Infecção pelo Toxoplasma gondii em pacientes vivendo com HIV/Aids: sororreatividade e perfil clínico
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Data
2022-03-30
Autores
Gava, Mariana Zanchetta
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Universidade Estadual Paulista (Unesp)
Resumo
A toxoplasmose é uma das principais infecções oportunistas que afetam as pessoas vivendo com HIV/Aids (PVHA), levando a alta taxa de morbidade e mortalidade. Diante da importância da toxoplasmose, tornou-se imprescindível o levantamento de dados epidemiológicos referentes à infecção pelo T. gondii, principalmente, em relação ao impacto para saúde pública. O presente estudo objetivou avaliar a prevalência de exposição e a presença de doença ativa por T. gondii em PVHA, atendidos no Serviço de Infectologia do Hospital das Clínicas (HC-FMBUnesp) e Serviço de Ambulatórios Especializados de Infectologia “Domingos Alves Meira” (SAEI-DAM), unidade do complexo médico-hospitalar da Faculdade de Medicina de Botucatu, no período março de 2020 a janeiro de 2022. Foi realizado um estudo de coorte prospectivo, no qual uma amostragem de conveniência foi estudada, baseando-se no fluxo histórico do Serviço de Infectologia do Hospital das Clínicas, onde os critérios históricos de inclusão foram categorizados por dois grupos, sendo eles: Grupo 01 sintomático para neurotoxoplasmose (NTX) e Grupo 02 Controle e sem sintomatologia para NTX. Foram coletadas amostras de soro, que posteriormente foram encaminhas ao Laboratório de Diagnóstico de Zoonoses (FMVZ-UNESP), para realização do exame de Reação de Imunofluorescência Indireta (RIFI). A Quimioluminescência foi realizada no Laboratório de Sorologia e Endocrinologia do Hospital das Clínicas (HC-FMB-Unesp). A Reação em Cadeia da Polimerase Convencional foi realizada no Laboratório de Biologia Molecular Aplicada a Zoonoses (FMVZ-UNESP). Dos 10 pacientes, três (30%) não foram sororreagentes para pesquisa de anticorpos anti-T. gondii, tanto na RIFI quanto na quimiluminescência. Adicionalmente, 7 (70%) pacientes dos dois grupos (1 e 2), apresentaram anticorpos IgG e IgM anti-T. gondii na primeira coleta em ambas as técnicas sorológicas, e seis (60%) foram sororreagentes nas duas técnicas no momento da segunda coleta. No momento da terceira coleta, 3 (30%) reagiram para os dois exames, e mantiveram-se sororreagentes para os dois exames sorológicos na quarta coleta. Na pesquisa de anticorpos IgG anti-T.gondii pela RIFI, o título prevalente foi 4096 (50%), seguido por 1024 (30%), e 64 (20%), enquanto que para os anticorpos IgM anti-T.gondii foi 1024 (50%),seguido por 4096 (20%), 64 (10%) e 256 (10%). E na pesquisa de anticorpos IgG anti-T.gondii pela quimiluminescência, o título prevalente foi ≥ 3,0 (40%), seguido por 2,90 (30%), 1,60 (10%), 1,50 (10%) e 1 (10%). E para os anticorpos IgM anti-T.gondii foi 0,60 (20%),seguido por 70 (10%), 80 (10%) e 90 (10%).Das 10 amostras de sangue analisadas pela Reação em Cadeia da Polimerase convencional, todas mostraram-se negativas. A realização deste estudo permitiu a determinação do perfil clínico da neurotoxoplasmose em PVHA, podendo contribuir na implementação de estratégias em saúde pública, com a finalidade de prevenir a morbidade e mortalidade associada a essa enfermidade.
