CHRISTINA TERRA GALLAFRIO NOVAES
Índice h a partir de 2011
3
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
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bookPart Infecção por HIV e AIDS(2015) GUTIERREZ, Eliana Battaggia; NOVAES, Christina Terra GallafrioconferenceObject CHAGAS DISEASE CARDIOMYOPATHY: ASSOCIATION WITH IL-17 AND IL-18 GENETIC POLYMORPHISMS(2018) SANTOS, Alexandra dos; FERREIRA, Daiane; OLIVEIRA, Jamile; OLIVEIRA, Claudia; BOCCHI, Edimar; NOVAES, Cristina; CRUZ, Fatima; CARVALHO, Noemia; SATO, Paula; FREITAS, Vera; SHIKANAI-YASUDA, Maria- Estimating health service utilization for treatment of pneumococcal disease: The case of Brazil(2013) SARTORI, A. M. C.; NOVAES, C. G.; SOAREZ, P. C. de; TOSCANO, C. M.; NOVAES, H. M. D.Background: Health service utilization (HSU) is an essential component of economic evaluations of health initiatives. Defining HSU for cases of pneumococcal disease (PD) is particularly complex considering the varying clinical manifestations and diverse severity. Objective: We describe the process of developing estimates of HSU for PD as part of an economic evaluation of the introduction of pneumococcal conjugate vaccine in Brazil. Methods: Nationwide inpatient and outpatient HSU by children under-5 years with meningitis (PM), sepsis (PS), non-meningitis non-sepsis invasive PD (NMNS), pneumonia, and acute otitis media (AOM) was estimated. We assumed that all cases of invasive PD (PM, PS, and NMNS) required hospitalization. The study perspective was the health system, including both the public and private sectors. Data sources were obtained from national health information systems, including the Hospital Information System (SIH/SUS) and the Notifiable Diseases Information System (SINAN); surveys; and community-based and health care facility-based studies. Results: We estimated hospitalization rates of 7.69 per 100,000 children under-5 years for PM (21.4 for children <1 years of age and 4.3 for children aged 1-4 years), 5.89 for PS (20.94 and 2.17), and 4.01 for NMNS (5.5 and 3.64) in 2004, with an overall hospitalization rate of 17.59 for all invasive PD (47.27 and 10.11). The estimated incidence rate of all-cause pneumonia was 93.4 per 1000 children under-5 (142.8 for children <1 years of age and 81.2 for children aged 1-4 years), considering both hospital and outpatient care. Discussion: Secondary data derived from health information systems and the available literature enabled the development of national HSU estimates for PD in Brazil. Estimating HSU for noninvasive disease was challenging, particularly in the case of outpatient care, for which secondary data are scarce. Information for the private sector is lacking in Brazil, but estimates were possible with data from the public sector and national population surveys.
- Genetic diversity of Trypanosoma cruzi strains isolated from chronic chagasic patients and non-human hosts in the state of Sao Paulo, Brazil(2022) SOUZA, Thiago Kury Moreno de; WESTPHALEN, Elizabeth Visone Nunes; WESTPHALEN, Sansao da Rocha; TANIGUCHI, Helena Hilomi; ELIAS, Carlos Roberto; MOTOIE, Gabriela; GAVA, Ricardo; PEREIRA-CHIOCCOLA, Vera Lucia; NOVAES, Christina Terra Gallafrio; CARVALHO, Noemia Barbosa; BOCCHI, Edimar Alcides; CRUZ, Fatima das Dores da; ROCHA, Mussya Cisotto; SHINJO, Samuel Katsuyuki; SHIKANAI-YASUDA, Maria Aparecida; ORTIZ, Paola Andrea; TEIXEIRA, Marta Maria Geraldes; TOLEZANO, Jose EduardoBACKGROUND Trypanosoma cruzi shows an exuberant genetic diversity. Currently, seven phylogenetic lineages, called discrete typing units (DTUs), are recognised: TcI-TcVI and Tcbat. Despite advances in studies on T. cruzi and its populations, there is no consensus regarding its heterogeneity. OBJECTIVES This study aimed to perform molecular characterisation of T. cruzi strains, isolated in the state of S??o Paulo, to identify the DTUs involved and evaluate their genetic diversity. METHODS T. cruzi strains were isolated from biological samples of chronic chagasic patients, marsupials and triatomines through culture techniques and subjected to molecular characterisation using the fluorescent fragment length barcoding (FFLB) technique. Subsequently, the results were correlated with complementary information to enable better discrimination between the identified DTUs. FINDINGS It was possible to identify TcI in two humans and two triatomines; TcII/VI in 19 humans, two marsupials and one triatomine; and TcIII in one human host, an individual that also presented a result for TcI, which indicated the possibility of a mixed infection. Regarding the strains characterised by the TcII/VI profile, the correlation with complementary information allowed to suggest that, in general, these parasite populations indeed correspond to the TcII genotype. MAIN CONCLUSIONS The TcII/VI profile, associated with domestic cycles and patients with chronic Chagas disease, was the most prevalent among the identified DTUs. Furthermore, the correlation of the study results with complementary information made it possible to suggest that TcII is the predominant lineage of this work.
