LEA CAMPOS DE OLIVEIRA

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LIM/46 - Laboratório de Parasitologia Médica, Hospital das Clínicas, Faculdade de Medicina
LIM/03 - Laboratório de Medicina Laboratorial, Hospital das Clínicas, Faculdade de Medicina

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  • article 22 Citação(ões) na Scopus
    Risk Score for Predicting 2-Year Mortality in Patients With Chagas Cardiomyopathy From Endemic Areas: SaMi-Trop Cohort Study
    (2020) OLIVEIRA, Claudia Di Lorenzo; NUNES, Maria Carmo P.; COLOSIMO, Enrico Antonio; LIMA, Emilly Malveira de; CARDOSO, Clareci S.; FERREIRA, Ariela Mota; OLIVEIRA, Lea Campos de; MOREIRA, Carlos Henrique Valente; BIERRENBACH, Ana Luiza; HAIKAL, Desiree Sant'Ana; PEIXOTO, Sergio Viana; LIMA-COSTA, Maria Fernanda; SABINO, Ester Cerdeira; RIBEIRO, Antonio Luiz P.
    Background Risk stratification of Chagas disease patients in the limited-resource setting would be helpful in crafting management strategies. We developed a score to predict 2-year mortality in patients with Chagas cardiomyopathy from remote endemic areas. Methods and Results This study enrolled 1551 patients with Chagas cardiomyopathy from Minas Gerais State, Brazil, from the SaMi-Trop cohort (The Sao Paulo-Minas Gerais Tropical Medicine Research Center). Clinical evaluation, ECG, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) were performed. A Cox proportional hazards model was used to develop a prediction model based on the key predictors. The end point was all-cause mortality. The patients were classified into 3 risk categories at baseline (low, <2%; intermediate, >= 2% to 10%; high, >= 10%). External validation was performed by applying the score to an independent population with Chagas disease. After 2 years of follow-up, 110 patients died, with an overall mortality rate of 3.505 deaths per 100 person-years. Based on the nomogram, the independent predictors of mortality were assigned points: age (10 points per decade), New York Heart Association functional class higher than I (15 points), heart rate >= 80 beats/min (20 points), QRS duration >= 150 ms (15 points), and abnormal NT-proBNP adjusted by age (55 points). The observed mortality rates in the low-, intermediate-, and high-risk groups were 0%, 3.6%, and 32.7%, respectively, in the derivation cohort and 3.2%, 8.7%, and 19.1%, respectively, in the validation cohort. The discrimination of the score was good in the development cohort (C statistic: 0.82), and validation cohort (C statistic: 0.71). Conclusions In a large population of patients with Chagas cardiomyopathy, a combination of risk factors accurately predicted early mortality. This helpful simple score could be used in remote areas with limited technological resources.
  • article 1 Citação(ões) na Scopus
    ELISA Saliva for Trypanosoma cruzi Antibody Detection: An Alternative for Serological Surveys in Endemic Regions
    (2020) OLIVEIRA, Lea Campos de; PEREIRA, Natalia Bueno; MOREIRA, Carlos Henrique Valente; BIERRENBACH, Ana Luiza; SALLES, Flavia Cristina; SOUZA-BASQUEIRA, Marcela de; MANULI, Erika Regina; FERREIRA, Ariela Mota; OLIVEIRA, Claudia Di Lorenzo; CARDOSO, Clareci Silva; RIBEIRO, Antonio Luiz P.; SABINO, Ester Cerdeira
    Chagas is a neglected disease endemic in Latin America. Vector transmission control had been aggressively performed. Recent entomological surveillance in Brazil has revealed natural infection rates ranging from 0.40% to 0.52%. Although serological surveys are complex to develop, they are important for disease control. In this study, we validated the use of saliva in ELISA commercial kits with a cohort of 100 patients with Chagas disease followed at Hospital das Clinicas in Sao Paulo, Brazil, and 50 healthy controls. Five ELISA kits for detecting antibodies against Trypanosome cruzi were tested. The best discrimination between Chagas patients and controls was observed with the Wiener kit, which yielded a sensitivity of 97% and a specificity of 100%. Our findings reveal that the use of saliva may be an alternative to large-scale screening surveys in detecting T. cruzi antibodies; it is a noninvasive sample collection method potentially key to large-scale screening in children.