Toxoplasmosis has the opportunity to increase the birth rate of people living with HIV/PLHA. Given the importance, it became necessary to survey epidemiological data related to T. gondii infection, mainly in relation to the impact on public health. The present study aimed to evaluate the prevalence of exposure and presence of active disease by T. gondii in PLWHA, treated at the Infectious Diseases Service of Hospital das Clínicas (HC-FMBUnesptórios) and Specialized Infectology Outpatient Service “Domingos Alves Meira” (SAEI DAM medical-hospital unit of the Faculty of Medicine of Bot, in the period of March 202020202. Service of Infectious Diseases Hospital das Clínicas, where the two historical symptoms of inclusion were categorized into two groups, namely: Symptomatic Group 01 (NTX) and Group 02 Control and semtology for NTX. Serum samples were collected, which were later sent to the Zoonoses Laboratory (FMVZ-UNESP), for the Indirect Immunofluorescence (IRFI) test. Chemiluminescence was performed at the Hospital's Serology and Endocrinology Laboratory das Clínicas (HC-FMB-Unesp) The Conventional Polymerase Chain Reaction was performed at the Laboratory of Molecular Biology Applied to Zoo noses (FMVZ-UNESP). Of the 10 patients, three (30%) were not tested for anti-T. gondii, both in IFAT and in chemiluminescence. Additionally, 7 (70%) patients in both groups (1 and 2) had IgG and IgM anti-T. gondii in the first collection in both serological techniques, and six (60%) were seroreactive in both techniques at the time of the second collection. At the time of collection, 3 (30%) reacted to both tests, and remained seroreactive for both serological tests in the fourth collection. In the search for IgG antiT.gondii by the IFAT, the prevalent titer was 4096 (50%), followed by 1024 (30%), and 64 (20%), and while for IgM anti-T.gondii it was 1024 ( 50%), followed by 4096 (20%), 64 (10%) and 256 (10%). And in the search for IgG anti-T.gondii by chemiluminescence, the titer was ≥ 3.0 (40%), followed by 2.90 (30%), 1.60 (10%), 1.50 (100%) %) and 1 (10%). And for anti-T.gondii IgM it was 0.60 (20%), followed by 70 (10%), 80 (10%) and 90 (10%). Conventional polymerases, all of them conventional polymerases. The implementation of this metamorphosis study to determine the clinical profile of PLWHA can contribute to the implementation of strategies in public health, in order to prevent morbidity associated with this disease.
Toxoplasmosis has the opportunity to increase the birth rate of people living with HIV/PLHA. Given the importance, it became necessary to survey epidemiological data related to T. gondii infection, mainly in relation to the impact on public health. The present study aimed to evaluate the prevalence of exposure and presence of active disease by T. gondii in PLWHA, treated at the Infectious Diseases Service of Hospital das Clínicas (HC-FMBUnesptórios) and Specialized Infectology Outpatient Service “Domingos Alves Meira” (SAEI DAM medical-hospital unit of the Faculty of Medicine of Bot, in the period of March 202020202. Service of Infectious Diseases Hospital das Clínicas, where the two historical symptoms of inclusion were categorized into two groups, namely: Symptomatic Group 01 (NTX) and Group 02 Control and semtology for NTX. Serum samples were collected, which were later sent to the Zoonoses Laboratory (FMVZ-UNESP), for the Indirect Immunofluorescence (IRFI) test. Chemiluminescence was performed at the Hospital's Serology and Endocrinology Laboratory das Clínicas (HC-FMB-Unesp) The Conventional Polymerase Chain Reaction was performed at the Laboratory of Molecular Biology Applied to Zoo noses (FMVZ-UNESP). Of the 10 patients, three (30%) were not tested for anti-T. gondii, both in IFAT and in chemiluminescence. Additionally, 7 (70%) patients in both groups (1 and 2) had IgG and IgM anti-T. gondii in the first collection in both serological techniques, and six (60%) were seroreactive in both techniques at the time of the second collection. At the time of collection, 3 (30%) reacted to both tests, and remained seroreactive for both serological tests in the fourth collection. In the search for IgG antiT.gondii by the IFAT, the prevalent titer was 4096 (50%), followed by 1024 (30%), and 64 (20%), and while for IgM anti-T.gondii it was 1024 ( 50%), followed by 4096 (20%), 64 (10%) and 256 (10%). And in the search for IgG anti-T.gondii by chemiluminescence, the titer was ≥ 3.0 (40%), followed by 2.90 (30%), 1.60 (10%), 1.50 (100%) %) and 1 (10%). And for anti-T.gondii IgM it was 0.60 (20%), followed by 70 (10%), 80 (10%) and 90 (10%). Conventional polymerases, all of them conventional polymerases. The implementation of this metamorphosis study to determine the clinical profile of PLWHA can contribute to the implementation of strategies in public health, in order to prevent morbidity associated with this disease.
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Palavras-chave
Neurotoxoplasmose, HIV, Reação em cadeia da polimerase, Reação de imunofluorescência indireta, Neurotoxoplasmosis