Há uma simbiose quadripartida no ecossistema das formigas cultivadoras de fungos entre três mutualistas (Formiga da tribo Attini, jardim fúngico e actinomicetos simbiontes) e um parasita (fungo patogênico especializado Escovopsis sp). As actinobactérias associadas à formiga hospedeira produzem metabólitos secundários para inibir este patógeno, mas não o fungo mutualista. Produtos naturais interessantes foram relatados a partir destas bactérias com um amplo espectro de atividades biológicas. Portanto, várias actinobactérias foram isoladas do exoesqueleto e do jardim das formigas agricultoras para isolar compostos ativos contra diferentes alvos como Leishmania donovani e Escovopsis. Os antibióticos e compostos citotóxicos conhecidos griseorhodina A (1), griseorhodina C (2), griseorhodina G (3) e a dinactina (4) foram produzidos em cultivo sólido de ISP-2 por Streptomyces puniceus AB10, que foi isolada da formiga cortadeira Acromyrmex rugosus rugosus. As configurações absolutas de 1 e 2 foram inequivocamente estabelecidas como 6S,6aS,7S,8S e 6R,6aS,7S,8R, respectivamente, usando dicroísmo circular vibracional (VCD) e cálculos da Teoria do Funcional de Densidade (DFT). A bactéria Streptomyces puniceus AB10 produziu em meio-A líquido apenas uma familia de antibióticos como a dinactina (4). O composto 4 mostrou inibição contra Escovopsis e uma atividade maior contra L. donovani em promastigota e amastigota intracelular que a miltefosina. Dois estereoisômeros, strepchazolina A (5) e strepchazolina B (6), os antibióticos streptazolina (7), seu isômero-E (8), e o composto inorgânico octa-enxofre (9) foram produzidos em cultivo sólido de ISP-2 por Streptomyces chartreusis AC70, que foi isolada do jardim fúngico da formiga cortadeira Acromyrmex subterraneus brunneus. O composto 9 mostrou atividade antagonista contra o fungo patogênico especializado Escovopsis sp. Este é o primeiro relato de 8 como produto natural. As configurações absolutas de 5 e 6 foram inequivocamente estabelecida como 5S,6S,9R e 5S,6S,9S, respectivamente, usando dicroísmo circular vibracional (VCD) e cálculos da Teoria do Funcional de Densidade (DFT). A bactéria Candidatus Streptomyces philanthi ICBG292, isolada do exoesqueleto de operária de colônia de formiga Cyphomyrmex, produziu os antibióticos Mer-A2026B (10), piericidina-A1 (11) e nigericina (12). Os compostos 10-12 mostraram atividade contra Escovopsis sp e contra L. donovani. O composto 12 mostrou uma atividade maior contra L. donovani em promastigota e amastigota intracelular que a miltefosina. O composto 10 também foi ativo contra o fungo Trichoderma sp. Streptomyces sioyaensis ICBG311, isolada de machos alados de colônia de formiga Cyphomyrmex, produziu uma nova naftoquinona chamada cyphoquinona (13), dois novos compostos antifúngicos denominados cyphomycina (14) e epoxicyphomycina (15), e o antifúngico conhecido GT-35 (16). Os compostos 14-16 mostraram atividade contra diferentes linhagens de Escovopsis sp e Candida albicans K1 com MIC de 1.0, 0.5 e 0.25 ?g/mL, e uma atividade maior contra L. donovani em promastigota e amastigota intracelular que a miltefosina, enquanto 13 apresentou atividade baixa contra L. donovani. A cyphomycina (14) também mostrou uma potente atividade in vitro contra os patógenos humanos resistentes Aspergillus fumigatus 11628 (resistente à equinocandina), C. glabrata 4720 (resistente ao triazol), e C. auris B11211 (resistente à echinocandina, ao triazol, e à anfotericina B), com MIC de 0.5, 0.5 e 4 ?g/mL, respectivamente. Um estudo de dose única de cyphomycina (14) no modelo de camundongos neutropênicos de candidíase disseminada exibiu uma dose-resposta iv com um log de redução de 0.56 e 0.66 do carga infecciosa quando é tratado com 20 e 40 mg/kg da cyphomycina (14), respectivamente, e epoxicyphomycina (15) exibiu um log de redução de 0.53 com 40 mg/kg, demonstrando relevância clínica e eficácia de 14 e 15 neste modelo padrão da indústria de infecção por Candida. Por