Publications by authors named "Meri Bordignon Nogueira"

27 Publications

  • Page 1 of 1

Association Between COVID-19 Pregnant Women Symptoms Severity and Placental Morphologic Features.

Front Immunol 2021 26;12:685919. Epub 2021 May 26.

Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Brazil.

Since the beginning of the pandemic, few papers describe the placenta's morphological and morphometrical features in SARS-CoV-2-positive pregnant women. Alterations, such as low placental weight, accelerated villous maturation, decidual vasculopathy, infarcts, thrombosis of fetal placental vessels, and chronic histiocytic intervillositis (CHI), have been described.

Objective: To analyze clinical data and the placental morphological and morphometric changes of pregnant women infected with SARS-CoV-2 (COVID-19 group) in comparison with the placentas of non-infected pregnant women, matched for maternal age and comorbidities, besides gestational age of delivery (Control group).

Method: The patients in the COVID-19 and the Control group were matched for maternal age, gestational age, and comorbidities. The morphological analysis of placentas was performed using Amsterdam Placental Workshop Group Consensus Statement. The quantitative morphometric evaluation included perimeter diameter and number of tertiary villi, number of sprouts and knots, evaluation of deposition of villous fibrin, and deposition of intra-villous collagen I and III by Sirius Red. Additionally, Hofbauer cells (HC) were counted within villi by immunohistochemistry with CD68 marker.

Results: Compared to controls, symptomatic women in the COVID-19 group were more likely to have at least one comorbidity, to evolve to preterm labor and infant death, and to have positive SARS-CoV-2 RNA testing in their concepts. Compared to controls, placentas in the COVID-19 group were more likely to show features of maternal and fetal vascular malperfusion. In the COVID-19 group, placentas of symptomatic women were more likely to show CHI. No significant results were found after morphometric analysis.

Conclusion: Pregnant women with symptomatic SARS-CoV-2 infection, particularly with the severe course, are more likely to exhibit an adverse fetal outcome, with slightly more frequent histopathologic findings of maternal and fetal vascular malperfusion, and CHI. The morphometric changes found in the placentas of the COVID-19 group do not seem to be different from those observed in the Control group, as far as maternal age, gestational age, and comorbidities are paired. Only the deposition of villous fibrin could be more accentuated in the COVID-19 group (p = 0.08 borderline). The number of HC/villous evaluated with CD68 immunohistochemistry did not show a difference between both groups.
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http://dx.doi.org/10.3389/fimmu.2021.685919DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187864PMC
July 2021

SARS-CoV-2 in asymptomatic pregnant women in South Brazil: RT-PCR and serological detection.

J Perinat Med 2021 Jul 10;49(6):717-722. Epub 2021 Jun 10.

Department of Obstetrics and Gynecology, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil.

Objectives: This study aims to detect the SARS-CoV-2 infection prevalence in asymptomatic pregnant women.

Methods: A group of 195 asymptomatic pregnant women who attended the prenatal care outclinic and to the obstetric emergency department was tested concomitantly for SARS-CoV-2 by RT-PCR and serological tests.

Results: The virus was detected by RT-PCR in two (1.02%) cases and 17 (8.71%) patients had antibodies detected by immunochromatographic tests.

Conclusions: Due to the high risk of this emerging infection in the health of pregnant women, fetuses and newborns, we suggest the universal screening of all pregnant women admitted to hospital through the combined method RT-PCR and serological.
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http://dx.doi.org/10.1515/jpm-2021-0173DOI Listing
July 2021

Environmental Detection of SARS-CoV-2 Virus RNA in Health Facilities in Brazil and a Systematic Review on Contamination Sources.

Int J Environ Res Public Health 2021 04 6;18(7). Epub 2021 Apr 6.

Department of Biochemistry and Molecular Biology, Federal University of Paraná, Curitiba 81530-000, Brazil.

SARS-CoV-2 environmental monitoring can track the rate of viral contamination and can be used to establish preventive measures. This study aimed to detect by RT-PCR the presence of SARS-CoV-2 from inert surface samples in public health settings with a literature review about surface contamination and its burden on spread virus. Samples were collected from health settings in Curitiba, Brazil, between July and December 2020. A literature review was conducted using PRISMA. A total of 711 environmental surface samples were collected from outpatient areas, dental units, doctors' offices, COVID-19 evaluation areas, and hospital units, of which 35 (4.9%) were positive for SARS-CoV-2 RNA. The frequency of environmental contamination was higher in primary care units than in hospital settings. The virus was detected on doctors' personal items. Remarkably, the previously disinfected dental chair samples tested positive. These findings agree with those of other studies in which SARS-CoV-2 was found on inanimate surfaces. Detection of SARS-CoV-2 RNA on surfaces in public health settings, including those not meant to treat COVID-19, indicates widespread environmental contamination. Therefore, the intensification of disinfection measures for external hospital areas may be important for controlling community COVID-19 dissemination.
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http://dx.doi.org/10.3390/ijerph18073824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038740PMC
April 2021

Rapid Serological Tests for Sars-Cov-2: Diagnostic Performance of Four Commercial Assays.

