Departamento de Moléstias Infecciosas e Parasitárias - FM/MIP

URI Permanente desta comunidade

O Departamento de Moléstias Infecciosas e Parasitárias (MIP), da Faculdade de Medicina da Universidade de São Paulo (FMUSP) tem como objetivo contribuir para a formação de médicos, especialistas, docentes e pesquisadores; gerar conhecimentos pela pesquisa e estender serviços à comunidade. Oferece seis disciplinas nucleares: Microbiologia Médica, Parasitologia, Imunologia Médica, Patologia de Moléstias Transmissíveis, Clínica de Moléstias Transmissíveis, Bases do Controle e Prevenção de Moléstias Transmissíveis, além de outras treze disciplinas optativas capazes de dar uma visão mais ampla a respeito dessa área de estudo.

Oferece aos estudantes bases para a compreensão da relação saúde/moléstia/comunidade para colocá-los em contato com a realidade médica brasileira, no que diz respeito às moléstias transmissíveis. Oferece Pós-graduação lato sensu e stricto sensu, desenvolvendo pesquisa em linhas relacionadas às áreas de Infecção por HIV/AIDS, hepatites, infecções endêmicas, infecções hospitalares e infecções em imunodeprimidos, terapia intensiva, imunizações, acidentes causados por animais peçonhentos e infecções virais. O Programa de Residência Médica/Pós graduação lato sensu em infectologia do Hospital das Clínicas da FMUSP teve início em 1951 tendo formado dezenas de médicos residentes, muitos dos quais desenvolvem suas atividades em vários Estados brasileiros.

Site oficial: https://www.fm.usp.br/mip/portal/

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article 7 Citação(ões) na Scopus
Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories
(2024) RAZAVI-SHEARER, Devin M.; BUTI, Maria; TACKE, Frank; TERRAULT, Norah A.; ZEUZEM, Stefan; ABBAS, Zaigham; AGHEMO, Alessio; AKARCA, Ulus S.; MASRI, Nasser M. Al; ALALWAN, Abduljaleel M.; BLOME, Marianne Alanko; ALEMAN, Soo; ALGHAMDI, Abdullah S.; ALGHAMDI, Mohammed; ALGHAMDI, Saad; AL-HAMOUDI, Waleed K.; ALI, Ela; ALJUMAH, Abdulrahman A.; ALTRAIF, Ibrahim H.; AMARSANAA, Jazag; ASSELAH, Tarik; BAATARKHUU, Oidov; BABAMETO, Adriana; BEN-ARI, Ziv; BERG, Thomas; BIONDI, Mia J.; BRAGA, Wornei S. M.; BRANDAO-MELLO, Carlos E.; BROWN JR., Robert S.; BRUNETTO, Maurizia R.; CABEZAS, Joaquin; CARDOSO, Mariana; CHAN, Henry Lik Yuen; CHEINQUER, Hugo; CHEN, Chien-Jen; CHEN, Pei-Jer; CHIEN, Cheng-Hung; CHILD, Hailey; CHUANG, Wan-Long; GARZA, Laura E. Cisneros; COCO, Barbara; COFFIN, Carla S.; COPPOLA, Nicola; CORNBERG, Markus; CRAXI, Antonio; CRESPO, Javier; CUKO, Liri; LEDINGHEN, Victor De; DUBERG, Ann-Sofi; ETZION, Ohad; FERRAZ, Maria Lucia G.; FERREIRA, Paulo R. A.; FORNS, Xavier; FOSTER, Graham R.; FUNG, James; GAETA, Giovanni B.; GARCIA-SAMANIEGO, Javier; GENOV, Jordan; GHEORGHE, Liliana S.; GHOLAM, Pierre M.; GISH, Robert G.; GLENN, Jeffrey; GOLDIS, Adrian; HAMID, Saeed S.; HERCUN, Julian; HSU, Yao-Chun; HU, Ching-Chih; HUANG, Jee-Fu; IDILMAN, Ramazan; JAFRI, Wasim S. M.; JANJUA, Naveed; JELEV, Deian; JERKEMAN, Anna; JIA, Jidong; KABERG, Martin; KAITA, Kelly D. E.; KAO, Jia-Horng; KHAN, Aamir G.; KIM, Do Young; KONDILI, Loreta A.; LAGGING, Martin; LAMPERTICO, Pietro; LAZARO, Pablo; V, Jeffrey Lazarus; LEE, Mei-Hsuan; LIM, Young-Suk; LOBATO, Cirley M. O.; MACEDO, Guilherme; MARINHO, Rui T.; MAROTTA, Paul J.; MARTINS, Alexanda; MENDES-CORREA, Maria Cassia; MENDEZ-SANCHEZ, Nahum; NAVAS, Maria-Cristina; NING, Qing; ORMECI, Necati; ORREGO, Mauricio; OSIOWY, Carla; PAN, Calvin Q.; PESSOA, Mario G.; PIRACHA, Zahra Z.; POP, Cora; RAMOS, Jose A. Presa; QURESHI, Huma; RAIMONDO, Giovanni; RAMJI, Alnoor; RAZAVI-SHEARER, Kathryn; RIBEIRO, Sofia; RIOS-HINCAPIE, Cielo Y.; RODRIGUEZ, Manuel; ROSENBERG, William M. C.; ROULOT, Dominique; RYDER, Stephen D.; SAEED, Umar; SAFADI, Rifaat; SANAI, Faisal M.; SANCHEZ-AVILA, Juan F.; SANTANTONIO, Teresa A.; SARRAZIN, Christoph; SETO, Wai-Kay; SHOUVAL, Daniel; SIMONOVA, Marieta Y.; TANAKA, Junko; TERGAST, Tammo L.; TSENDSUREN, Oyunsuren; VALENTE, Cristina; VILLALOBOS-SALCEDO, Juan Miguel; VOELLER, Alexis S.; WAHEED, Yasir; WONG, Grace L-H; WONG, Vincent W-S; WU, Jaw-Ching; I, Hwai- Yang; YIP, Terry C-F; YU, Ming-Lung; YUEN, Man-Fung; YURDAYDIN, Cihan; ZUCKERMAN, Eli; RAZAVI, Homie A.
