Lipophosphoglycan From Dermotropic New World Leishmania Upregulates Interleukin-32 and Proinflammatory Cytokines Through TLR4 and NOD2 Receptors

Interleukin-32 (IL-32) is produced during Leishmania infection, but the components of the parasite that induce its production are unknown. An important multivirulence factor of Leishmania spp. protozoa is the lipophosphoglycan (LPG), which plays a crucial role in the host-parasite interaction. Here, the ability of LPGs from two dermotropic Leishmania species to induce IL-32 production was evaluated in human peripheral blood mononuclear cells (PBMCs). Additionally, the potential receptors involved in this activation were assessed. PBMCs from healthy individuals were stimulated with LPGs from L. amazonensis (La) or L. braziliensis (Lb), live promastigotes of La or Lb and E. coli lipopolysaccharide (LPS, TLR4 agonist) as control. Blockers of TLR4 (Bartonella quintana LPS or monoclonal antibody) and Ponatinib (RIPK2 inhibitor, NOD2 pathway) were used to evaluate the receptors. ELISA was performed for IL-32 expression and cytokine (IL-1β and IL-6) production in cell lysates and in supernatants, respectively. Expression of TLR4 (2 h, 24 h) was assessed by flow cytometry. IL-32γ mRNA transcript was analyzed by qPCR. It was observed that LPG from Leishmania, like whole parasites, induced the production of IL-32, IL-1β and IL-6. Both LPGs induced the expression of IL32γ mRNA. The production of IL-32 was earlier detected (6 h) and positively associated with the production of IL-1β and IL-6. The induction of cytokines (IL-32, IL-1β and IL-6) was dependent on TLR4 and NOD2. The TLR4 was internalized after interaction with LPG. Therefore, our data suggest that LPGs from La and Lb are components of Leishmania able to upregulate IL-32 and other pro-inflammatory cytokines in a TLR4- and NOD2-dependent manner. In addition, LPG-induced IL-32 seems to be necessary for IL-1β and IL-6 production. To identify the parasite factors and host receptors involved in IL-32 induction is crucial to reveal potential targets for novel strategies to control leishmaniasis.

New world Leishmania spp. infection in people living with HIV: Concerns about relapses and secondary prophylaxis

Coinfection with the human immunodeficiency virus (HIV) and Leishmania impairs immune responses, increases treatment failure and relapse rates in patients with American tegumentary leishmaniasis (ATL), as well as visceral leishmaniasis (VL). There is insufficient data on the treatment, relapse, and secondary prophylaxis in patients coinfected with HIV/Leishmania in Brazil. This study investigated patients with HIV/ATL and HIV/VL to describe the outcome of leishmaniasis in patients assisted at a referral hospital of Brazilian midwestern region. Patients with HIV/ATL (n = 21) mainly presented cutaneous diseases (76.2%) with an overall relapse rate of 28.57% after treatment, whereas HIV/VL (n = 28) patients accounted for 17.5% of the cases. The counts of CD4⁺ T cells and CD8⁺ T cells and the CD4⁺/CD8⁺ cell ratios at diagnosis or relapses were not significantly different between relapsing and non-relapsing patients. Patients with HIV/ATL or HIV/VL showed high levels of activation markers in CD4⁺ and CD8⁺ T cells. The regular use of highly active antiretroviral therapy (HAART) and viral load at the time of diagnosis did not influence the relapse rates. Relapses occurred in 36.4% (4/11) of the patients with HIV/VL receiving secondary prophylaxis and in 5.9% (1/17) of the patients who did not receive secondary prophylaxis (p = 0.06). These data are relevant for the therapeutic management of the patients coinfected with HIV/Leishmania.

Aspectos clínicos e epidemiológicos dos casos de síndrome gripal notificados por um laboratório de referência em saúde pública

RESUMO: Dentre as infecções respiratórias, a Síndrome Gripal (SG) é caracterizada em pacientes com febre de início súbito, com tosse, dor de garganta, e com sintomas como mialgia, artralgia ou cefaleia. O objetivo do presente estudo é analisar os casos de SG notificados e resultados obtidos por um Laboratório de Referência em Saúde Pública. Trata-se de um estudo de tipo transversal, desenvolvido a partir das fichas de notificação e resultados notificados de SG obtidos através do Núcleo de Vigilância do LACEN-GO. Utilizou-se o software Epi info 3.5.4 para transcrição dos resultados, análise das variáveis contidas na ficha de notificação e teste de Qui-quadrado (x2). Foram analisadas 645 fichas de notificação de SG e seus respectivos resultados notificados. A maioria dos casos possuíam entre 21-30 anos, para a identificação da etiologia viral utilizou a RT-PCR. Quanto ao perfil epidemiológico a maioria dos casos eram do sexo masculino, não gestantes, escolaridade maior que 8 anos, não vacinados. Os principais sinais e sintomas foram febre, tosse e dor de garganta. As principais comorbidades foram doença cardiovascular crônica e diabetes mellitus. O principal agente etiológico viral diagnosticado foi o vírus Influenza A/H3N2. A vigilância epidemiológica da Influenza através dos casos notificados pelas unidades sentinelas de SG, é uma importante ferramenta para a saúde pública e se tornou o fator fundamental para a prevenção, contenção, vigilância e manejo terapêutico de pacientes. PALAVRAS-CHAVE: Influenza. Síndrome Gripal. Vigilância Laboratorial.

