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de Oliveira SV, Willemann MCA, Gazeta GS, Angerami RN, Gurgel-Gonçalves R. Predictive Factors for Fatal Tick-Borne Spotted Fever in Brazil. Zoonoses Public Health 2017; 64:e44-e50. [PMID: 28169507 DOI: 10.1111/zph.12345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 11/28/2022]
Abstract
In Brazil, two pathogenic Rickettsia species have been identified causing tick-borne spotted fever (SF). The aetiological agent Rickettsia rickettsii causes serious illness, particularly in the south-eastern region of the country. Moreover, the Rickettsia sp. strain Atlantic Rainforest cause milder clinical manifestations in south-eastern, south and north-east regions. This study has sought to analyse predictive factors for fatal SF. A case-control study was performed using disease notification records in Brazil. The cases included were individuals with laboratory confirmation and fatal progression of SF, while the controls included individuals with SF who were cured. A total of 386 cases and 415 controls were identified (1 : 1.1), and the cases and controls were similar in age. The factors identified as being protective against death were reported presence of ticks (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.41-0.88), residing in urban areas (OR, 0.47, 95% CI, 0.31-0.74) and presenting lymphadenopathy (OR, 0.43; 95% CI, 0.23-0.82). Males exhibited a greater chance of death (OR, 1.57; 95% CI, 1.13-2.18), as did patients who were hospitalized (OR, 10.82; 95% CI, 6.38-18.35) and who presented hypotension or shock (OR, 10.80; 95% CI, 7.33-15.93), seizures (OR, 11.24; 95% CI, 6.49-19.45) and coma (OR of 15.16; 95% CI, 8.51-27.02). The study demonstrates the severity profile of the SF cases, defined either as the frequency of hospitalization (even in cases that were cured) or as the increased frequency of the clinical complications typically found in critical patients. Opportune clinical diagnosis, a careful evaluation of the epidemiological aspects of the disease and adequate care for patients are determining factors for reducing SF fatality rates.
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Affiliation(s)
- S V de Oliveira
- Graduate Program in Tropical Medicine at the University of Brasília, Brasília, DF, Brazil.,Health Surveillance Secretariat of the Ministry of Health, Brasília, DF, Brazil.,National Reference Laboratory for Rickettsial disease Vectors of the Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - M C A Willemann
- Department of Health Surveillance of the Secretariat of Health of Santa Catarina State, Florianópolis, SC, Brazil
| | - G S Gazeta
- National Reference Laboratory for Rickettsial disease Vectors of the Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - R N Angerami
- Clinical Hospital of the State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - R Gurgel-Gonçalves
- Medical Parasitology and Vector Biology Laboratory, University of Brasília, Brasília, DF, Brazil
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Zanaga LP, Vigani AG, Angerami RN, Giorgetti A, Escanhoela CAF, Ataíde EC, Boin IFSF, Stucchi RSB. Survival benefits of interferon-based therapy in patients with recurrent hepatitis C after orthotopic liver transplantation. ACTA ACUST UNITED AC 2017; 50:e5540. [PMID: 28076451 PMCID: PMC5264534 DOI: 10.1590/1414-431x20165540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 11/01/2016] [Indexed: 12/13/2022]
Abstract
Recurrent hepatitis C after orthotopic liver transplantation (OLT) is universal and
can lead to graft failure and, consequently, reduced survival. Hepatitis C treatment
can be used to prevent these detrimental outcomes. The aim of this study was to
describe rates of hepatitis C recurrence and sustained virological response (SVR) to
interferon-based treatment after OLT and its relationship to survival and progression
of liver disease through retrospective analysis of medical records of 127 patients
who underwent OLT due to cirrhosis or hepatocellular carcinoma secondary to chronic
hepatitis C between January 2002 and December 2013. Fifty-six patients were diagnosed
with recurrent disease, 42 started interferon-based therapy and 37 completed
treatment. Demographic, treatment- and outcome-related variables were compared
between SVR and non-responders (non-SVR). There was an overall 54.1% SVR rate with
interferon-based therapies. SVR was associated with longer follow-up after treatment
(median 66.5 vs 37 months for non-SVR, P=0.03) and after OLT (median
105 vs 72 months, P=0.074), and lower rates of disease progression
(15 vs 64.7%, P=0.0028) and death (5 vs 35.3%,
P=0.033). Regardless of the result of therapy (SVR or non-SVR), there was a
significant difference between treated and untreated patients regarding the
occurrence of death (P<0.001) and months of survival (P<0.001). Even with
suboptimal interferon-based therapies (compared to the new direct-acting antivirals)
there is a 54.1% SVR rate to treatment. SVR is associated with improved survival and
reduced risks of clinical decompensation, loss of the liver graft and death.
