Soropositividade de Brucella spp. e Coxiella burnetii em pacientes com suspeita de dengue no Estado de São Paulo
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Data
2021-06-30
Autores
França, Danilo Alves de
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Universidade Estadual Paulista (Unesp)
Resumo
A Febre Q e a Brucelose são zoonoses que causam febre e outros sinais clínicos sistémicos em humanos, tendo suas ocorrências negligenciadas e o diagnóstico diferencial para algumas doenças desconsiderado. Este estudo visou investigar a soropositividade de Coxiella burnetii e Brucella spp. em pacientes suspeitos de Dengue, atendidos em 38 municípios do Estado de São Paulo, Brasil. As amostras (n=604) foram obtidas por conveniência e pertenciam ao banco de soros do Instituto Adolfo Lutz. Para avaliar a positividade de C. burnetii, os soros foram submetidos à técnica de Imunofluorescência Indireta (IFA) utilizando protocolos de diagnóstico in-house e comerciais. Para avaliar a positividade de Brucella spp., os soros foram submetidos às técnicas de Soroaglutinação Rápida em Placa com Antígeno Acidificado Tamponado (AAT), Soroaglutinação Lenta em Tubos (SAL) e 2-Mercaptoetanol (2-ME). Foram realizadas análises multivariadas a partir dos dados dos casos detectados. Do total, 129 pacientes apresentaram resultados positivos, indicando uma soropositividade de 21,36% (95% CI 18,15-24,85). Os títulos observados (mediana) indicam que os pacientes não estavam apenas expostos ao agente, mas também que haviam desenvolvido a doença. De todas as variáveis analisadas, a duração dos sintomas dos pacientes com Febre Q mostrou uma diferença significativa; com ênfase nos pacientes com 7 a 21 dias de sintomas (p-valor=0,0199). Não foi observada qualquer positividade para a Brucelose. Este estudo é a primeira descoberta significativa de pessoas soropositivas para a Febre Q no Estado de São Paulo e uma das primeiras no Brasil. A Febre Q consolida-se como um importante diagnóstico diferencial de doenças febris na região, reivindicando a atenção do governo e o investimento na saúde.
Q fever and Brucellosis are zoonoses that cause fever and other systemic clinical signs in humans, having their occurrences neglected and the differential diagnosis for some diseases disregarded. This study aimed to investigate the seropositivity for Coxiella burnetii and Brucella spp. in patients suspected of Dengue, attended in 38 municipalities in the State of São Paulo, Brazil. The samples (n=604) were obtained by convenience and belonged to the Adolfo Lutz Institute serum bank. To evaluate C. burnetii positivity, sera were submitted to the Indirect Immunofluorescence technique (IFA) using in-house and commercial diagnostic protocols. To assess Brucella spp. positivity, sera were subjected to Rapid Plate Serum Agglutination with Buffered Acidified Antigen (AAT), Slow Tube Serum Agglutination (SAL) and 2-Mercaptoethanol (2-ME) techniques. Multivariate analyses of the data of detected cases were performed. Of the total, 129 patients showed positive results, indicating seropositivity of 21.36% (95% CI 18.15-24.85). The observed titers (median) indicate that, in addition to being exposed to the agent, the patients had developed the disease. Of all the variables analyzed, the duration of symptoms of Q fever patients showed a significant difference; with emphasis on patients with 7 to 21 days of symptoms (p-value=0.0199). No positivity for brucellosis was observed. This study is the first significant finding of persons seropositive for Q fever in São Paulo State and one of the first in Brazil. Q fever is consolidated as an important differential diagnosis of febrile illnesses in the region claiming the government attention and investment in health.
Q fever and Brucellosis are zoonoses that cause fever and other systemic clinical signs in humans, having their occurrences neglected and the differential diagnosis for some diseases disregarded. This study aimed to investigate the seropositivity for Coxiella burnetii and Brucella spp. in patients suspected of Dengue, attended in 38 municipalities in the State of São Paulo, Brazil. The samples (n=604) were obtained by convenience and belonged to the Adolfo Lutz Institute serum bank. To evaluate C. burnetii positivity, sera were submitted to the Indirect Immunofluorescence technique (IFA) using in-house and commercial diagnostic protocols. To assess Brucella spp. positivity, sera were subjected to Rapid Plate Serum Agglutination with Buffered Acidified Antigen (AAT), Slow Tube Serum Agglutination (SAL) and 2-Mercaptoethanol (2-ME) techniques. Multivariate analyses of the data of detected cases were performed. Of the total, 129 patients showed positive results, indicating seropositivity of 21.36% (95% CI 18.15-24.85). The observed titers (median) indicate that, in addition to being exposed to the agent, the patients had developed the disease. Of all the variables analyzed, the duration of symptoms of Q fever patients showed a significant difference; with emphasis on patients with 7 to 21 days of symptoms (p-value=0.0199). No positivity for brucellosis was observed. This study is the first significant finding of persons seropositive for Q fever in São Paulo State and one of the first in Brazil. Q fever is consolidated as an important differential diagnosis of febrile illnesses in the region claiming the government attention and investment in health.
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Febre Q, Brucelose, Saúde pública, Prevalência, Vigilância, Q fever, Brucelosis, Public health