Browsing by Author "Corte-Real, Rita"
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- Chlamydia trachomatis outbreak: when the virulence-associated genome backbone imports a prevalence-associated major antigen signaturePublication . Borges, Vitor; Cordeiro, Dora; Salas, Ana Isabel; Lodhia, Zohra; Correia, Cristina; Isidro, Joana; Fernandes, Cândida; Rodrigues, Ana; Azevedo, Jacinta; Alves, João; Rôxo, João; Rocha, Miguel; Corte-Real, Rita; Vieira, Luís; Borrego, Maria José; Gomes, João PauloChlamydia trachomatis is the most prevalent sexually transmitted bacterium worldwide and the causative agent of trachoma. Its strains are classified according to their ompA genotypes, which are strongly linked to differential tissue tropism and disease outcomes [ocular disease, urogenital disease and lymphogranuloma venereum (LGV)]. While the genome-based species phylogenetic tree presents four main clades correlating with tropism/prevalence, namely ocular, LGV, urogenital T1 (more prevalent genotypes) and urogenital T2 (less prevalent genotypes), inter-clade exchange of ompA is considered a rare phenomenon probably mediating marked tropism alterations. An LGV epidemic, associated with the clonal expansion of the L2b genotype, has emerged in the last few decades, raising concerns particularly due to its atypical clinical presentation (ulcerative proctitis) and circulation among men who have sex with men (MSM).
- Distinguishing Kingella kingae from Pyogenic Acute Septic Arthritis in Young Portuguese ChildrenPublication . Gouveia, Catarina; Subtil, Ana; Norte, Susana; Arcangelo, Joana; Santos, Madalena Almeida; Corte-Real, Rita; Simões, Maria João; Canhão, Helena; Tavares, Delfin(1) Background: We aim to identify clinical and laboratorial parameters to distinguish Kingella kingae from pyogenic septic arthritis (SA). (2) Methods: A longitudinal, observational, single-centre study of children < 5 years old with microbiological positive SA admitted to a paediatric hospital from 2013-2020 was performed. Clinical and laboratorial data at admission and at 48 h, as well as on treatment and evolution, were obtained. (3) Results: We found a total of 75 children, 44 with K. kingae and 31 with pyogenic infections (mostly MSSA, S. pneumoniae and S. pyogenes). K. kingae affected younger children with low or absent fever, low inflammatory markers and a favourable prognosis. In the univariate analyses, fever, septic look, CRP and ESR at admission and CRP at 48 h were significantly lower in K. kingae SA. In the multivariate analyses, age > 6 months ≤ 2 years, apyrexy and CRP ≤ 100 mg/L were significative, with an overall predictive positive value of 86.5%, and 88.4% for K. kingae. For this model, ROC curves were capable of differentiating (AUC 0.861, 95% CI 0.767-0.955) K. kingae SA from typical pathogens. (4) Conclusions: Age > 6 months ≤ 2 years, apyrexy and PCR ≤ 100 mg/L were the main predictive factors to distinguish K. kingae from pyogenic SA < 5 years. These data need to be validated in a larger study.
- Enterovirus D68. Vírus emergente também em Portugal?Publication . Padeira, Gonçalo; Corte-Real, Rita; Guiomar, Raquel; Brito, Maria JoãoIntrodução: Em Setembro de 2014, nos EUA, ocorreu a emergência do enterovirus (EV) D68, com morbilidade e mortalidade significativas por complicações respiratórias e neurológicas. A população pediátrica foi a mais atingida. Em Portugal esta infecção não tinha sido ainda descrita. Objectivo Identificar o EV68 e caracterizar estas infecções num hospital pediátrico terciário português. Métodos: Identificação do EV68 por PCR-TR multiplex nas secreções respiratórias, em crianças com doença respiratória grave e neurológica, entre Novembro de 2015 e Fevereiro de 2016. A análise filogenética foi feita pelo estudo das regiões genómicas VP1/VP3. Resultados: Identificados 18 doentes, com mediana de idade de 2 anos (máx 6anos, mín 22dias). Registou-se prematuridade em 56% casos e sibilância recorrente em 33%. Os diagnósticos foram infecção respiratória baixa (13), infecção respiratória alta (3) e outros (2) (convulsão febril, paralisia facial periférica). O padrão radiológico foi intersticial (9), segmentar (2) e em quatro casos normal. Registaram-se co-infecções em 9/18 (50%) casos: influenza AH1N1, adenovírus, Rhinovirus, Bocavirus, Bordetela pertussis, Campylobacter, Micobacterium tuberculosis. Ocorreram complicações em 9/18 (50%) doentes: hipoxemia (8), desidratação e insuficiência renal aguda (1). A duração média do internamento foi 5 dias. Todos evoluíram favoravelmente. Comentários. O EV68 circula também no nosso país, mas sem a gravidade descrita nos EUA. Poderão existir alterações da sua virulência, imunidade protectora na nossa população mas outros factores ainda desconhecidos devem também ser ponderados. O número de casos num curto período de tempo e as coinfecções foram superiores ao descrito noutros locais da Europa.