outro lado, GT-35 (16) matou os ratos 1 hora após a dose de 40 mg/kg. / There is a quadripartite symbiosis in the fungus-growing ant ecosystem between three mutualist (Attine ant, fungal garden and symbiotic actinomycetes) and one parasite (specialized pathogenic fungus Escovopsis sp). The actinobacteria associated to the ant host produce secondary metabolites to inhibit this pathogen but not the crop fungus. Interesting natural products have been reported from these bacteria with a wide spectrum of biological activities. In this thesis, several actinobacteria were isolated from the exoskeleton and garden of fungus-growing ants to isolate active compounds against different targets such as Leishmania donovani and Escovopsis. The known antibiotic and cytotoxic compounds griseorhodin A (1), griseorhodin C (2), griseorhodin G (3) and dinactin (4) were produced in solid ISP-2 culture by Streptomyces puniceus AB10, which was isolated from the leaf-cutter ant Acromyrmex rugosus rugosus. The absolute configurations of 1 and 2 were unambiguously established as 6S,6aS,7S,8S and 6R,6aS,7S,8R, respectively, using vibrational circular dichroism (VCD) and density functional theory (DFT) calculations. The bacterium Streptomyces puniceus AB10 produced in broth A-medium only one family of antibiotics as dinactin (4). Compound 4 showed inhibition against Escovopsis and a higher activity against L. donovani promastigotes and intracellular amastigotes than miltefosine. Two stereoisomers strepchazolin A (5) and strepchazolin B (6), the antibiotic streptazolin (7), its E-isomer (8), and the inorganic compound cyclooctasulfur (9) were produced in solid ISP-2 culture by Streptomyces chartreusis AC70, which was isolated from the fungal garden of the leaf-cutter ant Acromyrmex subterraneus brunneus. Compound 9 showed antagonist activity against the specialized pathogenic fungus Escovopsis sp. This is the first report of 8 as natural product. The absolute configurations of 5 and 6 were unambiguously established as 5S,6S,9R and 5S,6S,9S, respectively, using vibrational circular dichroism (VCD) and density functional theory (DFT) calculations. The bacterium Candidatus Streptomyces philanthi ICBG292, isolated from the exoskeleton of a worker of a Cyphomyrmex colony, produced the antibiotics Mer-A2026B (10), piericidin-A1 (11) and nigericin (12). Compounds 10-12 showed activity against Escovopsis sp and against L. donovani. Compound 12 showed higher activity against L. donovani promastigotes and intracellular amastigotes than miltefosine. Compound 10 was also active against the fungus Trichoderma sp. Streptomyces sioyaensis ICBG311, isolated from winged male ants of Cyphomyrmex colonies, produced a new naphtoquinone named cyphoquinone (13), two new antifungal compounds named cyphomycin (14) and epoxycyphomycin (15), and the known antifungal GT-35 (16). Compounds 14-16 displayed activity against several strains of Escovopsis sp and Candida albicans K1 with a MIC of 1.0, 0.5 and 0.25 ?g/mL, and a higher activity against L. donovani promastigotes and intracellular amastigotes than miltefosine, while 13 a weak activity against L. donovani. Cyphomycin (14) also showed potent in vitro activity against the resistant human pathogens Aspergillus fumigatus 11628 (echinocandin resistance), C. glabrata 4720 (triazole resistance), and C. auris B11211 (echinocandin, triazole, and amphotericin B resistance), with MIC of 0.5, 0.5 and 4 ?g/mL, respectively. A single-dose study of cyphomycin (14) in a neutropenic mouse disseminated candidiasis model exhibited a dose-like response with 0.56 and 0.66 log reduction of infectious burden when treated with 20 and 40 mg/kg cyphomycin (14), respectively, and epoxycyphomycin (15) exhibited 0.53 log ii reduction with 40 mg/kg, demonstrating clinical relevance and effectiveness of 14 and 15 in this industry-standard model of Candida infection. On the other hand, GT-35 (16) killed the mice 1 hr post dose at 40 mg/kg.

