CECILIA SALETE ALENCAR DA SILVA

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/03 - Laboratório de Medicina Laboratorial, Hospital das Clínicas, Faculdade de Medicina

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  • article 7 Citação(ões) na Scopus
    Molecular characterization of viruses associated with encephalitis in Sao Paulo, Brazil
    (2019) FERREIRA, Jerenice E.; FERREIRA, Suzete C.; ALMEIDA-NETO, Cesar; NISHIYA, Anna S.; ALENCAR, Cecilia S.; GOUVEIA, Gisele R.; CAIAFFA-FILHO, Helio; GOMES, Helio; SANTOSID, Raimunda Telma de Macedo; WITKIN, Steven S.; MENDRONE-JUNIOR, Alfredo; SABINO, Ester C.
    The objective of this study was to characterize the prevalence of viral encephalitis due to arbovirus infection of the Togaviridae and Flaviviridae families in Sao Paulo, Brazil. A total of 500 cerebrospinal fluid (CSF) samples collected between August 2012 and January 2013, from patients with symptoms of acute encephalitis were analyzed. Findings suggestive of viral encephalitis-elevations in cell concentration, glucose and total protein-were observed in 234 (46.8%) samples, designated as Group 1. The remaining 266 samples comprised Group 2. All samples were tested for Flaviviruses (dengue virus 1, 2, 3 and 4, yellow fever virus and West Nile virus), Alphavirus (NS5 region) and enterovirus by RT-PCR and for herpesviruses and enteroviruses using CLART(-)Entherpex. A presumptive viral etiological agent was detected in 26 samples (5.2%), 18 (8.0%) in Group 1 and 8 (3.0%) in Group 2. In Group 1 human herpesviruses were detected in 9 cases, enteroviruses in 7 cases, dengue viruses (DENV) in 2 CSFs and St. Louis encephalitis virus (SLEV) in one case. In Group 2 there were 3 CSFs positive for human herpesviruses, 2 for enteroviruses, 2 for DENV and 1 for SLEV. Detection of arboviruses, even though present in a minority of infected patients, identifies these viruses as a probable etiological agent of encephalitis. This is of special concern in regions where this class of viruses is endemic and has been linked to other recent epidemics.
  • article 26 Citação(ões) na Scopus
    HCV Genotypes, Characterization of Mutations Conferring Drug Resistance to Protease Inhibitors, and Risk Factors among Blood Donors in Sao Paulo, Brazil
    (2014) NISHIYA, Anna S.; ALMEIDA-NETO, Cesar de; FERREIRA, Suzete C.; ALENCAR, Cecilia S.; DI-LORENZO-OLIVEIRA, Claudia; LEVI, Jose E.; SALLES, Nanci A.; MENDRONE JR., Alfredo; SABINO, Ester C.
    Background: Hepatitis C virus (HCV) infection is a global health problem estimated to affect almost 200 million people worldwide. The aim of this study is to analyze the subtypes and existence of variants resistant to protease inhibitors and their association with potential HCV risk factors among blood donors in Brazil. Methods: Repeat anti-HCV reactive blood donors are systematically asked to return for retest, notification, and counseling in which they are interviewed for risk factors for transfusion-transmitted diseases. We analyzed 202 donors who returned for counseling from 2007 to 2010 and presented enzyme immunoassay-and immunoblot-reactive results. The HCV genotypes and resistance mutation analyses were determined by the direct sequencing of the NS5b and NS3 regions, respectively. The HCV viral load was determined using an in-house real-time PCR assay targeting the 5'-NCR. Results: HCV subtypes 1b, 1a, and 3a were found in 45.5%, 32.0%, and 18.0% of the donors, respectively. The mean viral load of genotype 1 was significantly higher than that of the genotype 3 isolates. Subtype 1a was more frequent among young donors and 3a was more frequent among older donors. Protease inhibitor-resistant variants were detected in 12.8% of the sequenced samples belonging to genotype 1, and a higher frequency was observed among subtype 1a (20%) in comparison to 1b (8%). There was no difference in the prevalence of HCV risk factors among the genotypes or drug-resistant variants. Conclusions: We found a predominance of subtype 1b, with an increase in the frequency of subtype 1a, in young subjects. Mutations conferring resistance to NS3 inhibitors were frequent in treatment-naive blood donors, particularly those infected with subtype 1a. These variants were detected in the major viral population of HCV quasispecies, have replicative capacities comparable to nonresistant strains, and could be important for predicting the response to antiviral triple therapy.
