main themes found were related to adherence to tuberculosis treatment, knowledge, attitudes and practices, health education, and public policies. Conclusions: We observed that both the number of researchers dedicated to the topic and the presence of a truly person-centered view are still scarce elements in tuberculosis among adolescents research.

RESUMO Objetivo: Identificar, por meio de uma revisão integrativa, como o cuidado centrado no paciente tem sido abordado nos estudos de tuberculose com adolescentes. Fontes de dados: Buscamos artigos publicados em português, espanhol e inglês nas bases de dados da Biblioteca Virtual em Saúde - BVS (LILACS), PubMed (MedLine) e Scopus (Elsevier), de 2000 a 2020, utilizando descritores (DeCS, MeSH) em português e inglês. Síntese dos dados: Foram identificados 1.322 estudos, dos quais 18 foram selecionados. Os principais temas encontrados foram relacionados à adesão ao tratamento da tuberculose, conhecimentos, atitudes e práticas, educação em saúde e políticas públicas. Conclusões: Observamos que tanto o número de pesquisadores dedicados ao tema quanto a presença de uma visão verdadeiramente centrada na pessoa ainda são elementos escassos na pesquisa da tuberculose entre adolescentes.

The first Miocene fossils from coastal woodlands in the southern East African Rift.

The Miocene was a key time in the evolution of African ecosystems witnessing the origin of the African apes and the isolation of eastern coastal forests through an expanding arid corridor. Until recently, however, Miocene sites from the southeastern regions of the continent were unknown. Here, we report the first Miocene fossil teeth from the shoulders of the Urema Rift in Gorongosa National Park, Mozambique. We provide the first 1) radiometric ages of the Mazamba Formation, 2) reconstructions of paleovegetation in the region based on pedogenic carbonates and fossil wood, and 3) descriptions of fossil teeth. Gorongosa is unique in the East African Rift in combining marine invertebrates, marine vertebrates, reptiles, terrestrial mammals, and fossil woods in coastal paleoenvironments. The Gorongosa fossil sites offer the first evidence of woodlands and forests on the coastal margins of southeastern Africa during the Miocene, and an exceptional assemblage of fossils including new species.

Pervasive transcription enhances the accessibility of H-NS-silenced promoters and generates bistability in Salmonella virulence gene expression.

In Escherichia coli and Salmonella, many genes silenced by the nucleoid structuring protein H-NS are activated upon inhibiting Rho-dependent transcription termination. This response is poorly understood and difficult to reconcile with the view that H-NS acts mainly by blocking transcription initiation. Here we have analyzed the basis for the up-regulation of H-NS-silenced Salmonella pathogenicity island 1 (SPI-1) in cells depleted of Rho-cofactor NusG. Evidence from genetic experiments, semiquantitative 5' rapid amplification of complementary DNA ends sequencing (5' RACE-Seq), and chromatin immunoprecipitation sequencing (ChIP-Seq) shows that transcription originating from spurious antisense promoters, when not stopped by Rho, elongates into a H-NS-bound regulatory region of SPI-1, displacing H-NS and rendering the DNA accessible to the master regulator HilD. In turn, HilD's ability to activate its own transcription triggers a positive feedback loop that results in transcriptional activation of the entire SPI-1. Significantly, single-cell analyses revealed that this mechanism is largely responsible for the coexistence of two subpopulations of cells that either express or do not express SPI-1 genes. We propose that cell-to-cell differences produced by stochastic spurious transcription, combined with feedback loops that perpetuate the activated state, can generate bimodal gene expression patterns in bacterial populations.

Facilitação educativa em Tuberculose baseada na abordagem centrada na pessoa para adolescentes afetados pela doença / Educational facilitation on Tuberculosis based on a person centered approach for adolescents affected by the disease

