Co-infecção humana pelo plasmódio e o vírus da hepatite B: aspectos clínicos, sorológicos e imunológicos

Abstract

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.

Seroprevalence of viral and bacterial pathogens among malaria patients in an endemic area of southern Venezuela

“…In Venezuela, in the case of hepatitis A vaccination, it is not included in the Venezuelan Expanded Programme on Immunisation, it is only applied in the private sub-sector and in the years of better economic boom, prior to 2013, it reached between 10 and 15% of vaccination coverage, according to personal and press reports [ 16 ]. On the other hand, the prevalence of CoRE with HBV (6.2%) in our study was similar to that found in Nigeria (6.6%) [ 24 ], but higher than that documented by Braga et al [ 34 ] in western Brazilian Amazon (4.2%). In the same study, patients with co-infection showed no clinical differences from those with only malaria, and similar to our findings also showed no association with classic signs of a liver disorder.…”

Mansonella ozzardi in Amazonas, Brazil: prevalence and distribution in the municipality of Coari, in the middle Solimões River

“…Therefore, additional studies are required to define clearly the pathogenesis of this parasite in relation to its manifestation. We have also observed that the symptoms correlated with M. ozzardi infection are frequently evidenced in the local people infected with malaria and other serious endemic disease of the area (Braga et al 2006), which makes it crucial that differential diagnosis through identification of the parasite be made using blood smear examinations ). Due to the high percentage of people found without apparent symptoms, more accurate studies must be made to evaluate the life quality impact of this disease.…”