Mestrado em Doenças Infecciosas
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- ItemAnálise de aspectos de virulência, resistência aos antimicrobianos e diversidade genética de Staphylococcus aureus isolados de colonização nasal em puérperas(Universidade Federal do Espírito Santo, 2024-06-22) Nilo, Ana Paula Marques Caldeira; Co-orientador1; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador2; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador3; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador4; ID do co-orientador4; Lattes do co-orientador4; Schuenck, Ricardo Pinto ; https://orcid.org/; http://lattes.cnpq.br/; Orientador2; https://orcid.org/; http://lattes.cnpq.br/; https://orcid.org/; http://lattes.cnpq.br/; Cavalcante, Fernanda Sampaio ; https://orcid.org/; http://lattes.cnpq.br/; Palaci, Moises ; https://orcid.org/; http://lattes.cnpq.br/; 3º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 4º membro da banca; http://lattes.cnpq.br/; 5º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 6º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 7º membro da banca; https://orcid.org/; http://lattes.cnpq.br/Nasal colonization by Staphylococcus aureus in postpartum women is relevant due to the risk of colonization of newborns and of infections in both groups. This study aimed to evaluate the colonization rate, resistance, virulence, and genetic diversity of S. aureus isolated from nasal colonization in postpartum women. Nasal swabs were collected (n = 306) within 48h after birth in the maternity ward of a hospital in Brazil, between March/2018 and March/2019. Demographic data were obtained from medical records. Antimicrobial susceptibility was determined by the disk diffusion test and Minimum Inhibitory Concentrations (MICs) were obtained by broth microdilution. Biofilm production was evaluated using a polystyrene microplate test. Polymerase Chain Reaction (PCR) was used to perform SCCmec typing and detect the following adhesin and toxin genes: fnbB, clfA, clfB, cna, bbp, hla, hld, hlg, hlg-2, lukSF-PV, lukED, eta, etb, sea, seb, sec, sed, see and tsst-1. Genetic diversity was assessed by Random Amplified Polymorphic DNA (RAPD). The rate of S. aureus nasal colonization was 14.7% (45/306), with seven (15.6%) MRSA. The overall MRSA rate was 2.3% (7/306). Demographic data demonstrated an average age of 30 years, and high rates of unemployment (66.7%), multiparity (83.3%), and comorbidities (85.7%). High resistance rates to penicillin (88.9%) and erythromycin (53.3%) were observed. All MRSA isolates carried SCCmec type IVa and one was characterized as oxacilin-susceptible methicilin-resistant S. aureus (OS-MRSA). Most isolates (84.4%) were classified as strong biofilm producers. Several virulence genes were detected and the most prevalent were hld (93.3%), hla and eta (48.9%), and sea (42.2%). RAPD analysis identified 14 profiles. Profile J grouped 11 isolates (among them, five MRSA, one OS-MRSA, and one MSSA-MDR) and was the second with the greatest diversity of virulence genes (n = 14). The study highlights the high rates of toxin genes among nasal isolates of S. aureus in postpartum women, with emphasis on the genes for exfoliative toxin A and enterotoxin A. These toxins are relevant in puerperal mastitis and severe neonatal infections. This is the first report of an OS-MRSA isolate colonizing the anterior nares of postpartum women
- ItemAnálise espaço-temporal dos casos de chikungunya no Espírito Santo entre 2018 e 2020: um estudo dos fatores associados(Universidade Federal do Espírito Santo, 2023-10-24) Clipes, Marcus Vinícius Salvador; Cerutti Junior, Crispim; https://orcid.org/0000000294854191; http://lattes.cnpq.br/4257067087979999; https://orcid.org/0009-0005-6925-0272; http://lattes.cnpq.br/2449228239599129; Teixeira, Carlos Graeff; https://orcid.org/0000000327250061; http://lattes.cnpq.br/0464152494769261; Jabor, Pablo Medeiros; http://lattes.cnpq.br/1542876666875683Introdução: Chikungunya (CHIK) is a febrile illness caused by the Chikungunya virus (CHIKV), a global-wide distributed Alphavirus. The transmission of CHIKV occurs by the bites of female Aedes vector mosquitoes. CHIK was first evidenced and identified in 1953 in Tanzania. In Brazil, there have been autochthonous cases reported since 2014. Clinically, CHIK manifests itself by intense and sudden fever, followed by fatigue, headache, skin rash, and arthralgia, which can last for weeks to months, with consequences regarding public health and the quality of life for those affected. Although mortality is low, there are substantial morbid effects related to the disease. An understanding of the social and environmental determinants related to CHIK is crucial to establish disease control and mitigation strategies. Objective: This study aims to describe the social and demographic characteristics of individuals affected by Chikungunya (CHIK) in Espírito Santo state, evaluating their association with the disease incidence. Methods: We performed a cross-sectional study to describe temporal, spatial, and sociodemographic data of individuals with a confirmed diagnosis of CHIK in Espírito Santo state, Brazil, from 2018 to 2020. The analysis included monthly incidence calculation. The data processing regarding the annual spatial distribution resulted in the construction of maps disclosing the relative risks by each municipality and the distribution of clusters. Statistical analysis through the chi-square test indicated associations between sex, race, education, and age with the disease occurrence. Results: During the period and through the area analyzed, a CHIK epidemic occurred in 2020, with 2,198.2 cases per million inhabitants incidence. Southern and central regions harbored a risk five times higher than the others in the epidemic region. Women (odds ratio - OR 1.65; 95% Confidence Interval - CI 1.58- 1.72), afro descendants (OR 1.22; 95% CI 1.13-1.33), individuals with less than 11 years of education (OR 1.48; 95% CI 1.37-1.61), and elders (OR 7.49; 95% CI 6.53- 8.59) had the highest risk for the disease occurrence, a difference statistically significant. Conclusion: CHIK stands as an emerging public health problem in Brazil since its introduction in 2014. The population susceptibility and the broad vector distribution facilitate the virus dispersion through the country’s territory. Espírito Santo suffered a substantial epidemic in 2020, possibly related to outbreaks in neighboring 12 states. The population under risk should be prioritized in health care, considering the morbidity potential of the disease.