Leishmania donovani is a blood-borne tropicial parasite, which infects humans through bites by Phlebotomus sandflies. The parasite survives and multiplies inside macrophages in inner organs, and causes the deadly disease visceral leishmaniasis (Kala-Azar). Macrophages and dendritic cells (DC) are professional antigen-presenting cells involved in the initiation of immune responses. Immature DC are present in all tissues where they internalise and process antigen, in response to which they migrate from tissue, into draining lymphoid organs, undergo maturation and present antigens to lymphocytes. Control measures for leishmaniasis include testing of new diagnostics and development of affordable and effective vaccines for humans. Lipophosphoglycan (LPG) is the major surface component of Leishmania donovani promastigotes. LPG comprises a membrane-anchoring lysophosphatidylinositol part and an extracellular chain of disaccharide phosphates. These repetitions are crucial for parasite survival inside macrophages following phagocytosis. LPG has several specific effects on the host cell including inhibition of protein kinase C (PKC) activity, and inhibition of phagosomal maturation, a process requiring depolymerization of periphagosomal F-actin. Confocal microscopy and image analysis were used to follow F-actin dynamics in single macrophages during phagocytosis of L. donovani promastigotes and LPG-coated particles. F-actin did not depolymerize, but instead progressively polymerized around phagosomes with LPG-containing prey. This correlated with reduced translocation of PKCα to the phagosome and blocked phagosomal maturation. LPG also inhibited cortical actin turnover, which could be the underlying cause of the reduced uptake of LPG-containing prey. Extracellular- and intracellular calcium was necessary for phagocytosis, periphagosomal F-actin breakdown and phagosomal maturation in macrophages interacting with unopsonized prey,and for the action of LPG. We also studied F-actin turnover in macrophages overexpressing dominant-negative (DN) PKCα. DN PKCα macrophages showed increased amounts of cortical F-actin, decreased phagocytic capacity, inhibition of periphagosomal F-actin breakdown and defective phagosomal maturation. When DN PKCα macrophages interacted with LPG-containing prey, phagocytosis was almost completely blocked. Moreover, we found that Leishmania promastigotes and particularly LPG inhibit DC maturation and detachment from distinct surfaces. Thus, LPG from Leishmania donovani could directly inhibit DC migration to lymphoid organs, antigen-presentation and development of immunity.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 4 uppsatser.

Thesis (Ph.D.). / Written for the Institute of parasitology. Title from title page of PDF (viewed 2009/06/10). Includes bibliographical references.

Infectious diseases continue to be a major concern worldwide. They are the second leading cause of death after heart disease. Factors such as an increasing global population, travel, urbanization, global climate change and evolution of pathogens have made infectious diseases more common. Infectious diseases, particularly neglected tropical diseases (NTDs) result in many deaths worldwide. Malaria and leishmaniasis are two common (NTDs) which affect low income countries around the globe. Low cost drugs with novel mechanism of action are required to tackle the growing resistances of parasites against current drugs used in the developing world, where most of the cases occur. The first part of this manuscript (chapters 1 - 3) describes the synthesis of novel analogs active against Leishmania donovani parasite which causes leishmaniasis. Leishmaniasis is a vector-borne complex group of diseases transmitted through the bite of an infected female sand-fly. Its clinical manifestations range from the less severe (cutaneous) to fatal (visceral) forms depending upon infecting species, immunity of host and the environment. Reports have suggested the role of Heat shock protein 90 (Hsp 90) in the differentiation of the Leishmania parasite from the promastigote stage to the pathogenic amastigote stage inside the host. A series of tetrahydro-indazole, tetrahydro-pyrazolo pyridine and radicicol hybrid compounds were prepared based on known Hsp 90 inhibitors, SNX2112 and NVP-AUY922. The synthetic approach allowed us to generate a diverse library of analogs which were used to probe the hydrophobic pocket of Hsp 90 active site. The most active compound, was found to be twice more active as the clinically used drug, Miltefosine, in an infected macrophage assay with an IC50 = 0.88 µM. The second part of this manuscript (chapters 4 - 5) describes the synthesis of xanthurenic acid analogs as antimalarial drugs. Xanthurenic acid (XA) is a vital component for the gametogenesis of the Plasmodium inside the mosquito’s gut. Gametogenesis plays an important part in the continuation of the parasite’s life cycle. A series of xanthurenic acid analogs were synthesized with the aim of inducing premature exflagellation of the microgametes, thus blocking the key step required for the transmission of parasites from humans to the mosquito. A biotinylated xanthurenic acid analog and a clickable xanthurenic acid analog were also synthesized which will help us investigate the mechanism of action of xanthurenic acid in inducing gametogenesis in mosquito. In the preliminary screening efforts in an exflagellation assay, analog 4.40 showed promising activity and was more active in inducing exflagellation than xanthurenic acid. An exflagellation assay of other analogs is currently being pursued. Further investigations into the molecular target and mechanism of action are underway with the biotinylated xanthurenic acid analog.

