JOSE ERNESTO VIDAL BERMUDEZ
Projetos de Pesquisa
Unidades Organizacionais
P ICHC, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina - Líder
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- Plasma extracellular microRNAs are related to AIDS/cerebral toxoplasmosis co-infection(2020) PEREIRA, Ingrid de Siqueira; MAIA, Marta Marques; CRUZ, Allecineia Bispo da; TELLES, Joao Paulo Marochi; VIDAL, Jose Ernesto; GAVA, Ricardo; MEIRA-STREJEVITCH, Cristina Silva; PEREIRA-CHIOCCOLA, Vera LuciaThis study investigated the potential of five miRNA candidates for cerebral toxoplasmosis/HIV co-infection (CT/HIV) biomarkers. miR-155-5p, miR-146a-5p, miR-21-5p, miR-125b-5p and miR-29c-3p were tested in 79 plasma divided into groups: 32 CT/HIV patients; 27 individuals with asymptomatic toxoplasmosis (AT); and 20 individuals seronegative for toxoplasmosis (NC). From each was collected peripheral blood/EDTA for laboratory diagnosis. Blood cells for DNA extractions (molecular diagnosis), plasma for RNA extractions (gene expression) and ELISA (serological diagnosis). miRNA expression was performed by qPCR, and values were expressed in Relative Quantification (RQ). Among the five miRNAs, miR-21-5p and miR-146a-5p were up-expressed in CT/HIV group when compared with AT and NC groups. RQ means for miR-21-5p and miR-146a-5p in CT/HIV group were 3.829 and 2.500, while in AT group, were 1.815 and 1.661, respectively. Differences between 3 groups were statistically significant (Kruskal-Wallis ANOVA test), as well as CT/HIV and AT groups (Mann-Whitney test). Plasma of CT/HIV and AT groups expressed similar levels of miR-29c-3p, miR-155-5p and miR-125b-5p. As NC group was different of CT/HIV and AT groups, differences between three groups were statistically significant (Kruskal-Wallis ANOVA test). No difference was shown between CT/HIV and AT groups (Mann-Whitney test). These results suggest the host miRNAs modulation by Toxoplasma gondii.
- First case report of eosinophilic meningitis associated with cerebral toxoplasmosis in an HIV-positive patient(2020) VIDAL, Jose E.; CUNHA, Mirella Alves; KASSAB, Maria J.; DAUAR, Rafi F.; VASCONCELOS, Dewton de MoraesCerebral toxoplasmosis is the most common cause of focal brain lesion in people living with HIV (PLWH) and usually causes multifocal encephalitis with little or no meningeal involvement. Classically, only subtle cerebrospinal fluid (CSF) abnormalities are described. There are no prior case reports in the literature on eosinophilic meningitis associated with cerebral toxoplasmosis in PLWH. We report on an HIV-positive man from Brazil who presented to the emergency department with headache, nausea, vomiting, and hemiparesis. He had a T-CD4+ lymphocyte count of 145 cells/mm(3), and antiretroviral failure was identified. Brain computed tomography showed a contrast-enhancing lesion with mild mass effect and trimethoprim-sulfamethoxazole and dexamethasone were started. Examination of CSF showed 194 cells/mm(3) (74% eosinophils, 18% lymphocytes, 4% monocytes, and 2% neutrophils), protein = 83 mg/dL, and glucose = 49 mg/dL. Detection of Toxoplasma gondii on CSF by polymerase chain reaction confirmed the diagnosis of cerebral toxoplasmosis. An exhaustive laboratorial investigation excluded other possible etiologies. After 14 days, the patient showed complete resolution of neurological and CSF alterations and substantial improvement in the brain lesion and was discharged home. We suggest that eosinophilic meningitis should be included in the spectrum of manifestations of HIV-related cerebral toxoplasmosis, especially in countries with high prevalence of toxoplasmosis in the general population.
- Cognitive assessment in patients with Hepatitis C submitted to treatment with Sofosbuvir and Simeprevir or Daclatasvir(2020) GASCON, Maria Rita Polo; BENUTE, Glaucia Rosana Guerra; MACEDO, Elizeu Coutinho; CAPITAO, Claudio Garcia; VIDAL, Jose Ernesto; SMID, Jerusa; MARCUSSO, Rosa Maria Nascimento; LUCIA, Mara Cristina Souza de; PENALVA-DE-OLIVEIRA, Augusto Cesar; DIAMENT, DecioBackground:Hepatitis C can be defined as an infectious disease that develops an inflammatory activity, which may cause an impairment in the central nervous system, may cause cognitive impairments and symptoms of depression.Objective:The objective of this study was to verify the cognitive performance of patients with chronic hepatitis C before and after treatment with simeprevir, sofosbuvir, and daclatasvir. Methods:A prospective study was carried out in three stages: before, right after treatment, and six months after. Fifty-eight patients under clinical follow-up were evaluated at the Emilio Ribas Infectology Institute, in Sao Paulo, Brazil. The following instruments were used: sociodemographic questionnaire, Lawton's Scale, Beck's Depression Inventory, and a battery of neuropsychological tests that evaluated: intellectual function, memory, attention, executive function, and motor and processing speed). For statistical analysis, the analyses described (mean, frequency, and standard deviation), chi-square, and ANOVA were used. Results:Most of the participants were male (n=30, 51.7%), with a mean of 58.23 +/- 8.79 years, mean schooling of 9.75 +/- 4.43 years. Comparing the results of neuropsychological evaluations (before, just after completion of drugs, and six months), a significant improvement was observed in relation to the acquisition of new knowledge (p=0.03), late visual memory (p=0.01), and tendency towards alternate attention (p=0.07). Conclusion:The treatment of the hepatitis C virus improved cognitive performance, especially in relation to memory.