Frequência de Doenças Infecciosas em Gestantes de Aparecida de Goiânia, Goiás, Brasil

O período gestacional não é isento de infecções que comprometam a saúde materno-fetal. Existem riscos do desenvolvimento de doenças infecciosas de transmissão vertical, que pode levar diversos problemas ao desenvolvimento e vitalidade do futuro concepto. O objetivo do presente estudo foi avaliar a frequência de doenças infecciosas em gestantes submetidas à triagem do pré-natal através da técnica do papel filtro na cidade de Aparecida de Goiânia –GO. Trata-se de um estudo transversal de 1.328 gestantes submetidas à triagem pré-natal no período de 2011 a 2016 através da técnica de papel filtro. Após a confirmação dos resultados positivos em papel filtro, a confirmação foi realizada e as frequências encontradas foram de 22,52% para sífilis, 14,23% para toxoplasmose,  7,45% para doenças de Chagas, 4,74% para hepatite pelo vírus B (HBsAg), 3,77% para o vírus HIV, 1,73% para hepatite pelo vírus C (anti-HCV), 1,05% para vírus HTLV, 0,98% para citomegalovírus e 0,15% para rubéola. A importância da triagem para doenças infecciosas de transmissão vertical, é notória  no presente estudo, principalmente pela frequência do número de casos de sífilis, toxoplasmose, doença de Chagas e hepatite pelo vírus B. Através do diagnóstico precoce é possível evitar a transmissão vertical e/ou diminuir os comprometimentos fetais. A metodologia de triagem através do papel filtro para diagnóstico de várias infecções de importância na saúde materno-fetal, ressalta a sua necessidade e importância no período pré-natal.

OCORRÊNCIA DE PARASITOS EM FRUTAS COMERCIALIZADAS NAS RUAS DA CIDADE DE APARECIDA DE GOIÂNIA, GOIÁS, BRASIL

A principal fonte de infecção por parasitos intestinais pode ser a água e/ou alimentos contaminados ingeridos. O objetivo deste trabalho foi avaliar a ocorrência de parasitos em frutas comercializadas nas ruas de Aparecida de Goiânia, Goiás, Brasil. Foram avaliadas frutas no primeiro semestre de 2017, coletadas nas ruas. A análise parasitológica foi realizada com as técnicas de Willis, Faust, Hoffman, Sheather, cultura para o isolamento de Amebas de Vida Livre e coloração por Ziehl-Nielsen modificado. Em 30 amostras analisadas, 15 (50%) foram positivas. Os parasitos encontrados foram: Acanthamoeba spp. em 5(17%), Giardia intestinalis em 2(6,6%), Entamoeba coli em 2(6,6%), Cryptosporidium spp. em 1 (3,3%), Endolimax nana em 1(3,3%), ovo de Fascíola Hepática em 1(3,3%), ovo de Ascaris lumbricoides em 1(3,3%), Endolimax nana em 1(3,3%). Foi possível, com as técnicas utilizadas, verificar que as amostras de frutas apresentaram contaminação por parasitos, o que evidencia a exposição da população consumidora destes alimentos. Portanto, medidas profiláticas como ações educativas com a propagação de informações sobre higienização por parte dos consumidores, produtores e manipuladores fazem-se necessárias.

FREQUÊNCIA DE ANTICORPOS ANTI-TOXOPLASMA GONDII EM GATOS ERRANTES (Felis catus domesticus) EM GOIÂNIA, GOIÁS, BRASIL

O gato doméstico (Felis catus domesticus) é um importante transmissor de agentes zoonóticos para o homem, em especial Toxoplasma gondii. O gato infectado é capaz de eliminar milhões de oocistos no meio ambiente, provocando uma contaminação maciça nestes locais, sendo considerado um problema de saúde pública. A toxoplasmose é uma doença com alta prevalência em todo o mundo, sendo o gato responsável pela perpetuação do parasito. O objetivo deste trabalho foi verificar a frequência de anticorpos IgG anti-T. gondii pelo teste de aglutinação modificado (MAT) em gatos errantes capturados pelo Centro de Controle de Zoonoses de Goiânia, Goiás no ano de 2016. Foram coletadas 50 amostras sanguínes de gatos e foi realizado o MAT. Ao analisar a frequência de anticorpos 64% (32/50) eram soropositivos e 36% (18/50) soronegativos. Com isso ressaltamos a importância do gato doméstico na epidemiologia da toxoplasmose, por ser o perpetuador do parasito no meio ambiente. A frequência de anticorpos anti-T. gondii em gatos errantes ainda não havia sido determinada no estado de Goiás, esses resultados contribuem com a literatura para analisar a distribuição do parasito e favorecer estudos da epidemiologia da doença.