- ItemFATORES ASSOCIADOS À HOSPITALIZAÇÃO NA FEBRE DE CHIKUNGUNYA Vitória - ES 2022(Universidade Federal do Espírito Santo, 2022-12-15) Lopes, Danielle Torres dos Santos; Vicente, Creuza Rachel; https://orcid.org/0000-0003-0182-7969; http://lattes.cnpq.br/0530544422426629; https://orcid.org/; http://lattes.cnpq.br/; Miranda, Angelica Espinosa Barbosa; https://orcid.org/0000-0002-5556-8379; http://lattes.cnpq.br/5842271060162462Introduction: Chikungunya is a disease caused by the RNA virus Chikungunya (CHIKV), of the genus Alphavirus, family Togaviridae, transmitted to humans through the bite of infected female mosquitoes of the species Aedes aegypti and Aedes albopictus. It manifests itself in an acute febrile form, with symptoms similar to those of other arboviruses. Autochthonous transmission of CHIKV has already been reported in 114 countries and the annual estimate of cases ranges from 52,774 to 328,943. Hospitalization is uncommon in cases of Chikungunya and there are gaps in knowledge about the factors associated with this outcome. Objective: The present study evaluated factors associated with hospitalization in patients with acute CHIKV infection. Method: A cross-sectional study was carried out, including data from cases of the acute form of Chikungunya fever with laboratory confirmation in residents of the municipality of Vitória, state of Espírito Santo, Brazil, which occurred between 2016 and 2020, and accessed through the databases of the Notifiable Diseases Information System and eSUS Health Surveillance. Results: 2,868 patients were included, of which 1.42% (n = 41) were hospitalized. There was a difference in terms of age between hospitalized and non-hospitalized patients, which was smaller in hospitalized patients (median = 26 years, interquartile range = 12 - 61) than in non-hospitalized patients (median = 47 years, interquartile range = 34 - 59) (p -value = 0.001). Pregnancy was significantly longer in hospitalized patients (n = 2, 10.5%) than in nonhospitalized patients (n = 36, 2.0%) (p-value = 0.010). As for clinical manifestations, some symptoms were significantly less frequent among hospitalized patients, such as myalgia (pvalue = 0.006), headache (p-value < 0.001), nausea (p-value = 0.009), back pain (p-value < 0.001), arthritis (p-value = 0.014), arthralgia (p-value < 0.001) and retro-orbital pain (p-value < 0.001). There was no statistically significant difference between the groups in terms of gender, with greater involvement of women among hospitalized (n = 26) and non-hospitalized (n = 1,910) (p-value = 0.573), in addition to pre-existing diseases, and time disease evolution (p-value = 0.102). Back pain (OR = 0.134; 95% CI = 0.044 - 0.409) and arthralgia (OR = 0.226; 95% CI = 0.083 - 0.613) were protective predictors of hospitalization. Conclusion: The study demonstrated that milder clinical manifestations in the acute phase of Chikungunya fever were identified among hospitalized patients, and some signs and symptoms were protective predictors of hospitalization. Therefore, understanding the correlation between sociodemographic characteristics, comorbidities and symptoms presented by individuals affected by the disease allows the development of measures for effective prevention, control and management of the disease, reducing hospitalizations.