Submitted by Nuzia Santos (nuzia@cpqrr.fiocruz.br) on 2013-08-14T17:17:44Z No. of bitstreams: 1 dissertação Fernanda Alvarenga Cardoso 1.pdf: 1458584 bytes, checksum: a3070865cab7509b6900f5f36ab2b623 (MD5) / Made available in DSpace on 2013-08-14T17:17:44Z (GMT). No. of bitstreams: 1 dissertação Fernanda Alvarenga Cardoso 1.pdf: 1458584 bytes, checksum: a3070865cab7509b6900f5f36ab2b623 (MD5) Previous issue date: 2013 / Nas últimas décadas, a reação em cadeia da polimerase (PCR) vem sendo utilizada para o diagnóstico da leishmaniose visceral (LV) com diferentes objetivos: o diagnóstico da infecção, da doença e o controle de cura. Para utilização em larga escala, a etapa de eletroforese para detecção dos produtos amplificados na PCR, torna a técnica complexa e onerosa. A PCR-ELISA representa uma alternativa de detecção do produto amplificado por PCR através de um ensaio imunoenzimático (ELISA). Esta técnica é capaz de conferir maior sensibilidade e rapidez para a análise de grandes números de amostras clínicas com o uso de equipamentos utilizados para processamento de ELISA e, portanto, permite realizar PCR para fins de diagnóstico em laboratórios de média complexidade. Assim, este estudo objetivou desenvolver e validar o método de detecção colorimétrica dos produtos de amplificação gerados pela reação de PCR para o diagnóstico da LV em amostras de sangue periférico.O método de PCR-ELISA foi desenvolvido para detecção de fragmento de DNA do cinetoplasto (kDNA), complexo Donovani-específico. Utilizando-se cepas referências de Leishmania em cultivo e de painel de amostras de sangue periférico humano de 11 indivíduos não infectados, moradores de área endêmica e 14 casos de LV, caracterizadas clínica e parasitologicamente, determinou-se o limite de detecção da reação, medidas de precisão (repetibilidade e reprodutibilidade) e limite entre positivo e negativo (cut-off). A avaliação do desempenho do ensaio foi realizada com amostras de sangue periférico de 105 pacientes portadores de LV, 25 pacientes portadores da co-infecção Leishmania/HIV e de 73 indivíduos moradores de área endêmica para a LV. Foi desenvolvido ainda um ensaio de PCR-ELISA para detecção do DNA amplificado do gene humano ACTB, para uso como controle do processo de extração de DNA e amplificação por PCR das amostras clínicas. O ensaio PCR-ELISA kDNA desenvolvido apresentou limite de detecção de 1 parasito/mL de sangue e 0,07fg/µL de DNA de L. (L.) infantum, sensibilidade de 100% (IC 95%: 97,1 a 100%) e especificidade de 95% (IC 95%: 83,5 a 98,6%). Todos os indivíduos assintomáticos de área endêmica, com positividade por outras técnicas diagnósticas, foram também positivos pela PCR-ELISA. Todas as amostras foram testadas satisfatoriamente para o ensaio de PCR-ELISA ACTB. O ensaio de PCR-ELISA kDNA, desenvolvido e validado neste estudo, apresenta simplicidade metodológica e operacional, permite interpretação objetiva da amplificação por PCR do DNA de Leishmania do complexo Donovani e desempenho adequado no diagnóstico da LV em laboratórios de referência. / In recent decades, the polymerase chain reaction (PCR) has been used for the diagnosis of visceral leishmaniasis (VL) with different goals: diagnosis of infection, disease control and cure. For large-scale use, the step of electrophoresis to detect amplified products of PCR makes this technique more complex and costly. The PCR-ELISA is an alternative for the detection of the amplified PCR product through an immunoenzymatic assay (ELISA). This technique offers higher sensitivity and speed for the analysis of large numbers of clinical specimens, using equipment widely used for processing sets of ELISA and therefore allows performing PCR for diagnostic purposes in laboratory of medium complexity. Thus, this study aimed to develop and validate the colorimetric detection method (ELISA) for amplification products generated by PCR targeting the diagnosis of VL.The method of PCR-ELISA was developed to detect a fragment of DNA of kinetoplast (kDNA) specific from Leishmania donovani complex. Using reference strains of Leishmania in cultivation and a panel of human peripheral blood samples of 11 non-infected individuals, residents of endemic area and 14 cases of VL with clinical and parasitological characterization, we determined the detection limit of the reaction, precision measurements (repeatability and reproducibility) and limit between positive and negative (cut-off). The performance of the assay was evaluated with peripheral blood samples of 105 patients with VL, 25 patients showing the co-infection Leishmania/HIV and 73 individuals living in endemic areas for VL. A PCR-ELISA assay for detection of DNA from the human ACTB gene was also developed for use as control for the process of DNA extraction and amplification by PCR of clinical samples. The PCR-ELISA kDNA assay developed showed a detection limit of 1 parasite/ml blood and 0.07 fg/µL of DNA from L. (L.) infantum. The assay showed a sensitivity of 100% (IC 95%: 97.1 to 100%) and specificity of 95% (IC 95%: 83.5 to 98.6%). All asymptomatic individuals from an endemic area, who were diagnosed for LV by other techniques, were also positive by PCR-ELISA kDNA. All samples were tested satisfactorily by PCR-ELISA ACTB assay. The PCR-ELISA kDNA assay was developed and validated in this study. It presents methodological and operational simplicity; enables objective interpretation of PCR amplification of DNA from Leishmania donovani complex and have sufficient performance for diagnosis of VL in reference laboratories.

