RESUMO
Con el objetivo de describir los primeros casos autóctonosde Hepatitis E se realizó un estudio descriptivo. La población,9 enfermos, se identificó en el periodo noviembre 2009a julio 2010. Se seleccionaron por IgG e IgM específicaspara VHE y se realizó búsqueda de ARN viral en suero porRT-PCR. Presentaron una media de 51 años, 8 del sexo masculino, educación terciaria, nivel socioeconómico medio alto, atención en el sector privado y residencia urbana. La clínica fue similar a Hepatitis A, con transaminasas elevadas por encima de 1500 (mU/ml), la glutamicopiruvica convalores máximos de 5270 (mU/ml). Todos presentaron hiperbilirrubinemia a predominio directa, aumento de lagamaglutamil transferasa y de Fosfatasa Alcalina. Se demostrócirculación en Uruguay del VHE con manifestaciones clínicas, lo que traduce la presencia de una enfermedad emergente. Se plantea introducir el diagnostico del VHE en forma protocolizada en pacientes sin diagnostico etiológico de hepatitis.
In order to describe the first autochthonous Hepatitis E cases, we carried out a descriptive study. The population, 9 patients, was identified from November 2009 to July 2010. They were selected by specificIgG and IgM for HEV and we made viral RNA search in serum by RT-PCR. Patients average age was 51 years old, 8 male, tertiary education, upper middle socioeconomic level, health attention in private sector and urban residence. Clinic results similar to hepatitis A, with elevated transaminases over 1500 (mU/ml) and glutamic pyruvic with maximum values of 5270 (mU/ml). All patients presented hyperbilirubinemia (direct predominance) and increased gamma glutamyl transferase and alkaline phosphatase. Circulation of HEV with clinical manifestations was demonstrated in Uruguay, this showsthe presence of an emergent disease. We suggest introducing a formalized HEV diagnosis in patients without etiologic diagnosis of hepatitis.
Assuntos
Humanos , Masculino , Feminino , Hepatite E , Hepatite E/diagnósticoAssuntos
Proteína gp120 do Envelope de HIV/genética , Soropositividade para HIV/genética , Fragmentos de Peptídeos/genética , Adulto , Sequência de Aminoácidos , Feminino , Proteína gp120 do Envelope de HIV/química , Humanos , Masculino , Dados de Sequência Molecular , Fragmentos de Peptídeos/química , Alinhamento de SequênciaRESUMO
The 4-year study (1987-1990) covered the major clinical-epidemiological characteristics of pneumonia in children as diagnosed at the emergency service of the Children's Hospital, as well as etiologies, and factors involved in the most severe cases. Etiology was determined in 47.7% of the 541 pneumonia cases, involving 283 pathogens of which 38.6% were viruses and 12.6% bacteria. Viral and mixed etiologies were more frequent in children under 12 months of age. Bacteria predominated in ages between 6 and 23 months. Among the viruses, respiratory syncytial virus predominated (66%). The bacterial pneumonias accounted for 12.2% of the recognized etiologies. The most important bacterial agents were S. pneumoniae (64%) and H. influenzae (19%). H. influenzae and mixed infections had a relevant participation during the 1988 season, pointing to annual variations in the relative participation of pathogens and its possible implication in severity of diseases. Correlation of severity and increased percentage of etiological diagnosis was assessed: patients with respiratory rates over 70 rpm, or pleural effusion and/or extensive pulmonary parenchyma compromise yielded higher positive laboratory results. Various individual and family risk factors were recognized when comparing pneumonia children with healthy controls.
Assuntos
Pneumonia/epidemiologia , Fatores Etários , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/etiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Infecções por Haemophilus/epidemiologia , Haemophilus influenzae , Hospitalização , Humanos , Lactente , Recém-Nascido , Masculino , Infecções Pneumocócicas/epidemiologia , Pneumonia/microbiologia , Fatores de Risco , Índice de Gravidade de Doença , Streptococcus pneumoniae , Uruguai/epidemiologiaRESUMO
To obtain base line data on incidence, duration, clinical characteristics and etiology of acute respiratory infections (ARI), 276 children from deprived families living in Montevideo were followed during 32 months. The target population was divided into two groups for the analysis of the results: children aged less than 12 months and those older than this age. During the follow-up period 1.056 ARI episodes were recorded. ARI incidence was 5.2 per child/year. It was 87% higher in infants than in the older group, as was the duration of the episodes. Most of the diseases were mild. Tachypnea and retractions were seldom observed, but 12 children were referred to the hospital, and 2 infants died. Viral etiology was identified in 15.3% of the episodes. RSV was the predominant agent producing annual outbreaks. Moderate to heavy colonization of the upper respiratory tract by Streptococcus pneumoniae (32.3%) and Hemophilus sp. (18.9%) was recorded during ARI episodes. This community-based study furnish original data on ARI in Uruguay. It enabled to assess the impact of these infections on childhood.
