Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2018-03-20T15:51:33Z No. of bitstreams: 1 MariaJoseDeBrittoCostaFernandes_TESE.pdf: 1428494 bytes, checksum: 420a9e6903513c10cd3daa65554ed75d (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2018-03-21T14:40:26Z (GMT) No. of bitstreams: 1 MariaJoseDeBrittoCostaFernandes_TESE.pdf: 1428494 bytes, checksum: 420a9e6903513c10cd3daa65554ed75d (MD5) / Made available in DSpace on 2018-03-21T14:40:26Z (GMT). No. of bitstreams: 1 MariaJoseDeBrittoCostaFernandes_TESE.pdf: 1428494 bytes, checksum: 420a9e6903513c10cd3daa65554ed75d (MD5) Previous issue date: 2017-12-12 / A sinergia entre a tuberculose e o v?rus da imunodefici?ncia humana (HIV) vem causando grande impacto na epidemiologia da tuberculose nas Am?ricas, seja em pa?ses desenvolvidos ou naqueles em desenvolvimento, configurando um problema emergente em todo o continente. A coinfec??o pelo Micobacterium tuberculosis e o HIV vem sendo estuda em v?rios pa?ses, onde as duas infec??es representam importantes problemas de sa?de p?blica. A infec??o pelo HIV pode ser considerada, um dos principais fatores de risco que faz com que um indiv?duo com tuberculose latente (TBL) desenvolva a tuberculose ativa. Este trabalho teve como objetivo analisar o padr?o da varia??o espacial da incid?ncia de tuberculose (TB) e sua coinfec??o com HIV no estado do Rio Grande do Norte (RN), no per?odo de janeiro de 2001 a dezembro de 2011. A popula??o de estudo constitui-se de todos os casos de TB e da co-infec??o TB/HIV ocorridos no Estado do Rio Grande do Norte, notificados no banco de dados do Sistema de Informa??o de Agravos de Notifica??o (SINAN-MS) no per?do analisado. Para uma an?lise temporal mais consistente, foram constru?dos mapas considerando o tri?nio 2001 ? 2003 e os quadri?nios 2004 ? 2007 e 2008 ? 2011. Informa??es s?cio demogr?ficas foram obtidas com base no censo 2010 ? IBGE em n?vel de munic?pio. Com rela??o a an?lise estat?stica, utilizou-se ferramentas SIG usando o software QGIS vers?o 2.0.1 Dufour (www.qgis.org), t?cnicas de an?lise estat?stica espacial para dados de ?reas usando o software R-System, vers?o 2.15.0 (www.r-project.gov), al?m do SPSS, vers?o 18. A forma padr?o de apresenta??o de dados de ?rea foi feita por meio de mapas tem?ticos referentes ? taxa de incid?ncia (TI), permitindo observar o padr?o de varia??o espacial. Constatou-se uma varia??o temporal com tend?ncia ascendente da coinfec??o TB/HIV, com uma maior incid?ncia na faixa et?ria de 20 a 49 anos, seguida da faixa et?ria ? 50 anos, a forma pulmonar a mais frequente, com predomin?ncia no sexo masculino. Espera-se, que esse estudo possa contribuir com indicadores que ajudem melhorar o direcionamento dos recursos na rotina do tratamento dos coinfectados no Estado do Rio Grande do Norte, Brasil. / The synergy between tuberculosis and human immunodeficiency virus (HIV) has been causing great impact on the epidemiology of tuberculosis in the Americas, whether in developed countries or those in development, setting up an emerging problem across the continent. The co-infection by the Micobacterium tuberculosis and HIV has been studied in several countries, where the two infections represent important problem of public health. HIV infection can be considered one of the main risk factors that makes a person with latent tuberculosis (TBL) develop active tuberculosis. This work had as objective analyze the pattern of spatial variation in the incidence of tuberculosis (TB) and HIV co-infection your in the State of Rio Grande do Norte (RN), from January 2001 to December 2011. The study population consists of all cases of TB and TB/HIV co-infection occurred in the State of Rio Grande do Norte, reported in the database of the information system of reportable diseases (SINAN-MS) in the period analyzed. For a more consistent temporal analysis, maps were constructed considering the triennium 2001-2003 and 2004-2007 quadrennium and 2008-2011. Social and demographic information were obtained based on the 2010 census ? IBGE municipality level. With respect to statistical analysis, we used GIS tools using QGIS version 2.0.1 software Dufour (www.qgis.org), spatial statistical analysis techniques to data of areas using the R-System software, version 2.15.0 (www.r-project.gov ), in addition to the SPSS, version 18. The standard way of presenting data from the area was made by using thematic maps concerning the incidence rate (TI), allowing you to see the pattern of spatial variation. It has a temporal variation with upward trend of co-infection TB/HIV, with a higher incidence in the age group of 20 to 49 years, followed by the age group 50 years ?, the most frequent pulmonary, with predominance in males. It is expected, that this study can contribute to indicators, which help improve the targeting of resources in the routine treatment of Coinfected in the State of Rio Grande do Norte, Brazil.