- Enterovírus não-polio e infeções do sistema nervoso central em crianças: avaliação laboratorial, 2023-2024Publication . Palminha, Paula; Neves, Raquel; Ribeiro, Carlos; Garcia, Ana Margarida; Fontes, Inês Sousa; Gouveia, Catarina; Corte-Real, RitaOs enterovírus não-polio permanecem como os principais agentes patogénicos do sistema nervoso central (SNC) em todo o mundo, especialmente em crianças com idade inferior a 5 anos, causando desde doença ligeira a quadros graves que podem evoluir para desfechos fatais. Entre 2023 e 2024 foram analisadas no INSA fezes de 327 crianças com suspeita de infeção por enterovírus. O diagnóstico laboratorial incluiu a deteção do RNA viral por RT-PCR em tempo real e o isolamento viral. A identificação viral foi realizada por sequenciação genómica. Neste período foram identificados 109 (33,3%) casos de infeção a enterovírus, dos quais 26 casos (23,9%) corresponderam a infeções do SNC, maioritariamente em crianças com menos de 5 anos (88,5%), sem uma evidente distribuição temporal. Os enterovírus mais frequentes foram os echovírus (tipos 5, 6,7, 9, 18, 21, 25, 30, 31 e 32), detetados em 13 casos (52,0%), seguidos pelos Coxsackievírus A (tipos 4, 6, 9, 10 e 16), em 7 casos (28,0%), ambos associados a meningite e meningoencefalite. O Enterovírus 71 (EV71) foi detetado em dois casos, um de romboencefalite e um de paralisia flácida aguda (PFA), e um caso de meningite esteve associado ao EV-C99. Não se observou nenhum padrão de surto nestes dois anos. Estes resultados reforçam a relevância da identificação rápida e dirigida para enterovírus como agentes etiológicos de infeções do SNC, fundamental para uma intervenção clínica direcionada, evitando o uso desnecessário de antibióticos e de múltiplos exames complementares de diagnóstico
- Implementing an Influenza Vaccine Effectiveness Study in a Hospital Context in Portugal: The EVA Hospital ProjectPublication . Machado, Ausenda; Gomez, Verónica; Panarra, António; Poças, Jose; Corte-Real, Rita; Peres, Maria João; Nunes, Baltazar; EVA Hospital GroupIntroduction: The project ‘Integrated Monitoring of Vaccines in Europe’ aimed to measure seasonal influenza vaccine effectiveness against hospitalised adults, aged 65 years and over, with influenza. We describe the protocol implementation in Portugal. Material and Methods: We implemented a test-negative design, targeting community-dwelling patients aged 65 years old and over hospitalised with severe acute respiratory illness. Patients were reverse transverse-polymerase chain reaction tested for influenza. Cases were those positive for influenza while others were controls. Most variables were collected using hospital medical records. Selection bias was evaluated by comparison with the laboratory influenza test requests database according to demographic characteristics. Crude, season-adjusted influenza vaccine effectiveness was estimated as = 1 – odds ratio, and 95% confidence intervals were obtained by conditional logistical regression, matched with the disease onset month. Results: The recruitment rate was 37.8%. Most participants (n = 368) were female (55.8%) and aged 80 years old and over (55.8%). This was similar to values for potentially eligible severe acute respiratory illness patients (80 years old and over: 56.8%, female: 56.2%). The proportion of missing values was below 2.5% for 20 variables and above 5% (maximum 11.6%) for six variables. Influenza vaccine effectiveness estimates were 62.1% against AH1pdm09 (95% confidence intervals: -28.1 to 88.8), 14.9% against A(H3N2) (95% confidence intervals: -69.6 to 57.3), 43.6% against B/Yam (95% confidence intervals: -66.2 to 80.8). Discussion: Given the non-existence of a coded admission database in either participating hospital the selection of severe acute respiratory illness due to clinical features was the feasible one. These results are only valid for the older adult population residing in the catchment area of the two participating hospitals who were admitted to a public hospital with severe influenza or SARI symptoms. Conclusion: Despite the low participation rate, we observed comparable characteristics of participants and eligible severe acute respiratory illness patients. Data quality was high, and influenza vaccine effectiveness results were in accordance with the results of meta-analyses and European season-specific estimates. The final sample size was low, which inhibited obtaining estimates with good precision.
