Browsing by Author "Sousa, Rita"
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- Atypical bartonellosis in children: What do we know?Publication . Lemos, Ana P.; Domingues, Rui; Gouveia, Catarina; Sousa, Rita; Brito, Maria J.Aim: To characterise Bartonella infections in a paediatric population requiring hospital admission and review its treatment. Methods: Longitudinal observational retrospective data analysis of children and adolescents admitted with Bartonella infection at a paediatric tertiary hospital from 2010 to 2019. Results: We identified 16 cases of bartonellosis, with a mean age of 8.0 ± 4.5 years old, no sex predominance and 14 had contact with cats. Most of the cases occurred in fall and winter. Clinical presentations included osteomyelitis/arthritis (n = 9), hepatosplenic disease (n = 2), lymphadenitis (n = 2), neuroretinitis (n = 2) and encephalitis (n = 1). Clinical diagnosis was confirmed by serology (n = 16) and Bartonella DNA detection in patient's lymph nodes/hepatic lesion (n = 3). Therapeutic approach varied according to the clinical presentation: azithromycin in lymphadenitis, rifampicin plus ciprofloxacin in hepatosplenic disease, rifampicin and doxycycline in neuroretinitis, ceftriaxone in encephalitis and azithromycin, cotrimoxazole or rifampicin plus azithromycin, cefuroxime, ciprofloxacin or doxycycline in osteomyelitis/arthritis. Immunodeficiency was excluded in seven patients. Seven patients' cats were screened by veterinarians and treated when infected (n = 5). Conclusions: In these clinical presentations, where other infections may be involved, a high index of suspicion is necessary, with emphasis on the epidemiological context. The association of systemic forms with immunodeficiency did not occur in our study. The lack of recommendations for treatment of atypical infection makes the approach of these cases a challenge. Randomised control studies are essential to define the best approach in each case.
- Canine lymphoma and vector‐borne diseases: Molecular and serological evaluation of a possible complicityPublication . Henriques, Joaquim; Felisberto, Ricardo; Almeida, Bruno; Ramos, Joana; Constantino‐Casas, Fernando; Dobson, Jane; Matos, Raquel; Santos, Ana; Sousa, Rita; Alves, MargaridaLymphoma is the most common haematological malignancy in dogs and its aetiology is largely unknown. The presence of canine vector-borne agents (CVBD) in lymphoma tissues has been described and its causative effects questioned. We intended to evaluate the presence and extent of Leishmania infantum, Ehrlichia canis, Anaplasma phagocytophilum and Bartonella henselae infection in dogs with lymphoma. Sixty-one dogs, living in the Lisbon metropolitan area, with a diagnosis of lymphoma were enrolled. Immunofluorescence assays were used to detect serum IgG's. The presence of DNA from CVBD agents in tumour tissue was assessed by PCR. All dogs tested negative for B. henselae, A. phagocytophilum and E. canis by both serology and PCR. Regarding L. infantum, 8.2% (n = 5) of the dogs had a positive serologic result. L. infantum DNA was detected in two samples of diffuse large B-cell lymphoma (DLBCL). These results show an increased, but not significant, seropositivity (8.2% vs 7.9%) and molecular detection (3.3% vs 1.2%) for L. infantum in dogs with lymphoma, when compared to the reported canine population in the same geographical area. We could not identify an association between lymphoma and E. canis, A. phagocytophilum, B. henselae or Leishmania infantum infection in the studied population. Nevertheless, further studies, following dogs trough their CVBD disease evolution, are worthwhile and may help clarify a possible role of CVBD agents in lymphomagenesis.
