EXPEDITO JOSE DE ALBUQUERQUE LUNA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Microbial Translocation Is Associated with Extensive Immune Activation in Dengue Virus Infected Patients with Severe Disease(2013) WEG, Cornelia A. M. van de; PANNUTI, Claudio S.; ARAUJO, Evaldo S. A. de; HAM, Henk-Jan van den; ANDEWEG, Arno C.; BOAS, Lucy S. V.; FELIX, Alvina C.; CARVALHO, Karina I.; MATOS, Andreia M. de; LEVI, Jose E.; ROMANO, Camila M.; CENTRONE, Cristiane C.; RODRIGUES, Celia L. de Lima; LUNA, Expedito; GORP, Eric C. M. van; OSTERHAUS, Albert D. M. E.; MARTINA, Byron E. E.; KALLAS, Esper G.Background: Severe dengue virus (DENV) disease is associated with extensive immune activation, characterized by a cytokine storm. Previously, elevated lipopolysaccharide (LPS) levels in dengue were found to correlate with clinical disease severity. In the present cross-sectional study we identified markers of microbial translocation and immune activation, which are associated with severe manifestations of DENV infection. Methods: Serum samples from DENV-infected patients were collected during the outbreak in 2010 in the State of Sao Paulo, Brazil. Levels of LPS, lipopolysaccharide binding protein (LBP), soluble CD14 (sCD14) and IgM and IgG endotoxin core antibodies were determined by ELISA. Thirty cytokines were quantified using a multiplex luminex system. Patients were classified according to the 2009 WHO classification and the occurrence of plasma leakage/shock and hemorrhage. Moreover, a (non-supervised) cluster analysis based on the expression of the quantified cytokines was applied to identify groups of patients with similar cytokine profiles. Markers of microbial translocation were linked to groups with similar clinical disease severity and clusters with similar cytokine profiles. Results: Cluster analysis indicated that LPS levels were significantly increased in patients with a profound pro-inflammatory cytokine profile. LBP and sCD14 showed significantly increased levels in patients with severe disease in the clinical classification and in patients with severe inflammation in the cluster analysis. With both the clinical classification and the cluster analysis, levels of IL-6, IL-8, sIL-2R, MCP-1, RANTES, HGF, G-CSF and EGF were associated with severe disease. Conclusions: The present study provides evidence that both microbial translocation and extensive immune activation occur during severe DENV infection and may play an important role in the pathogenesis.
- CD8+T Lymphocyte Expansion, Proliferation and Activation in Dengue Fever(2015) MATOS, Andreia Manso de; CARVALHO, Karina Inacio; ROSA, Daniela Santoro; VILLAS-BOAS, Lucy Santos; SILVA, Wanessa Cardoso da; RODRIGUES, Celia Luiza de Lima; OLIVEIRA, Olimpia Massae Nakasone Peel Furtado; LEVI, Jose Eduardo; ARAUJO, Evaldo Stanislau Affonso; PANNUTI, Claudio Sergio; LUNA, Expedito Jose Albuquerque; KALLAS, Esper GeorgeDengue fever induces a robust immune response, including massive T cell activation. The level of T cell activation may, however, be associated with more severe disease. In this study, we explored the level of CD8+ T lymphocyte activation in the first six days after onset of symptoms during a DENV2 outbreak in early 2010 on the coast of Sao Paulo State, Brazil. Using flow cytometry we detected a progressive increase in the percentage of CD8+ T cells in 74 dengue fever cases. Peripheral blood mononuclear cells from 30 cases were thawed and evaluated using expanded phenotyping. The expansion of the CD8+ T cells was coupled with increased Ki67 expression. Cell activation was observed later in the course of disease, as determined by the expression of the activation markers CD38 and HLA-DR. This increased CD8+ T lymphocyte activation was observed in all memory subsets, but was more pronounced in the effector memory subset, as defined by higher CD38 expression. Our results show that most CD8+ T cell subsets are expanded during DENV2 infection and that the effector memory subset is the predominantly affected sub population.