Med Princ Pract 2021 Apr 22. Epub 2021 Apr 22.

To assess the diagnostic performance of lateral flow immunochromatographic assays (LFA) of four different manufacturers to identify SARS-CoV-2 antibodies (IgM, IgG or total), comparing them with the nucleic acid amplification test (NAAT) or clinical defined (definite or probable SARS-CoV-2 infection respectively).

Methods: 119 serum samples were randomly selected by convenience and distributed in the groups: (1) Group with SARS-CoV-2 infection [n=82; RT-qPCR positive (definite, n=70), and probable (n=12)]; (2) other diseases [n= 27; other viruses identified (n=8), SARS of other etiologies (n=19)]; (3) healthy control group (n=10). LFA essays of four manufacturers were compared: MedTest Coronavírus (COVID-19) IgG/IgM (MedLevensohn, Brazil); COVID-19 IgG/IgM ECO Test (Ecodiagnóstica, Brazil); Camtech COVID-19 IgM/IgG Rapid Test Kit (Camtech Diagnostics Pte Ltd, Singapore); and one Step COVID-19 Test for total antibodies (Guangzhou Wondfo Biotech Co, China).

Results: The four tests studied showed high diagnostic performance characteristics for the diagnoses of definite or probable SARS-CoV-2 infection. The best measures were for the Wondfo test: sensitivity (86.59%; 95%CI, 77.26-93.11%); specificity (100%; 90.51-100%); DOR (257; 60-1008); LR+ (33.43; 4.82-231.85); LR- (0.13; 0.08 - 0.23); accuracy (90.76%; 84.06- 95.29%); Matthews Correlation coefficient (MCC) 0.82. Although considering only the probable SARS-CoV-2 infection (PCR-) cases, all the kits studied showed limited values.

Conclusion: Our data demonstrate the excellent performance of LFA for the diagnoses of definite or probable SARS-CoV-2 infection. There was substantial heterogeneity in sensitivities of IgM and IgG antibodies among the manufacturers. LFA tests cannot replace molecular diagnostics, but should be used as additional screening tool.
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http://dx.doi.org/10.1159/000516776DOI Listing
April 2021

Intrauterine Transmission of SARS-CoV-2.

Emerg Infect Dis 2021 Feb 13;27(2):638-641. Epub 2020 Nov 13.

We documented fetal death associated with intrauterine transmission of severe acute respiratory syndrome coronavirus 2. We found chronic histiocytic intervillositis, maternal and fetal vascular malperfusion, microglial hyperplasia, and lymphocytic infiltrate in muscle in the placenta and fetal tissue. Placenta and umbilical cord blood tested positive for the virus by PCR, confirming transplacental transmission.
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http://dx.doi.org/10.3201/eid2702.203824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853547PMC
February 2021

Clinical performance of amperometry compared with enzymatic ultra violet method for lactate quantification in cerebrospinal fluid.

Diagnosis (Berl) 2020 Aug 27. Epub 2020 Aug 27.

Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.

Objectives: The differential diagnosis between acute bacterial meningitis (BM) and viral meningitis (VM) is crucial for treatment and prognosis. Cerebrospinal fluid (CSF) lactate (LA) is considered a good biomarker for differentiating BM from VM. The objective of this study was to compare the clinical performance of amperometry, which is not validated for measurement of LA in CSF samples, with a validated method (enzymatic ultra violet), for their ability to discriminate between acute BM and VM.

Methods: It was a retrospective, descriptive comparative study, 320 CSF reports were included; LA was quantified in CSF using either Dimension AR machine (Dade Behring) or amperometry (RAPID Point 500, Siemens). All samples with bacteria (n=54) or virus (n=139) identified, compared with a control with normal CSF (n=127).

Results: CSF LA levels were comparable for amperometry or enzymatic methods on each group studied, in a wide range of LA levels; it was capable to distinguish BM from VM independent of the method used to quantify.

