Avaliação da frequência do vírus respiratório sincicial humano em indivíduos assintomáticos e sintomáticos em um complexo hospitalar terciário
Data
2015-06-24
Autores
Moreira, Luciana Peniche 
Orientadores
Bellei, Nancy Cristina Junqueira
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
O vírus respiratório sincicial humano (VRSH) tem reconhecida importância como causador de infecções do trato respiratório de crianças, idosos e imunocomprometidos desde os primeiros anos após sua descoberta. Com o passar do tempo e o advento da biologia molecular a detecção do VRSH passou a ser investigada também em casos de infecção de adultos previamente saudáveis. Pacientes imunocomprometidos, profissionais de saúde e familiares de crianças possuem risco aumentado de adquirir a infecção e contribuir na disseminação do vírus. Este estudo teve como objetivo avaliar a frequência do VRSH em amostras de swabs nasais de indivíduos considerados de alto risco para a aquisição da infecção, e avaliar e comparar a carga viral do VRSH nos grupos avaliados. Foram analisadas 696 amostras, coletadas entre os anos de 2009 a 2013, de 6 grupos distintos de indivíduos sendo: 70 amostras de profissionais de saúde sintomáticos e 95 amostras de assintomáticos, 43 amostras de pacientes HIV positivos sintomáticos e 100 amostras de assintomáticos, 192 amostras de contactantes assintomáticos de crianças sintomáticas e 196 amostras de crianças sintomáticas. Como teste diagnóstico foi utilizado o real-time RT-PCR, sendo realizada análise qualitativa e quantitativa das amostras. Após avaliação o VRSH foi detectado em 10,1% (70/696) das amostras sendo 4,4% (17/387) das amostras de pacientes assintomáticos e 17,1% (53/309) das amostras de pacientes sintomáticos, positivas para o VRSH, tendo sido encontrada diferença estatisticamente significativa quando comparado de forma geral (p<0,0001), mas esta diferença não é observada quando excluímos as amostras de crianças da análise (p=0,62). Entre os grupos avaliados o VRSH foi detectado em 3% (3/100) das amostras de HIV positivos assintomáticos e em 7% (3/43) das amostras de sintomáticos, no grupo de profissionais de saúde o vírus foi encontrado em 1,05% (1/95) dos assintomáticos e em 4,3% (3/70) dos sintomáticos. Entre os contactantes assintomáticos a positividade foi de 6,8% (13/192) e entre as crianças sintomáticas o VRSH foi detectado em 24% das amostras (47/196). Os contactantes assintomáticos apresentam número significativamente maior de amostras positivas (13/192) do que os grupos de HIV e profissionais assintomáticos (4/195), com p= 0,0252. Obtivemos 11 pares de crianças sintomáticas e contactantes assintomáticos com amostras positivas para VRSH, sendo que os pais de crianças com amostras positivas para VRSH tem 22 vezes mais chances de estar infectado pelo vírus do que pais de crianças com amostras negativas (95% IC 4,8 - 106,7). Houve diferença estatisticamente significativa entre a carga viral dos grupos de sintomáticos e assintomáticos (p<0,0001), e as crianças sintomáticas apresentaram carga viral significativamente maior do que a de seus pares contactantes assintomáticos (p<0,0001) e do que as crianças que não tiveram contactantes assintomáticos com amostras positivas (p<0,0001). Nosso estudo mostrou como importante fator de risco para aquisição da infecção pelo VRSH, o contato próximo com crianças infectadas pelo vírus. Esse risco se estende aos profissionais de saúde, pacientes HIV positivos e até mesmo visitantes de pacientes hospitalizados, que tenham contato com crianças em casa. Sendo assim a necessidade de manter a equipe de profissionais e a população informados acerca das medidas de profilaxia contra a aquisição da infecção pelo vírus respiratório sincicial é fundamental.
