Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-04-03T22:31:55Z No. of bitstreams: 1 MarianneGarciaDeOliveira_DISSERT.pdf: 1689030 bytes, checksum: 7a391e7ba53ea61b94026888e1a5be01 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-04-11T18:26:00Z (GMT) No. of bitstreams: 1 MarianneGarciaDeOliveira_DISSERT.pdf: 1689030 bytes, checksum: 7a391e7ba53ea61b94026888e1a5be01 (MD5) / Made available in DSpace on 2017-04-11T18:26:00Z (GMT). No. of bitstreams: 1 MarianneGarciaDeOliveira_DISSERT.pdf: 1689030 bytes, checksum: 7a391e7ba53ea61b94026888e1a5be01 (MD5) Previous issue date: 2016-10-31 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / O Toxoplasma gondii ? o principal agente etiol?gico respons?vel pelo acometimento do SNC em pacientes HIV/Aids. A triagem de pacientes portadores de HIV/Aids em rela??o ? positividade para T. gondii, associada ? determina??o do n?mero de linf?citos TCD4, pode auxiliar na redu??o da morbi-mortalidade relacionada a esta co-infec??o. O presente estudo teve como objetivo geral avaliar a frequ?ncia da infec??o pelo T. gondii em pacientes HIV positivos e correlacionar aos aspectos cl?nicos, sorol?gicos e epidemiol?gicos. Para isto, foram avaliados 179 pacientes HIV positivos acompanhados no Hospital Giselda Trigueiro. As an?lises sorol?gicas foram realizadas atrav?s da t?cnica de ELISA, enquanto que as an?lises cl?nicas e epidemiol?gicas ocorreram por meio da pesquisa em prontu?rios e aplica??o de question?rio, respectivamente. Al?m disso, foi realizada an?lise molecular a partir de PCR em amostras de sangue perif?rico de 11 pacientes HIV internados com neurotoxoplasmose (suspeita ou confirma??o). Nossos resultados indicam alta taxa de infec??o por T. gondii entre pacientes portadores de HIV/Aids (83,8%), sendo detectadas a neurotoxoplasmose (11,7%) e a toxoplasmose ocular (3,35%). A presen?a de gatos e a ingest?o de salada crua foram fatores de risco identificados, aumentando a chance de adquirir a infec??o em 2,6 e 3,4 vezes, respectivamente. As manifesta??es cl?nicas mais frequentes entre todos os pacientes acometidos pela toxoplasmose cerebral consistiram em: paresia/hemiparesia (65,62%), cefaleia (37,50%) e altera??es da consci?ncia (28,12%). Al?m disso, entre os pacientes HIV/Aids internados, a neurotoxoplasmose foi decorrente de reativa??o da infec??o latente. A avalia??o molecular apresentou limita??es quanto ao diagn?stico da neurotoxoplasmose. Conclui-se que a realiza??o deste trabalho permitiu uma caracteriza??o epidemiol?gica e cl?nica da toxoplasmose em pacientes HIV/Aids do Rio Grande do Norte, sendo um estudo pioneiro na regi?o. / Toxoplasma gondii is the main etiological agent responsible for central nervous system involvement in HIV / AIDS patients. The screening of patients with HIV / AIDS related to the positivity for T. gondii, associated to the determination of the number of CD4+ T lymphocytes, may help to reduce the morbidity and mortality related to this co-infection. The present study had as general objective to evaluate the frequency of T. gondii infection in HIV positive patients and to correlate clinical, serological and epidemiological aspects. For this, 179 HIV positive patients were evaluated at the Hospital Giselda Trigueiro. Serological tests were performed using the ELISA technique, while the clinical and epidemiological analyzes occured through research in medical records and questionnaire application, respectively. In addition, molecular analysis was performed by PCR in peripheral blood samples from 11 HIV patients hospitalized with neurotoxoplasmosis (suspected or confirmed). Our results indicate a high rate of T. gondii infection among patients with HIV / AIDS (83.8%), being detected neurotoxoplasmosis (11.7%) and ocular toxoplasmosis (3.35%). The presence of cats and raw salad ingestion were identified as risk factors, increasing the chance of acquiring the infection in 2.6 and 3.4 times, respectively. The most frequent clinical manifestations among all patients affected by cerebral toxoplasmosis consisted of: paresis / hemiparesis (65.62%), headache (37.50%) and changes in consciousness (28.12%). Besides that, among hospitalized HIV / AIDS patients, neurotoxoplasmosis was due to latent infection reactivation. The molecular evaluation presented limitations on the diagnosis of neurotoxoplasmosis. It is concluded that the accomplishment of this work allowed an epidemiological and clinical characterization of the toxoplasmosis in HIV / AIDS patients of Rio Grande do Norte, being a pioneer study in the region.