Mestrado em Medicina Tropical e Saúde Pública (IPTSP)
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Navegando Mestrado em Medicina Tropical e Saúde Pública (IPTSP) por Por Orientador "Alves, Maria de Fátima Costa"
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Item Diagnóstico molecular das infecções por Chlamydia trachomatis e Neisseria gonorrhoeae: avaliação do desempenho do swab vaginal(Universidade Federal de Goiás, 2010-12-14) Cardoso, Fernanda Alves de Brito e; Turchi, Marília Dalva; http://lattes.cnpq.br/3769826743537934; Alves, Maria de Fátima Costa; http://lattes.cnpq.br/1412047788155346; Alves , Maria de Fátima Costa; Turchi, Marília Dalva; Alves, Rosane Ribeiro FigueiredoThe introduction of the nucleic acid amplification tests (NAATs) was a major breakthrough in the screening for the sexually transmitted diseases (STD) caused by Chlamydia trachomatis and Neisseria gonorrhoeae because they are highly sensitive and they can be used with noninvasive specimens, such as urine. The use of urine has made it far easier to test asymptomatic individuals and has also made it possible to perform epidemiological studies in places other than clinical settings. Many studies have shown also that vaginal swab can be used for detection of both infections, however, just the NAAT Aptima Combo 2 has been cleared by Food and Drug Administration for this specimen use. In Brazil, the most widely used NAAT for the diagnosis of chlamydia and neisseria is the kit Amplicor CT/NG (Roche) and, up to date, there isn’t any study which evaluates the use of vaginal swabs. Objectives: To evaluate the performance of the kit AMPLICOR CT/NG (Roche) in the diagnosis of C. trachomatis and N. gonorrhoeae using urine, endocervical and vaginal swabs and to analyze the agreement of results between the different biological specimens. Methods: The target population was sexually active adolescents and young women between 15 and 24 years from Inhumas, Goias. Socio-demographic and sexual behavior were obtained through a face-to-face interview. The diagnosis was performed by PCR using the AMPLICOR CT/NG (Roche) assay in urine, vaginal swab (VS) and endocervical swab (ES) specimens. For the performance evaluation were calculated the sensitivity, specificity, positive predictive value and negative predictive value. The kappa coefficient was calculated to assess agreement between the samples. It was considered a true-positive result when at least two of three biological samples from the same patient were positive for chlamydia and/or gonococcus. Results:Among the 428 participants the mean age was 19,4 years. The three biological specimens were collected from 309 adolescents (72.2%). Among these, the prevalence rates were 8.7% (IC95% 5,8-12,4) for C. trachomatis and 2.3% (IC95% 0,9-4,6) for N. gonorrhoeae.For chlamydia the sensitivities observed with the different samples were above 80% and specificities exceeding 97% with positive predictive values (PPV) between 78.8% and 84.6% and negative predictive values (VPNs) >98%. For the gonococcus the sensitivities were 42.8% for urine, 71.4% for ES and 100% for VS with specificities >96% for the three samples. The two types of swab showed low PPVs for gonococcus (≈40%) and urine showed PPV of 100%. VPNs were >98%. The agreement of results between specimens was around 94% for the detection of both infections. However, the values of kappa (κ) coefficient ranged from 0.68 to 0.73 for chlamydia, which means substantial agreement between samples. For gonococcal infection, the agreement was slight or fair with κ coefficients ranging from 0.13 to 0.33. Conclusions:The performances of the specimens and the κ values suggest that the vaginal swab appears to be equivalent to urine and endocervical swab for detection of chlamydia and may be suitable for screening studies. The three samples showed different performance in the detection of gonococcus and did not present good agreement of results, suggesting that they are not equivalent in the diagnosis of this infection with the PCR kit used.Item Detecção do DNA de Chlamydia trachomatis em espondiloartopatias e artrite reumatóide(Universidade Federal de Goiás, 2004-04-20) Fernandez, Rafael Navarrete; Ximenes, Antonio Carlos; Alves, Maria de Fátima Costa; http://lattes.cnpq.br/1412047788155346Introduction: Chlamydia trachomatis is