Conclusions: The findings support the use of the amperometric method in measuring LA concentrations in CSF in a wide range of values. Amperometry is a less expensive method, validated for blood, easily available in small laboratories including in limited resources countries.
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http://dx.doi.org/10.1515/dx-2020-0065DOI Listing
August 2020

Influenza Sentinel Surveillance and Severe Acute Respiratory Infection in a Reference Hospital in Southern Brazil.

Rev Soc Bras Med Trop 2019 20;53:e20170498. Epub 2019 Dec 20.

Universidade Federal do Paraná, Serviço de Doenças Infecciosas, Curitiba, PR, Brasil.

Introduction: We report the results of the active surveillance of influenza infections in hospitalized patients and the evaluation of the seasonality and correlation with temperature and rainfall data.

Methods: During the 2-year study period, 775 patients were tested for 15 respiratory viruses (RVs).

Results: Most of the 57% of (n=444) virus-positive samples were human rhinovirus and respiratory syncytial virus. However, 10.4% (n=46) were influenza virus (80% FluA; 20% FluB). Age and SARI were significantly associated with influenza. FluB circulation was higher is 2013.

Conclusions: In the post-epidemic period, influenza remains an important cause of hospitalization in SARI patients.
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http://dx.doi.org/10.1590/0037-8682-0498-2017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083379PMC
February 2020

Comparison of Cerebrospinal Fluid Biomarkers for Differential Diagnosis of Acute Bacterial and Viral Meningitis with Atypical Cerebrospinal Fluid Characteristics.

Med Princ Pract 2020 3;29(3):244-254. Epub 2019 Sep 3.

Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil.

Objective: Several cerebrospinal fluid (CSF) biomarkers are used to distinguish between acute bacterial meningitis (BM) and viral meningitis (VM). We compared the ability of lactate and glucose (GL) in CSF and the CSF/blood GL ratio to distinguish between acute BM and VM with typical and atypical CSF characteristics.

Methods: Three hundred and twenty-four CSF reports were included, which were distributed as the acute BM, VM, and normal control groups (n = 63, 139, and 122, respectively).

Results: Lactate level in the CSF of acute BM group was 4-fold higher than that in the acute VM and control groups (p < 0.0001). CSF lactate presented higher specificity (92%) and negative predictive value (94%) compared to CSF GL and CSF/blood GL ratio in distinguishing acute BM and VM. Definitive acute BM or VM with atypical CSF cell characteristics was observed in 23.2 and 21.6% of samples, respectively, and these groups showed reduced performance of characteristics of all CSF biomarkers. CSF lactate showed better operational characteristics than those of CSF GL and CSF/blood GL ratio, presenting the highest positive likelihood ratio, and thus aided in the differential diagnosis of VM with atypical CSF.

Conclusion: The CSF lactate assay can be routinely used in laboratories as a rapid, automated, and easy method that is independent of lactate blood levels.
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http://dx.doi.org/10.1159/000501925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315170PMC
May 2021

Cerebrospinal fluid lactate levels according to the site of puncture.

Clin Chem Lab Med 2020 01;58(2):e54-e56

Laboratório de Patologia Clinica, Hospital de Clınicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.

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http://dx.doi.org/10.1515/cclm-2019-0726DOI Listing
January 2020

Human adenovirus meningoencephalitis: a 3-years' overview.

J Neurovirol 2019 08 17;25(4):589-596. Epub 2019 May 17.

Virology Laboratory, Clinical Pathology Laboratory - Hospital de Clínicas, Universidade Federal do Paraná, Rua Padre Camargo, n. 280, Setor de Ciências da Saúde, Bairro Alto da Glória, Curitiba, Parana, 80060240, Brazil.

Human adenovirus (HAdV) has been recognized as a significant viral pathogen implicated in neurological diseases, particularly in immunocompromised patients. However, its involvement in meningoencephalitis remains unclear. The aim of this study was to investigate HAdV and other viral co-infections in the cerebrospinal fluid (CSF) of patients suspected of having either meningoencephalitis or encephalitis. A total of 373 CSF samples from patients under clinical suspicion of neurological viral infection were included in this study. HAdV was investigated by conventional or multiplex real-time PCR, for different time periods. The frequency of HAdV central nervous system (CNS) infection was 1.08%, predominating in female patients with a predisposing condition, and presented with HAdV encephalitis. HAdV CNS infection was found to occur during the months of autumn and winter. The frequency of HAdV detected in CSF positive samples increased after the change in the diagnostic method from conventional to multiplex real-time PCR. There were no specific NMRI or EEG characteristics and two CSF samples with HAdV encephalitis had normal CSF WBC count. There were two cases of co-infection with HIV; no other co-infections with enterovirus or herpes family viruses were detected. All patients had good outcome. Although HAdV is rarely observable in CNS infectious syndromes, it must be investigated particularly in immunocompromised patients.
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http://dx.doi.org/10.1007/s13365-019-00758-7DOI Listing
August 2019

High frequency of multiple HPV types detection in Fanconi anemia patients oral swabs.