- Diversity and distribution of avian malaria and related haemosporidian parasites in captive birds from a Brazilian megalopolis(2017) CHAGAS, Carolina Romeiro Fernandes; VALKIUNAS, Gediminas; GUIMARAES, Lilian de Oliveira; MONTEIRO, Eliana Ferreira; GUIDA, Fernanda Junqueira Vaz; SIMOES, Roseli Franca; RODRIGUES, Priscila Thihara; LUNA, Expedito Jose de Albuquerque; KIRCHGATTER, KarinBackground: The role of zoos in conservation programmes has increased significantly in last decades, and the health of captive animals is essential to guarantee success of such programmes. However, zoo birds suffer from parasitic infections, which often are caused by malaria parasites and related haemosporidians. Studies determining the occurrence and diversity of these parasites, aiming better understanding infection influence on fitness of captive birds, are limited. Methods: In 2011-2015, the prevalence and diversity of Plasmodium spp. and Haemoproteus spp. was examined in blood samples of 677 captive birds from the Sao Paulo Zoo, the largest zoo in Latin America. Molecular and microscopic diagnostic methods were used in parallel to detect and identify these infections. Results: The overall prevalence of haemosporidians was 12.6%. Parasites were mostly detected by the molecular diagnosis, indicating that many birds harbour subclinical or abortive infections. In this project, birds of 17 orders (almost half of all the orders currently accepted in taxonomy of birds), 29 families, and 122 species, were tested, detecting positive individuals in 27% of bird species. Birds from the Anatidae were the most prevalently infected (64.7% of all infected animals). In all, infections with parasites of the genus Plasmodium (overall prevalence 97.6%) predominated when compared to those of the genus Haemoproteus (2.4%). In total, 14 cytochrome b (cytb) lineages of Plasmodium spp. and 2 cytb lineages of Haemoproteus spp. were recorded. Eight lineages were new. One of the reported lineages was broad generalist while others were reported in single or a few species of birds. Molecular characterization of Haemoproteus ortalidum was developed. Conclusion: This study shows that many species of birds are at risk in captivity. It is difficult to stop haemosporidian parasite transmission in zoos, but is possible to reduce the infection rate by treating the infected animals or/and while keeping them in facilities free from mosquitoes. Protocols of quarantine should be implemented whenever an animal is transferred between bird maintaining institutions. This is the first survey of haemosporidians in captive birds from different orders maintained in zoos. It is worth emphasizing the necessity of applying practices to control these parasites in management and husbandry of animals in captivity.
- Interdisciplinary approach at the primary healthcare level for Bolivian immigrants with Chagas disease in the city of Sao Paulo(2017) YASUDA, Maria Aparecida Shikanai; SATOLO, Camila Goncalves; CARVALHO, Noemia Barbosa; ATALA, Magda Maya; FERRUFINO, Rosarlo Quiroga; LEITE, Ruth Moreira; FURUCHO, Celia Regina; LUNA, Expedito; SILVA, Rubens Antonio; HAGE, Marcia; OLIVEIRA, Caroline Medeji Ramos de; BUSSER, Felipe Delatorre; FREITAS, Vera Lucia Teixeira de; WANDERLEY, Dalva Marli Valerio; MARTINELLI, Luzia; ALMEIDA, Sonia Regina; VINAS, Pedro Albajar; CARNEIRO JR., NivaldoBackground/Methods In a pioneering cross-sectional study among Bolivian immigrants in the city of Sao Paulo, Brazil, the epidemiological profile, clinical manifestations and morbidity of Chagas disease were described. The feasibility of the management of Chagas disease at primary healthcare clinics using a biomedical and psychosocial interdisciplinary approach was also tested. Previously, a Trypanosoma cruzi (T. cruzi) infection rate of 4.4% among 633 immigrants was reported. The samples were screened using two commercial enzyme-linked immunoassay (ELISA) tests generated with epimastigote antigens, and those with discrepant or seropositive results were analyzed by confirmatory tests: indirect immunofluorescence (IFI), TESA-blot and a commercial recombinant ELISA. PCR and blood cultures were performed in seropositive patients. Results The majority of the 28 seropositive patients were women, of whom 88.89% were of childbearing age. The predominant clinical forms of Chagas disease were the indeterminate and atypical cardiac forms. Less than 50% received the recommended antiparasitic treatment of benznidazole. An interdisciplinary team was centered on primary healthcare physicians who applied guidelines for the management of patients. Infectologists, cardiologists, pediatricians and other specialists acted as reference professionals. Confirmatory serology and molecular biology tests, as well as echocardiography, Holter and other tests, were performed for the assessment of affected organs in secondary healthcare centers. The published high performance of two commercial ELISA tests was not confirmed. Conclusion An interdisciplinary approach including antiparasitic treatment is feasible at the primary healthcare level for the management of Chagas disease in Bolivian immigrants. The itinerant feature of immigration was associated with a lack of adherence to antiparasitic treatment and was considered a main challenge for the clinical management of this population. This approach is recommended for management of the infected population in endemic and nonendemic areas, although different strategies are needed depending on the severity of the disease and the structure of the healthcare system.