- ItemPERFIL EPIDEMIOLÓGICO E MICROBIOLÓGICO DE PACIENTES COM OSTEOMIELITES EM UM SERVIÇO DE REFERÊNCIA NO ESTADO DO ESPÍRITO SANTO ENTRE 2017 E 2019(Universidade Federal do Espírito Santo, 2022-08-23) Xavier, Carolina Salume; Vicente, Creuza Rachel; https://orcid.org/0000-0003-0182-7969; http://lattes.cnpq.br/0530544422426629; https://orcid.org/; http://lattes.cnpq.br/; Santos, Kenia Valeria dos; https://orcid.org/0000-0001-6871-3128; http://lattes.cnpq.br/9074173162086323; Neto, Lauro Ferreira da Silva Pinto; https://orcid.org/; http://lattes.cnpq.br/1528710938091794Abstract Introduction: One of the most challenging complications of trauma surgery is infection after fracture fixation (IAFF), whose early diagnosis and proper management is essential for the prevention of chronic osteomyelitis, which has increased globally over the years. The increasing occurrence of traffic accidents which lead to high-energy traumas and complex open fractures, is a factors that contributes to the this rising number. The higher frequency of multidrug- resistant microorganisms makes treatment even more challenging and a multidisciplinary team including orthopedic surgeons and infectious disease specialists is necessary to manage the cases properly. Objective: Describe the epidemiological and microbiological profile of patients with osteomyelitis assisted at Hospital Dório Silva (HDS) between 2017 and 2019, and their clinical outcome evaluated 12 months after surgical treatment. Methods: A case series study of patients diagnosed with osteomyelitis assisted at HDS was conducted, evaluating clinical-demographic variables, microorganisms identified in cultures of bone fragments and clinical outcome 12 months after treatment was completed. Results: One hundred and seventy- nine patients were included in the study. Most patients were male (n = 128; 71.5%) and diagnosed with chronic osteomyelitis (n = 169; 94.4%). One hundred and thirty-seven of the osteomyelitis cases were caused by a single bacterial agent (76.6%), and 42 (26.47%) were polymicrobial. One hundred and forty patients (78.2%) presented with recurrence of osteomyelitis. The most prevalent pathogens identified were gram-positive cocci, Staphylococcus aureus (n = 104; 37.4%) and coagulase-negative Staphylococcus (n = 52; 18.7%) followed by gram-negative bacteria (n = 109; 39.2%.). Conclusion: The epidemiological and microbiological profile found in this study is similar to the current literature, and have shown a highest prevalence of chronic post-traumatic osteomyelitis of the lower limb among men over 50 years old, and infections by gram-positive cocci, but with a higher proportion of recurrences. It points out to the importance of elucidating the risk factors that lead to recurrence of the infection, as well as structuring health centers compound by an integrated multidisciplinary team to assist patients with orthopedic fractures and consequent bone infections.
- ItemAnálise do perfil de imunossenescência em células T de pacientes em diferentes estágios de infecção por SARS-CoV-2(Universidade Federal do Espírito Santo, 2022-08-12) Sarmento, Isabela Valim; Gomes, Daniel Claudio de Oliveira; http://lattes.cnpq.br/3965075540969796; https://orcid.org/0000000322719190; Silva, Eduardo de Almeida Marques da; Palaci, Moises; https://orcid.org/0000000320136071; http://lattes.cnpq.br/2602694352713051; Tadokoro, Carlos Eduardo; https://orcid.org/0000000278745657; http://lattes.cnpq.br/9447506269190990COVID-19 is a disease caused by SARS-CoV-2 that affects the respiratory system, causing lung damage that can progress to severe acute respiratory syndrome (ARDS), acute increase in inflammatory cytokines (cytokine storm), hepatic, cardiovascular, and renal damage. An exacerbated inflammatory environment, as seen in COVID-19, can lead to changes in the profile of differentiation and functionality of T cells. These factors promote the expansion of senescent T cells, which is defined by the progressive loss of costimulatory receptors (CD27 and CD28), DNA damage, p38 MAPK activation, and loss of proliferative capacity. The accumulation of senescent T cells has been associated with the immunopathogenesis of many diseases. However, it is still poorly understood in the context of COVID-19. This work evaluated the clinical/laboratory profile of patients with COVID-19, clinically classified between oligosymptomatic, moderate, and severe. In addition, we evaluated senescent phenotype characteristics in T cell compartments. Our results demonstrate alterations in several laboratory parameters such as leukocytosis, neutrophilia, eosinopenia, monocytosis, lymphopenia, increased LDH, direct bilirubin, triglycerides, C-reactive protein, urea, and creatinine. In addition, patients with COVID-19, especially the severe and moderate groups, showed changes in blood gas with disturbances in arterial pH and PCO2. Our phenotypic analyses showed a decrease in cell viability in the groups most affected by the disease (moderate and severe), with changes in the frequencies of CD4+ and CD8+ T cells, increased DNA damage identified by γH2Ax phosphorylation, as well as increased expression of MAPK p38 that is linked to senescence. Furthermore, compared to the oligosymptomatic group, critically ill patients showed an accumulation of highly differentiated populations, identified by the CD28-CD27- and terminal memory cells (T EMRA) subgroups. Thus, patients with the most severe shape of COVID-19 exhibit a senescent T-cell phenotype, which may be one of the aggravating factors for this disease.