Transpl Infect Dis 2019 Apr 14;21(2):e13030. Epub 2018 Dec 14.

Department of Stomatology, Federal University of Paraná, Curitiba, Brazil.

Background: Fanconi anemia (FA) is a rare genetic disease usually characterized by bone marrow failure and congenital malformations. The risk of development of malignancies in the oral cavity of FA patients, such as squamous cell carcinoma (SCC), increases significantly after a hematopoietic stem cells transplant (HSCT), and may also be linked with the presence of human papillomavirus (HPV) infections in the oral cavity. We investigated the prevalence and the HPV genotypes in oral mucosa of Brazilian FA patients.

Methods And Results: Oral swabs of 49 FA patients were collected. The median age of patients was 20 years (range 5-44) and 57% were over 18 years. Oral lesions were present in 20% of all patients, being 90% leukoplakia. HPV DNA was detected in 28% (14/49) of patients, and one of them also reported genital HPV lesions. Sixty-seven percent of all patients had undergone HSCT, including 12 patients (86%) of those with HPV results. Multiple HPV types were detected in 78% and 71% of HPV samples by Sanger sequencing and reverse hybridization methods, respectively. The most prevalent HPV types detected were 6, 11, 18, and 68.

Conclusions: HPV prevalence in the oral mucosa of the assessed FA patients was higher than reported in the general population. Additional studies with collection of sequential samples are needed to know the natural history of the presence of multiple HPV types in these individuals and its association with the development of tumors, to evaluate the implementation of preventive measures, such as vaccination, and to guide early treatment.
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http://dx.doi.org/10.1111/tid.13030DOI Listing
April 2019

Confirmatory molecular method for HTLV-1/2 infection in high-risk pregnant women.

J Med Virol 2018 05 30;90(5):998-1001. Epub 2018 Jan 30.

Virology Section, Clinical Analyses Laboratory, Clinical Hospital, Universidade Federal do Paraná, Paraná, Brazil.

Human T-cell lymphotropic virus types 1/2 (HTLV-1/2) are transmitted through sexual intercourse, transfusion of blood components, and vertical transmission, predominantly through breastfeeding. Six hundred forty-three pregnant women from a high-risk prenatal care unit at a general hospital were tested by serological tests using chemiluminescence (CMIA) for screening, followed by a molecular confirmatory test. Four patients (0.6%) tested positive for HTLV-1/2 by CMIA, two samples (0.3%) for each patient were confirmed as having HTLV-1 or HTLV-2 by PCR. The results show the importance of inclusion of HTLV-1/2 screening for pregnant women in high-risk prenatal care and the need for a molecular biological method to confirm HTLV-1/2 infection.
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http://dx.doi.org/10.1002/jmv.25014DOI Listing
May 2018

Profile of HIV subtypes in HIV/HBV- and HIV/HCV-coinfected patients in Southern Brazil.

Rev Soc Bras Med Trop 2017 Jul-Aug;50(4):470-477

Programa de Pós Graduação em Medicina Interna, Universidade Federal do Paraná, Curitiba, PR, Brasil.

Introduction: : HIV and viral hepatitis infections are major causes of chronic disease worldwide and have some similarities with regard to routes of transmission, epidemiology, front barriers faced during access of treatment, and strategies for a global public health response. The objective was to describe the HIV-1 subtypes, viral tropism and single-nucleotide polymorphisms (SNPs) of interleukin 28B (IL28B) from a case series of HIV/viral hepatitis coinfected patients from southern Brazil.

Methods:: Clinical and epidemiological data were evaluated by a review of medical records. Periodic blood draws were taken to determine the viral and host characteristics.