  • article 19 Citação(ões) na Scopus
    Antiretroviral Drug Resistance in a Respondent-Driven Sample of HIV-Infected Men Who Have Sex With Men in Brazil
    (2011) BERMUDEZ-AZA, Elkin Hernan; KERR, Ligia Regina Franco Sansigolo; KENDALL, Carl; PINHO, Adriana Araujo; MELLO, Maeve Brito de; MOTA, Rosa Salani; GUIMARAES, Mark Drew Crosland; ALENCAR, Cecilia Salete; BRITO, Ana Maria de; DOURADO, Ines Costa; BATISTA, Sonia Maria Batista da; ABREU, Fabiano; OLIVEIRA, Lisangela Cristina de; MORAES, Adao de Souza; BENZAKEN, Adele Schwartz; MERCHAN-HAMANN, Edgar; FREITAS, Gisele Maria Brandao de; MCFARLAND, Willi; ALBUQUERQUE, Elizabeth; RUTHERFORD, George W.; SABINO, Ester
    Background: There are few studies on HIV subtypes and primary and secondary antiretroviral drug resistance (ADR) in community-recruited samples in Brazil. We analyzed HIV clade diversity and prevalence of mutations associated with ADR in men who have sex with men in all five regions of Brazil. Methods: Using respondent-driven sampling, we recruited 3515 men who have sex with men in nine cities: 299 (9.5%) were HIV-positive; 143 subjects had adequate genotyping and epidemiologic data. Forty-four (30.8%) subjects were antiretroviral therapy-experienced (AE) and 99 (69.2%) antiretroviral therapy-naive (AN). We sequenced the reverse transcriptase and protease regions of the virus and analyzed them for drug resistant mutations using World Health Organization guidelines. Results: The most common subtypes were B (81.8%), C (7.7%), and recombinant forms (6.9%). The overall prevalence of primary ADR resistance was 21.4% (i.e. among the AN) and secondary ADR was 35.8% (i.e. among the AE). The prevalence of resistance to protease inhibitors was 3.9% (AN) and 4.4% (AE); to nucleoside reverse transcriptase inhibitors 15.0% (AN) and 31.0% (AE) and to nonnucleoside reverse transcriptase inhibitors 5.5% (AN) and 13.2% (AE). The most common resistance mutation for nucleoside reverse transcriptase inhibitors was 184V (17 cases) and for nonnucleoside reverse transcriptase inhibitors 103N (16 cases). Conclusions: Our data suggest a high level of both primary and secondary ADR in men who have sex with men in Brazil. Additional studies are needed to identify the correlates and causes of antiretroviral therapy resistance to limit the development of resistance among those in care and the transmission of resistant strains in the wider epidemic.
  • article 23 Citação(ões) na Scopus
    Methicillin-resistant Staphylococcus aureus carrying SCCmec type II was more frequent than the Brazilian endemic clone as a cause of nosocomial bacteremia
    (2013) CAIAFFA-FILHO, Helio Hehl; TRINDADE, Priscila A.; CUNHA, Paula Gabriela da; ALENCAR, Cecilia Salete; PRADO, Gladys V. B.; ROSSI, Flavia; LEVIN, Anna S.
    Fifty consecutive MRSA blood isolates were evaluated: 30(60%) carried SCCmec type II (single PFGE clone; sequence type 5 or ST105); 12 (26%), IV; 5 (10%), III; 3 (6%), I. Brazilian endemic clone, carrying SCCmec type III, has been the main nosocomial clone in Brazil; however, this study showed that a clone carrying. type II predominated.