A tuberculose (TB) continua sendo uma das principais causas de mortalidade no mundo e os adolescentes são um grupo frequentemente negligenciado nas agendas de pesquisa e estratégias de controle da TB. Os adolescentes têm peculiaridades relativas à TB, como alta incidência da doença e de abandono do tratamento, porém não contam com uma abordagem distinta para sua idade e singularidade. Em vista disso, elaboramos um estudo qualitativo de facilitação educativa à distância, baseada no cuidado centrado na pessoa, com adolescentes de 10 a 19 anos tratados para TB ativa em dois ambulatórios de tisiologia do estado do Rio de Janeiro, visando mensurar e compreender os conhecimentos, atitudes e práticas (CAP) sobre TB, assim como a autoestima dos pacientes e o estigma associado à doença. Para tanto, organizamos encontros remotos individuais, com a aplicação de três questionários/escalas (CAP, autoestima de Rosenberg, Tuberculosis-related stigma), seguidos de uma entrevista semiestruturada e, posteriormente, foi organizado um encontro coletivo com os adolescentes. As entrevistas foram transcritas para a análise do conteúdo. Como forma de avaliação da atividade realizada, os adolescentes responderam a uma escala de empatia. Foram incluídos 15 adolescentes, sendo 60% mulheres, 80% apresentavam TB pulmonar e 53% TB-RR ou MDR. Os participantes demonstraram ter um bom conhecimento acerca da doença, porém com alguns equívocos relacionados à transmissão da TB. Foi evidenciada a forte presença de estigma, representada no medo de conversar sobre a doença e no sentimento de tristeza com a reação das pessoas e com consequente isolamento do adolescente. Observamos no geral moderada a elevada autoestima nos adolescentes, no entanto 60% deles referiram se sentirem inúteis. Identificamos que o estigma e o sofrimento psíquico foram causados principalmente pelo medo da transmissão da doença. O encontro coletivo foi destacado como oportunidade de conhecer pessoas que passaram por situações parecidas e terem recebido as respostas para as suas dúvidas. Concluímos ser necessária uma abordagem centrada no cuidado à pessoa para o adolescente com TB, incluindo atividades educativas sobre a doença, melhor treinamento dos profissionais de saúde e a criação de programas de aconselhamento por pares. Tal abordagem poderia contribuir para a redução do estigma e do sofrimento relacionados à TB, reduzindo assim o impacto negativo da TB na vida desses jovens e promovendo a adesão ao tratamento e a cura da doença.(AU)

Adaptação transcultural do Team Member Perspectives of Person-centered Care (TM-PCC) em pessoas idosas institucionalizadas / Cross-cultural adaptation of the Team Member Perspectives of Person-Centered Care (TM-PCC) in institutionalized older adults

Resumo Objetivo Realizar a tradução, retrotraduação para o português falado no Brasil e a adaptação transcultural do instrumento Team Member Perspectives of Person-Centered Care (TM-PCC) e ainda, a sua validade de constructo. O objetivo do TM-PCC é avaliar a frequência de comportamentos e de práticas de cuidados centrados no indivíduo segundo os profissionais que atuam nas Instituições de Longa Permanência para Idosos (ILPIs). Método Foram seguidos o processo de tradução, retrotraduação e adaptação transcultural por meio da equivalência semântica, idiomática, experiencial e conceitual realizado por cinco juízes especialistas da área de Geriatria e da Gerontologia e, por fim, aplicou-se o instrumento piloto em 49 profissionais de quatro ILPIs de três estados brasileiros. Resultados Após a avaliação realizada pelos juízes especialistas, obteve-se discordância quanto aos termos "previous associations", "fufilling relationships" e "incorporate this caring into my daily routine", os quais foram substituídos por "histórias pregressas", "relações satisfatórias", e "incorporar esse cuidado na minha rotina diária". Após as correções e revisões, o questionário foi reenviado aos juízes, obtendo-se 100% de concordância. Observou-se boa compreensão das questões durante a aplicação piloto e boa consistência interna por meio do alfa de Cronbach= 0,78. Conclusão O TM-PCC pode ser ferramenta útil para avaliação dos cuidados centrados ao indivíduo em ILPIs, no Brasil, segundo a avaliação de profissionais. Isso possibilitará ao gestor ou profissional supervisor de cuidados, planejar e desenvolver intervenções educacionais e de gestão voltadas a promoção dos cuidados centrados ao indivíduo nas ILPI.