  • article 12 Citação(ões) na Scopus
    Gut Dysbiosis in Chagas Disease. A Possible Link to the Pathogenesis
    (2020) SOUZA-BASQUEIRA, Marcela de; RIBEIRO, Roberto Marques; OLIVEIRA, Lea Campos de; MOREIRA, Carlos Henrique Valente; MARTINS, Roberta Cristina Ruedas; FRANCO, Diego Castillo; AMADO, Pamela Pontes Penas; MAYER, Marcia Pinto Alves; SABINO, Ester Cerdeira
    Chagas disease is caused by the flagellate protozoanTrypanosoma cruzi. Cardiomyopathy and damage to gastrointestinal tissue are the main disease manifestations. There are data suggesting that the immune response toT. cruzidepends on the intestinal microbiota. We hypothesized that Chagas disease is associated with an altered gut microbiome and that these changes are related to the disease phenotype. The stool microbiome from 104 individuals, 73 with Chagas disease (30 with the cardiac, 11 with the digestive, and 32 with the indeterminate form), and 31 healthy controls was characterized using 16S rRNA amplification and sequencing. The QIIME (Quantitative Insights Into Microbial Ecology) platform was used to analyze the data. Alpha and beta diversity indexes did not indicate differences between the groups. However, the relative abundance ofVerrucomicrobia, represented primarily by the genusAkkermansia, was significantly lower in the Chagas disease groups, especially the cardiac group, compared to the controls. Furthermore, differences in the relative abundances ofAlistipes, Bilophila, andDialisterwere observed between the groups. We conclude thatT. cruziinfection results in changes in the gut microbiome that may play a role in the myocardial and intestinal inflammation seen in Chagas disease.
  • article 86 Citação(ões) na Scopus
    SARS-CoV-2 and the COVID-19 disease: a mini review on diagnostic methods
    (2020) OLIVEIRA, Beatriz Araujo; OLIVEIRA, Lea Campos de; SABINO, Ester Cerdeira; OKAY, Thelma Suely
    Coronavirus disease 2019 (COVID-19) is an infectious disease initially reported in China and currently worldwide dispersed caused by a new coronavirus (SARS-CoV-2 or 2019-nCoV) affecting more than seven million people around the world causing more than 400 thousand deaths (on June 8th, 2020). The diagnosis of COVID-19 is based on the clinical and epidemiological history of the patient. However, the gold standard for COVID-19 diagnosis is the viral detection through the amplification of nucleic acids. Although the quantitative Reverse-Transcription Polymerase Chain Reaction (RT-PCR) has been described as the gold standard for diagnosing COVID-19, there are several difficulties involving its use. Here we comment on RT-PCR and describe alternative tests developed for the diagnosis of COVID-19.