Submitted by Nuzia Santos (nuzia@cpqrr.fiocruz.br) on 2013-10-08T12:26:57Z No. of bitstreams: 1 Tese Jacqueline Fiuza.pdf: 10186945 bytes, checksum: ad5d72f0c0040b9985453d0f8d1b7116 (MD5) / Made available in DSpace on 2013-10-08T12:26:57Z (GMT). No. of bitstreams: 1 Tese Jacqueline Fiuza.pdf: 10186945 bytes, checksum: ad5d72f0c0040b9985453d0f8d1b7116 (MD5) Previous issue date: 2013 / Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Imunologia Celular e Molecular / A leishmaniose visceral zoonótica (LVZ), causada pelo parasito intracelular Leishmania infantum, é uma doença tropical negligenciada que pode ser fatal quando não tratada. Os cães são considerados os principais reservatórios domésticos de L. infantum na LVZ, já que a presença de cães infectados pode aumentar o risco de infecção humana. A leishmaniose visceral canina (LVC) representa um dos maiores problemas veterinários e de saúde pública no sul da Europa, Oriente Médio e América do Sul. O controle de reservatórios animais é baseado na eliminação de cães soropositivos em áreas endêmicas. Contudo, o tratamento de cães infectados não é indicado no Brasil, pois esse procedimento pode levar a seleção de parasitos resistentes já que as mesmas drogas são usadas no tratamento de infecções em humanos. Sendo assim, o uso de vacinas contra a LVC continua sendo a melhor alternativa no controle de parasitos. Nesse trabalho, nós apresentamos dados de perfil de imunogenicidade e proteção conferido pelo uso de parasitos vivos atenuados LdCen -/-em modelo canino, comparando com Leishmune ® , uma vacina disponível comercialmente. A imunogenicidade e proteção foram avaliadas através da produção de anticorpos, proliferação e ativação celular, expressão de receptores TLR, produção de citocinas intracitoplasmáticas e secretadas no sobrenadante, e carga parasitária por Real Time PCR. A vacinação com LdCen -/-resultou em alta imunogenicidade e proteção, observado pela maior produção de IgG Total, IgG1, e IgG2, e maior linfoproliferação em resposta a antígenos solúveis. Além disso, cães vacinados com LdCen -/-apresentaram maior frequência de células T CD4 + e CD8 + ativadas, maior produção de IFN-γ e menor produção de IL-4 por essas células, secreção aumentada de TNF-α e IL-12/IL-23p40 e menor secreção de IL-4 em sobrenandante de culturas estimuladas. Também podemos observar alta expressão de receptores TLR2, 4 e 9 por linfócitos T CD4 +, maior expressão de TLR4 por células T CD8 +, e menor carga parasitária em cães vacinados. Os dados sugerem que a vacinação com parasitos LdCen -/-induz a produção de anticorpos, proliferação e ativação celular, expressão de receptores Toll e produção de citocinas pró-inflamatórias, sendo que esse conjunto de fatores permitiu a indução de proteção contra o desafio com L. infantum. Baseando nesses dados, a imunização com esses parasitos se mostrou segura e imunogênica, conferindo proteção em cães. / Zoonotic visceral leishmaniasis, caused by the intracellular protozoan parasite Leishmania infantum, is a neglected tropical disease that is often fatal when untreated. Dogs are considered the main reservoir of L. infantum in zoonotic VL as the presence of infected dogs may increase the risk for human infection. Canine visceral leishmaniasis (CVL) is a major veterinary and public health problem in Southern Europe, Middle East and South America. Control of animal reservoirs relies on elimination of seropositive dogs in endemic areas. However, treatment of infected dogs is not allowed in Brazil as this approach can lead to emergence of drug resistance since the same drugs are used to treat human infections. Therefore, vaccination against CVL remains the best alternative in control of the animal reservoirs. In this study, we present data on the immunogenicity and protection profile of a live attenuated parasite LdCen -/-in a canine infection model and compared it to that of Leishmune ®, a commercially available recombinant vaccine. The immunogenicity and protection of the LdCen -/-parasites was evaluated by antibody secretion, activation and proliferation of T cells, production of intracytoplasmic and secreted cytokines, TLR expression and parasite load by Real Time PCR. Vaccination with LdCen -/-resulted in high immunogenicity and protection as revealed by the higher IgG Total, IgG1, and IgG2 production and higher lymphoproliferative response. Further, LdCen -/-vaccinated dogs showed higher