  • article 13 Citação(ões) na Scopus
    Enhanced detection of viral diversity using partial and near full-length genomes of human immunodeficiency virus Type 1 provirus deep sequencing data from recently infected donors at four blood centers in Brazil
    (2015) PESSOA, Rodrigo; WATANABE, Jaqueline Tomoko; CALABRIA, Paula; ALENCAR, Cecilia Salete; LOUREIRO, Paula; LOPES, Maria Esther; PROETTI, Anna Barbara; FELIX, Alvina Clara; SABINO, Ester C.; BUSCH, Michael P.; SANABANI, Sabri S.
    BackgroundHere, we report application of high-throughput near full-length genome (NFLG) and partial human immunodeficiency virus Type 1 (HIV-1) proviral genome deep sequencing to characterize HIV in recently infected blood donors at four major blood centers in Brazil. Study Design and MethodsFrom 2007 to 2011, a total of 341 HIV+ blood donors from four blood centers were recruited to participate in a case-control study to identify HIV risk factors and motivations to donate. Forty-seven (17 from SAo Paulo, eight from Minas Gerais, 11 from Pernambuco, and 11 from Rio de Janeiro) were classified as recently infected based on testing by less-sensitive enzyme immunoassays. Five overlapping amplicons spanning the HIV genome were polymerase chain reaction amplified from peripheral blood mononuclear cells. The amplicons were molecularly barcoded, pooled, and sequenced by a paired-end protocol (Illumina). ResultsOf the 47 recently infected donor samples studied, 39 (82.9%) NFLGs and six (12.7%) partial fragments were de novo assembled into contiguous sequences and successfully subtyped. Subtype B was the only nonrecombinant virus identified in this study and accounted for 62.2% (28/45) of samples. The remaining 37.8% (17/45) of samples showed various patterns of subtype discordance in different regions of HIV-1 genomes, indicating two to four circulating recombinant subtypes derived from Clades B, F, and C. Fourteen samples (31.1%) from this study harbored drug resistance mutations, indicating higher rate of drug resistance among Brazilian blood donors. ConclusionOur findings revealed a high proportion of HIV-1 recombinants among recently infected blood donors in Brazil, which has implications for future blood screening, diagnosis, therapy, and vaccine development.
  • article 0 Citação(ões) na Scopus
    Investigation of etiology of community-acquired pneumonia in hospitalized patients in a tertiary hospital of Sao Paulo City, Brazil
    (2023) JOELSONS, Daniel; ALENCAR, Cecilia Salete; PINHO, Joao Renato Rebello; HO, Yeh-Li
    Background: Community-Acquired Pneumonia (CAP) is the primary cause of hospitalization in the United States and the third leading cause of death in Brazil. The gold standard for diagnosing the etiology of CAP includes blood culture, Gram-stained sputum, and sputum culture. However, these methods have low sensitivity. No studies investigating the etiology of CAP have been conducted in Brazil in the last 20-years, and the empirical choice of antimicrobials is mainly based on the IDSA guidelines. This is the first national study with this aim, and as a result, there's potential for the Brazilian consensus to be impacted and possibly modify its guidelines rather than adhering strictly to the IDSA's recommendations. Methods: The aim of this study is to identify the main microorganisms implicated in CAP by employing a multiplex Polymerase Chain Reaction (mPCR) at the foremost public hospital in Brazil. All patients who were admitted to the emergency department and diagnosed with severe CAP underwent an mPCR panel using nasopharyngeal and oropharyngeal swabs, with the aim of detecting 13 bacterial and 21 viral pathogens. Results: A total of 169 patients were enrolled in the study. The mPCR panel identified an etiological agent in 61.5% of patients, with viruses being the most common (42.01%), led by Rhinovirus, followed by Influenza and Coronavirus (non-SARS-CoV-2). Bacterial agents were identified in 34.91% of patients, with S. pneumoniae being the most common, followed by H. influenzae, M. catarrhalis, and S. aureus. Additionally, we found that the prescription for 92.3% of patients could be modified, with most changes involving de-escalation of antibiotics and antiviral therapy. Conclusion: Our study revealed different etiological causes of CAP than those suggested by the Brazilian guidelines. Using molecular diagnostic tests, we were able to optimize treatment by using fewer antibiotics. (c) 2023 Sociedade Brasileira de Infectologia.