Abstract Objective carry out the translation and back-translation into Brazilian Portuguese, and the cross-cultural adaptation of the instrument called Team Member Perspectives of Person-Centered Care (TM-PCC), as well as its construct validity. The objective of the TM-PCC is to assess the frequency of behaviors and care practices centered on the individual according to professionals who work in Long-Term Care Facilities for Older Adults (ILPIs). Method The process of translation, back-translation, and cross-cultural adaptation was followed through semantic, idiomatic, experiential, and conceptual equivalence carried out by five expert judges in the field of Geriatrics and Gerontology, with the pilot instrument being administered to 49 professionals from four ILPIs in three Brazilian states Results After the assessment was conducted by the expert judges, disagreement was found regarding the terms "previous associations," "fulfilling relationships," and "incorporate this caring into my daily routine," which were replaced by"histórias pregressas" (past stories), "relações satisfatórias" (satisfactory relationships), and "incorporar esse cuidado na minha rotina diária" (incorporate this care into my daily routine). After these corrections and revisions, the questionnaire was sent back to the judges, who were in total agreement. Good understanding of the questions was observed during the pilot application and good internal consistency through Cronbach's alpha (0.78 Conclusion The TM-PCC can be a useful tool for assessing individual-centered care in ILPIs in Brazil, according to the assessment of professionals. This will enable patient care managers or supervisors to plan and develop educational and management interventions aimed at promoting individual-centered care in ILPIs.

Cross-cultural adaptation of the PEAK 2 0 instrument for the measurement of satisfaction and quality of care for institutionalized older adults / Adaptação transcultural do instrumento PEAK 2 0 para mensuração da satisfação e da qualidade do cuidado de idosos institucionalizados

OBJECTIVE: To perform the Brazilian Portuguese cross-cultural adaptation of scales of satisfaction, quality of care, and quality of service constructed by the Promoting Excellent Alternatives in Kansas (PEAK 2.0) program for the measurement of person-centered care practices in the context of institutionalized older persons. METHODS: Cross-cultural adaptation was performed according to the following steps: translation; back translation; semantic, idiomatic, experiential, and conceptual equivalence; validation by an expert panel; and pre-test. This is an instrument with 32 individual items grouped into 4 subscales: overall satisfaction, quality of life, quality of care, and quality of service. RESULTS: The highest disagreement between experts was observed regarding verb conjugation and/or agreement aspects, which were adjusted. The pre-test, performed with 10 residents of long-term care facilities for older adults, showed that the "quality of life" and "quality of care" items had low levels of satisfaction. Although the residents demonstrated increased concern with the objective aspects of care, such as security and cleanliness, subjective aspects such as spirituality showed the lowest satisfaction levels. CONCLUSION: After cross-cultural adaptation, the overall satisfaction, quality of life, quality of care, and quality of service instruments of the PEAK 2.0 program were well understood by older adults and interviewers. The pre-test assessment showed that these instruments have a quick and easy application and can be used in Brazilian institutions.

OBJETIVO: Realizar a adaptação transcultural para o português brasileiro de escalas de satisfação, qualidade do cuidado e do serviço desenvolvidas pelo programa Promoting Excellent Alternatives in Kansas (PEAK 2.0) para a mensuração de práticas associadas aos cuidados centrados no indivíduo no contexto da população idosa institucionalizada. METODOLOGIA: Seguiram-se os passos para a adaptação cultural: tradução; retrotradução; equivalência semântica, idiomática, experiencial e conceitual; validação por juízes especialistas; e pré-teste. Trata-se de instrumento com 32 itens individuais agrupados em quatro subescalas: Satisfação global, Qualidade de Vida, Qualidade relacionada aos cuidados e Qualidade relacionada aos serviços. RESULTADOS: O maior índice de discordância entre os juízes foi referente à conjugação e/ou concordância verbal, pontos que foram ajustados. Em relação ao pré-teste, realizado com dez residentes de instituições de longa permanência para idosos, constatou-se que os itens de "qualidade de vida" e de "qualidade de cuidado" tiveram baixo nível de satisfação. Verificou-se também que apesar de os residentes demonstrarem maior preocupação com os aspectos objetivos do cuidado, como segurança e limpeza, os aspectos subjetivos, como a espiritualidade, apresentaram menor satisfação entre eles. CONCLUSÃO: Após passarem pelo processo de adaptação transcultural, as ferramentas de Satisfação global, Qualidade de Vida, Qualidade relacionada aos cuidados e Qualidade relacionada aos serviços do programa PEAK 2.0 foram bem compreendidas pelas pessoas idosas e os aplicadores. A avaliação pré-teste indicou que se trata de ferramentas de rápida e fácil aplicação, que podem ser usadas em instituições brasileiras.