frequencies of activated CD4 + and CD8 + T cells, IFN-γ production by CD4 + and CD8 + T cells and decreased production of IL-4 by theses cells, increased secretion of TNF-α and IL-12/IL-23p40 and decreased secretion of IL-4 in supernatant of stimulated cultures. We also observed higher expression of TLR2, 4 and 9 by CD4 + T cells, higher expression of TLR4 by CD8 + T cells, and lower parasite load in vaccinated dogs. These data suggest the vaccination using LdCen -/-can induce antibodies secrection, cell activation, lymph proliferative response, TLR expression, proinflammatory cytokines production, and all these factors together induced protection against challenge with L. infantum. Based on that, the immunization with these parasites shown to be safe and immunogenic, conferring protection in dogs.

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Belo Horizonte, MG, Brasil / No Brasil, observa-se aumento dos casos de leishmaniose visceral (LV) nos últimos anos, associado à alta letalidade. É necessária a identificação de indicadores sensíveis e específicos que reconheçam precocemente a gravidade e possibilitem intervenção imediata e adequada. O objetivo do presente estudo prospectivo foi correlacionar parâmetros clínicos e laboratoriais e carga parasitária à evolução da LV em crianças. Foram incluídas 48 crianças com diagnóstico de LV, internadas no Hospital Infantil João Paulo II, em Belo Horizonte, de junho de 2010 a junho de 2011. Os pacientes foram avaliados clinicamente e tiveram amostras de sangue periférico coletadas antes (T0), entre 10 e 15 dias (T1) e entre 40 e 60 dias (T2) após início do tratamento. Nestas amostras, a carga parasitária foi quantificada por PCR quantitativa em tempo real (qPCR), sendo o gene alvo a SSU rRNA de Leishmania. Evolução grave foi definida como internação em UTI ou administração de amina vasoativa, ventilação mecânica ou hemotransfusão. As manifestações clínicas mais observadas à admissão foram febre, palidez e hepatosplenomegalia, associado à pancitopenia, elevação das aminotransferases hepáticas e hipoalbuminemia. A positividade da RIFI e dos testes rápidos Kalazar Detect® e Diamed-IT Leish® foi de 66,7%, 85,4% e 100%, respectivamente. Observou-se elevada positividade (100%) em exames de PCR convencional em sangue periférico e aspirado de medula óssea. Como tratamento específico, administrou-se Glucantime® em 45,8%, anfotericina B desoxicolato em 35,5%, anfotericina B lipossomal em 8,3% e associação de anfotericina B lipossomal e Glucantime® em 10,4% dos pacientes. Considerou-se que 56,2% das crianças apresentaram evolução grave, mas sem nenhum óbito. Em T2, todos apresentavam melhora clínica. A classificação por critérios de gravidade proposta pelo Ministério da Saúde em 2006 foi aplicada à admissão, não apresentando boa acurácia para detecção de casos com evolução grave. O qPCR apresentou bom desempenho e foi positivo em todas as crianças em T0. Observou-se variação ampla da carga parasitária em T0, não correlacionada a características clínicas e laboratoriais, a critérios de gravidade e escores preditores de óbito à admissão e à evolução grave durante a internação. Redução significativa do número de cópias do fragmento gênico foi constatada em T1 e T2, que não variou de acordo com a medicação usada. Identificaram-se como fatores de risco para evolução grave idade menor do que 12 meses, taquidispneia, infecção, hepatomegalia volumosa, anemia, plaquetopenia e hipoalbuminemia à admissão. / In Brazil, there is an increasing number of cases of visceral leishmaniasis (VL) in recent years, associated to a high case-fatality rate. It is necessary to identify sensitive and specific clinical factors that may prompt to adequate and immediate intervention. The purpose of this prospective study was to correlate clinical and laboratory parameters and parasite load with clinical outcome in children with VL. Forty-eight children diagnosed with VL and hospitalized in Hospital Infantil João Paulo II, in Belo Horizonte, Brazil, were included from June 2010 to June 2011. The patients were assessed clinically and peripheral blood samples were obtained before (T0), from 10 to 15 (T1) and from 40 to 60 days (T2) after starting treatment. In these samples, the parasite load was quantified by real-time quantitative PCR (qPCR) using as molecular target the SSU rRNA gene of Leishmania. Severe outcome was defined as admission in intensive