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-09-04T20:38:59Z No. of bitstreams: 1 ManoellaDoMonteAlves_DISSERT.pdf: 1198432 bytes, checksum: ece756325d875906e5cafaa70c73612e (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-09-06T19:35:23Z (GMT) No. of bitstreams: 1 ManoellaDoMonteAlves_DISSERT.pdf: 1198432 bytes, checksum: ece756325d875906e5cafaa70c73612e (MD5) / Made available in DSpace on 2017-09-06T19:35:23Z (GMT). No. of bitstreams: 1 ManoellaDoMonteAlves_DISSERT.pdf: 1198432 bytes, checksum: ece756325d875906e5cafaa70c73612e (MD5) Previous issue date: 2017-03-17 / A Leishmania infantum ? um pat?geno de comportamento oportunista. O risco de pessoas com infec??o assintom?tica por L. infantum desenvolverem leishmaniose visceral (LV) ? maior naquelas coinfectadas com HIV (v?rus da imunodefici?ncia humana) do que em imunocompetentes. A hip?tese do presente estudo ? que ativa??o persistente de c?lulas T em pessoas coinfectadas com HIV (HIV+) e L. infantum aumenta o risco de progress?o para LV. Para testar essa hip?tese, foi realizado um estudo, entre maio de 2014 a agosto de 2016, em uma ?rea end?mica para LV no estado do Rio Grande do Norte, Brasil, com objetivo de determinar a frequ?ncia de coinfec??o assintom?tica HIV/L. infantum e avaliar a resposta imune em pessoas com coinfec??o Leishmania-HIV. Em estudo transversal, um total de 1.134 pessoas HIV+ foram avaliadas quanto a frequ?ncia de infec??o por L. infantum, usando-se como marcador anticorpo anti-Leishmania. Um subgrupo de coinfectados HIV/L. infantum foi seguido e determinados os n?veis de ativa??o, senesc?ncia, anergia, exaust?o e regula??o de c?lulas T e a evolu??o cl?nica, comparando-os com pessoas HIV+, AIDS/LV, LV e saud?veis. A taxa de infec??o assintom?tica por L. infantum em pessoas HIV+ foi de 23,6% (n=268), destas 2 desenvolveram LV dentro de 1 ano e foram a ?bito. Pessoas dos grupos HIV/L. infantum, AIDS/LV e LV apresentaram maior express?o de CD38HLA-DR e PD1 em linf?citos T CD8 do que pessoas com HIV. Em todos os grupos houve express?o aumentada de CD57 nos linf?citos T CD8. O grupo HIV/L. infantum apresentou maior express?o de CD25FoxP3 nos linf?citos T CD8. Pessoas infectadas por L. infantum apresentaram uma maior ativa??o de linf?citos T CD8. Essa ativa??o persistente em pessoas com HIV/L. infantum pode levar a d?ficits imunol?gicos que aumentaria o risco de progress?o para LV. Esses resultados sinalizam para a necessidade de avalia??o de profilaxia com drogas leishmanicidas como medida para reduzir o risco de desenvolver LV sintom?tica. / The risk to develop visceral leishmaniasis (VL) in subjects with HIV+ (Human immunodeficiency virus) is greater than for immunocompetent people with asymptomatic Leishmania infantum. The hypothesis of this study was that persistent T cell activation in HIV co-infected persons and asymptomatic Leishmania infection increases the risk of progression to VL and to relapse. To test this hypothesis, a crosssectional study of subjects HIV+ was carried out between May 2014 and August 2016 in an endemic area for LV, in the state of Rio Grande do Norte, northeast Brazil, with the goal to determine the rate of asymptomatic L. infantum infection in HIV-infected persons (HIV +) and the immunological status of this co-infection. A total of 1,134 HIV+ subjects was recruited. A subgroup of HIV/L. infantum was followed to determine the level of T cell activation, senescence, anergy, exhaustion and regulation and clinical follow up and compared to a HIV+, AIDS/VL, VL alone and healthy individuals. The rate of L. infantum asymptomatic infection was 23.6%. Of the 268 HIV/L. Infantum, 2 developed VL and died. Subjects with HIV/L. infantum, AIDS/VL and VL group presented higher expression of CD38HLA-DR and PD1 in CD8 cells than subjects with only HIV. For all groups, there was an increased expression of CD57 in T CD8 lymphocytes. HIV/L. infantum group presented the higher CD25FoxP3 expression in T CD8 lymphocytes. People infected with L. infantum had a greater activation of CD8 T lymphocytes. This persistent activation may lead to possible immunologic deficits that in individuals with immunosuppressive diseases would increase the risk to develop VL. Therefore, prophylaxis with leishmanicidal drugs should be considered.