Institutional protocol adherence in the incidence of recurrent urinary tract infection after kidney transplantation.

OBJECTIVES: Recurrent urinary tract infections (rUTIs) occur frequently after kidney transplantation (KT), however their optimal management remains undefined. This study aimed to identify risk factors for rUTI and to validate a protocol for UTI and rUTI treatment after KT. METHODS: This retrospective cohort study involved patients undergoing KT between January 2013 and July 2016. Patients were followed-up from day of KT until graft loss, death or end of follow-up (31 December 2018). We analysed all episodes of symptomatic UTI. The main outcome measure was rUTI after KT. Analysis was done per episode in a multilevel approach; patient features were considered in the distal level and UTI features in the proximal level. Univariate and multivariate analyses were performed by Cox regression. A propensity score was used to adjust the risk of patients with carbapenem-resistant Enterobacteriaceae. RESULTS: During the study period, 787 patients underwent KT, of whom 152 (19.3%) developed 356 UTI episodes. The most common micro-organisms wereEscherichia coli (165/356; 46.3%) and Klebsiella pneumoniae (101/356; 28.4%). Multidrug-resistant micro-organisms were isolated in 161 UTIs (45.2%). Risk factors for rUTI were diabetic nephropathy as the cause of end-stage renal disease (P = 0.02), UTI in first 180 days after KT (P = 0.04), anatomic alteration of the urinary tract at UTI diagnosis (P = 0.004) and length of time to effective therapy (P = 0.002); UTI treatment duration according to institutional protocol (P = 0.04) was the only protective factor identified. CONCLUSION: Appropriate therapy duration has an impact on rUTI prevention after KT.

Does the urinary tract infection caused by carbapenem-resistant Gram-negative bacilli impact the outcome of kidney transplant recipients?

The incidence of urinary tract infection (UTI) after kidney transplantation (KT) caused by multidrug-resistant (MDR) bacteria is growing. The aim of this study was to analyze the impact of UTI caused by carbapenem-resistant Gram-negative bacteria (CR-GNB) in the survival of graft and recipients following KT. This was a retrospective cohort study involving patients who underwent KT between 2013 and 2016. Patients were followed since the day of the KT until loss of graft, death or end of the follow-up period (31th December 2016). The outcomes measured were UTI by MDR following KT and graft and patient survival. Analyses were performed using Cox regression; for the graft and patient survival analysis, we used a propensity score for UTI by CR-GNB to matching a control group. UTI was diagnosed in 178 (23.9%) of 781 patients, who developed 352 UTI episodes. 44.6% of the UTI cases were caused by MDR bacteria. Identified risk factors for UTI by MDR bacteria were DM, urologic disease as the cause of end-stage renal failure, insertion of ureteral stent, carbapenem use, and delayed graft function (DGF). Risk factors for death during the follow-up period were female gender, patients over 60 years old at the time of KT, DM, body mass index over 31.8, UTI caused by CR-GNB. In conclusion, UTIs caused by CR-GNB have great impact on patients' survival after KT.

Asymptomatic cryptococcal antigen prevalence detected by lateral flow assay in hospitalised HIV-infected patients in São Paulo, Brazil

OBJECTIVE: To determine the prevalence of asymptomatic cryptococcal antigen (CRAG) using lateral flow assay (LFA) in hospitalised HIV-infected patients with CD4 counts <200 cells/ll. METHODS: Hospitalised HIV-infected patients were prospectively recruited at Instituto de Infectologia Emilio Ribas, a tertiary referral hospital to HIV-infected patients serving the S~ao Paulo State, Brazil. All patients were >18 years old without prior cryptococcal meningitis, without clinical suspicion of cryptococcal meningitis, regardless of antiretroviral (ART) status, and with CD4 counts <200 cells/ll. Serum CRAG was tested by LFA in all patients, and whole blood CRAG was tested by LFA in positive cases. RESULTS: We enrolled 163 participants of whom 61% were men. The duration of HIV diagnosis was a median of 8 (range, 1­29) years. 26% were antiretroviral (ART)-na€ive, and 74% were ARTexperienced. The median CD4 cell count was 25 (range, 1­192) cells/ll. Five patients (3.1%; 95%CI, 1.0­7.0%) were asymptomatic CRAG-positive. Positive results cases were cross-verified by performing LFA in whole blood. CONCLUSIONS: 3.1% of HIV-infected inpatients with CD4 <200 cells/ll without symptomatic meningitis had cryptococcal antigenemia in São Paulo, suggesting that routine CRAG screening may be beneficial in similar settings in South America. Our study reveals another targeted population for CRAG screening: hospitalised HIV-infected patients with CD4 <200 cells/ll, regardless of ART status. Whole blood CRAG LFA screening seems to be a simple strategy to prevention of symptomatic meningitis