  • article 9 Citação(ões) na Scopus
    Performance of a qualitative rapid chromatographic immunoassay to diagnose COVID-19 in patients in a middle-income country
    (2020) COSTA, Silvia Figueiredo; BUSS, Lewis; ESPINOZA, Evelyn Patricia Sanchez; JR, Jose Mauro Vieira; SILVA, Lea Campos de Oliveira da; SOUZA, Regina Maia de; NETO, Lauro Perdigao; PORTO, Ana Paula Matos; LAZARI, Carolina; SANTOS, Vera Aparecida dos; DUARTE, Alberto da Silva; NASTRI, Ana Catharina; LEITE, Gabriel Fialkovitz da Costa; MANULI, Erika; OLIVEIRA, Maura Salaroli de; ZAMPELLI, Daniella Bosco; PASTORE JUNIOR, Laerte; SEGURADO, Aluisio Cotrim; LEVIN, Anna S.; SABINO, Ester
    Objectives: We evaluated a rapid chromatographic immunoassay (IgG/IgM antibodies) and an ELISA assay to diagnose COVID-19 in patient sat two Brazilian hospitals. Methods: A total of 122 subjects with COVID-19 were included: 106 SARS-COV-2 RT-PCR-positive patients and 16 RT-PCR-negative patients with symptoms and chest computed tomography (CT) consistent with COVID-19. Ninety-six historical blood donation samples were used as controls. Demographic and clinical characteristics were retrieved from electronic records. Sensitivity and specificity were calculated, as were their 95% binomial confidence intervals using the Clopper-Pearson method. All analyses were performed in R version 3.6.3. Results: The sensitivity of the chromatographic immunoassay in all RT-PCR-positive patients, irrespective of the timing of symptom onset, was 85.8% (95% binomial CI 77.7% to 91.9%). This increased with time after symptom onset, and at >14 days was 94.9% (85.9% to 98.9%). The specificity was 100% (96.4% to 100%). 15/16 (94%) RT- PCR-negative cases tested positive. The most frequent comorbidities were hypertension and diabetes mellitus and the most frequent symptoms were fever, cough, and dyspnea. All RT-PCR-negative patients had pneumonia. The most frequent thoracic CT findings were ground glass changes (n = 11, 68%), which were bilateral in 9 (56%) patients, and diffuse reticulonodular infiltrates (n = 5, 31%). Conclusions: The COVID-19 rapid chromatographic immunoassay evaluated in this study had a high sensitivity and specificity using plasma, particularly after 14 days from symptom onset. ELISA and qualitative rapid chromatographic immunoassays can be used for the diagnosis of RT-PCR-negative patients.
  • conferenceObject
    Level of literacy and clinical outcomes in patients with Chagas disease: SaMi-Trop project
    (2020) QUINTINO, N.; DAVID, G.; SABINO, E.; SILVA, J. L.; RIBEIRO, A. L.; FERREIRA, A.; OLIVEIRA, L.; OLIVEIRA, C.; CARDOSO, C.
  • article 0 Citação(ões) na Scopus
    Blood Gene Signatures of Chagas Cardiomyopathy With or Without Ventricular Dysfunction (vol 215, pg 387, 2017)
    (2020) FERREIRA, Ludmila Rodrigues Pinto; FERREIRA, Frederico Moraes; NAKAYA, Helder Imoto; DENG, Xutao; CANDIDO, Darlan da Silva; OLIVEIRA, Lea Campos de; BILLAUD, Jean-Noel; LANTERI, Marion C.; RIGAUD, Vagner Oliveira-Carvalho; SEIELSTAD, Mark; KALIL, Jorge; FERNANDES, Fabio; RIBEIRO, Antonio Luiz Pinho; SABINO, Ester Cerdeira; CUNHA-NETO, Edecio
  • article 11 Citação(ões) na Scopus
    Declining antibody levels to Trypanosoma cruzi correlate with polymerase chain reaction positivity and electrocardiographic changes in a retrospective cohort of untreated Brazilian blood donors
    (2020) BUSS, Lewis F.; SILVA, Lea Campos de Oliveira-da; MOREIRA, Carlos H. V.; MANULI, Erika R.; SALES, Flavia C.; MORALES, Ingra; GERMANIO, Clara Di; ALMEIDA-NETO, Cesar de; BAKKOUR, Sonia; CONSTABLE, Paul; PINTO-FILHO, Marcelo M.; RIBEIRO, Antonio L.; BUSCH, Michael; SABINO, Ester C.