- Influenza seroprotection correlates with predominant circulating viruses during 2014/15 and 2015/16 seasons in PortugalPublication . Guiomar, Raquel; Cristóvão, Paula; Conde, Patrícia; Costa, Inês; Pechirra, Pedro; Rodrigues, Ana Paula; Pereira da Silva, Susana; Nunes, Baltazar; Mouro Pinto, Rita; Sobrinho Simões, Joana; Costa, Maria do Rosário; Guimarães, João Tiago; Rodrigues, Fernando; Correia, Lurdes; Pereira-Vaz, João; Caseiro, Paula; Cabral Veloso, Rita; Mota Vieira, Luísa; Pimentel Couto, Ana Rita; Santos, Margarida; Bruges Armas, Jácome; Branquinho, Paula; Corte-Real, Rita; Martins, Luís; Cunha, Mário; Almeida, Sofia; Viseu, Regina; Inácio, Filipe; Peres, Maria João; Milho, Luís; Fernandes, Aida; Maurílio, Manuel; Caldeira, Filomena; Sanches, Raquel; Dantas, Filipa; Freitas, Ludivina; Andrade, Graça; Mota, PaulaBACKGROUND: Population immune profile for influenza is highly affected by circulating influenza viruses, thus changing the risk of infection for influenza. This study aims to assess influenza immunity in the Portuguese population by age groups, during 2014 and 2015 and establish a relationship between seroprotection and circulating influenza viruses in 2014/15 and 2015/16 seasons. METHODS: Two cross-sectional studies were developed based on a convenience serum sample collected in June 2014 (n=626) and July 2015 (n=675) in hospitals from mainland and Azores and Madeira.Serums equally represent all age groups. Antibody titers were evaluated by HI assay for strains recommended for seasonal influenza vaccine northern hemisphere,2014/15 and 2015/2016. Seroprevalences were estimated for each strain by age group and the association with seasonal cumulative influenza-like illness (ILI) rates for influenza virus during both seasons was analised. RESULTS: In June 2014 the highest seroprotection was observed for influenza A(H3) (39.0%; 95% CI: 36.2-43.8%) and A(H1)pdm09 (29.7; 95% CI: 26.3-33.4%), with higher levels in children 5-14 years old. In 2014/2015 a dominant circulation of influenza B/Yamagata was observed with high incidence rates in individuals under 65 years old, the ones that had lower seroprotection. Although before the start of the season high protection for A(H3) was observed, the circulation of the new drift A(H3) strains had gained an immunological advantage,in accordance with A(H3) elevated incidence rates observed during 2014/15. In July 2015 the highest seroprotection was observed for influenza B/ Yamagata (55.1%; 95% CI: 51.4-58.9%), 2.4 times the estimated 2014.This increase was even more pronounced in younger (≤ 4 years old), 6.3 times increase in 2015.This fact is in agreement with the predominant influenza B virus detected and the high ILI incidence rate observed in children during 2014/2015 epidemic. Seroprotection levels for influenza A in July 2015 were not significantly different from 2014.During 2015/16 season, influenza A(H1N1)pdm09 was predominant, with high incidence rate in < 65 year old. Influenza B/Victoria lineage,although detected at low levels increased in frequency, in agreement with the lowest level of seroprotection detected in the general population before the start of 2015/2016 season (21.8%; 95% CI: 18.7-24.0%). CONCLUSIONS There was a correlation between virus circulation, incidence rates for each age group and the previous seroprotection for seasonal influenza viruses.Our study highlights the value of measuring the serological profile for influenza to establishe risk groups for infection for which an increase preventive measures, including vaccination, should be fostered.