- Geoclimatic, demographic and socioeconomic characteristics related to dengue outbreaks in Southeastern Brazil: an annual spatial and spatiotemporal risk model over a 12-year period(2021) VERNAL, Sebastian; NAHAS, Andressa K.; NETO, Francisco Chiaravalloti; PRETE JUNIOR, Carlos A.; CORTEZ, Andre L.; SABINO, Ester Cerdeira; LUNA, Expedito Jose de AlbuquerqueDengue fever is re-emerging worldwide, however the reasons of this new emergence are not fully understood. Our goal was to report the incidence of dengue in one of the most populous States of Brazil, and to assess the high-risk areas using a spatial and spatio-temporal annual models including geoclimatic, demographic and socioeconomic characteristics. An ecological study with both, a spatial and a temporal component was carried out in Sao Paulo State, Southeastern Brazil, between January 1st, 2007 and December 31st, 2019. Crude and Bayesian empirical rates of dengue cases following by Standardized Incidence Ratios (SIR) were calculated considering the municipalities as the analytical units and using the Integrated Nested Laplace Approximation in a Bayesian context. A total of 2,027,142 cases of dengue were reported during the studied period. The spatial model allocated the municipalities in four groups according to the SIR values: (I) SIR<0.8; (II) SIR 0.8<1.2; (III) SIR 1.2 2.0 and SIR 2.0 identified the municipalities with higher risk for dengue outbreaks. ""Hot spots"" are shown in the thematic maps. Significant correlations between SIR and two climate variables, two demographic variables and one socioeconomical variable were found. No significant correlations were found in the spatio-temporal model. The incidence of dengue exhibited an inconstant and unpredictable variation every year. The highest rates of dengue are concentrated in geographical clusters with lower surface pressure, rainfall and altitude, but also in municipalities with higher degree of urbanization and better socioeconomic conditions. Nevertheless, annual consolidated variations in climatic features do not influence in the epidemic yearly pattern of dengue in southeastern Brazil.
- Prevalence of SARS-CoV-2 infection among health care workers in a reference hospital in Brazil(2023) ALMEIDA, Vanessa Neves; CAVALIN, Roberta Figueiredo; GALLO, Juliana Failde; GUERRA, Cleide Aparecida; MADUREIRA, Karen Cristina Rolim; ROSSI, Meire Bocoli; SOBREIRA, Rozania Soeli dos Santos; SANTOS, Ana Paula; LUNA, Expedito; LINDOSO, Jose Angelo LaulettaHealth care workers (HCW) are the frontline workforce for COVID-19 patient care and, consequently, are exposed to SARS-CoV-2 infection due to close contact to infected patients. Here, we evaluate the prevalence of SARS-CoV-2 infection among HCW from an infectious disease hospital, reference center for COVID-19 care in the metropolitan area of Sao Paulo city, Brazil. Among 2,204 HCW, 1,417 (64.29%) were subjected to detection of anti-SARS-CoV-2 antibodies by chemiluminescent immunoassay. Out of the total, 271 (19.12%) presented anti-SARS-CoV-2 antibodies. Prevalence varied according to HCW categories. The highest prevalence was observed in workers from outsourced companies, cooks and kitchen assistants, hospital cleaning workers, and maintenance workers. On the other hand, resident physicians and HCW from the institution itself presented lower prevalence (nurses, nursing assistants, physicians, laboratory technicians). Social and environmental factors are important determinants, associated with exposure in the hospital environment, which can determine the greater or lesser risk of infection by pathogens that spread rapidly by air.
- A cohort study to assess the incidence of dengue, Brazil, 2014-2018(2020) LUNA, Expedito J. A.; FIGUEIREDO, Gerusa M.; LEVI, Jose E.; CAMPOS, Sergio R. S. L. C.; FELIX, Alvina Clara; SOUZA, Nathalia Santiago E; FIGUEIREDO, Walter M.; COSTA, Angela A.; CARDOSO, Maria R. A.; PANNUTI, Claudio S.The present cohort study was set up with the aim of determining the incidence of dengue among children and adolescents, from 2 to 16 years of age, living in Araraquara, South-Eastern Brazil, a city classified as a mid-level endemicity location for dengue. Enrollment took place from September 2014 to March 2015. Baseline socio-demographic data were collected, and a blood sample from the participant was drawn, for dengue serology. Families were contacted weekly for fever surveillance. If the child developed fever, a nurse visited the household to collect a blood sample. PCR, NS1 and IgM were used for dengue diagnosis. Parents or legal guardians of participating children provided a written informed consent. 3,514 children and adolescents were enrolled in the cohort. Dengue baseline seroprevalence was 12.2% (95%CI: 11.1 - 13.3). The incidence density of symptomatic dengue was 8.94 per 100 person/years in the first year of follow-up, 0.58 in the second, and 0.19 in the fourth. No cases were confirmed in the third year. Incidence was associated with age, sex, baseline seroprevalence and with living in a house as opposed to an apartment. This study provides relevant information on the epidemiology of dengue in mid-level transmission settings that may be useful to policymakers in the evaluation of control strategies.