Results:: This study included 38 patients with HIV/HBV or HIV/HCV coinfection; the median age was 49 years. Thirty-seven (97.4%) were on antiretroviral therapy, 32 (84.2%) had an undetectable viral load, a median CD4+ T-cell count of 452 cells/mm3. HIV-1 subtyping showed 47.4 and 31.6% of patients with subtypes C and B, respectively. Analysis of viral co-receptor usage showed a predominance of the R5 variant (64.7%), with no significant difference between the subtypes. Twenty patients with HIV/HCV coinfection were eligible to receive HCV therapy with pegylated-interferon-alpha plus ribavirin, and 10/20 (50%) of them achieved sustained virological response. SNPs of IL28B were evaluated in 93.3% of patients with HIV/HCV coinfection, and 17 (60.7%) presented the CC genotype.

Conclusions:: In the present case series, a higher frequency of HIV subtype C was found in coinfected patients. However such findings need to be prospectively evaluated with the inclusion of data from regional multicenter analyses.
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http://dx.doi.org/10.1590/0037-8682-0450-2016DOI Listing
November 2017

Neurological and multiple organ involvement due to Paracoccidioides brasiliensis and HIV co-infection diagnosed at autopsy.

J Neurovirol 2017 12 11;23(6):913-918. Epub 2017 Sep 11.

Medical Pathology Department, Medicine School, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.

Paracoccidioidomycosis (PCM), caused by Paracoccidioides brasiliensis, is the most prevalent systemic mycosis among immunocompetent patients in Latin America; it is rare in immunocompromised patients. The estimated frequency of central nervous system (CNS) involvement in the HIV/PCM population was 2.5%. We report a case of HIV/P. brasiliensis co-infection, with neurological (NPCM) and multiple organ involvement, indicating a diagnosis of AIDS. PCM diagnosis was established during the autopsy. This is the first described case of HIV/P. brasiliensis co-infection with CNS involvement diagnosed at autopsy. In conclusion, the diagnosis of NPCM is challenging, and it must be considered in the differential diagnosis in HIV-positive patients who reside in or have visited areas in which the condition is endemic and who present with neurological symptoms.
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http://dx.doi.org/10.1007/s13365-017-0577-1DOI Listing
December 2017

Human parechovirus: sepsis-like illness with pulmonary infection.

Braz J Infect Dis 2017 Nov - Dec;21(6):675-677. Epub 2017 Jul 7.

Universidade Federal do Paraná, Hospital de Clínicas, Laboratório de Virologia, Curitiba, PR, Brazil; Universidade Federal do Paraná, Programa de Pós-graduação em Tocoginecologia, Curitiba, PR, Brazil; Universidade Federal do Paraná, Departamento de Análises Clínicas, Curitiba, PR, Brazil.

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http://dx.doi.org/10.1016/j.bjid.2017.06.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7129718PMC
November 2018

Molecular characterization and clinical epidemiology of human respiratory syncytial virus (HRSV) A and B in hospitalized children, Southern Brazil.

J Med Virol 2017 08 14;89(8):1489-1493. Epub 2017 Mar 14.

Postgraduate Program in Microbiology, Parasitology and Pathology, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.

Human respiratory syncytial virus (HRSV) is a major etiologic agent of pediatric respiratory infections. Genetic variability of its glycoprotein G enables HRSV to evade the immune response and determines its seasonal dissemination. This study reports genetic variability and clinical profiles of HRSV-infected patients from Southern Brazil. Seventy positive samples, 78% type A and 22% type B, were analyzed. Of the patients (median age, 6 months; interquartile range, 2-11 years), 16% had co-morbidities and 17% developed severe disease. The ON1 HRSV genotype first appeared in 2012, and patients infected with this genotype showed an increased tendency to develop severe disease.
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http://dx.doi.org/10.1002/jmv.24795DOI Listing
August 2017

Red blood cells in cerebrospinal fluid as possible inhibitory factor for enterovirus RT-PCR.

Arq Neuropsiquiatr 2016 Oct;74(10):810-815

Universidade Federal do Paraná, Hospital de Clínicas, Seção de Virologia, Curitiba PR, Brasil.

The presence of hemoglobin in samples are considered an important inhibitory factor for polymerase chain reaction (PCR). The aim of this study was to examine the influence of red blood cells (RBC)s in cerebrospinal fluid (CSF) as an inhibitory factor to reverse transcription polymerase chain reaction (RT-PCR) for enteroviruses (EV). Forty-four CSF samples from patients showing characteristics of viral meningitis were assessed for EV by RT-PCR. Viral RNA extracted with guanidine isothyocianate buffer and virus detection was performed by in-house nested PCR. Positivity for EV RT-PCR was higher in CSF samples without RBCs than in samples with RBCs: 13(26%) and 36(9.2%), p = 0.001. In the group with positive EV RT-PCR, the mean + SD CSF RBC was 37 ± 183 cell/mm3; the group with negative results had 580 + 2,890 cell/mm3 (p = 0.007). The acceptable upper limit for CSF RBCs that could not influence RT-PCR was 108 cells/mm3. CSF samples with negative results for EV RT-PCR have more erythrocytes.
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http://dx.doi.org/10.1590/0004-282X20160119DOI Listing
October 2016

Reactivation of herpes simplex virus-1 following epilepsy surgery.