Background & Aims: Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories. Methods: We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level. Results: After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases. Conclusions: We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened.
article 0 Citação(ões) na Scopus
Guideline Adherence and Outcomes of Patients with Candidemia in Brazil
(2024) ARAUJO, Jordana Machado; ALMEIDA JUNIOR, Joao Nobrega de; MAGRI, Marcello Mihailenko Chaves; COSTA, Silvia Figueiredo; GUIMARAES, Thais
Candidemia is a significant cause of mortality among hospitalized patients, both worldwide and in Brazil. Prompt and appropriate treatment are essential to mitigate mortality, and clinical practice guidelines aim to optimize patient care based on the best scientific evidence. This study aims to examine the management of candidemia, assessing adherence to the guidelines of the Brazilian Society of Infectious Diseases in a single center located at S & atilde;o Paulo, Brazil. All adult patients hospitalized from 2016 to 2018 who presented one positive blood culture for Candida spp. were included. Electronic medical records were retrospectively reviewed to collect information relevant to the treatment for candidemia, in order to assess the adherence to the Brazilian guideline for the management of candidemia in relation to nine defined outcomes, and we correlated those findings with 30-day mortality by using uni- and multivariate analyses. A total of 115 patients were included; 68 patients (59.1%) were male, with a mean age of 55 years. C. albicans, C. tropicalis and C. glabrata were the most prevalent species. In total, 80 patients (69.5%) received antifungal treatment. The adherence to Brazilian guideline recommendations was determined as described in the following: initial treatment with echinocandin in 48 (60%); step-down to fluconazole in 21 (26.2%); collection of first control blood culture in 43 (58.9%); collection of second control blood culture, if the first one had been positive, in 14 (73.6%); treatment for 14 days after the first negative blood culture in 53 (65.4%); central venous catheter (CVC) removal in 66 (82.5%); CVC removal if the first control blood culture had been positive in 17 (89.4%); performance of a transthoracic echocardiogram in 51 (63.7%) and performance of a fundoscopy in 59 (73.7%). Univariate analysis showed that CVC removal and initial echinocandin therapy were more prevalent in the surviving group, but with no statistically significant difference. On the other hand, step-down to fluconazole demonstrated higher survival rate in the multivariate analysis OR 0.15 (95% CI 0.03-0.8); p = 0.02. The analysis of these nine recommendations demonstrates that it is necessary to improve adherence to specific recommendations and also disseminate strategies of the initial use of echinocandin as the drug of choice and addressing length of treatment and follow-up and complementary exams. Our study provides reassurance that the step-down to fluconazole is safe and may be recommended, if the preexisting conditions are present.