- Indoor Air Quality in Primary SchoolsPublication . Freitas, Maria do Carmo; Canha, Nuno; Martinho, Maria; Almeida-Silva, Marina; Almeida, Susana Marta; Pegas, Priscilla; Alves, Célia; Pio, Casimiro; Trancoso, Maria; Sousa, Rita; Mouro, Filomena; Contreiras, TeresaClean air is a basic requirement of life (World Health Organization, 2010). The Indoor Air Quality (IAQ) has been the object of several studies due to an increasing concern within the scientific community on the effects of indoor air quality upon health, especially as people tend to spend more time indoors than outdoors (Franck et al., 2011; Canha et al., 2010; WHO, 2010; Environmental Protection Agency, 2010; Saliba et al., 2009; Fraga et al., 2008; Fromme et al., 2007; Guo et al., 2004; Kosonen, 2004; Lee et al., 2002a; Lee et al., 2002b; Carrer et al., 2002; Lee et al., 2001; Li et al., 2001; Wilson & Spengler, 1996; Allen & Miguel, 1995; Jenkins et al., 1992; WHO, n.d.). The quality of air inside homes, offices, schools or other private and public buildings is an essential determinant of healthy life and people’s well-being (WHO, 2010). People can be exposed to contaminants by inhalation, ingestion and dermal contact. In the past, scientists have paid much attention to the study of exposure to outdoor air contaminants, because they have realised the seriousness of outdoor air pollution problems. However, each indoor microenvironment has unique characteristics, determined by the local outdoor air, specific building characteristics and indoor activities (Pegas et al, 2010). Indeed, hazardous substances are emitted from buildings, construction materials and indoor equipment or due to human activities indoors (WHO, 2010; Carrer et al., 2002). Reports about buildings with air-related problems have received increasing attention since the 1970s (Spengler & Sexton, 1983; Hodgson, 1992). In an indoor environment, dust on floors and other surfaces contains minerals, metals, fibres from textiles, paper, and insulation material, particles from tobacco smoke, including polycyclic aromatic compounds (PAH’s). For this reason, the indoor environment is cleaned to maintain an acceptable level of perceived cleanliness, to prevent surface degradation, to control potential risk of infection from microorganisms, and to control dust exposure in general (Wolkoff et al., 1998). All of these pollutants could cause significant damage to health globally (WHO, 2010).The IAQ in school buildings is expected to be a key role player in the assessment of the effects of the children personal exposure to air pollution as children spend at least a third of their time inside school buildings, that is, approximately seven or more hours a day in school (Almeida et al., 2010; EPA, 2010; Pegas et al., 2010; Wheeler et al., 2009; Ramachandran et al., 2005). Poor IAQ can affect scholarly performance and attendance (Daisey et al. 2003; Godoi et al. 2009). Hence, several studies about air quality in schools have recently been published (Goyal & Khare, 2009; Tippayawong et al., 2009; Fraga et al., 2008; Fromme et al., 2007; Hwang et al., 2006). Environmental asthma triggers commonly found in school buildings include respiratory viruses; cockroaches and other pests; mold resulting from excess moisture in the building; dander from animals in the classroom; and dander brought on the clothing from animals at home. Second-hand smoke and dust mites are other known environmental asthma triggers found in schools. Children with asthma may be affected by other pollutants from sources inside schools, such as unvented stoves or heaters and common products including chemicals, cleaning agents, perfumes, pesticides and sprays. Indoor Air Quality problems in schools may be even more serious than in other categories of buildings, due to higher occupant density and insufficient outside air supply, aggravated by frequent poor construction and/or maintenance of school buildings (Pegas et al., 2010). Schools are seen as particularly likely to have environmental deficiencies because chronic shortages of funding contribute to inadequate operation and maintenance of facilities (Mendell & Heath, 2005). Previous studies showed the poor indoor environmental quality at schools may be explained by: (1) insufficient ventilation in schools, specially in winter, (2) infrequently and not thoroughly cleaned indoor surfaces, and (3) a large number of students in relation to room area and volume, with constant re-suspension of particles from room surfaces (Janssen et al., 1999). Children constitute a sensitive group with higher risk than adults (Stranger et al., 2007a) because children are particularly vulnerable to pollutants due to their undeveloped airways (Stranger et al., 2007a; Mendell et al., 2005). Moreover, children have greater susceptibility to some environmental pollutants than adults, because they breathe higher volumes of air relative to their body weights and their tissues and organs are actively growing (Mendell & Heath, 2005). The effects of air pollution on children have been growing (Khan et al., 2007) and one of the consequences is the increase of the prevalence of allergic rhinitis (ISAAC, 1998). The chemical and microbiological parameters required by the Portuguese Legislation for IAQ monitoring purposes are: carbon dioxide (CO2), carbon monoxide (CO), ozone (O3), formaldehyde (HCHO), volatiles organic compound (VOCs), bacteria and fungi (DL n.º 79/2006).