Epilepsy Behav Case Rep 2015 27;4:76-8. Epub 2015 Aug 27.

Laboratório de Virologia, 1-4 Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.

Purpose: The present study reports a case of encephalitis due to herpes simplex virus-1 (HSV-1), following surgical manipulation of the site of a primary infection.

Methods: Herpes simplex virus-1 infection was confirmed by CSF PCR and DNA sequencing.

Results: The patient was an 11-year-old girl who required temporal lobe surgery for epilepsy. She had meningoencephalitis due to HSV at the age of 20 months, and she was treated with acyclovir. Three years later, the patient developed uncontrolled seizures that became more frequent and changed in character at 11 years of age. On the 12th postoperative day, she developed fever and seizures, and she was diagnosed with HSV-1 by positive CSF PCR. She was treated with acyclovir (30 mg/kg/day for 21 days). In this report, we describe the patient and review the relevant literature.

Conclusion: The authors stress the potential risk of reactivation of HSV encephalitis after intracranial surgery. Herpes simplex virus encephalitis must be considered in neurosurgical patients who develop postoperative seizures and fever.
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http://dx.doi.org/10.1016/j.ebcr.2014.08.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556748PMC
November 2015

Viral acute gastroenteritis: clinical and epidemiological features of co-infected patients.

Braz J Infect Dis 2012 May-Jun;16(3):267-72

Virology Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.

Background: Acute gastroenteritis (AGE) is a common disorder that affects children worldwide. It is usually caused by viral agents, including rotavirus, enteric adenovirus, norovirus, and astrovirus groups. Currently, there are few reports about co-infection among these viruses, mainly in Brazil.

Methods: This is a retrospective study in which 84 rotavirus-positive samples from hospitalized patients at a teaching hospital in Southern Brazil, collected in the 2001-2010 period, were analyzed by polymerase chain reaction (PCR) and reverse transcription-polymerase chain reaction (RT-PCR), for the investigation of enteric adenovirus, astrovirus, and norovirus.

Results: In total, 12 of the 84 (14%) samples were positive to enteric adenovirus or norovirus. Clinical, laboratory, and demographic data showed statistically significant differences between mono and co-infected patients, including age and depletion rate.

Conclusions: These findings highlight the need for implementation of other enteric virus detection assays in clinical diagnosis for a complete laboratory investigation of hospitalized pediatric patients with AGE, in order to understand the impact of these pathogens on disease severity, spread within hospital, and consequently, prevent the dissemination of nosocomial infections.
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http://dx.doi.org/10.1590/s1413-86702012000300009DOI Listing
November 2012

Enterovirus and herpesviridae family as etiologic agents of lymphomonocytary meningitis, Southern Brazil.

Arq Neuropsiquiatr 2011 Jun;69(3):475-81

Virology Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.

Viral meningitis is a common infectious disease of the central nervous system (CNS) that occurs worldwide. The aim of this study was to identify the etiologic agent of lymphomonocytary meningitis in Curitiba, PR, Brazil. During the period of July 2005 to December 2006, 460 cerebrospinal fluid (CSF) samples with lymphomonocytary meningitis were analyzed by PCR methodologies. Fifty nine (12.8%) samples were positive. Enteroviruses was present in 49 (83%) samples and herpes virus family in 10 (17%), of these 6 (10%) herpes simplex virus, 1 (2%) Epstein Barr virus, 2 (3%) human herpes virus type 6 and 1 (2%) mixed infection of enterovirus and Epstein Barr virus. As conclusion enterovirus was the most frequent virus, with circulation during summer and was observed with higher frequency between 4 to 17 years of age. PCR methodology is an important method for rapid detection of RNA enterovirus and DNA herpesvirus in CSF.
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http://dx.doi.org/10.1590/s0004-282x2011000400013DOI Listing
June 2011

Quantification of cerebrospinal fluid lactic acid in the differential diagnosis between HIV chronic meningitis and opportunistic meningitis.

Clin Chem Lab Med 2011 May 11;49(5):891-6. Epub 2011 Feb 11.

Virology Section, Clinical Pathology Laboratory, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil.

