RESUMO ABSTRACT The Amazon region is known for the high occurrence of hepatitis B virus (HBV) infection, and accounts for more than 98% of malaria cases in Brazil. Despite the controversy, it has been proposed that when associated they may lead to important effects in the natural history of both infections. This study estimates the prevalence of coinfection within general population of an endemic region of HBV and malaria in the Brazilian

The frequency of Neospora spp., Leptospira spp. and Brucella abortus infections in adult cattle was determined in herds of the State of Pará, Brazil, which is an important region for cattle production located in the Amazon region. A total of 3466 adult female cattle from 176 herds were tested, leading to a frequency of seropositive animals of 14.7%, 3.7% and 65.5% and a herd positivity of 87.4%, 41.3% and 98.8% for infections caused by Neospora spp., B. abortus and Leptospira spp., respectively. The five most frequently diagnosed serologic responses to Leptospira spp. were those against serovars hardjo, wolfii, grippotyphosa, hebdomadis and shermani. The following associations were found: practice of artificial insemination, large farm size, large herd size, large number of dogs and high number of total abortions per year with the presence of antibodies against serovar hardjo; positive results to serovar grippotyphosa with the presence of dogs; inappropriate disposal of aborted foetuses with positivity to serovar hebdomadis. Serovar grippotyphosa was also associated with number of episodes of abortions. Neospora spp. positive herds were associated with episodes of abortion and B. abortus infection with the disposal of dead animals and aborted foetuses on pastures and with the use of artificial insemination. In conclusion, the high frequency of brucellosis, leptospirosis and neosporosis in the region may be a consequence of social, natural and raising conditions as: (i) climate conditions that favour the survival and spread of pathogens in the environment; (ii) farms located in regions bordering forest areas; (iii) farms in areas of difficult access to the veterinary service; (iv) extensive beef herds raised at pastures with different age and productive groups inter-mingled; and (v) minimal concerns regarding hygiene practices and disease prevention measures.

The histological findings of fulminant hepatic failure were correlated to the demographic, clinical, biochemical and virological features in children and adolescents, native to the Amazonas State in Northern Brazil. 96.2% had evidence of infection by primary hepatotrophic viruses. Histological analysis revealed three distinct patterns of fulminant hepatic failure.

RESUMOA Amazônia é conhecida pela elevada prevalência de infecção pelo vírus da hepatite B, contribui também com mais de 90% dos casos de malária do país. É proposto que a ocorrência de co-infecções seja importante e que na associação ocorram alterações na história natural dessas enfermidades. O estudo avalia 545 pacientes com malária, em Coari, AM: 333 (61,1%) pelo Plasmodium vivax, 193 (35,4%) pelo Plasmodium falciparum e 19 (3,5%) com infecção mista. A prevalência do AgHBs foi 4,2% e a do anti-HBc total 49,7%. Os pacientes sororreativos para o VHB, não apresentaram diferenças clínicas dos outros pacientes com malária, nem associação a sinais clássicos de comprometimento hepático. Apesar de não ter sido detectada associação estatisticamente significativa, os indivíduos AgHBs reativos apresentaram baixas parasitemias e índices de reatividade de anticorpos mais elevados, sugerindo a possibilidade da resposta imune em um indivíduo co-infectado ser diferenciada e favorecer variações em relação à parasitemia e produção de anticorpos. Palavras-chaves: Hepatite B. Malária. Co-infecção. Amazônia. ABSTRACTThe Amazon region is known for a high prevalence of hepatitis B infection, and accounts for more than 90% of malaria cases in Brazil. It has been suggested that the occurrence of coinfections may be important, and may influence the natural history of both diseases. This study evaluated 545 patients with acute malaria, in Coari, Western Brazilian Amazon. 333 (61.1%) presented Plasmodium vivax malaria, 193 (35.4%) Plasmodium falciparum and 19 (3.5%) mixed infections. The HBsAg prevalence was 4.2% and total anti-HBc 49.7%. Patients with HBV serological markers presented no clinical differences than those with malaria only, nor showed any association with classic signs of hepatic disorder. Although showing no statistical significance, HBsAg reactive subjects presented lower parasitic load and higher antibody titers, suggesting the possibility that the immune response in a coinfected individual is differentiated and leads to a variation in the parasite load and antibody production.

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