Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.S.)--University of Michigan, 1983.

Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.S.)--University of Michigan, 1983.

Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.S.)--University of Michigan, 1989.

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Orientador: Rinaldo Poncio Mendes / Coorientador: James Venturini / Coorientador: Ana Pardini Vicentini / Coorientador: Daniela Vanessa Moris de Oliveira / Banca: Mário León Silva-Vergara / Banca: Anamaria Mello Miranda Peniago / Resumo: O reaparecimento de manifestações clínicas após tratamento eficaz, neste texto identificado como recaída, tem sido pouco avaliado. Assim, foram estudados os casos de recaída observados em 400 pacientes, 93 com a forma aguda/subaguda (FA) e 307 com a crônica (FC), que já tinham apresentado cura aparente, isto é, com cura clínica, normalização da velocidade de hemossedimentação e cura sorológica - caracterizada pela presença de teste negativo à imunodifusão dupla em gel de agar por dois anos. Vinte e um (5,2%) desses pacientes apresentaram recaídas da doença. Três (14,3%) eram do sexo feminino e 18 (85,7%) do masculino, com razão de masculinidade de 6:1. Dos 21 pacientes com recaída, 15 (4,8%) apresentavam a FC e 6 (6,4%) a FA (p>0,05). As reativações ocorreram de 46 a 296 meses após introdução do tratamento (Md=96) e de 4 a 267 meses (Md= 60) após sua suspensão. As formas clínicas não diferiram quanto aos tempos decorridos até a reativação. O diagnóstico sorológico de recaída pela IDD foi feito em apenas 45% dos casos, o que levou à avaliação de outros testes para esse fim. Assim, foi realizado o enzimaimunoensaio (ELISA) e o immunoblotting (IB). A sensibilidade da IDD e do ELISA / 0,710 foi 76,1% em amostras de soro obtidos no pré-tratamento (p=0,25). No diagnóstico de recaída, a sensibilidade da IDD foi menor que no pré-tratamento (80% vs 45%; p=0,017), enquanto o ELISA / 0,710 foi igual (80% vs 65%;p=0,125). A sensibilidade do IB para diagnóstico de recaída foi de 12,5% na identificação da gp70 e 43,8% na da gp43 (p<0,05). A avaliação da acurácia do teste ELISA revelou sensibilidade de 96%, especificidade de 95%, valor preditivo positivo de 95%, valor preditivo negativo de 96% e acurácia de 95,5% quando o cut-off utilizado foi a densidade óptica de 0,710, obtido em função da construção da receiver operator characteristc - ROC, para um intervalo de confiança ... / Abstract: The reappearance of clinical manifestations after efficacious treatment, here identified as relapse, has been rarely evaluated. Thus, the cases of relapse observed in a cohort of 400 patients, 93 with acute/subacute form (AF) and 307 with chronic form (CF) were studied. They had already reached apparent cure, characterized as clinical cure, normalization of the erythrocyte sedimentation rate and serological cure, with a negative double agar gel immunodiffusion test (DID) for two years after antifungal discontinuation. Twenty-one (5.2%) of these patients had relapses. Three (14.3%) were female and 18 (85.7%) were male, with a male:female ratio of 6:1. Of the 21 relapsed patients, 15 (4.8%) presented the CF and 6 (6.4%) the AF (p>0.05). The relapse occurred 46-296 months after introduction of the treatment (Md=8 yrs) and from 4 to 267 months (Md=5 yrs) after withdrawal. Clinical forms did not differ regarding to the time elapsed until relapse. DID was positive in only 45% of the relapsed cases, which led to the evaluation of other tests to diagnose this condition. Thus, the enzyme-linked immunosorbent assay (ELISA) was standardized and the cut off was determined using the curve receiver operator characteristic - ROC and confidence intervals of 95% and 99%, showing optical densities of 0.710 and 0.850, respectively. Then, serological evaluation was performed using ELISA/0.710 and ELISA/0.850, and immunoblotting identifying gp43 (IBgp43) and gp70 (IBgp70). ELISA 0.710 and DID showed the same sensitivity, 76.1%, in serum samples obtained before treatment (p=0.25). DID sensitivity was lower at relapse than before the initial treatment (45% vs 80%; p=0.017), whereas ELISA/0,710 was the same (65% vs 80%; p=0.125). IBgp70 showed a 12.5% and IBgp43 a 43.8% sensitivity for diagnosing relapse (p<0.05). ELISA/0.710 showed a 96% sensitivity, 95% specificity, 95% positive predictive value, 96% negative ... / Mestre

CHIKV is the prototype of Alphaviruses and it causes an acute febrile illness with rash, severely painful arthralgias, and sometimes arthritis. While CHIKV has first been identified in the 1950s in Africa, recent outbreaks of CHIKV in the islands of the Indian Ocean and particular in Italia have re-drawn attention to CHIKV. In the past CHIKV disease was considered self-limiting and non-fatal. However, a number of deaths on Reunion (Anonym, 2006) during the outbreak, which was affected directly or indirectly by CHIKV, have changed this view. To defeat CHIKV outbreaks diagnostic tools and anti CHIKV therapies are urgently needed. In this thesis, we generated tools to investigate CHIKV at the molecular level by serological tests. CHIKV was isolated from a German woman who was infected during her holidays on the Mauritius Island. To characterize this viral isolate the complete viral genome was amplified by PCR and molecular cloned. In order to analyse antibody responses of infected individuals some of the structural and non-structural genes were subcloned in bacterial expression vectors. The NSP2, proteinase, capsid, E1 and E2 were subsequently expressed in E.coli using purified successfully. In this thesis, the structural proteins were used to develop a screening test for anti-CHIKV antibodies in patient derived serum samples. These tests were evaluated with pre-characterized anti-CHIKV sera (30 samples) obtained from the BNI Hamburg and 100 serum samples from German blood donors used as negative controls. Immunoblotting analysis revealed that up to 77% of precharacterised positive sera could recognize the recombinant proteins and there were no detectable reactivity of CHIKV-negative German donor sera. The recombinant proteins were also recognized by 71.4% of positive sera in the newly established ELISA. In order to go further in analyses of the results, an in house IFA was performed. Positive sera (21 samples) were used. The results showed that all of them reacted positive, but this assay was less sensitive than the IFA from BNI. In comparison with the IFA result from BNI Hamburg, the results were not congruent in all test performed. This could be due to various drawbacks of the tests. A cross reaction in Alphaviruses and the different strains are mentioned as well as the denatured forms of the structural proteins. Besides the main structural proteins (E1, E2 and C), other proteins such as non-structural proteins, uncleaved precursor proteins could participate in the different outcomes of serological assays. In order to go further in the CHIKV diagnoses, the CHIKV recombinant proteins were applied to screen the anti-CHIKV antibodies in the Vietnamese population, who are considered to live in the high risk regions. In serological tests, 158 sera of Vietnamese donors were incubated with the recombinant proteins or the fixed CHIKV infected cells. The results showed that 24% of Vietnamese donor sera recognized the recombinant proteins in immunoblot assay, while 36% scored positive in the ELISA assay. In IFA, the sera considered positive were 11.4%. While some discrepancies in serological tests were found, these results showed that the ratio of CHIKV-positive sera seem to be equal to the other regions in the world, which are affected by CHIKV. It is suggested that CHIKV infection in Vietnam has been repeatedly misdiagnosed. This study cohort consisted only of samples originating from Hanoi area of Northern Vietnam, thus, future studies should expand to include samples from other Vietnam areas. To do this the various subtypes of the virus in the different regions should be isolated and the sequences of these viruses should be well characterized.