    Author summary Infection with the single-celled parasite Trypanosoma cruzi (Chagas disease) is thought to be lifelong. However, only a third of infected people develop Chagas cardiomyopathy-the main disease manifestation. This may reflect the different extent to which individuals control the parasite, with some potentially clearing it entirely. In chronically infected immunocompetent patients, a marker of parasite burden is the quantity of antibody against T. cruzi in the blood: more parasite, more immune stimulation, more antibody. In this study we show how antibody levels change over many years in a cohort of untreated patients with Chagas disease. We find that among individuals with falling or low/borderline antibody levels there was a lower rate of parasite detection in the blood and a lower rate of cardiomyopathy. 60% of subjects with falling antibody levels had no evidence of active disease, twice as many as among patients with other antibody trajectories (stable or rising). Our findings support an account of the natural history of Chagas disease in which a proportion of those infected achieve a greater control of the parasite, with some individuals potentially clearing it completely. Background Although infection with Trypanosoma cruzi is thought to be lifelong, less than half of those infected develop cardiomyopathy, suggesting greater parasite control or even clearance. Antibody levels appear to correlate with T. cruzi (antigen) load. We test the association between a downwards antibody trajectory, PCR positivity and ECG alterations in untreated individuals with Chagas disease. Methodology/Principal findings This is a retrospective cohort of T. cruzi seropositive blood donors. Paired blood samples (index donation and follow-up) were tested using the VITROS Immunodiagnostic Products Anti-T.cruzi (Chagas) assay (Ortho Clinical Diagnostics, Raritan NJ) and PCR performed on the follow-up sample. A 12-lead resting ECG was performed. Significant antibody decline was defined as a reduction of > 1 signal-to-cutoff (S/CO) unit on the VITROS assay. Follow-up S/CO of < 4 was defined as borderline/low. 276 untreated seropositive blood donors were included. The median (IQR) follow-up was 12.7 years (8.5-16.9). 56 (22.1%) subjects had a significant antibody decline and 35 (12.7%) had a low/borderline follow-up result. PCR positivity was lower in the falling (26.8% vs 52.8%, p = 0.001) and low/borderline (17.1% vs 51.9%, p < 0.001) antibody groups, as was the rate of ECG abnormalities. Falling and low/borderline antibody groups were predominantly composed of individuals with negative PCR and normal ECG findings: 64% and 71%, respectively. Conclusions/Significance Low and falling antibody levels define a phenotype of possible spontaneous parasite clearance.
  • article 2 Citação(ões) na Scopus
    Serological screening for Chagas disease in an endemic region of Northern Minas Gerais, Brazil: the SaMi-Trop project
    (2020) CRUZ, Dardiane Santos; SOUZA, Nubia Nunes de; RAFAEL, Aline Ferreira; DAMASCENO, Renata Fiuza; RIBEIRO, Antonio Luiz Pinho; OLIVEIRA, Lea Campos de; SABINO, Ester Cerdeira; GHILARDI, Fabio de Rose; CRUZ, Ozorino Caldeira; FERREIRA, Ariela Mota; HAIKAL, Desiree Sant'Ana; CARDOSO, Clareci Silva; OLIVEIRA, Claudia Di Lorenzo; BIERRENBACH, Ana Luiza; VIEIRA, Thallyta Maria
    Chagas disease (CD) is still a neglected disease. Infected individuals are diagnosed late, being treated in worse clinical conditions. Thus, this study aimed to analyze the prevalence and the factors associated with new confirmed cases of CD identified by serological screening in an endemic region of Minas Gerais State, Brazil. This is an analytical crosssectional study with data from a project of the Research Center in Tropical Medicine of Sao Paulo- Minas Gerais (SaMi-Trop) conducted in two municipalities. Data collection included a questionnaire with closed questions, a venous blood collection and an ELISA serological test for CD. A total of 2,038 individuals with no previous diagnosis of CD participated in the study. The result of the serological test for CD was adopted as the dependent variable. The independent variables addressed personal issues, health conditions and lifetime housing. A descriptive analysis of individual variables was performed. Subsequently, a bivariate analysis was performed using the Pearson's chi-square test. Households sheltering individuals positive for CD were georeferenced, and the analysis of spatial distribution was performed using the quartic function to estimate the density of the nucleus. Among the participants, 188 (9.2 %) were positive for CD. The profile of participants with CD was associated with place of residence, age, relative/family member with CD and living conditions. It is noteworthy that there are still patients with CD who are unaware of their diagnosis in both, rural and urban areas.