care unit, administration of vasoactive amines, mechanical ventilation or blood transfusion. The most frequently observed features were fever, pallor and hepatosplenomegaly associated with pancytopenia, elevated liver aminotransferases and hypoalbuminemia. The positivity of IFAT and of the rapid tests Kalazar Detect® and Diamed-IT Leish® was 66,7%, 85,4% e 100%, respectively. There was a high positive rate (100%) in conventional PCR in peripheral blood and bone marrow aspirates. The drugs used for specific therapy were Glucantime® in 45,8%, amphotericin B deoxycholate in 35,5%, liposomal amphotericin B in 8,3% and combination of liposomal amphotericin B and Glucantime® in 10,4% of the patients. It was considered that 56,2% of the children presented severe outcome but no deaths occurred. At T2, all patients had clinical improvement. The classification of severity proposed by the Ministry of Health in 2006, applied at admission, showed low accuracy for detection of severe cases. The quantitative PCR assay presented high performance and was positive in all children in T0. There was a wide variation in parasite load at T0 and no correlation was observed with clinical and laboratory features, with severity at admission and with severe outcome. Significant decrease in the number of copies of the gene fragment was found in T1 and T2, which did not vary according to the drug used. The identified risk factors for severe outcome were children younger than 12 months and the presence of tachydyspnea, infection, hepatomegaly, anemia, thrombocytopenia and hypoalbuminemia at admission.

Submitted by Nuzia Santos (nuzia@cpqrr.fiocruz.br) on 2016-04-07T19:04:34Z No. of bitstreams: 1 Tese_DIP_SharaReginadaSilva.pdf: 575472 bytes, checksum: 90fbdbc94aef7c2eb888b39541523483 (MD5) / Approved for entry into archive by Nuzia Santos (nuzia@cpqrr.fiocruz.br) on 2016-04-07T19:08:47Z (GMT) No. of bitstreams: 1 Tese_DIP_SharaReginadaSilva.pdf: 575472 bytes, checksum: 90fbdbc94aef7c2eb888b39541523483 (MD5) / Made available in DSpace on 2016-04-07T19:08:47Z (GMT). No. of bitstreams: 1 Tese_DIP_SharaReginadaSilva.pdf: 575472 bytes, checksum: 90fbdbc94aef7c2eb888b39541523483 (MD5) Previous issue date: 2015 / Fundação Oswaldo Cruz. Centro de Pesquisa Rene Rachou / O presente trabalho avaliou a transmissibilidade de Leishmania spp. para Lutzomyia longipalpis em 136 cães nativos e beagles-sentinelas , vacinados ou não (placebo) com Leish- Tec ® (vacina anti-leishmaniose visceral canina), domiciliados em Porteirinha, município endêmico para leishmaniose visceral, em Minas Gerais. Esses animais foram selecionados a partir da amostra total de cães que compõem o ensaio clínico de fase III que determinou a eficácia da vacina Leish-Tec ® , conforme diretrizes estabelecida s pelo Ministério da Saúde do Brasil. Além da técnica de xenodiagnóstico, e sses cães também foram submetidos aos testes diagnósticos ELISA, RIFI, te ste rápido Kalazar Detect TM e exames de detecção do parasito. Uma tendência de redução da infectividade (p -valor 0,052) foi obser vada no grupo de cães vacinados com Leish-Tec ® que apresentaram resposta sorológi ca positiva ao antígeno vacinal A2. Os testes RIFI, Kalazar Detect TM e xenodiagnóstico apresentar am maior percentual de positividade entre os cães sintomáticos da amostra (p<0,05), quando comparados aos cães assintomáticos, na análise global. Na análise estr atificada e, para o grupo de cães que recebeu vacina, as diferenças se mantiveram para a RIFI e o teste rápido, mas não para o xenodiagnóstico; já para os cães que receberam pl acebo, as diferenças entre grupos clínicos se mantiveram para o xenodiagnóstico e teste rápido, mas não para a RIFI. Nossos resultados sugerem que a Leish-Tec ® possui potencial de redução da in fectividade em cães vacinados e desafiados em área endêmica e que a vacinação com Leish-Tec ® pode contribuir para a redução da transmissão da leishmaniose viscer al canina, desde que utilizada como medida protetiva individual e em conjunto com as dema is estratégias, individuais e coletivas, de prevenção e controle da doença. Com rel ação à diferença de desempenho dos testes diagnósticos entre grupos clínicos, nossos resultados apontam para a necessidade de desenvolvimento de testes mais eficazes no di agnóstico da infecção assintomática por Leishmania e demonstra que essas diferenças in terferem nos resultados e devem ser consideradas na avaliação