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Sacchi C.T.,Instituto Adolfo Lutz | Fukasawa L.O.,Instituto Adolfo Lutz | Goncalves M.G.,Instituto Adolfo Lutz | Salgado M.M.,Instituto Adolfo Lutz | And 10 more authors.
PLoS ONE | Year: 2011

Real-time (RT)-PCR increases diagnostic yield for bacterial meningitis and is ideal for incorporation into routine surveillance in a developing country. We validated a multiplex RT-PCR assay for Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae in Brazil. Risk factors for being culture-negative, RT-PCR positive were determined. The sensitivity of RT-PCR in cerebrospinal fluid (CSF) was 100% (95% confidence limits, 96.0%-100%) for N. meningitidis, 97.8% (85.5%-99.9%) for S. pneumoniae, and 66.7% (9.4%-99.2%) for H. influenzae. Specificity ranged from 98.9% to 100%. Addition of RT-PCR to routine microbiologic methods increased the yield for detection of S. pneumoniae, N. meningitidis, and H. influenzae cases by 52%, 85%, and 20%, respectively. The main risk factor for being culture negative and RT-PCR positive was presence of antibiotic in CSF (odds ratio 12.2, 95% CI 5.9-25.0). RT-PCR using CSF was highly sensitive and specific and substantially added to measures of meningitis disease burden when incorporated into routine public health surveillance in Brazil. © 2011 Sacchi et al.

Rowlands R.E.G.,Adolfo Lutz Institute | Ristori C.A.,Adolfo Lutz Institute | Lopes G.I.S.L.,Adolfo Lutz Institute | de PAULA A.M.R.,Adolfo Lutz Institute | And 6 more authors.
Revista do Instituto de Medicina Tropical de Sao Paulo | Year: 2010

Botulism is a rare and potentially lethal illness caused by Clostridium botulinum neurotoxin. We describe the findings of a laboratorial investigation of 117 suspected cases of botulism reported to the surveillance system in Brazil from January 2000 to October 2008. Data on the number and type of samples analyzed, type of toxins identified, reporting of the number of botulism cases and transmission sources are discussed. A total of 193 clinical samples and 81 food samples were analyzed for detection and identification of the botulism neurotoxin. Among the clinical samples, 22 (11.4%) presented the toxin (nine type A, five type AB and eight with an unidentified type); in food samples, eight (9.9%) were positive for the toxin (five type A, one type AB and two with an unidentified type). Of the 38 cases of suspected botulism in Brazil, 27 were confirmed by a mouse bioassay. Laboratorial botulism diagnosis is an important procedure to elucidate cases, especially food-borne botulism, to confirm clinical diagnosis and to identify toxins in food, helping sanitary control measures.

Ciccone F.H.,University of Sao Paulo | Carvalhanas T.R.M.P.,Center for Epidemiologic Surveillance | Afonso A.M.S.,Adolfo Lutz Institute | Flannery B.,Pan American Health Organization | Waldman E.A.,University of Sao Paulo
Revista da Sociedade Brasileira de Medicina Tropical | Year: 2010

Introduction: To review measles IgM-positive cases of febrile rash illnesses in the state of São Paulo, Brazil, over the five-year period following interruption of measles virus transmission. Methods: We reviewed 463 measles IgM-positive cases of febrile rash illness in the state of São Paulo, from 2000 to 2004. Individuals vaccinated against measles ≤ 56 days prior to specimen collection were considered to be exposed to the vaccine. Serum from the acute and convalescent phases was tested for evidence of measles, rubella, parvovirus B19 and human herpes virus-6 infection. In the absence of seroconversion to measles immunoglobulin-G, measles IgM-positive cases were considered false positives in individuals with evidence of other viral infections. Results: Among the 463 individuals with febrile rash illness who tested positive for measles IgM antibodies during the period, 297 (64%) were classified as exposed to the vaccine. Among the 166 cases that were not exposed to the vaccine, 109 (66%) were considered false positives based on the absence of seroconversion, among which 21 (13%) had evidence of rubella virus infection, 49 (30%) parvovirus B19 and 28 (17%) human herpes virus-6 infection. Conclusions: Following the interruption of measles virus transmission, thorough investigation of measles IgM-positive cases is required, especially among cases not exposed to the vaccine. Laboratory testing for etiologies of febrile rash illness aids interpretation of these cases.

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