- Indoor air quality in primary schoolsPublication . Canha, Nuno; Martinho, Maria; Almeida-Silva, Marina; Almeira, Susana Marta; Pegas, Priscilla; Alves, Célia; Pio, Casimiro; Trancoso, Maria Ascensão; Sousa, Rita; Mouro, Filomena; Contreiras, Teresa; Freitas, Maria do CarmoThe indoor air quality (IAQ) in classrooms is expected to play a key role in the assessment of the effects of the children’s personal exposure to air pollution since they spend on average 7–11 h per weekday at school. A statistical treatment was conducted over a database of indoor air parameters and the primary schools where these parameters were sampled (urban area of Lisbon, Portugal). The aim of this study was to assess the associations between indoor air parameters with the schools’ building characteristics, through the use of statistical methods. Several associations were found and allow pointing out from this study several recommendations to improve the classrooms IAQ. For example, some factors such as ventilation, cleanings and chalk use instead whiteboard pens, can reduce or increase specific contaminants inside the classrooms.
- Investigação laboratorial de surtos de toxinfeções alimentares, 2014Publication . Viegas, Silvia; Cunha, Isabel Campos; Correia, Cristina Belo; Sousa, Rita; Bonito, Conceição Costa; Coelho, Anabela; Maia, Carla; Pena, Cláudia; Sousa, Isabel; Flores, Cristina; Barreira, Maria João; Moura, Isabel Bastos; Furtado, Rosália; Marcos, Silvia; Toscano, Maria Manuel; Santos, Susana; Lopes, Teresa Teixeira; Oleastro, Mónica; Saraiva, Margarida; Calhau, Maria AntóniaObjetivo: Compilação, análise e interpretação de dados e surtos de toxinfeções alimentares investigados no INSA em 2014.
- Molecular detection of hemoprotozoa and Rickettsia species in arthropods collected from wild animals in the Burgos Province, SpainPublication . Lledó, Lourdes; Giménez-Pardo, Consuelo; Domínguez-Peñafiel, Gerardo; Sousa, Rita; Gegúndez, Maria Isabep; Casado, Nieves; Criado, AngelLimited information on the presence of bacterial and hematozoan infections in parasitic arthropods from Spain is available. In an attempt to address this issue, the prevalence of Theileria, Babesia, Hepatozoon, and Rickettsia species was investigated by polymerase chain reaction plus sequencing. In a survey for zoonotic pathogens in ectoparasites, 42 wild animals (which included rodents, carnivores, Sciuridae, and Cervidae) were captured in Burgos (Spain). A total of 256 arthropods (including 107 ticks, 76 fleas, and 73 mites) were collected from these mammals. Molecular diagnostic results showed that (i) Rickettsia felis was found in fleas (two Ctenocephalides felis), (ii) Hepatozoon sp. infected some fleas (two Ctenophtalmus sp. and a DNA pool of Ceratophyllus sciurorum) and Acari (one Neotrombicula sp.), and (iii) Theileria annae was found in Ixodes ricinus and I. hexagonus (each a single infected specimen). All microorganisms and parasites were genetically identical to pathogens already described in Spain or elsewhere. Infected arthropods were recovered from beech marten, bank vole, squirrel, wood mouse, and red fox. Our findings emphasize the potential risk for transmission of rickettsias to humans (namely, R. felis) in Burgos, since C. felis is capable to seek out humans for feeding. No hemoprotozoa with proven significance as human pathogens were found in the survey. However, finding T. annae in ticks recovered from wild canids suggests possible links of sylvatic and domestic cycles for some Piroplasmida.
- Prevalence and risk factors of fatty liver in Portuguese adultsPublication . Leitão, Jorge; Carvalhana, Sofia; Cochicho, Joana; Silva, Ana Paula; Velasco, Francisco; Medeiros, Isabel; Alves, Ana Catarina; Bourbon, Mafalda; Oliveiros, Bárbara; Rodrigues, Vitor; Sousa, Rita; Sampaio, Filipa; Carvalho, Armando; Cortez‐Pinto, HelenaBackground: Prevalence of fatty liver (FL) and nonalcoholic fatty liver disease (NAFLD) depends mainly on obesity, diabetes and genetic factors. FL and NAFLD prevalence was evaluated in Portuguese adult population and correlated with several risk factors and related mortality data, within the same period. Materials and methods: A cross-sectional, population-based multicenter study, voluntary and randomly selected in 834 Portuguese adults (18-79 years). Participants were evaluated after 12-hour fasting. Anthropometric data, past history including alcohol consumption, and associated diseases were registered. Blood samples were collected for biochemical testing. Dietary intake was evaluated using a semi-quantitative food frequency questionnaire. Presence of FL was evaluated using ultrasound, and NAFLD was diagnosed after exclusion of other causes for liver disease. Results: Adjusted prevalence of FL and NAFLD was 37.8% and 17.0%, respectively. FL individuals were older, more frequently males, with increased probability of having obesity, diabetes or harmful alcohol consumption (HAC). NAFLD individuals were also older, but had a similar sex distribution and an increased probability of obesity and diabetes. In both groups, no differences were found regarding dietary pattern or physical activity. During the same time period, nonalcoholic steatohepatitis (NASH) liver-related deaths in Portugal were 0.105/100 000, while alcohol-related liver disease mortality was 6.790/100 000. Conclusion: The large spectrum of FL was present in more than one third of the population, although only less than half could be classified as NAFLD. Other significant risk factors, such as HAC, are probably implicated in FL, explaining the low NASH-related mortality compared with the high alcohol-related mortality during the same time period.