- Molecular detection of prepatent Schistosoma mansoni infection in Biomphalaria glabrata snail vectors(2020) CASOTTI, Marcia Oliveira; GRYSCHEK, Ronaldo Cesar Borges; PAULA, Fabiana Martins de; GOMES-GOUVEA, Michele; PINHO, Joao Renato Rebello; TUAN, Roseli; DIAS-NETO, Emmanuel; LUNA, Expedito Jose de Albuquerque; ESPIRITO-SANTO, Maria Cristina Carvalho doApproximately 240 million people worldwide are infected by Schistosoma. In Brazil, one of the main intermediate hosts of this parasite is Biomphalaria glabrata snails. The early detection of larval stages in intermediate hosts is an important challenge to public health. but it also represents an opportunity as a new alternative to indicate earlier natural infections before cercariae differentiation and emergence. In this context, we demonstrated that PCR amplification of a 28S gene fragment from the parasite does demonstrate S. mansoni infection in snails 14 days post infection. This conventional polymerase chain reaction amplified clear bands and was able to detect parasitic infection in the intermediate host B. glabrata under experimental conditions. However, we reinforce that this approach requires deeper investigations and further comparisons to confirm its specificity and sensitivity in earlier time points after miracidia infection. This approach has relevant potential as an effective molecular-based strategy for the monitoring of schistosomiasis transmission.
- Advancing towards the elimination of trachoma as a cause of blindness in two cities in Sao Paulo State, Southeastern Brazil(2022) MEDINA, Norma Helen; JOSEPH, Vera Helena; KOIZUMI, Ines Kazue; PEREIRA, Renata Piffer; SILVA, Miria Lazzarin da; LUNA, ExpeditoThe World Health Organization recommends conducting prevalence surveys to validate the elimination of trachoma as a public health problem by the year 2030. The recommendation specifies that the surveys should be directed to previous endemic poor rural areas. Brazil is an endemic country for trachoma and has experienced a large internal migration from the rural areas to the outskirts of the major cities. This study aimed to determine the prevalence of trachoma in children aged 1 to 9 years old in two of the poorest municipalities on the outskirts of Sao Paulo to test the hypothesis of whether internal migration brought trachoma with it. A household survey was conducted between 2013 and 2014. The field teams went door-to-door to collect data on households with children of the selected age group and their members. The trachoma prevalence in this group was 1.5% (79/5,393). In the 10 to 19 years old group, the trachoma prevalence was significantly higher among girls 3.2% (47/1,448) than among boys 1.5% (20/1,361). This result adds evidence to the elimination of trachoma as a public health problem and will be included in the supporting material to validate its elimination in Brazil.
- Prevalence of Trypanosoma cruzi infection among Bolivian immigrants in the city of Sao Paulo, Brazil(2017) LUNA, Expedito J. A.; FURUCHO, Celia R.; SILVA, Rubens A.; WANDERLEY, Dalva M.; CARVALHO, Noemia B.; SATOLO, Camila G.; LEITE, Ruth M.; SILVEIRA, Cassio; SILVA, Lia M. B.; AITH, Fernando M.; CARNEIRO JR., Nivaldo; SHIKANAI-YASUDA, Maria A.With the urbanisation of the population in developing countries and the process of globalisation, Chagas has become an emerging disease in the urban areas of endemic and non-endemic countries. In 2006, it was estimated that the prevalence of Chagas disease among the general Bolivian population was 6.8%. The aim of the present study was to determine the prevalence of Trypanosoma cruzi infection among Bolivian immigrants living in Sao Paulo, Brazil. This study had a sample of 633 volunteers who were randomly selected from the clientele of primary care units located in the central districts of Sao Paulo, Brazil. Infection was detected by two different ELISA assays with epimastigote antigens, followed by an immunoblot with trypomastigote antigens as a confirmatory test. The prevalence of the infection was 4.4%. Risk factors independently associated with the infection were: a history of rural jobs in Bolivia, knowledge of the vector involved in transmission, and having relatives with Chagas disease. Brazil has successfully eliminated household vector transmission of T. cruzi, as well as its transmission by blood transfusion. The arrival of infected immigrants represents an additional challenge to primary care clinics to manage chronic Chagas disease, its vertical transmission, and the blood derivatives and organ transplant programs.