Teses em Doenças Tropicais (Doutorado) - PPGDT/NMT

URI Permanente para esta coleçãohttps://repositorio.ufpa.br/handle/2011/3560

O Doutorado Acadêmico em Doenças Tropicais iniciou em 2007 e pertence ao Programa de Pós-Graduação em Doenças Tropicais do Núcleo de Medicina Tropical (NMT) da Universidade Federal do Pará (UFPA).

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Acesso aberto (Open Access)
Avaliação do hemograma, da velocidade de hemossedimentação (VHS) e da proteína C reativa (PCR) como preditores diagnósticos da síndrome febril de caráter infeccioso
(Universidade Federal do Pará, 2022-02-22) RAMOS, Francisco Lúzio de Paula; RODRIGUES, Anderson Raiol
Fever is the oldest and most frequent sign/symptom in the entire field of medicine. It is present in all ages and comprises all medical specialties. Currently, are known more than 200 causes of fever, being the etiology infectious the most common. The fever can be short term – more related to viral etiology -, and long-term, more frequently caused by bacteria, protozoa and, fungi. When excessively prolonged, it is more linked to structural factors, such as autoimmune diseases and neoplasms. The extension of etiology poses fever as a challenge most of the time. The hemogram, in turn, is the most requested exam in the medical routine due to its wide utility, since it can provide more than 20 parameters for analysis, enabling to perform a broad clinical evaluation and monitor the evolution of cases. Hemogram is very useful in the assessment of fever syndrome, as it shows a reactional state in response to infectious diseases, mainly if added to the evaluation of inflammatory tests, including the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). This study aimed to evaluate the application of the hemogram, ESR and CRP combined with clinical-epidemiological factors and time of illness as diagnostic predictors of infectious fever syndrome. We evaluated 319 patients with fever syndrome of infectious origin, being 77 of bacterial causes, 113 of viral causes, and 129 parasitic etiology, aged between 18 and 60 years old, who were attended at the Unified Medical Care Sector of Evandro Chagas Institute, between the period from 02/2018 to 01/2020. Another 213 healthy individuals were included in the study as control group. For data analysis, we used Microsoft Office Excel (2007), Biostat 5.0 (2007), SPSS Statistics 17.0 (2010), GraphPad Prism 9.0.0 Release Notes (2020), and Rv 3.5.2 (2018) software. We applied the Odds ratio (OR) to assess chances; Kruskal-Wallis for variance; Youden index for the cutoff points between variables, and ROC curve (AUROC) for accuracy. The p-value < 0.05 was considered statistically significant. The results revealed that the bacterial diseases have as characteristics in hemogram the increase in the number of neutrophils, which reflects in the numerical increase of leukocytes; In contrast, the viral diseases are characterized by the numerical reduction of lymphocytes, mainly of neutrophils, with reflection on the total number of leukocytes defined as leukopenia; the parasitic diseases assumed an intermediate profile between bacterial and viral, marked by the numerical normality of white blood cells, thus resembling the control group. However, the mean of lymphocytes was higher than in the other diseases, including the control group. In general, in bacterial diseases, there is an increase in ERS, and especially in CRP, which are also increased in parasitic diseases; but in viral diseases, these tests tend to be numerically normal, being similar to the control group in this aspect. Therefore, the inflammatory tests are increased in bacterial and parasitic diseases, but mainly in the first-mentioned, and are normal in viral diseases. Diseases such as malaria, visceral leishmaniasis, typhoid fever, HIV, and Epstein-Barr virus infections can be identified by findings peculiar to them observed in hemogram. We concluded that the numerical values of the hemogram, as well as the levels of ESR and CRP, combined with clinical and epidemiological factors and to the time of illness can predict groups of diseases and even predict specific diseases causative of infectious fever syndrome.
Acesso aberto (Open Access)
Perfil microbiológico e taxa de letalidade das infecções primárias de corrente sanguínea nas crianças menores de um ano em um hospital público de Belém/Pa.
(Universidade Federal do Pará, 2019-12-19) LOPES, Cássia de Barros; FUZII, Hellen Thais; RODRIGUES, Anderson Raiol
Primary Bloodstream Infections (BSI) are among the most prevalent health care-related infections (HAI) and are associated with high morbidity and mortality, especially in young children, preterm, low birth weight newborns and admitted in intensive care units (ICU) . These infections are even more severe when caused by antimicrobial resistant microorganisms common to clinical practice. To determine the type of etiological agents involved in primary BSI acquired hospitals and to know the local profile of antibiotic resistance will improve an appropriate choice of empirical antibiotic therapy and consequent positive impact on clinical outcomes. The objective of this study was to know the microbiological profile and mortality rates of primary BSI in children under one year of age in a public hospital of Belem, a maternal and referral maternity hospital in northern Brazil. A retrospective cohort study was conducted utilizing demographic and microbiologic data and clinical outcome of laboratory-confirmed primary BSIs with a blood culture positive for a known pathogen and its antibiotic susceptibility which was assessed using an automated system Vitek2 (bioMérieux, France), between april 2015 and april 2018. There were 1736 cases of IPCS in children under one year of age with 631 blood culture positive with pathogenic strains. Candida e Klebsiella were the three most prevalent genders; premature newborns, males and low birth weight were the most affected. The ESBL phenotype (extended-spectrum beta-lactamase / extended-spectrum beta-lactamase) occurred in 70,8% Serratia marsecens. Overall crude mortality was elevated, 36,3% (224/617). Use of central venous catheter, mechanical ventilation and admitted in UCI were risk factors to mortality. In multivariate analysis, the pathogen Candida (p = 0.05) was the most significantly associated with deaths. Hospital IPCS are serious adverse events and are associated with a high fatality rate in children under one year of age.

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