- Probe-based metagenomic pathogen detection: advancing laboratory capacity for complex diagnosisPublication . Ferreira, Rita; Coelho, Luís; Santos, João Dourado; Sobral, Daniel; Isidro, Joana; Mixão, Verónica; Pinto, Miguel; Nunes, Alexandra; Borrego, Maria José; Lopo, Sílvia; Oleastro, Mónica; Sousa, Rita; Palminha, Paula; Veríssimo, Cristina; Gargaté, Maria João; Guiomar, Raquel; Cordeiro, Rita; Macedo, Rita; Bajanca-Lavado, Paula; Paixão, Paulo; Duarte, Sílvia; Vieira, Luís; Borges, Vítor; Gomes, João PauloProbe-based pathogen enrichment, followed by NGS, is a promising tool for complex diagnosis, overcoming traditional challenges of shotgun metagenomics, namely small microbial/human genetic material ratio and demanding computational resources. Here, we assessed the combined detection performance of two Illumina probe-based panels, the Respiratory and the Urinary Pathogen ID panels (RPIP and UPIP), using 99 clinical samples of 15 different matrices (e.g., cerebrospinal fluid, plasma, serum, urine, swabs, biopsies, etc.) available from Portuguese National Reference Laboratories. This sample set involved 114 "PCR-positive hits" (Ct values range of 9.7-41.3; median of 28.4) for 52 non-redundant human pathogens. For a more detailed bioinformatics assessment, as a complement of the Illumina turnkey solution (Explify), we applied an extended version of our INSaFLU-TELEVIR(+) metagenomics pipeline. Whereas Explify analyses resulted in an initial detection frequency of 73.7% (84/114), the subsequent application of INSaFLU-TELEVIR(+), including taxonomic classification followed by confirmatory read mapping, enabled an overall detection proportion of 79.8% (91/114) of the PCR-positive hits. This translated into a detection rate increment from 54.3% (19/35) to 65.7% (23/35) for bacteria, and from 85.3% (58/68) to 89.7% (61/68) for viruses. The implemented workflow was also very satisfactory for samples with qPCR Ct values above 30, with an overall detection frequency of 71.8% (28/39) when compared with the 92.0% (46/50) observed for those with Ct ≤ 30. In summary, this study validated and established a pioneering approach at the Portuguese National Institute of Health to support clinicians in complex diagnosis, contributing to advance diagnostic capabilities toward a more informed clinical decision and potential improvement of infectious disease outcomes.
- REVIVE (Rede Nacional de Vigilância de Vetores), 2008-2014Publication . Alves, M.J.; Santos-Silva, M.M.; Osório, Hugo; Carvalho, Isabel Lopes de; Zé-Zé, Líbia; Sousa, Rita; Amaro, Fátima; Santos, Ana Sofia; Núncio, Sofia; Equipa REVIVEApresentar os resultados do programa REVIVE (Rede de Vigilância de Vetores), relativos aos anos 2008-2014.
- Severe interstitial pneumonia due to murine typhus in a patient returning from BaliPublication . Malheiro, Luís; Ceia, Filipa; Alves, João; Carvalho, Ana Cláudia; Sobrinho-Simões, Joana; Sousa, Rita; Sarmento, António; Santos, LurdesMurine typhus has been increasingly reported as a cause of fever in returning travelers from Southeast Asia. We report a case of a previously healthy traveler returning from Bali with an non-specific febrile illness which quickly progressed to a severe form of interstitial pneumonia. After a careful epidemiological evaluation and laboratory analysis, murine typhus was diagnosed.