- Quantitative PCR as a marker for preemptive therapy and its role in therapeutic control in Trypanosoma cruzi/HIV coinfection(2024) FREITAS, Vera Lucia Teixeira de; NOVAES, Christina Terra Gallafrio; SARTORI, Ana Marli Christovam; CARVALHO, Noemia Barbosa; SILVA, Sheila Cristina Vicente da; NAKANISHI, erika Shimoda; SALVADOR, Fernando; CASTRO, Cleudson Nery de; BEZERRA, Rita Cristina; WESTPHALEN, Elizabeth Visone Nunes; OLIVEIRA, Caroline Medeji Ramos de; BUSSER, Felipe Delatorre; HO, Yeh-Li; BUCCHERI, Renata; BONILLA, Carolina; SHIKANAI-YASUDA, Maria AparecidaBackground Trypanosoma cruzi and HIV coinfection can evolve with depression of cellular immunity and increased parasitemia. We applied quantitative PCR (qPCR) as a marker for preemptive antiparasitic treatment to avoid fatal Chagas disease reactivation and analyzed the outcome of treated cases. Methodology This mixed cross-sectional and longitudinal study included 171 Chagas disease patients, 60 coinfected with HIV. Of these 60 patients, ten showed Chagas disease reactivation, confirmed by parasites identified in the blood, cerebrospinal fluid, or tissues, 12 exhibited high parasitemia without reactivation, and 38 had low parasitemia and no reactivation. Results We showed, for the first time, the success of the timely introduction of benznidazole in the non-reactivated group with high levels of parasitemia detected by qPCR and the absence of parasites in reactivated cases with at least 58 days of benznidazole. All HIV+ patients with or without reactivation had a 4.0-5.1 higher chance of having parasitemia than HIV seronegative cases. A positive correlation was found between parasites and viral loads. Remarkably, treated T. cruzi/HIV-coinfected patients had 77.3% conversion from positive to negative parasitemia compared to 19.1% of untreated patients. Additionally, untreated patients showed similar to 13.6 times higher Odds Ratio of having positive parasitemia in the follow-up period compared with treated patients. Treated and untreated patients showed no differences regarding the evolution of Chagas disease. The main factors associated with all-cause mortality were higher parasitemia, lower CD4 counts/mu L, higher viral load, and absence of antiretroviral therapy. Conclusion We recommend qPCR prospective monitoring of T. cruzi parasitemia in HIV+ coinfected patients and point out the value of pre-emptive therapy for those with high parasitemia. In parallel, early antiretroviral therapy introduction is advisable, aiming at viral load control, immune response restoration, and increasing survival. We also suggest an early antiparasitic treatment for all coinfected patients, followed by effectiveness analysis alongside antiretroviral therapy.
- Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the ""Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions"" (vol 15, e0009809, 2021)(2023) SHIKANAI-YASUDA, Maria Aparecida; MEDIANO, Mauro Felippe Felix; NOVAES, Christina Terra Gallafrio; SOUSA, Andrea Silvestre de; SARTORI, Ana Marli Christovam; SANTANA, Rodrigo Carvalho; CORREIA, Dalmo; CASTRO, Cleudson Nery de; SEVERO, Marilia Maria dos Santos; HASSLOCHER-MORENO, Alejandro Marcel; FERNANDEZ, Marisa Liliana; SALVADOR, Fernando; PINAZO, Maria Jesus; BOLELLA, Valdes Roberto; FURTADO, Pedro Carvalho; CORTI, Marcelo; PINTO, Ana Yece Neves; FICA, Alberto; MOLINA, Israel; GASCON, Joaquim; VINAS, Pedro Albajar; CORTEZ-ESCALANTE, Juan; RAMOS JR., Alberto Novaes; ALMEIDA, Eros Antonio de
bookPart Infecção pelo Vírus da Imunodeficiência Humana (HIV) e Síndrome da Imunodeficiência Adquirida (Aids)(2016) SEGURADO, Aluísio Augusto Cotrim; FREITAS, Angela Carvalho; ATOMIYA, Angela Naomi; WüNSCH, Celia Torrens; NOVAES, Christina Terra Gallafrio; HIGASHINO, Hermes Ryoiti; BERMUDEZ, Jose Ernesto Vidal; CHAVES NETTO, Lucas; VICENTINE, Margarete Paganotti; BOULOS, Maria Ivete Castro; LOPES, Max Igor Banks Ferreira; VASCONCELOS, Ricardo de Paula; SANTOS, Sigrid de Sousa dos; MELLO, Valéria Antakly de; AVELINO-SILVA, Vivian Helena Iida- Yellow fever(2018) LITVOC, Marcelo Nobrega; NOVAES, Christina Terra Gallafrio; LOPES, Max Igor Banks FerreiraThe yellow fever (YF) virus is a Flavivirus, transmitted by Haemagogus, Sabethes or Aedes aegypti mosquitoes. The disease is endemic in forest areas in Africa and Latin America leading to epizootics in monkeys that constitute the reservoir of the disease. There are two forms of YF: sylvatic, transmitted accidentally when approaching the forests, and urban, which can be perpetuated by Aedes aegypti. In Brazil, the last case of urban YF occurred in 1942. Since then, there has been an expansion of transmission areas from the North and Midwest regions to the South and Southeast. In 2017, the country faced an important outbreak of the disease mainly in the states of Minas Gerais, Espirito Santo and Rio de Janeiro. In 2018, its reach extended from Minas Gerais toward Sao Paulo. Yellow fever has an incubation period of 3 to 6 days and sudden onset of symptoms with high fever, myalgia, headache, nausea/ vomiting and increased transaminases. The disease ranges from asymptomatic to severe forms. The most serious forms occur in around 15% of those infected, with high lethality rates. These forms lead to renal, hepatic and neurological impairment, and bleeding episodes. Treatment of mild and moderate forms is symptomatic, while severe and malignant forms depend on intensive care. Prevention is achieved by administering the vaccine, which is an effective (immunogenicity at 90-98%) and safe (0.4 severe events per 100,000 doses) measure. In 2018, the first transplants in the world due to YF were performed. There is also an attempt to evaluate the use of active drugs against the virus in order to reduce disease severity.
- Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the ""Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions""(2021) SHIKANAI-YASUDA, Maria Aparecida; MEDIANO, Mauro Felippe Felix; NOVAES, Christina Terra Gallafrio; SOUSA, Andrea Silvestre de; SARTORI, Ana Marli Christovam; SANTANA, Rodrigo Carvalho; CORREIA, Dalmo; CASTRO, Cleudson Nery de; SEVERO, Marilia Maria dos Santos; HASSLOCHER-MORENO, Alejandro Marcel; FERNANDEZ, Marisa Liliana; SALVADOR, Fernando; PINAZO, Maria Jesus; BOLELLA, Valdes Roberto; FURTADO, Pedro Carvalho; CORTI, Marcelo; PINTO, Ana Yece Neves; FICA, Alberto; MOLINA, Israel; GASCON, Joaquim; VINAS, Pedro Albajar; CORTEZ-ESCALANTE, Juan; JR, Alberto Novaes Ramos; ALMEIDA, Eros Antonio deObjective Chagas disease (CD) globalization facilitated the co-infection with Human Immunodeficiency Virus (HIV) in endemic and non-endemic areas. Considering the underestimation of Trypanosoma cruzi (T. cruzi)-HIV co-infection and the risk of life-threatening Chagas Disease Reactivation (CDR), this study aimed to analyze the major co-infection clinical characteristics and its mortality rates. Methods This is a cross-sectional retrospective multicenter study of patients with CD confirmed by two serological or one parasitological tests, and HIV infection confirmed by immunoblot. CDR was diagnosed by direct microscopy with detection of trypomastigote forms in the blood or other biological fluids and/or amastigote forms in inflammatory lesions. Results Out of 241 patients with co-infection, 86.7% were from Brazil, 47.5% had <200 CD4(+) T cells/mu L and median viral load was 17,000 copies/mu L. Sixty CDR cases were observed. Death was more frequent in patients with reactivation and was mainly caused by CDR. Other causes of death unrelated to CDR were the manifestation of opportunistic infections in those with Acquired Immunodeficiency Syndrome. The time between the co-infection diagnosis to death was shorter in patients with CDR. Lower CD4(+) cells count at co-infection diagnosis was independently associated with reactivation. Similarly, lower CD4(+) cells numbers at co-infection diagnosis and male sex were associated with higher lethality in CDR. Additionally, CD4(+) cells were lower in meningoencephalitis than in myocarditis and milder forms. Conclusion This study showed major features on T. cruzi-HIV co-infection and highlighted the prognostic role of CD4(+) cells for reactivation and mortality. Since lethality was high in meningoencephalitis and all untreated patients died shortly after the diagnosis, early diagnosis, immediate antiparasitic treatment, patient follow-up and epidemiological surveillance are essentials in T. cruzi/HIV co-infection and CDR managements.
- Sporadic Creutzfeldt-Jakob disease in two clinically and virologically controlled Brazilian HIV patients who progressed rapidly to dementia: case reports and literature review(2021) DAHY, Flavia Esper; NOVAES, Christina T. G.; BANDEIRA, Gabriela A.; RAMIN, Lais F.; OLIVEIRA, Augusto Cesar Penalva de; SMID, JerusaHuman immunodeficiency virus (HIV)-associated neurocognitive disorders are the main cause of cognitive decline and dementia in people living with HIV (PLHIV). However, extensive workup should be done in patients with rapidly progressive dementia (RPD) and HIV, especially when secondary infection in the central nervous system (CNS) is ruled out. Sporadic Creutzfeldt-Jakob disease (sCJD) is the main cause of RPD in non-HIV patients. It is a fatal neurodegenerative condition caused by prions that mainly affects elderly patients. Our objective is to describe two cases of PLHIV presenting with controlled infections and sCJD, and to review the literature. Our patients were younger than expected for sCJD and one of them had a longer disease course. As aging is expected to occur earlier in PLHIV, sCJD must be excluded in younger PLHIV presenting with RPD and without CNS infection.