Background: Approximately 40% of HIV infected patients have chronic meningitis at various stages during the infection, 59% are asymptomatic. This is a diagnosis of exclusion and a confounding factor in cerebrospinal fluid (CSF) analysis, any other causes of chronic meningitis by opportunistic or co-infection must be ruled out. The aim of this study was to analyze CSF lactic acid (LA) as an adjuvant biomarker in chronic meningitis due to HIV.

Methods: CSF LA was quantified in 223 CSF samples by the Dimension AR (Dade Behring, Deerfield, IL, USA), distributed into nine groups: 1) HIV positive with an increase in CSF WBCs (n=17); 2) HIV positive with normal CSF (n=20); 3) enterovirus meningitis (n=33); 4) Herpesviridae meningoencephalitis (n=30); 5) fungal meningitis (n=25); 6) tuberculosis (TB) meningitis (n=17); 7) toxoplasmosis (n=18); 8) neurosyphilis (n=6); 9) control group (n=57).

Results: CSF LA (median; IQR) was higher in samples with TB meningitis (5.5; 2.9-7.5 mmol/L) and Cryptococcus neoformans meningitis (3.9; 2.7-5.8 mmol/L) compated with samples with HIV chronic meningitis (1.7; 1.4-1.9 mmol/L) and other groups (p ≤ 0.0001). For the diagnosis of HIV chronic meningitis, using a cut-off of 3.5 mmol/L, CSF LA showed high sensitivity and negative predictive value, although low specificity.

Conclusions: CSF LA helps to discriminate between C. neoformans or TB meningitis and HIV chronic meningitis: CSF LA can be included with the methods currently used to identify these specific pathogens, though it does not replace them. It is rapid, inexpensive and easy to perform, and can be used in developing countries.
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http://dx.doi.org/10.1515/CCLM.2011.131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5572653PMC
May 2011

Molecular epidemiology of HIV-1 clades in Southern Brazil.

Mem Inst Oswaldo Cruz 2010 Dec;105(8):1044-9

Laboratório de Virologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brasil, 80060-240.

Human immunodeficiency virus (HIV) clades B and C account for more than 60% of the HIV-1 infections worldwide. In this paper, we describe the profiles of patients infected with subtypes of HIV-1 from the state of Paraná, Southern Brazil, and correlate them with demographic and epidemiological findings. A retrospective analysis of HIV cases reported from 1999-2007 was also performed. Data from 293 patients were reviewed and 245 were older than 13 (58% female). The distribution of clades was as follows: B 140 (57%), C 67 (23%), F 24 (10%) and mosaic or unique recombinant forms (URFs) 24 (10%). Of the 48 patients younger than 13 years of age (62.5% male), vertical transmission occurred in 46 and the distribution of clades was as follows: B 14 (29%), C 24 (50%), F 7 (15%) and URFs 6 (13%). There was no significant difference in mortality between HIV-1 subtypes. In both groups, patients infected with clade C tended to have higher rates of injection drug use exposure risk.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867634PMC
http://dx.doi.org/10.1590/s0074-02762010000800015DOI Listing
December 2010

Comparison of immunoperoxidase and immunofluorescence assays for pp65 cytomegalovirus antigen in immunocompromised patients.

Braz J Infect Dis 2009 Apr;13(2):142-6

Virology Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.

We compared the pp65 antigen detection by an in house method (immunoperoxidase assay) and by a commercial kit (immunofluorescence assay) available for cytomegalovirus infection diagnosis in immunocompromised patients. Sixty-four blood samples were analyzed in duplicate for both techniques. Eight-six percent of the samples had concordant qualitative results. The discordant results occurred more frequently in samples with low quantity of positive cells. There were no significant differences with qualitative and quantitative results of the methods.
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http://dx.doi.org/10.1590/s1413-86702009000200014DOI Listing
April 2009

Quantitation of cerebrospinal fluid lactic acid in infectious and non-infectious neurological diseases.

Clin Chem Lab Med 2009 ;47(6):755-61

Virology Section, Clinical Pathology Laboratory, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil.

Background: The differential diagnosis between bacterial and viral meningitis is not easy in some cases. Cerebrospinal fluid (CSF) analysis is essential for establishing this diagnosis. The objectives were to quantitate lactic acid (LA) concentrations in bacterial and viral meningitis, and other central nervous system (CNS) diseases in order to evaluate the diagnostic utility of CSF LA for discriminating bacterial from viral meningitis.