Assuntos
Pobreza , Infecções Respiratórias/epidemiologia , Doença Aguda , Fatores Etários , Diarreia Infantil/epidemiologia , Diarreia Infantil/virologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Vírus Sincicial Respiratório Humano/isolamento & purificação , Infecções Respiratórias/virologia , População Urbana , Uruguai/epidemiologiaRESUMO
Enzyme immunoassays were developed to detect the presence of specific immunoglobulin E (IgE) antibodies and respiratory syncytial (RS) virus structural proteins in nasopharyngeal secretions in order to improve the knowledge on some aspects of the pathogenesis of severe acute lower respiratory tract infections caused by RS virus. These assays were used to analyze clinical specimens from children with RS virus-associated infections (bronchiolitis and pneumonia), and the findings were correlated with the patients' clinical symptoms. The results indicate the presence of specific IgE against the two external glycoproteins (G and F) and the absence of detectable IgE levels for the internal viral antigens. There was a correlation between the levels of IgE-specific antibodies and the amount of viral protein F in the secretions, indicating that the IgE response against the viral glycoproteins might be related to the antigen load. In addition, a correlation was found between higher levels of both viral protein F-specific IgE and F antigen with higher respiratory rates in children with pneumonia. These findings may be relevant because they suggest an association between the virus load and the immune response in the pathogenesis of RS virus infections.
Assuntos
Antígenos Virais/análise , Proteína HN , Imunoglobulina E/análise , Nasofaringe/microbiologia , Vírus Sinciciais Respiratórios/imunologia , Infecções por Respirovirus/imunologia , Proteínas Virais/análise , Anticorpos Antivirais/análise , Antígenos Virais/imunologia , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Estações do Ano , Proteínas do Envelope Viral , Proteínas Virais/imunologiaRESUMO
The etiology of severe pneumonia, not frequently encountered in a community-based study, was determined in 204 hospitalized children less than 5 years of age. Potential pathogens were identified in 41% of episodes. Viruses were isolated or antigen was detected in 36.3% of cases; 82.4% of these cases were due to respiratory syncytial virus. Bacteria or bacterial antigens were identified in 13.2% of cases; Streptococcus pneumoniae and Haemophilus influenzae were the most frequently identified bacterial pathogens isolated from blood and/or pleural effusions. Mixed infections were identified in 4.9% of the episodes. Among the 17 patients with pleural effusion whose pleural space was drained, the etiology was suggested for 10 (58.8%). A clear-cut seasonal variation was seen, with the highest prevalence between May and October. Viral infections were more common in the first 6 months of life, although viral and bacterial infections were distributed throughout the first 5 years of life.
Assuntos
Infecções Bacterianas/microbiologia , Pneumonia Viral/microbiologia , Pneumonia/microbiologia , Fatores Etários , Infecções Bacterianas/epidemiologia , Pré-Escolar , Humanos , Lactente , Faringe/microbiologia , Derrame Pleural/microbiologia , Pneumonia/epidemiologia , Pneumonia Viral/epidemiologia , Prevalência , Estações do Ano , Sepse/microbiologia , Uruguai/epidemiologiaRESUMO
For the purpose of identifying viral agents associated with acute respiratory tract infections (ARI) in children less than 5 years old, a longitudinal community study was undertaken in Montevideo, Uruguay, from May 1985 to December 1987. This report includes results obtained by cell culture and immunofluorescence techniques for detection of respiratory syncytial virus (RSV), influenza A and B viruses, parainfluenza 1 and 3 viruses, and adenovirus. Two populations were studied: children visited at home by pediatricians (group 1) and children with an ARI episode who attended an outpatient clinic (group 2). Nasopharyngeal aspirates were obtained at the time of an ARI episode: 858 from group 1 and 488 from group 2. Viruses were identified in 15.3% of group 1 specimens and in 17.6% of group 2 specimens. RSV was the most frequently recovered agent, accounting for 67.9% and 58.1%, respectively, of all viruses detected. The sensitivity and specificity of RSV isolation by cell culture are compared with detection by indirect immunofluorescence.
Assuntos
Infecções Respiratórias/microbiologia , Doença Aguda , Imunofluorescência , Humanos , Lactente , Recém-Nascido , Nasofaringe/microbiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores Socioeconômicos , População Urbana , UruguaiRESUMO
The occurrence of subgroup A and B strains of respiratory syncytial virus (RSV) was studied during three epidemic years, 1985 to 1987, in Uruguay. A set of monoclonal antibodies was selected according to their reactivity with local RSV isolates and used for the typing of RSV directly in nasopharyngeal cells by indirect immunofluorescence. Of 77 specimens, 69 could be typed as belonging to subgroup A or B, 5 could not be typed with the restricted set of monoclonal antibodies employed, and 3 reacted with both subgroup-specific antibodies. In 1985 and 1986 subgroup A predominated, accounting for 65.7% of all typed specimens, but in 1987 subgroup B surpassed subgroup A, accounting for 82.4% of the samples.
Assuntos
Antígenos Virais/análise , Vírus Sinciciais Respiratórios/classificação , Infecções Respiratórias/microbiologia , Infecções por Respirovirus/microbiologia , Anticorpos Monoclonais/imunologia , Pré-Escolar , Imunofluorescência , Humanos , Lactente , Nasofaringe/microbiologia , Vírus Sinciciais Respiratórios/imunologia , Infecções por Respirovirus/epidemiologia , Estações do Ano , UruguaiRESUMO
Un ensayo inmunoenzimático comercial Abboutt-RSV-EIA fue evaluado comprarándolo con la inmunofluorescencia indirecta. Aspirados nasofaríngeos de 95 niños con infección respiratoria aguda baja fueron procesados por inmunofluorescencia y por enzimoinmunoensayo para revelar la presencia de antígenos del virus respiratorio sincicial. De los 60 materiales positivos por inmunofluorescencia, 46 también lo fueron por enzimoinmunoensayo (sensibilidad 78,7%); de 35 negativos, 34 fueron también negativos por el Abbout-RSV-EIA (especificidad 97,1%). Según los resultados presentados, la evaluada es aceptable como una alternativa para el diagnóstico rápido de VRS en lugares donde no se cuente con otros recursos