- Influenza severe cases in hospitals, between 2014 and 2016 in PortugalPublication . Guiomar, Raquel; Pechirra, Pedro; Cristóvão, Paula; Costa, Inês; Conde, Patrícia; Corte-Real, Rita; Branquinho, Paula; Silvestre, Maria José; Almeida Santos, Madalena; Fernandes, Isabel; Dias, Isabel; Rodrigues, Sónia; Sena, Nadir; Lazzara, Daniela; Sobrinho Simões, Joana; Costa, Maria do Rosário; Guimarães, João Tiago; Rodrigues, Fernando; Pereira-Vaz, João; Correia, Lurdes; Andrade, Graça; Freitas, Ludivina; Figueira, Neuza; Sanches, Raquel; Marques, Mónica; Barros, Margarida; Mota Vieira, Luísa; Cabral Veloso, Rita; Castelo Branco, Cláudia; Pimentel, Sílvia; Duarte, Joana; Pereirinha, Tânia; Bulhões, Sara; Moniz, Raquel; Brilhante, Maria José; Bruges Armas, Jácome; Pimentel Couto, Ana Rita; Santos, Margarida; Soares, Marta; Melo Cristino, José; Ribeiro, Carlos; Carvalho, Dinah; Barreto, Rosário; Ramos, Maria Helena; Castro, Ana Paula; Matos Santos, Ana Cláudia; Cunha, Mário; Martins, Luís; Almeida, Sofia; Peres, Maria João; Viseu, Regina; Inácio, Filipe; Mota, PaulaBackground: Since 2009, the Portuguese Laboratory Network (PLNID) for Influenza Diagnosis has integrated 15 Laboratories in mainland and Atlantic Islands of Azores and Madeira. This PLNID added an important contribute to the National Influenza Surveillance Program regarding severe and hospitalized influenza cases. The present study aims to describe influenza viruses detected in influenza like illness (ILI) cases: outpatients (Outp), hospitalized (Hosp), and intensive care units (ICU), between 2014 and 2016. Methods: The PLNID performs influenza virus diagnosis by biomolecular methodologies. Weekly reports to the National Influenza Reference Laboratory ILI cases tested for influenza. Reports include data on detecting viruses, hospital assistance, antiviral therapeutics, and information on death outcome. Were reported during two winter seasons 8059 ILI cases,being 3560 cases in 2014/15 (1024 in Outp, 1750 Hosp, and 606 in ICU) and 4499 cases in 2015/2016 (1933 in Outp, 1826 Hosp, and 740 in ICU). Results: The higher percentage of influenza positive cases were detected in Outp in both seasons, 18% during 2014/15 and 20% in 2015/16. In 2014/15,influenza cases were more frequent in individuals older than 65 years old and these required more hospitalizations,even in ICU. In 2015/16,the influenza cases were mainly detected in individuals between 15-64 years old. A higher proportion of influenza positive cases with hospitalization in ICU were observed in adults between 45-64 years old.During the study period,the predominant circulating influenza viruses were different in the two seasons: influenza B and A(H3) co-circulated in 2014/15,and influenza A(H1)pdm09 was predominant during 2015/16. Even when influenza A is notthe dominant virus, A(H3) and A(H1)pdm09 subtypes correlate with higher detection rate in hospitalized cases (Hosp and UCI), with higher frequencies in adults older than 45. Influenza B,detected in higher proportion in outpatients, was frequently relatedwith influenza cases in younger age groups: 0-4 and 5-14 years old. Conclusions: This study highlights the correlation of theinfluenza virus type/subtype that circulates in each season with the possible need for hospitalization and intensive care in special groups of the population. Circulation of influenza A subtypes can cause more frequentdisease in individuals older than 45, with need of hospitalization including intensive care. On the other hand, influenza B is more frequently associated with less severe cases and with infection in children and younger adults. Influenza B circulation might predict lower number of hospitalizations.The identification of influenza type in circulation,byPLNID ineach season, could guide action planning measures in population health care.