article 0 Citação(ões) na Scopus
Epidemiological Assessment and Risk Factors for Mortality of Bloodstream Infections by Candida sp. and the Impact of the COVID-19 Pandemic Era
(2024) ARAUJO, Jordana Machado; ALMEIDA JUNIOR, Joao Nobrega de; MAGRI, Marcello Mihailenko Chaves; COSTA, Silvia Figueiredo; GUIMARAES, Thais
Candidemia is one of the healthcare-associated infections that has high mortality. The risk factors that predispose a patient to develop this infection are mostly found in patients of greater severity and COVID-19 contributes to the risk of death. The aim of this study is to evaluate epidemiological characteristics and risk factors for mortality in patients with candidemia before and during the COVID-19 pandemic era. This is a retrospective study conducted at Instituto Central from 2016 to 2020 of patients with candidemia that were evaluated for demographic data, medical history, risk factors, microbiological data, therapeutic measures, complementary exams, device management, and outcome defined by 30-day mortality. A total of 170 episodes were included (58.2% males; mean age of 56 years). The overall incidence density of candidemia per 1000 admissions and per 1000 patient-days was 1.17 and 0.17, respectively, with an increase of 38% in the year 2020. The use of a central venous catheter was the most prevalent (93.5%) condition, followed by the previous use of antibiotics (91.1%). Corticosteroid use ranked seventh (56.4%). C. albicans was responsible for 71 (41.7%) of the isolates, followed by C. tropicalis and C. glabrata, with 34 (20%) isolates each. Echinocandin was prescribed in 60.1% of cases and fluconazole in 37%. Echocardiography resulted in six (5.08%) cases of endocarditis and fundoscopy resulting in two (2.4%) endophthalmitis. The 30-day mortality was 93/170 (54.7%). The risk factors associated with mortality were age (OR 1.03, CI 95% 1.01-1.06), heart disease (OR 7.51, CI 95% 1.48-37.9), hemodialysis (OR 3.68, CI 95% 1.28-10.57), and use of corticosteroids (OR 2.83, CI 95% 1.01-7.92). The COVID-19 pandemic had an impact on the increase incidence of candidemia. The persistently high mortality highlights the need for better management strategies, control of risk factors, and guarantee of adequate treatment.
article 0 Citação(ões) na Scopus
Recurrent acquired ocular toxoplasmosis associated with Kyrieleis plaques and documented allergy to sulfonamide-A treatment proposal for two rare conditions
(2024) AMATO, Valdir Sabbaga; RIBEIRO, Victoria Stadler Tasca; SILVA, Allan Gomes; GOMES, Andre Marcelo Vieira; TUON, Felipe Francisco
The aim of this study was to describe a case of a patient with ocular toxoplasmosis, which has resulted in Kyrieleis plaques formation (segmental periarteritis associated with severe inflammation) and later follow-up and alternative treatment due to documented allergy to sulfonamide. A 33 -year -old Brazilian woman diagnosed with acute toxoplasmosis, initially treated with sulfonamide, developed a critical cutaneous rash. Cotrimoxazole was changed to clindamycin and pyrimethamine, and prednisone was started. The medication was maintained for 45 days. Four months later, she developed retinal lesions suggestive of toxoplasmosis with Kyrieleis plaques in the upper temporal vessels. Pyrimethamine, clindamycin, and prednisone were initiated until healing. She presented reactivation months later, and a suppressive treatment with pyrimethamine was instituted for one year. This is the first report to use the combination of clindamycin with pyrimethamine in the treatment and recurrence prophylaxis for OT in a documented allergy to sulfonamide.