de ensaios clínicos. / This study evaluated the transmission of Leishmania spp. to Lutzomyia longipalpis in 136 native and beagles sentinel dogs, vaccina ted or not (placebo) with Leish-Tec ® (canine visceral anti-leishmaniasis vaccine), domiciled in Port eirinha, visceral leishm aniasis endemic county in Minas Gerais, Brazil. These animals were sele cted from the total sample of dogs that make up the phase III clinical trial that determined the efficacy of Leish-Tec ® vaccine, according to guidelines established by Brazilia n Ministry of Health. Beside s the xenodiagnosis technique, these dogs were also subjected to the sorological tests ELI SA, IFAT, rapid test Kalazar Detect TM and parasite detection. A tendency of reduction of infectivity (p-value 0.052) was observed in the group of dogs vaccinated with Leish-Tec ® that presented positive serological response to the vaccine antig en A2. IFAT, Kalazar Detect TM and xenodiagnosis showed a higher percentage of positivity among symptomatic dogs (p <0.05) compared to asymptomatic dogs. In stratified analysis, and for the vaccine dogs group, differences remained for the IFAT and the rapid test, bu t not for xenodiagnosis; already for placebo dogs group, the differences between clinical groups re mained to xenodiagnosis and rapid test, but not for the IFAT. Our results suggest that the Leish-Tec ® has the potential to reduce the infectivity of vaccinated and challenged dogs in endemic areas and could contribute to the reduction of transmission of canine visceral le ishmaniasis, since used as an individual protective measure and together w ith other strategies, individual and collective, to prevent and control the disease. Regarding the performance difference of di agnostic tests between clinical groups, our results point to the need for developm ent of more effective tests in the diagnosis of asymptomatic Leishmania infection and shows that these di fferences affect the results and should be considered in ev aluating clinical trials.

abstract: The Visceral Leishmaniasis (VL) is primarily endemic in five countries, with India and Sudan having the highest burden. The risk factors associated with VL are either unknown in some regions or vary drastically among empirical studies. Here, a dynamical model, motivated and informed by field data from the literature, is analyzed and employed to identify and quantify the impact of region dependent risks on the VL transmission dynamics. Parameter estimation procedures were developed using model-derived quantities and empirical data from multiple resources. The dynamics of VL depend on the estimates of the control reproductive number, RC, interpreted as the average number of secondary infections generated by a single infectious individual during the infectious period. The distribution of RC was estimated for both India (with mean 2.1 ± 1.1) and Sudan (with mean 1.45 ± 0.57). This suggests that VL can be established in naive regions of India more easily than in naive regions of Sudan. The parameter sensitivity analysis on RC suggests that the average biting rate and transmission probabilities between host and vector are among the most sensitive parameters for both countries. The comparative assessment of VL transmission dynamics in both India and Sudan was carried out by parameter sensitivity analysis on VL-related prevalences (such as prevalences of asymptomatic hosts, symptomatic hosts, and infected vectors). The results identify that the treatment and symptoms’ developmental rates are parameters that are highly sensitive to VL symptomatic and asymptomatic host prevalence, respectively, for both countries. It is found that the estimates of transmission probability are significantly different between India (from human to sandflies with mean of 0.39 ± 0.12; from sandflies to human with mean 0.0005 ± 0.0002) and Sudan (from human to sandflies with mean 0.26 ± 0.07; from sandflies to human with mean 0.0002 ± 0.0001). The results have significant implications for elimination. An increasing focus on elimination requires a review of priorities within the VL control agenda. The development of systematic implementation of con­trol programs based on identified risk factors (such as monitoring of asymptomatically infected individuals) has a high transmission-blocking potential. / Dissertation/Thesis / Doctoral Dissertation Applied Mathematics for the Life and Social Sciences 2016