Submitted by Sandra Pereira (srpereira@ufrrj.br) on 2016-08-03T15:45:32Z No. of bitstreams: 1 2010 - Raquel Silva Lisboa.pdf: 4230911 bytes, checksum: e7087ccd29d417f592ca09ec5f49c657 (MD5) / Made available in DSpace on 2016-08-03T15:45:32Z (GMT). No. of bitstreams: 1 2010 - Raquel Silva Lisboa.pdf: 4230911 bytes, checksum: e7087ccd29d417f592ca09ec5f49c657 (MD5) Previous issue date: 2010-04-14 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico, CNPq. / Dogs can be infected with various hemoparasites, and the occurrence of co-infections between Ehrlichia canis, Babesia canis, Anaplasma platys, and Hepatozoon canis species is very common, since they have the same tick vector. The objectives of this study were to delineate a multiplex PCR technique for the simultaneous diagnostic of microorganisms of Babesia and Ehrlichia genera in canine blood samples, and to realize the partial characterization of fragments of the 16S rRNA gene of the family Anaplasmataceae agents and, of 18S rRNA gene of Babesia detected in some samples PCR-positive, comparing the sequences obtained with sequences of other strains previously deposited in GenBank. Total DNA of 119 blood samples was extracted, of these, 40 were selected by showing cytoplasmatic inclusions in leukocytes and/or platelets suggesting infection by agents of Anaplasmataceae family (1E to 40E), 37 by showing piroplasms (1B to 37B), and two by presenting structures of both agents (M1 and M2), and finally, 40 samples with negative parasitological diagnostic and hematological exam without alterations. All these samples were tested by PCR to confirm the absence or presence of these hemoparasites, and them utilized in the multiplex PCR delineation. In multiplex PCR reactions the primers A17/EC3 were used to amplify an approximately 600bp region of the 16S rRNA gene of Ehrlichia species and the primers PIRO-A1/PIRO-B were used to amplify an approximately 450bp region of the 18S rRNA gene of Babesia species. Validation of multiplex PCR was performed by real time multiplex PCR. The multiplex PCR was able to simultaneously detect both agents in a DNA sample of a dog naturally co-infected and all the single infections by Babesia, but does not detected all the Ehrlichia infections. The real-time multiplex PCR was more sensitive in detect both single and also co-infections, as well as positive DNA mixtures for the two agents. The sequencing results confirmed the isolates identity, and that the primers PIRO-A1/PIRO-B also amplified the DNA of Hepatozoon canis. Phylogenetic analysis indicated that E. canis, A. platys, B. canis and H. canis species found in this study showed close similarities with sequences previously deposited in GenBank, forming monophyletic groups. / Os c?es podem se infectar com diversos hemoparasitos, sendo muito comum a ocorr?ncia de coinfec??es entre as esp?cies Ehrlichia canis, Babesia canis, Anaplasma platys e Hepatozoon canis, visto que possuem o mesmo carrapato vetor. Este estudo teve como objetivos delinear uma t?cnica de PCR multiplex para diagnosticar simultaneamente microrganismos dos g?neros Ehrlichia e Babesia em amostras de sangue de c?es e realizar a caracteriza??o parcial de fragmentos do gene 16S rRNA de agentes da fam?lia Anaplasmataceae e do gene 18S rRNA de Babesia detectados em algumas amostras positivas pela PCR, comparando as sequ?ncias obtidas com as sequ?ncias de outras cepas depositadas previamente no GenBank. O DNA total de 119 amostras de sangue foi extra?do. Destas, 40 foram selecionadas por apresentar inclus?es citoplasm?ticas em leuc?citos e/ou plaquetas sugestivas de infec??o por agentes da fam?lia Anaplasmataceae (1E a 40E), 37 por apresentar formas parasit?rias de piroplasm?deos (1B a 37B), duas por apresentar estruturas de ambos os agentes (M1 e M2) e, finalmente, 40 amostras com diagn?stico parasitol?gico negativo e exame hematol?gico sem altera??es. Todas estas amostras foram testadas por PCR, para a confirma??o da aus?ncia ou presen?a destes hemoparasitos, e depois utilizadas no delineamento da PCR multiplex. Nas rea??es de PCR multiplex utilizou-se os oligonucleot?deos iniciadores A17/EC3 que amplificam um produto de aproximadamente 600pb de uma por??o do gene 16S rRNA de esp?cies de Ehrlichia e os oligonucleot?deos iniciadores PIRO-A1/PIRO-B que amplificam um produto de aproximadamente 450pb de uma por??o do gene 18Sr RNA de esp?cies de Babesia. A valida??o da PCR multiplex foi realizada por PCR multiplex em tempo-real. A PCR multiplex foi capaz de detectar simultaneamente os dois agentes em uma amostra de DNA de um c?o naturalmente coinfectado e todas as infec??es individuais por Babesia, mas n?o detectou todas as infec??es por Ehrlichia. A PCR multiplex em tempo real foi mais sens?vel em detectar tanto infec??es ?nicas quanto coinfec??es, al?m de misturas de DNA positivo para os dois agentes. Os resultados dos sequenciamentos confirmaram a identidade dos isolados, e que os oligonucleot?deos PIRO-A1/PIRO-B amplificaram tamb?m, o DNA de Hepatozoon canis. As an?lises filogen?ticas indicaram que as esp?cies de E. canis, A. platys, B. canis e H. canis encontradas neste estudo possuem similaridades pr?ximas com sequ?ncias previamente depositadas no GenBank, formando grupos monofil?ticos.