article 0 Citação(ões) na Scopus
Case Report: In Situ and Systemic Immune Response to Mucosal Leishmaniasis in an HIV-Infected Patient
(2024) AMATO, Valdir Sabbaga; FRANCO, Lucas Augusto Moyses; SOUZA, Regina Maia de; SILVA, Camila Alves Maia da; RAMUNDO, Mariana Severo; CORTES, Marina Farrel; CORREA-CASTRO, Gabriela; SANTOS-OLIVEIRA, Joanna Reis; DA-CRUZ, Alda M.; PAGLIARI, Carla; GALO, Luciane Kanashiro; TUON, Felipe Francisco
In situ and systemic evaluations of the immune responses of HIV -infected patients to mucosal leishmaniasis have been poorly described. We describe a recently diagnosed HIV -infected patient with mucosal leishmaniasis who was characterized by a CD4 count of 85 cells/mm3 and nasal septum destruction resulting from pruritic and ulcerated nasal mucosa with crust formation and progression over 2 years. In situ and systemic immune evaluations of T cell activation, memory, and exhaustion were conducted using cytofluorometric assays, and sequencing of the Leishmania species was performed. The immune profile of HIV -infected patient with mucosal leishmaniasis shows a mixed Th1/Th2 pattern and an activated and exhausted status.
article 0 Citação(ões) na Scopus
Immunogenicity of COVID-19 adsorbed inactivated vaccine (CoronaVac) and additional doses of mRNA BNT162b2 vaccine in immunocompromised adults compared with immunocompetent persons
(2024) IBRAHIM, Karim Yaqub; MOREIRA, Raquel Megale; SANTOS, Carolina Ferreira dos; STRABELLI, Tania Mara Varejao; BELIZARIO, Juliana de Cassia; PINTO, Maria Isabel de Moraes; MARINHO, Ana Karolina Barreto Berselli; PEREIRA, Juliana Marquezi; MELLO, Liliane Saraiva de; ANDO, Mauricio Cesar; SILVA, Vitor Gabriel Lopes da; SATO, Paula Keiko; LIMA, Marcos Alves de; FRANCA, Joao Italo Dias; LOCH, Ana Paula; MIYAJI, Karina Takesaki; INFANTE, Vanessa; PRECIOSO, Alexander Roberto; SARTORI, Ana Marli Christovam
Inactivated COVID-19 vaccines data in immunocompromised individuals are scarce. This trial assessed the immunogenicity of two CoronaVac doses and additional BNT162b2 mRNA vaccine doses in immunocompromised (IC) and immunocompetent (H) individuals. Adults with solid organ transplant (SOT), hematopoietic stem cell transplant, cancer, inborn immunity errors or rheumatic diseases were included in the IC group. Immunocompetent adults were used as control group for comparison. Participants received two CoronaVac doses within a 28-day interval. IC received two additional BNT162b2 doses and H received a third BNT162b2 dose (booster). Blood samples were collected at baseline, 28 days after each dose, pre-booster and at the trial end. We used three serological tests to detect antibodies to SARS-CoV-2 nucleocapsid (N), trimeric spike (S), and receptor binding domain (RBD). Outcomes included seroconversion rates (SCR), geometric mean titers (GMT) and GMT ratio (GMTR). A total of 241 IC and 100 H adults participated in the study. After two CoronaVac doses, IC had lower SCR than H: anti-N, 33.3% vs 79%; anti-S, 33.8% vs 86%, and anti-RBD, 48.5% vs 85%, respectively. IC also showed lower GMT than H: anti-N, 2.3 vs 15.1; anti-S, 58.8 vs 213.2 BAU/mL; and anti-RBD, 22.4 vs 168.0 U/mL, respectively. After the 3 rd and 4 th BNT162b2 doses, IC had significant anti-S and anti-RBD seroconversion, but still lower than H after the 3 rd dose. After boosting, GMT increased in IC, but remained lower than in the H group. CoronaVac two-dose schedule immunogenicity was lower in IC than in H. BNT162b2 heterologous booster enhanced immune response in both groups.