The human respiratory syncytial virus (HRSV) is recognized as an important cause of respiratory tract infections in children, the elderly and immunocompromised since the first years after its discovery. Over time and with the advent of molecular biology the researchers started investigating HRSV in cases of infection of previously healthy adults. Immunocompromised patients, health care workers and children relatives are at increased risk of acquiring the infection and spreading the virus. This study aimed to evaluate the frequency of HRSV in nasal swab samples of individuals considered at high risk for acquiring the infection, and evaluate and compare the viral load of HRSV on the assessed groups. We analysed 696 samples, collected during the period of 2009 to 2013, among 6 distinct groups of individuals as follows: 70 samples of symptomatic health care workers and 95 samples of asymptomatics, 43 samples from symptomatic HIV positive patients and 100 samples of asymptomatics, 192 samples from household contacts of symptomatic children and 196 samples from symptomatic children. A real time RT-PCR was used as the diagnostic test, being conducted qualitative and quantitative analysis of samples. After the evaluation, HRSV was detected in 10.1% (70/696) of samples, being 4.4% (17/387) of asymptomatic patients and 17.1% (53/309) from samples of symptomatic patients. The positivity for HRSV showed statistically significant difference when compared between symptomatics and asymptomatics in general (p<0.0001), but this difference was not observed when we exclude children samples from the analysis (p = 0.62). Among the different groups, HRSV was detected in 3% (3/100) of asymptomatic HIV positive samples and 7% (3/43) of the symptomatic samples, on the health care workers group the virus was found in 1.05% (1/95) of asymptomatic and on 4.3% (3/70) of symptomatic. Among asymptomatic household contacts the positivity was 6.8% (13/192) and among symptomatic children HRSV was detected in 24% of samples (47/196). The household contacts have significantly higher number of positive samples (13/192) when compared with asymptomatic HIV groups and health care workers (4/195), with p = 0.0252. We found 11 pairs of symptomatic children and asymptomatic household contacts with HRSV positive samples, and found that household contacts of children with positive samples for HRSV are 22 times more likely to be infected by the virus than household contacts of children with negative samples (95 % CI 4.8 - 106.7). We found statistically significant differences between viral load of symptomatic and asymptomatic groups (p<0.0001), and symptomatic children had significantly higher viral load than their asymptomatic household contacts pairs (p<0.0001) and significantly higher viral load than children who had asymptomatic contacts with negative samples (p < 0.0001).Our study showed the close contact with infected children as an important risk factor for acquiring the HRSV infection. This risk could be extended to health care workers, HIV positive patients and even visitors of hospitalized patients who have contact with children at home. Therefore, the need to maintain a team of professionals and even the public informed about the prophylactic measures against the acquisition of respiratory syncytial virus infection is critical.
The human respiratory syncytial virus (HRSV) is recognized as an important cause of respiratory tract infections in children, the elderly and immunocompromised since the first years after its discovery. Over time and with the advent of molecular biology the researchers started investigating HRSV in cases of infection of previously healthy adults. Immunocompromised patients, health care workers and children relatives are at increased risk of acquiring the infection and spreading the virus. This study aimed to evaluate the frequency of HRSV in nasal swab samples of individuals considered at high risk for acquiring the infection, and evaluate and compare the viral load of HRSV on the assessed groups. We analysed 696 samples, collected during the period of 2009 to 2013, among 6 distinct groups of individuals as follows: 70 samples of symptomatic health care workers and 95 samples of asymptomatics, 43 samples from symptomatic HIV positive patients and 100 samples of asymptomatics, 192 samples from household contacts of symptomatic children and 196 samples from symptomatic children. A real time RT-PCR was used as the diagnostic test, being conducted qualitative and quantitative analysis of samples. After the evaluation, HRSV was detected in 10.1% (70/696) of samples, being 4.4% (17/387) of asymptomatic patients and 17.1% (53/309) from samples of symptomatic patients. The positivity for HRSV showed statistically significant difference when compared between symptomatics and asymptomatics in general (p<0.0001), but this difference was not observed when we exclude children samples from the analysis (p = 0.62). Among the different groups, HRSV was detected in 3% (3/100) of asymptomatic HIV positive samples and 7% (3/43) of the symptomatic samples, on the health care workers group the virus was found in 1.05% (1/95) of asymptomatic and on 4.3% (3/70) of symptomatic. Among asymptomatic household contacts the positivity was 6.8% (13/192) and among symptomatic children HRSV was detected in 24% of samples (47/196). The household contacts have significantly higher number of positive samples (13/192) when compared with asymptomatic HIV groups and health care workers (4/195), with p = 0.0252. We found 11 pairs of symptomatic children and asymptomatic household contacts with HRSV positive samples, and found that household contacts of children with positive samples for HRSV are 22 times more likely to be infected by the virus than household contacts of children with negative samples (95 % CI 4.8 - 106.7). We found statistically significant differences between viral load of symptomatic and asymptomatic groups (p<0.0001), and symptomatic children had significantly higher viral load than their asymptomatic household contacts pairs (p<0.0001) and significantly higher viral load than children who had asymptomatic contacts with negative samples (p < 0.0001).Our study showed the close contact with infected children as an important risk factor for acquiring the HRSV infection. This risk could be extended to health care workers, HIV positive patients and even visitors of hospitalized patients who have contact with children at home. Therefore, the need to maintain a team of professionals and even the public informed about the prophylactic measures against the acquisition of respiratory syncytial virus infection is critical.
Descrição
Citação
MOREIRA, Luciana Peniche. Avaliação da frequência do vírus respiratório sincicial humano em indivíduos assintomáticos e sintomáticos em um complexo hospitalar terciário. 2015. 120 f. Tese (Doutorado em Infectologia ) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.