the bacteria responsible for the most prevalent sexually transmitted disease worldwide. Most of the infections in men and women is asymptomatic and when undiagnosed and untreated may reach the joints causing not only arthritis, but also other acknowledged complications related to the female reproductive system. Objective: To investigate C. trachomatis DNA in the urine and synovial fluid from patients with spondyloarthropathies (SpA) and rheumatoid arthritis (RA) and evaluate serum anti-C. trachomatisIgG and IgM antibodies. Methods: The population consisted of 15 patients with spondyloarthropathies, being nine with undifferentiated spondyloarthropathy (US) and six with reactive arthritis (ReA) (group I), and 15 patients with rheumatoid arthritis (RA) (group II). The chlamydial DNA was assessed in synovial fluid and urine samples of all patients by Amplicor PCR. The anti-chlamydial IgG and IgM antibodies were quantified through indirect imunofluorescence (IIF), while 15 patients of group I were typed for HLA-B27 by the use of flow citometry. Social demographical data and all information on sexual behavior and presence of symptoms were collected through a (questionnaire in the form of) an interview. Results: C. trachomatis DNA was found in only one synovial fluid sample from patient with ReA (6,7%). In two patients with RA, chlamydial DNA was identified in the urine sample (13,3%). The anti-chlamydial IgG antibodies were present in eight patients of the population studied; being three patients from group I (20%), and five from group II (33,3%). The greatest titer of this antibody 1/256 was associated with the presence of chlamydial DNA in a patient from group II. The IgM antibody was not detected in any of the samples from both groups. Four individuals from group II (26,7%) were HLA-B27 positive and its presence was 16 related to sacroiliitis. Conclusion: The results in this study show that in patients with spondyloarthropathies and rheumatoid arthritis, presenting a picture of articular activity one might not exclude C. trachomatisas the triggering agent.Item Prevalência e fatores de risco para infecção por Chlamydia trachomatis em adolescentes e jovens do sexo feminino em Goiás(Universidade Federal de Goiás, 2008-08-29) Lima, Yanna Andressa Ramos de; Alves, Maria de Fátima Costa; http://lattes.cnpq.br/1412047788155346Genital infections caused by Chlamydia trachomatis are frequent among adolescents and young people. In most cases chlamydial infections are asymptomatic and may cause serious complications such as pelvic inflammatory disease, ectopic pregnancy and infertility. In Brazil there are no screening programs for this infection, with few data about chlamydial prevalence, especially in young women. Objectives: To estimate the prevalence and risk factors for C. trachomatis infection in adolescents and young women, in two cities, Ceres and Catalão, Goiás; to describe the sexual behavior of this population. Methods: The investigation was designed as a cross-sectional survey. Female adolescents and young women between 15 and 24 years old attending the Family Health Program in Ceres and Catalão were randomly assigned. Sociodemographic and sexual behavior data was obtained through a face-to-face interview. Urine samples from young sexually active women were collected and analyzed for the presence of C. trachomatis DNA, using PCR. To identify potential risk factors, univariate analysis was performed. Results: Among the 406 women recruited, 253 were sexually active and eligible for the study. The mean age was 18.7 years (SD=2.9), 58.1% were single, 24.5% initiated sexual life before age 15 and 67% reported inconsistent use of condoms. The overall prevalence of C. trachomatis was 10.9% (CI 95%, 7.0% - 16.1%). Chlamydial infection was more frequent among adolescents and young women who was younger than 15 years at first intercourse (p<0.03), and those who reported less than three partners in life were less likely of being infected with C. trachomatis (p<0.001). Conclusions: This study showed a high frequency of chlamydial infection in an asymptomatic population at Ceres and Catalão, Goiás. Participants reported unsafe sexual behaviors, like early onset of sexual activity without protection and with multiple partners. It is a vulnerable high risk population for sexually transmitted diseases.