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-01-16T13:07:10Z No. of bitstreams: 2 Dissertação - Amanda Juliana Soaris de Souza - 2016.pdf: 2234438 bytes, checksum: 7ea39739a499e174ae4502af4bafbfaa (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-01-16T13:10:24Z (GMT) No. of bitstreams: 2 Dissertação - Amanda Juliana Soaris de Souza - 2016.pdf: 2234438 bytes, checksum: 7ea39739a499e174ae4502af4bafbfaa (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-01-16T13:10:24Z (GMT). No. of bitstreams: 2 Dissertação - Amanda Juliana Soaris de Souza - 2016.pdf: 2234438 bytes, checksum: 7ea39739a499e174ae4502af4bafbfaa (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-12-12 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Abstract: Toxoplasma gondii is a pathogenic agente capable o causing both local and systemic disease in immunocompetent and immunocompromised individuals. It can be agressive inducing lesions in the central nervous system, viscera, eye globe and/or lymohatic ganglia. Neurocysticercosis is the most severe form of cysticercosis. It is the one of the main helminthiasis of the central nervous system leasing to varied symptoms. During toxoplasmosis infection the inflammatory response is typically pro-inflammatory. When there is co-infection between these two agents, this typical pro-inflammatory response may lead to the death of the parasites resulting in the release of antigens. Therefore an experimental model using T. gondii cysts and T. crassiceps antigens was developed. The aim of this study was to evaluate the influence of T. crassiceps cysticerci antigens in the modulation of the inflammatory response of the experimental neurotoxoplasmosis. BALB/c mice were inoculated with T. gondii cysts and/or T. crassiceps cysticerci antigens. The animals were euthanized 60 or 90 days after the inoculation. The histopathologic analysis and the cytokine dosage from spleen cell culture were performed. The animals from the neurotoxoplasmosis group at 90 DAI (NT90) presented greater intensity of the lesions such as vasculitis, meningitis and microgliosis alongside with a Th1 immune profile with high dosages of IFNγ. While in the neurocysticercosis group at 60 DAI (NCC60) the lesions were more discrete with high dosages of IL4 displaying a Th2 immune profile. In the co-infected group the parenchyma lesions were more discrete. Also in the co-infected group there were lower dosages of IFNγ and higher dosages of IL4 in comparison to the NT90 group. It is possible to conclude that the T. crassiceps cysticerci antigens decreased the intensity of the lesions caused by the T. gondii infection inducing a Th2 immune response. / Resumo: O Toxoplasma gondii é um agente patogênico que pode causar doença sistêmica e local em indivíduos imunocompetentes e imunossuprimidos, podendo se mostrar agressivo, causando lesões no sistema nervoso central, órgãos viscerais, olhos e/ou gânglios linfáticos. A Neurocisticercose é a forma mais grave de cisticercose, sendo uma das principais helmintoses do sistema nervoso central, e podendo causar sintomas variados. Na infecção pela toxoplasmose, a resposta imunológica é tipicamente pró-inflamatória. Durante a coinfecção, este tipo de resposta pode causar a morte do parasito, causando a liberação dos antígenos. Desta forma, tornou-se necessário o desenvolvimento de um modelo experimental utilizando o T. gondii e os antígenos de cisticerco de T. crassiceps. O objetivo deste trabalho foi avaliar influência dos antígenos do cisticerco de Taenia crassiceps na modulação da resposta inflamatória na neurotoxoplasmose experimental. Para isso camundongos BALB/c foram inoculados com cistos de T. gondii e/ou antígenos de cisticercos e eutanasiados aos 60 ou 90 dias após a inoculação. Foi realizada análise histopatológica dos encéfalos e dosagem de citocinas a partir de cultura de células do baço. Os animais do grupo neurotoxoplasmose aos 90DAI (NT90) apresentaram maior intensidade de lesões, como vasculite, meningite e microgliose e perfil imune do tipo Th1, com dosagens elevadas de IFNγ, enquanto que o grupo neurocisticercose aos 60DAI (NCC60), as lesões foram mais discretas e dosagens elevadas de IL4, revelando perfil imune do tipo Th2. No grupo de animais coinfectados as lesões no parênquima foram mais discretas. Além disso, o grupo co-inoculado NT e NCC (COINF) apresentou dosagens baixas de IFNγ e aumentadas de IL4 em relação ao grupo NT90. Conclui-se que a inoculação de antígenos de T. crassiceps amenizou as lesões causadas pelo T. gondii induzindo uma resposta imunológica do tipo Th2.