- Lymphogranuloma venereum (LGV) ompA-subvariants of the Portuguese collection of Chlamydia trachomatis, 2007–2023Publication . Lodhia, Zohra; Cordeiro, Dora; Correia, Cristina; João, Inês; Carreira, Teresa; Nunes, Alexandra; Ferreira, Rita; Schäfer, Sandra; Aliyeva, Elzara; Portugal, Clara; Monge, Isabel; Gonçalves, Elsa; Matos, Susana; Dias, Ana Paula; Corte-Real, Rita; Vieira, Luís; Gomes, Joao Paulo; Borges, Vítor; Jose Borrego, MariaBackground: Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by Chlamydia trachomatis ompA-genotypes L1–L3, with increasing numbers of detected cases across Europe. Here, we analysed diversity and temporal distribution of the LGV ompA-subvariants detected in Portugal between 2007 and 2023, in order to better understand the dissemination and diversification landscape of LGV strains. Methods: The collection of the Portuguese National Reference Laboratory includes 1188 LGV ompA-genotyped samples between 2007 and 2023. In-depth analysis of the diversity of LGV ompA-subvariants circulating in Portugal across the years was performed, identifying newly described subvariants and integrating this data in a comprehensive compilation with all representative LGV ompA-subvariants described globally. Results: L2 ompA-variant (L2/434/Bu) was consistently the most frequently detected in our collection, with annual proportions ranging from 34.0% to 82.9%, between 2016 and 2023. L2bV5 was the second most frequent followed by L2b, ranging from 5.0% to 27.9% and 2.6% to 23.7% across the years, respectively, from 2017 to 2023. We highlighted the emergence and considerable increase in circulation of L1-like ompA-subvariants in recent years, representing 13.7% of LGV sequences in 2023. We also identified 13 novel LGV ompA-subvariants that had not been described before, differing by up to three mutations from the respective genotype reference sequences. Conclusions: This study contributes to the worldwide picture of the LGV molecular epidemiology, highlighting the importance of long-term molecular surveillance to monitor the circulation and geographical spread of LGV and to timely identify and track new strains, such as the recently emerging L1-like ompA-subvariants.
- Molecular characterization of respiratory syncycial virus during 2015-2016 season in PortugalPublication . Cristóvão, Paula; Pereira, Diogo; Pechirra, Pedro; Pereira-Vaz, João; Correia, Lurdes; Rodrigues, Fernando; Andrade, Graça; Corte-Real, Rita; Branquinho, Paula; Peres, Maria João; Viseu, Regina; Balseiro, Maria Jesus; Mota, Paula; Guiomar, RaquelBackground: Respiratory syncytial virus (RSV) is one of the most frequent and important respiratory viral agent that causes respiratory infection complications in younger children and elderly. RSV has an autumn / winter seasonality. Genetic diversity in both of RSV A and B subtypes increased in last years with the spread of new genotypes. This study aims to describe the genetic variability of RSV during 2015/2016 season in Portugal and correlate the circulating genotypes with detected ones in previous seasons. Will also be evaluated the association between genotype, clinical diagnosis and age. Methods: During 2015/16 winter season, between November/2015 and February/2016, 45 RSV were genetically characterized. RSV positive respiratory samples were collected in two settings: children under 5 years old diagnosed by hospital laboratories from the Portuguese Laboratory Network for the Diagnosis of Influenza Infection, and all age Influenza-like illness (ILI) patients reported by primary care health services and diagnosed by the National Influenza Reference Laboratory. All samples were irreversibly anonymized. Demographic and clinical data were collected. RSV detection was performed by real-time PCR and other biomolecular methods. RSV genotype was assigned by the nucleotide sequence of the hypervariable C-terminal region of the G protein gene and the phylogenetic analysis was performed in MEGA 6.0. Results: From 45 RSV genetically characterized, 31 (69%) were reported by hospitals, patients age ranged from newborn to 4 years old. From these, 25 (81%; 25/31) patients were hospitalized, being the bronchiolitis the most frequent diagnosis. While 14 (31%) RSV cases came from primary care health services, patients age ranged from 3 to 83 and all had a clinical diagnosis of ILI. Were included patients from both genders in equal proportions. RSV A and B co-circulated during 2015/2016 season. Were genetically characterized 21 (47%) RSV A and 24 (53%) RSV B. 90% (19/21) of RSV A clustered in ON1 genotype, the others 2 clustered with NA1 genotype. All RSV B present a BA-like genotype, 70% (17/24) were similar to BA9 and 30% (7/24) clustered with BA10 genotype. Conclusions: During 2015/2016 season was observed a co-circulation of RSVA and RSVB. In present study ON1genotype was predominant in circulation among RSVA, this was also detected as the major RSVA genotype at the global level. Only two RSVA belonged to NA1 genotype. In Portugal, NA1 was in circulation during 2010-2012 period. Undetected since 2012, it seems to reappear during 2015/16 season. All RSVB characterized belonged to BA genotypes, the majority clustered within BA9 genotype. BA10 genotype was also identified in circulation at low frequency. BA9 and BA10 were being found in co-circulation since 2011/12. No association was found between age, clinical diagnosis and RSVA and B genotypes. RSV has an important impact in children in high-risk groups highlighting the need off a continuous RSV surveillance each winter.