Validation of the Nursing Activities Score in Portuguese intensive care units. / Validação do Nursing Activities Score em unidades de cuidados intensivos portuguesas.

OBJECTIVE:: to describe the process of adaptation and validation of the Nursing Activities Score to the Portuguese context. METHOD:: this was a pilot study of adaptation and validation of the Nursing Activities Score with a sample consisting of 67 patients hospitalized in the intensive care units of three Portuguese hospitals. The construct validity was assessed through factor analysis procedures and the internal consistency of the items was measured through the Cronbach's alpha coefficient. RESULTS:: a mean workload value of 63.04% (SD = 14.25; Median = 61.30) was obtained. Psychometric data revealed a Cronbach's alpha of 0.71 in the total scale, indicating an acceptable accuracy. Confirmatory factor analysis suggested an appropriate adjustment between the model and the data (χ2(199) = 214.5, p = 0.214; CFI = 0.95; RMSA = 0.035). CONCLUSION:: in the present study, the Portuguese version of the Nursing Activities Score was found to be a valid instrument, enabling a safe assessment of the workload of nurses.

Asymptomatic cryptococcal antigen prevalence detected by lateral flow assay in hospitalised HIV-infected patients in São Paulo, Brazil.

OBJECTIVE: To determine the prevalence of asymptomatic cryptococcal antigen (CRAG) using lateral flow assay (LFA) in hospitalised HIV-infected patients with CD4 counts <200 cells/µl. METHODS: Hospitalised HIV-infected patients were prospectively recruited at Instituto de Infectologia Emilio Ribas, a tertiary referral hospital to HIV-infected patients serving the São Paulo State, Brazil. All patients were >18 years old without prior cryptococcal meningitis, without clinical suspicion of cryptococcal meningitis, regardless of antiretroviral (ART) status, and with CD4 counts <200 cells/µl. Serum CRAG was tested by LFA in all patients, and whole blood CRAG was tested by LFA in positive cases. RESULTS: We enrolled 163 participants of whom 61% were men. The duration of HIV diagnosis was a median of 8 (range, 1-29) years. 26% were antiretroviral (ART)-naïve, and 74% were ART-experienced. The median CD4 cell count was 25 (range, 1-192) cells/µl. Five patients (3.1%; 95%CI, 1.0-7.0%) were asymptomatic CRAG-positive. Positive results cases were cross-verified by performing LFA in whole blood. CONCLUSIONS: 3.1% of HIV-infected inpatients with CD4 <200 cells/µl without symptomatic meningitis had cryptococcal antigenemia in São Paulo, suggesting that routine CRAG screening may be beneficial in similar settings in South America. Our study reveals another targeted population for CRAG screening: hospitalised HIV-infected patients with CD4 <200 cells/µl, regardless of ART status. Whole blood CRAG LFA screening seems to be a simple strategy to prevention of symptomatic meningitis.

Validação do Nursing Activities Score em unidades de cuidados intensivos portuguesas / Validación del Nursing Activities Score en unidades de cuidados intensivos portuguesas / Validation of the Nursing Activities Score in Portuguese intensive care units

RESUMO Objetivo: descrever o processo de adaptação e validação do Nursing Activities Score para o contexto português. Método: trata-se de um estudo-piloto de adaptação e validação do Nursing Activities Score, com amostra de 67 doentes internados em unidades de cuidados intensivos de três hospitais portugueses. A validade de constructo avaliou-se mediante procedimentos de análise fatorial e a consistência interna dos itens através do coeficiente Alpha de Cronbach. Resultados: obteve-se um valor médio da carga de trabalho de 63,04% (DP = 14,25; Mediana = 61,30). Os dados psicométricos revelaram um Alpha de Cronbach de 0,71, na escala total, indicando uma fidelidade aceitável. A análise fatorial confirmatória sugeriu um ajustamento adequado entre o modelo e os dados (χ2(199) = 214,5, p = 0,214; CFI = 0,95; RMSA = 0,035). Conclusão: neste estudo, a versão portuguesa do Nursing Activities Score revelou-se um instrumento válido, permitindo avaliar a carga de trabalho dos enfermeiros com segurança.