EVALUTION OF RISK FACTORS AND SEROPREVALENCE RATE OF TOXOPLASMOSIS IN THE ELDERLY

Toxoplasmosis is an infection caused by the protozoan Toxoplasma gondii, whose definitive hosts are cats and whose intermediate hosts include humans.This research aims to evaluate aspects related to seroprevalence rates of anti-T. gondii antibodies among elderly users of the Primary Health Care Service in the municipality of Aparecida de Goiânia, state of Goiás, Brazil. A total of 101 elderly people participated in the study, and a questionnaire was applied to examine sociodemographic factors related to risk factors for toxoplasmosis. Five ml of peripheral blood were collected from all the participants for serological tests. IgM and IgG antibody screening was performed using the ELISA technique. The average age of the participants was 69.5 years, the seroprevalence rate was 75.2% (76/101) of IgG (+), and 24.8% (25/101) were non-reactive. IgM and IgG antibodies were found in 2.9% (3/101) of the participants. An IgG avidity test was performed, which revealed that the antibodies in the three samples were of low avidity, thus indicating that these individuals were in the acute phase of the infection. It was concluded that, in terms of socioeconomic conditions, an income of one to three monthly minimum salaries is the predominant risk factor for toxoplasmosis in this group.

New Radiation Dosimetry Estimates for [18F]FLT based on Voxelized Phantoms

3'-Deoxy-3-[¹⁸F]fluorothymidine, or [¹⁸F]FLT, is a positron emission tomography (PET) tracer used in clinical studies for noninvasive assessment of proliferation activity in several types of cancer. Although the use of this PET tracer is expanding, to date, few studies concerning its dosimetry have been published. In this work, new [¹⁸F]FLT dosimetry estimates are determined for human and mice using Monte Carlo simulations. Modern voxelized male and female phantoms and [¹⁸F]FLT biokinetic data, both published by the ICRP, were used for simulations of human cases. For most human organs/tissues the absorbed doses were higher than those reported in ICRP Publication 128. An effective dose of 1.70E-02 mSv/MBq to the whole body was determined, which is 13.5% higher than the ICRP reference value. These new human dosimetry estimates obtained using more realistic human phantoms represent an advance in the knowledge of [¹⁸F]FLT dosimetry. In addition, mice biokinetic data were obtained experimentally. These data and a previously developed voxelized mouse phantom were used for simulations of animal cases. Concerning animal dosimetry, absorbed doses for organs/tissues ranged from 4.47 ± 0.75 to 155.74 ± 59.36 mGy/MBq. The obtained set of organ/tissue radiation doses for healthy Swiss mice is a useful tool for application in animal experiment design.

[The prevalence of anemia in pregnant women in their first visit to health centers of a metropolitan area, Brazil]

Three hundred and sixty-three pregnant women enrolled in the Pregnancy Medical Care Program of S. Paulo Health Department from the district of Butantan, S. Paulo city, Brazil, were studied at the first routine consultation. At the time they were examined they were not given any medicine containing iron, folic acid or vitamin B12. Their average age was 25 and 65.9% belonged to families with a monthly per capita income below US$ 50.00. Only 3.1% had a per capita income above U$$ 150.00. The prevalence of anemia was 12.4%. The hemoglobin concentration (grams/dl) in the first trimester was significantly higher than in the second and third trimester of pregnancy. The prevalence of anemia in the first trimesters (3.6%) was significantly smaller than that found in the second (20.9%) and third semesters (32.1%). Those women who had had more than three gestations presented a higher prevalence of anemia than those with less than three, and the prevalence of anemia was higher in the group whose families had a monthly per capita income below US$ 25.00.

Early diagnosis of ABO haemolytic disease of the newborn

To assess the usefulness of cord blood tests in diagnosing ABO-haemolytic disease of the newborn (ABO-HDN), 132 term, adequate for gestational age (AGA) neonates were evaluated. The tests studied and their significant results were: quantitative elution test (greater than or equal to 1/16), direct Coombs test (positive), bilirubin concentration (greater than or equal to 4 mg/dl). In none of the 56 O+ newborn infants delivered by O+ women were the results of any test positive. Of the 76 A+ and B+ newborn infants delivered by O+ women, 17 (22%) developed ABO-HDN. When the combined result of any two tests was positive, the sensitivity, the specificity and the positive predictive accuracy for the diagnosis of ABO-HDN was higher than for any one of the isolated tests. The probability that ABO-HDN was present when the results of at least two cord blood tests were positive was 70%, and the probability that ABO-HDN was not present when less than two cord blood tests gave positive results was 93%. It is suggested that the combination of quantitative elution test, bilirubin concentration and direct Coombs test in the cord blood is useful for an early diagnosis of ABO-HDN.