article 0 Citação(ões) na Scopus
COVID-19 in hematopoietic stem cell transplant recipients during three years of the pandemic: a multicenter study in Brazil
(2024) RANDI, Bruno Azevedo; HIGASHINO, Hermes Ryoiti; SILVA, Vinicius Ponzio da; SALOMAO, Matias Chiarastelli; PIGNATARI, Antonio Carlos Campos; ABDALA, Edson; VASQUES, Fabiana; SILVA, Celso Arrais Rodrigues da; SILVA, Roberto Luiz da; LAZARI, Carolina dos Santos; LEVI, Jose Eduardo; XAVIER, Erick Menezes; CORTES, Marina Farrel; LUNA-MUSCHI, Alessandra; ROCHA, Vanderson; COSTA, Silvia Figueiredo
Hematopoietic stem cell transplant (HSCT) recipients are at -increased risk for severe COVID-19. The aim of this study was to evaluate the burden of COVID-19 in a cohort of HSCT recipients. This retrospective study evaluated a cohort of adult hospitalized HSCT recipients diagnosed with COVID-19 in two large hospitals in Sao Paulo, Brazil postHSCT, from January 2020 to June 2022. The primary outcome was all-cause mortality. Of 49 cases, 63.2% were male with a median age of 47 years. Allogeneic-HSCT (51.2%) and autologous-HSCT (48.9%) patients were included. The median time from HSCT to COVID-19 diagnosis was 398 days (IQR: 1211-134), with 22 (44.8%) cases occurring within 12 months of transplantation. Most cases occurred during the first year of the pandemic, in non-vaccinated patients (n=35; 71.4%). Most patients developed severe (24.4%) or critical (40.8%) disease; 67.3% received some medication for COVID-19, primarily corticosteroids (53.0%). The probable invasive aspergillosis prevalence was 10.2%. All-cause mortality was 40.8%, 51.4% in non-vaccinated patients and 14.2% in patients who received at least one dose of the vaccine. In the multiple regression analyses, the variables mechanical ventilation (OR: 101.01; 95% CI: 8.205 - 1,242.93; p = 0.003) and chest CT involvement at diagnosis >= 50% (OR: 26.61; 95% CI: 1.06 - 664.26; p = 0.04) remained associated with all-cause mortality. Thus, HSCT recipients with COVID-19 experienced high mortality, highlighting the need for full vaccination and infection prevention measures.
article 1 Citação(ões) na Scopus
First report of New Delhi metallo-beta-lactamase-5 (NDM-5)-producing Escherichia coli isolates from water environment in Cameroon
(2024) MEGUEYA, Armelle Leslie; MAKUETCHE, Kevine; SCACCIA, Nazareno; COSTA, Silvia Figueiredo; FONCESCA, Joyce Vanessa da Silva; KOMURIAN-PRADEL, Florence; TCHATCHOUANG, Serges; SIMO, Pierrette; TCHATCHUENG, Jules; NONO, Arsene Djoko; NGANG, Essia; NGANDJIO, Antoinette; NZOUANKEU, Ariane
article 0 Citação(ões) na Scopus
SARS-CoV-2 shedding, infectivity, and evolution in an immunocompromised adult patient
(2024) MENDES-CORREA, Maria Cassia; GHILARDI, Fabio de Rose; SALOMAO, Matias Chiarastelli; VILLAS-BOAS, Lucy Santos; PAULA, Anderson Vicente de; PAIAO, Heuder Gustavo Oliveira; COSTA, Antonio Charlys da; TOZETTO-MENDOZA, Tania Regina; FREIRE, Wilton; SALES, Flavia Cristina Silva; CLARO, Ingra Morales; SABINO, Ester Cerdeira; FARIA, Nuno Rodrigues; WITKIN, Steven Sol
This study aimed to provide further insight into the evolutionary dynamics of SARS-CoV-2 by analyzing the case of a 40 -year -old man who had previously undergone autologous hematopoietic stem cell transplantation due to a diffuse large B -cell lymphoma. He developed a persistent SARS-CoV-2 infection lasting at least 218 days and did not manifest a humoral immune response to the virus during this follow-up period. Whole-genome sequencing and viral cultures confirmed a persistent infection with a replication -positive virus that had undergone genetic variation for at least 196 days after symptom onset.
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(2021) OLIVEIRA, Maura Salaroli de; SANTOS, Ana Rubia Guedes dos; LEVIN, Anna Sara Shafferman