RESUMEN Objetivo: describir el proceso de adaptación y validación del Nursing Activities Score al contexto portugués. Método: estudio piloto de adaptación y validación del Nursing Activities Score, con muestra de 67 pacientes internados en unidades de cuidados intensivos de tres hospitales portugueses. La validez del constructo se evaluó mediante análisis factorial y por consistencia interna de los ítems evaluados a través del coeficiente Alpha de Cronbach. Resultados: se obtuvo un valor medio de carga de trabajo de 63,04% (SD=14,25; Mediana=61,30). Los datos psicométricos expresaron un Alpha de Cronbach de 0,71 en la escala total, indicando fidelidad aceptable. El análisis factorial confirmatorio sugirió un ajuste adecuado entre el modelo y los datos (χ2(199)=214,5; p=0,214; CFI=0,95; RMSA=0,035). Conclusión: en este estudio, la versión portuguesa del Nursing Activities Score demostró ser un instrumento válido, permitiendo evaluar la carga de trabajo de los enfermeros con precisión.

ABSTRACT Objective: to describe the process of adaptation and validation of the Nursing Activities Score to the Portuguese context. Method: this was a pilot study of adaptation and validation of the Nursing Activities Score with a sample consisting of 67 patients hospitalized in the intensive care units of three Portuguese hospitals. The construct validity was assessed through factor analysis procedures and the internal consistency of the items was measured through the Cronbach's alpha coefficient. Results: a mean workload value of 63.04% (SD = 14.25; Median = 61.30) was obtained. Psychometric data revealed a Cronbach's alpha of 0.71 in the total scale, indicating an acceptable accuracy. Confirmatory factor analysis suggested an appropriate adjustment between the model and the data (χ2(199) = 214.5, p = 0.214; CFI = 0.95; RMSA = 0.035). Conclusion: in the present study, the Portuguese version of the Nursing Activities Score was found to be a valid instrument, enabling a safe assessment of the workload of nurses.

Febre do Nilo ocidental: revisão de Literatura / West Nile Fever Literature review

Introdução: Devido às características geográficas e ecológicas, existem, no Brasil, condições ideias para manutenção e entrada de novas arboviroses. Com o primeiro diagnóstico de doença neuroinvasiva pelo vírus do Nilo Ocidental no Brasil em 2014, faz-se necessário obter mais informações sobre essa infecção. Objetivos: Elaborar revisão de literatura narrativa sobre a infecção pelo vírus do Nilo Ocidental; e elaborar revisão de literatura sistemática sobre manifestações neurológicas da infecção pelo vírus do Nilo Ocidental. Métodos: Bases de dados eletrônicas (LILACS e PubMed) foram consultadas, utilizando os seguintes descritores: 'West Nile Fever', West Nile Virus' e 'West Nile Fever Encephalitis' (MESH) e 'Febre do Nilo Ocidental' e 'Encefalite' (DecS). Revisão Narrativa: A introdução do VNO nas Américas em 1999 e sua distribuição por todo o continente é devido à presença de aves migratórias, que fazem suas rotas, durante o inverno, para a América do Sul. As manifestações clínicas da infecção são variadas, podendo haver apenas doença febril até doença neurológica grave. Não existe tratamento específico e o mesmo deve ser de suporte. Sequelas importantes estão associada, principalmente à forma neuroinvasiva da doença. Revisão Sistemática: Foram avaliados 71 artigos, onde eram relatadas manifestações clínicas neurológicas em pacientes sem imunossupressão. Casos de encefalite e paralisia flácida aguda foram os mais encontrados. Febre foi o sintoma mais prevalente. Conclusões: O risco de se tornar uma doença endêmica no Brasil existe. Deve-se ficar atento para casos de doenças virais inespecíficas e, principalmente, para casos de encefalite para que se possa pensar no diagnóstico