  • article 13 Citação(ões) na Scopus
    Impact of the social context on the prognosis of Chagas disease patients: Multilevel analysis of a Brazilian cohort
    (2020) FERREIRA, Ariela Mota; SABINO, Ester Cerdeira; OLIVEIRA, Lea Campos de; OLIVEIRA, Claudia Di Lorenzo; CARDOSO, Clareci Silva; RIBEIRO, Antonio Luiz Pinho; DAMASCENO, Renata Fiuza; NUNES, Maria do Carmo Pereira; HAIKAL, Desiree Sant' Ana
    Author summary Chagas disease (CD) is a serious public health problem in Latin America and has a strong social impact worldwide. Up to 30% of the infected people may have cardiac alterations, which are associated with a worse prognosis and with high mortality rates. The occurrence of CD is associated with contexts of social vulnerability. However, no studies have been identified that assessed whether unfavorable social contexts are related to the prognosis and evolution of CD, which is the purpose of our study. We evaluated 1,637 patients with CD who lived in 21 municipalities located in regions to which CD is endemic in Brazil, over a two-year period. Of these people, 12.5% evolved into a worse prognosis. Our study revealed that socio-demographic and clinical characteristics of individuals were not isolated protagonists of the evolution of CD. The context in which individuals lived was also a determining factor of a worse prognosis, including living in municipalities with a smaller rural population, fewer physicians, and a smaller Primary Health Care (PHC) coverage. Thus, we observed that characteristics related to the health care available in the municipalities influenced the evolution of CD. This knowledge has the potential to support health care planning that is more appropriate for the evolution of patients with CD, especially considering poor and remote regions. The present study aims to investigate how the social context contributes to the prognosis of Chagas disease (CD). This is a multilevel study that considered individual and contextual data. Individual data came from a Brazilian cohort study that followed 1,637 patients who lived in 21 municipalities to which CD is endemic, over two years. Contextual data were collected from official Brazilian government databases. The dependent variable wasthe occurrence of cardiovascular events in CDduring the two-year follow-up, defined from the grouping of three possible combined events: death, development of atrial fibrillation, or pacemaker implantation. Analysis was performed using multilevel binary logistic regression. Among the individuals evaluated, 205 (12.5%) manifested cardiovascular events in CD during two years of follow-up. Individuals living in municipalities with a larger rural population had protection for these events (OR = 0.5; 95% CI = 0.4-0.7), while those residing in municipalities with fewer physicians per thousand inhabitants (OR = 1.6; 95% CI = 1.2-2.5) and those living in municipalities with lower Primary Health Care (PHC) coverage (OR = 1.4; 95% CI = 1.1-2.1) had higher chances of experiencing cardiovascular events. Among the individual variables, the probability of experiencing cardiovascular events was higher for individuals aged over 60 years (OR = 1.4; 95% CI = 1.01-2.2), with no stable relationship (OR = 1.4; 95% CI = 0.98-2.1), without previous treatment with Benznidazole (OR = 1.5; 95% CI = 0.98-2.9), with functional class limitation (OR = 2.0; 95% CI = 1.4-2.9), with a QRS complex duration longer than 120 ms (OR = 1.5; 95% CI = 1.1-2.3), and in individuals with high NT-proBNP levels (OR = 6.4; 95% CI = 4.3-9.6). CONCLUSION: The present study showed that the occurrence of cardiovascular events in individuals with CD is determined by individual conditions that express the severity of cardiovascular involvement. However, these individual characteristics are not isolated protagonists of this outcome, and the context in which individuals live, are also determining factors for a worse clinical prognosis.