Methods: CSF LA was measured in 139 CSF samples from seven groups: viral meningitis with classic CSF; suspicion of viral meningitis with neutrophils in CSF; bacterial meningitis; non-infectious neurological diseases; chronic meningitis; traumatic lumbar puncture (LP) and normal CSF.

Results: CSF LA was higher in bacterial meningitis 8.7 + 5.4 mmol/L compared with viral meningitis (1.9 + 0.6) and the other groups (p < 0.0001). CSF LA in the groups with viral meningitis was not different compared to groups with non-infectious CNS diseases and chronic meningitis. The ability of CSF LA to discriminate bacterial from viral meningitis showed a sensitivity of 80% and specificity of 97%, positive predictive value (PPV) of 94%, and negative predictive value (NPV) of 89%.

Conclusions: CSF LA is a powerful test to discriminate bacterial from viral meningitis with high sensitivity, specificity and predictive values. CSF LA can help in the cases with diagnostic uncertainty.
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http://dx.doi.org/10.1515/CCLM.2009.160DOI Listing
October 2009

Evidence for the co-circulation of dengue virus type 3 genotypes III and V in the Northern region of Brazil during the 2002-2004 epidemics.

Mem Inst Oswaldo Cruz 2008 Aug;103(5):483-8

Instituto Carlos Chagas, Curitiba, PR, Brasil.

The reintroduction of dengue virus type 3 (DENV-3) in Brazil in 2000 and its subsequent spread throughout the country was associated with genotype III viruses, the only DENV-3 genotype isolated in Brazil prior to 2002. We report here the co-circulation of two different DENV-3 genotypes in patients living in the Northern region of Brazil during the 2002-2004 epidemics. Complete genomic sequences of viral RNA were determined from these epidemics, and viruses belonging to genotypes V (Southeast Asia/South Pacific) and III were identified. This recent co-circulation of different DENV-3 genotypes in South America may have implications for pathological and epidemiological dynamics.
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http://dx.doi.org/10.1590/s0074-02762008000500013DOI Listing
August 2008

Laboratorial diagnosis of lymphocytic meningitis.

Braz J Infect Dis 2007 Oct;11(5):489-95

Hospital de Clínicas, Federal University of Paraná, Rua Padre Camargo 280, Curitiba, PR, Brazil.

Meningitis is the main infectious central nervous system (CNS) syndrome. Viruses or bacteria can cause acute meningitis of infectious etiology. The term "Aseptic Meningitis" denotes a clinical syndrome with a predominance of lymphocytes in the cerebrospinal fluid (CSF), with no common bacterial agents identified in the CSF. Viral meningitis is considered the main cause of lymphocyte meningitis. There are other etiologies of an infectious nature. CSF examination is essential to establish the diagnosis and to identify the etiological agent of lymphocytic meningitis. We examined CSF characteristics and the differential diagnosis of the main types of meningitis.
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http://dx.doi.org/10.1590/s1413-86702007000500010DOI Listing
October 2007

Acute respiratory infection by human metapneumovirus in children in southern Brazil.

J Clin Virol 2007 May 12;39(1):59-62. Epub 2007 Mar 12.

Laboratório de Virologia, Hospital de Clínicas da Universidade Federal do Paraná, Brazil.

Background: Human metapneumovirus (hMPV) has been described as an etiologic agent of acute respiratory infections (ARI), mainly in pediatric patients. Viral isolation is difficult and has low sensitivity, and consequently RT-PCR assays are currently used for detection.

Objectives: Detect hMPV in ARI in hospitalized children in Southern Brazil; standardize a RT-PCR for routine hMPV diagnosis; validate a positive control for molecular tests; and perform phylogenetics analyses.

Study Design: Nasopharyngeal aspirates (NPA) from 156 hospitalized children were studied. A conserved region of the nucleoprotein gene was cloned, characterized and used to standardize an RT-PCR assay. Phylogenetic analyses were performed. Clinical data were obtained from medical records.

Results: hMPV was detected in 6.4% of the samples. Dyspnea and wheezing were frequently reported symptoms and the most common diagnoses were bronchiolitis, acute respiratory insufficiency or laryngotracheobronchitis. Nucleotide sequence alignment revealed 97.7% identity with genotype A1 of hMPV. The detection limit of hMPV genomes by RT-PCR in clinical samples was 180 copies/microL.

Conclusion: This is the first report of the detection and genetic characterization of hMPV infections in children with lower ARI in Southern Brazil.
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http://dx.doi.org/10.1016/j.jcv.2007.01.012DOI Listing
May 2007
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