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Affiliation(s)
- L P Zanaga
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - A G Vigani
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - R N Angerami
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - A Giorgetti
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - C A F Escanhoela
- Departamento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - E C Ataíde
- Unidade de Transplante de Fígado, Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - I F S F Boin
- Unidade de Transplante de Fígado, Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - R S B Stucchi
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
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Stucchi RSB, Boin IFSF, Angerami RN, Sinckoc V, Sa FC, Seva-Pereira T, Escanhoela CAF. Correlations between A/H1N1 influenza and acute cellular rejection in liver transplantation patients. Transplant Proc 2011; 42:4184-6. [PMID: 21168659 DOI: 10.1016/j.transproceed.2010.09.144] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 09/29/2010] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Influenza is a common cause of respiratory infection in transplant recipients. It is expected that A/H1N1 influenza virus causes more severe disease in solid-organ recipients. Our goal was to describe two A/H1N1 infections that occurred after Orthotopic liver transplantation followed by acute allograft rejection episodes. CASE REPORTS From March 2009 to March 2010 we observe two liver transplant patients with symptoms suggestive of A/H1N1 infection. The diagnosis was out based on a temperature of 37.8°C (100°F) or higher and the presence of a cough or using materials from anasopharyngeal and oropharyngeal swabs a sore throat. The diagnosis was confirmed by viral RNA detection by real-time reverse-transcriptase-polymerase-chain-reaction assay (RT-PCR) using materials from nasopharyngeal and oropharyngeal swabs. We performed the RT-PCR assay for A/H1N1 detection in a liver biopsy from one patient. Both patients were treated with usual doses of oseltamivir (75 mg twice daily for 5 days). One patient developed acute bacterial sinusitis requiring antibiotic therapy. Thereafter the liver enzymes increased and transplant biopsies showed moderate-to-severe acute cellular rejection. They were treated with corticosteroids. The liver enzymes normalized after 3 months. CONCLUSION A/H1N1 influenza can lead to a severe acute cellular rejection episode with corticosteroid resistant treatment in liver transplant patients. Transplant centers should be aware of a possible relationship between A/H1N1 infections and acute allograft rejection episodes.
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Affiliation(s)
- R S B Stucchi
- Unit of Liver Transplantation, State University of Campinas, Campinas, Brazil
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Angerami RN, Nunes E, Nascimento EM, Freitas AR, Kemp B, Feltrin A, Pacola M, Perecin G, Sinkoc V, Resende MR, Katz G, da Silva LJ. Clusters of Brazilian spotted fever in São Paulo State, southeastern Brazil. A review of official reports and the scientific literature. Clin Microbiol Infect 2009; 15 Suppl 2:202-4. [DOI: 10.1111/j.1469-0691.2008.02637.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nogueira Angerami R, Oliveira Morais E, Katz G, Jacintho da Silva L. Brazilian spotted fever in the paediatric age-segment in the State of São Paulo, southeastern Brazil, 2003-2006. Clin Microbiol Infect 2009; 15 Suppl 2:205-6. [PMID: 19374639 DOI: 10.1111/j.1469-0691.2008.02728.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R Nogueira Angerami
- Núcleo de Vigilância Epidemiológica/Serviço de Epidemiologia Hospitalar/Hospital das Clínicas/Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
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Morais EO, Resende MR, Oliveira AM, Sinkoc VM, Garcia MT, Angerami RN, da Silva LJ. Intradermal hepatitis B vaccination in patients with advanced chronic renal failure: immunogenicity and follow-up. Aliment Pharmacol Ther 2007; 25:849-55. [PMID: 17373924 DOI: 10.1111/j.1365-2036.2007.03210.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients undergoing dialysis usually have a poor response to conventional hepatitis B vaccination. AIM To observe the effects of intradermal hepatitis B (HB) vaccination in a 13-month prospective study of adult patients with end-stage renal failure. The patients were with or without previous hepatitis B vaccination, but all had antibody titres <10 mUI/mL. METHODS Patients were allotted to two groups: previous hepatitis B virus vaccination and no previous hepatitis B virus vaccination or anti-HBs titres <10 mUI/mL. Patients in both groups received 16 i.d. injections of 0.1 mL of hepatitis B virus vaccine over an eight-week period. Patients had antibody titres assessed before vaccination, 1 month after and every 3 months for a year. Antibody titres >/=10 mUI/mL were considered protective. RESULTS Seventy patients completed the protocol. Protective titres were elicited in 82% of each group. Age, time under dialysis, diabetes, smoking and body-mass index were not associated with seroconversion. Persistent protective titres >12 months occurred in 27 (58.7%). Adverse events were trivial. CONCLUSION Intradermal hepatitis B virus vaccination is an alternative in end-stage renal failure.
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Affiliation(s)
- E O Morais
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Unicamp, Campinas, SP, Brazil
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Abstract
A case of a pregnant patient with chronic hepatitis C who gave birth to monozygotic twins that were infected with HCV is reported. One of the newborns was positive for HCV-RNA in blood sample collected 12 hours after delivery. The other newborn was negative for HCV-RNA at birth, but was detected HCV viremia at three months of age. The results have led to the conclusion that one of the twins was probably contaminated in the intrauterine period, while the other acquired the infection in the perinatal period. Both were negative for HCV-RNA and for anti-HCV in the serum samples collected at nine months of age. The report describes the changes in the laboratory tests conducted in mother and twins until 29 months after delivery.
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Affiliation(s)
- F L Gonçales
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brasil.
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