- Human extracellular vesicles and correlation with two clinical forms of toxoplasmosis(2020) CRUZ, Allecineia Bispo da; MAIA, Marta Marques; PEREIRA, Ingrid de Siqueira; TANIWAKI, Noemi Nosomi; NAMIYAMA, Gislene Mitsue; TELLES, Joao Paulo Marochi; VIDAL, Jose Ernesto; SPEGIORIN, Ligia Cosentino Junqueira Franco; MATTOS, Cinara Cassia Brandao de; MATTOS, Luiz Carlos de; MEIRA-STREJEVITCH, Cristina da Silva; PEREIRA-CHIOCCOLA, Vera LuciaAim This study analyzed microvesicles and exosomes, called as extracellular vesicles (EVs) excreted in serum and cerebrospinal fluid (CSF) from patients with cerebral or gestational toxoplasmosis. Methods Clinical samples from 83 individuals were divided into four groups. Group I, 20 sera from healthy individuals and pregnant women (seronegative for toxoplasmosis); group II, 21 sera from seropositive patients for toxoplasmosis (cerebral or gestational forms); group III, 26 CSF samples from patients with cerebral toxoplasmosis/HIV co-infection (CT/HIV) (seropositive for toxoplasmosis); and group IV, 16 CSF samples from seronegative patients for toxoplasmosis, but with HIV infection and other opportunistic infections (OI/HIV). Serum and CSF samples were ultracentrifuged to recover EVs. Next, vesicle size and concentration were characterized by Nanoparticle Tracking Analysis (NTA). Results Concentrations of serum-derived EVs from toxoplasmosis patients (mean: 2.4 x 10(10) EVs/mL) were statically higher than of non-infected individuals (mean: 5.9 x 10(9) EVs/mL). Concentrations of CSF-derived EVs were almost similar in both groups. CT/HIV (mean: 2.9 x 10(9) EVs/mL) and OI/HIV (mean: 4.8 x 10(9) EVs/mL). Analyses by NTA confirmed that CSF-derived EVs and serum-derived EVs had size and shape similar to microvesicles and exosomes. The mean size of EVs was similar in serum and CSF. Thus, the concentration, and not size was able distinguish patients with toxoplasmosis than healthy individuals. Presence of exosomes was also confirmed by transmission electron microscopy and evidence of tetraspanins CD63 and CD9 in immunoblotting. Relative expressions of miR-146a-5p, miR-155-5p, miR-21-5p, miR-29c-3p and miR-125b-5p were estimated in exosomal miRNA extracted of EVs. Serum-derived EVs from group II (cerebral and gestational toxoplasmosis) up-expressed miR-125b-5p and miR-146a-5p. CSF-derived EVs from CT/HIV patients) up-expressed miR-155-5p and miR-21-5p and were unable to express miR-29c-3p. Conclusion These data suggest the participation of EVs and exosomal miRNAs in unbalance of immune response as elevation of TNF-alpha, IL-6; and downregulation of IFN-gamma in cerebral and gestational forms of toxoplasmosis.
- Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in Sao Paulo, Brazil(2020) MARCUSSO, Rosa Maria N.; WEYENBERGH, Johan Van; MOURA, Joao Victor Luisi de; DAHY, Flavia Esper; MATOS, Aline de Moura Brasil; HAZIOT, Michel E. J.; VIDAL, Jose E.; FONSECA, Luiz Augusto M.; SMID, Jerusa; ASSONE, Tatiane; CASSEB, Jorge; OLIVEIRA, Augusto Cesar Penalva deBackground: Despite its relatively low incidence of associated diseases, Human T-cell Leukemia Virus-1 (HTLV-1) infection was reported to carry a significant risk of mortality in several endemic areas. HTLV-1-associated diseases, adult T-cell leukemia /lymphoma (ATLL) and HTLV-1-associated myelopathy/tropical spastic paraperesis (HAM/TSP), as well as frequent coinfections with human immunodeficiency virus (HIV), hepatitis C virus (HCV), and Strongyloides stercoralis were associated to increased morbidity and mortality of HTLV-1 infection. Objective: To determine the mortality rate and its associated variables from an open cohort started in July 1997 at the HTLV Clinic, Emilio Ribas Institute (IIER), a major infectious disease hospital in Sao Paulo, Brazil. Methods: Since inception up to September 2018, we admitted 727 HTLV-1-infected individuals, with a rate of 30-50 new admissions per year. All patient data, including clinical and laboratory data, were regularly updated throughout the 21-year period, using a dedicated REDCap database. The Ethical Board of IIER approved the protocol. Results: During 21 years of clinical care to people living with HTLV-1 in the Sao Paulo region, we recruited 479 asymptomatic HTLV-1-infected individuals and 248 HAM/TSP patients, of which 632 remained under active follow-up. During a total of 3800 person-years of follow-up (maximum follow-up 21.5 years, mean follow-up 6.0 years), 27 individuals died (median age of 51.5 years), of which 12 were asymptomatic, one ATLL patient and 14 HAM/TSP patients. HAM/TSP diagnosis (but neither age nor gender) was a significant predictor of increased mortality by univariate and multivariate (hazard ratio (HR) 5.03, 95% CI [1.96-12.91], p = 0.001) Cox regression models. Coinfection with HIV/HCV was an independent predictor of increased mortality (HR 15.08; 95% CI [5.50-41.32]; p < 0.001), with AIDS-related infections as a more frequent cause of death in asymptomatics (6/13; p = 0.033). HIV/HCV-negative fatal HAM/TSP cases were all female, with urinary tract infection and decubitus ulcer-associated sepsis as the main cause of death (8/14, p = 0.002). Conclusions: All-cause mortality among people living with HTLV-1 in Sao Paulo differs between asymptomatic (2.9%) and HAM/TSP patients (7.3%), independent of age and gender. We observe a dichotomy in fatal cases, with HAM/TSP and HIV/HCV coinfection as independent risk factors for death. Our findings reveal an urgent need for public health actions, as the major causes of death, infections secondary to decubitus ulcers, and immune deficiency syndrome (AIDS)-related infections, can be targeted by preventive measures.
- Should we perform the serum cryptococcal antigen test in people living with HIV hospitalized due to a community-acquired pneumonia episode?(2020) SILVA, Adriana Paulino; ZENATTI, Carolina Toniolo; FIGUEIREDO-MELLO, Claudia; NEGRA, Marinella Della; LEVIN, Anna S.; BOULWARE, David R.; VIDAL, Jose ErnestoCommunity-acquired pneumonia (CAP) is a common cause of hospitalization among people living with human immunodeficiency virus (PLWH), particularly those with severe immunosuppression. Pulmonary disease due to cryptococcosis is uncommonly reported and likely under-diagnosed. There is scarce information about cryptococcal antigen (CrAg) prevalence in PLWH with CAP. The objectives of this study were to identify among PLWH who were hospitalized with CAP: (i) the prevalence of serum CrAg positivity, (ii) the proportion with asymptomatic vs. symptomatic cryptococcosis; and (iii) the prevalence of serum CrAg positivity in CD4+ T-cell count <100 cells/mm(3). We performed a sub-analysis of a prospective cohort of hospitalized adults enrolled into a randomized clinical trial testing therapy for CAP. We included 202 participants who had serum CrAg testing performed. We found a 3.5% prevalence of serum CrAg-positivity overall, being higher (5.7%) in CD4+ T-cell count <100 cells/mm(3). Overall, asymptomatic and symptomatic cryptococcosis were present in 2.0% and 1.5%, respectively. This study identifies a target population for CrAg testing: PLWH hospitalized with diagnosis of CAP, particularly those with CD4+ T-cell count <100 cells/mm(3) where the number needed to test was 18 to detect 1 CrAg-positive person. This approach may facilitate the detection of asymptomatic cryptococcal infection and allow a timely diagnosis of symptomatic cryptococcal disease.
- Long-term virological effectiveness with darunavir/ritonavir-based salvage therapy in people living with HIV/AIDS from Sao Paulo, Brazil(2020) SANTOS, Ariane Melare Ramos dos; MARTINS, Amaury Pachione; JULIATO, Denise; MIRANDA, Erique Jose Farias Peixoto de; LOPES, Giselle Ibette Silva Lopez; BRIGIDO, Luis Fernando de Macedo; VIDAL, Jose ErnestoEven though darunavir/ritonavir (DRV/r) has high potency and a greater genetic barrier, there are few studies on the long-term effectiveness of DRV/r-based salvage therapy in people living with HIV (PLWH) in low and middle-income countries. This retrospective cohort study, from Sao Paulo, Brazil, included ART-experienced PLWH aged >= 18 years with virological failure (VF) who had started DRV/r plus an optimized background regimen (OBR) between 2008 and 2012. The proportion of patients with viral load (VL) <50 copies/mL, the improved mean CD4+ T cell count and the factors associated with VF during the 144-week follow-up were assessed. The study included 173 patients with the following characteristics [median (interquartile range)]: age 48 (42 -53) years; CD4+ T cell count, 229 (89 -376) cells/mm3; VL, 4.26 (3.70 -4.74) log10; 6 (4 -7) previous regimens; and 100 (38 -156) months of VF. After 144 weeks, 129 (75%) patients had VL< 50 copies/mL and a mean increase in the CD4+ T cell count of 190 cells/mm3. VL>100,000 copies/mL and poor adherence were associated with VF. DRV/r plus an OBR showed high long-term virological suppression and immunological recovery. VL>100,000 copies/mL and poor adherence were associated with VF at 144 weeks.