  • article 2 Citação(ões) na Scopus
    Genome-wide association study of early ischaemic stroke risk in Brazilian individuals with sickle cell disease implicates ADAMTS2 and CDK18 and uncovers novel loci
    (2023) EARLEY, Eric Jay; KELLY, Shannon; FANG, Fang; ALENCAR, Cecilia Salete; RODRIGUES, Daniela de Oliveira Werneck; CRUZ, Dahra Teles Soares; FLANAGAN, Jonathan M.; WARE, Russell E.; ZHANG, Xu; GORDEUK, Victor; GLADWIN, Mark; ZHANG, Yingze; NOURAIE, Mehdi; NEKHAI, Sergei; SABINO, Ester; CUSTER, Brian; DINARDO, Carla; PAGE, Grier P.
    Ischaemic stroke is a common complication of sickle cell disease (SCD) and without intervention can affect 11% of children with SCD before the age of 20. Within the Trans-Omics for Precision Medicine (TOPMed), a genome-wide association study (GWAS) of ischaemic stroke was performed on 1333 individuals with SCD from Brazil (178 cases, 1155 controls). Via a novel Cox proportional-hazards analysis, we searched for variants associated with ischaemic stroke occurring at younger ages. Variants at genome-wide significance (p < 5 x 10(-8)) include two near genes previously linked to non-SCD early-onset stroke (< 65 years): ADAMTS2 (rs147625068, p = 3.70 x 10(-9)) and CDK18 (rs12144136, p = 2.38 x 10(-9)). Meta-analysis, which included the independent SCD cohorts Walk-PHaSST and PUSH, exhibited consistent association for variants rs1209987 near gene TBC1D32 (p = 3.36 x 10(-10)), rs188599171 near CUX1 (p = 5.89 x 10(-11)), rs77900855 near BTG1 (p = 4.66 x 10(-8)), and rs141674494 near VPS13C (1.68 x 10(-9)). Findings from this study support a multivariant model of early ischaemic stroke risk and possibly a shared genetic architecture between SCD individuals and non-SCD individuals younger than 65 years.
  • conferenceObject
    Case-Control Study of Risk Factors for Syphilis Among Blood Donors in Sao Paulo, Brazil
    (2012) FERREIRA, S. C.; ALMEIDA-NETO, C. de; NISHIYA, A. S.; DI-LORENZO-OLIVEIRA, C.; FERREIRA, J. E.; ALENCAR, C. S.; LEVI, J. E.; SALLES, N. A.; MENDRONE, A.; SABINO, E. C.
    Background/Case Studies: Syphilis is considered as a major public health problems in Brazil. To determine the risk factors associated with syphilis serological status among blood donors. Study Design/Methods: At Fundação Pro-Sangue, a cross section study was conducted from 2005 to 2008. At time of counseling, donors that were repeat reactive at screening for Syphilis, were invited to answer a questionnaire related to risk behavior and donor motivation. Donors were classifi ed according to their serological results into three groups: a) recent infection (EIA+, VDRL+ and FTA-abs+); b) previous infection or serological scar (EIA+, FTA-abs +, VDRL−) and c) false positive test result (EIA + at screening but EIA − and VDRL − at retest). Results/Findings: Recent syphilis infection was associated with younger age, single, lower education level and higher number of sexual partners in the past 12 months (Table). There was no statistical difference among groups regarding illicit drugs use, except. From the total, 30.7% of cases considered they had been in risk for HIV infection in the last 12 months compared to 12.5% of donors with past infection and 9.1% of false-positive results group (p = 0.004). Conclusion: Recent syphilis is still closely related to the number of sexual partners and male-male-sex among blood donors. Illicit drug use was not linked with the epidemiology of the infection in this population. Donors exposed to syphilis also referred risk exposition to HIV since both disease share the sexual transmission route. To monitor the profi le of syphilis among blood donors can help to treat and to prevent this infection and can add further benefi ts for Public Health. Disclosure of Commercial Conflict of Interest C. S. Alencar: Nothing to disclose; C. de Almeida-Neto: Nothing to disclose; C. Di-Lorenzo-Oliveira: No Answer; J. E. Ferreira: Nothing to disclose; S. C. Ferreira: Nothing to disclose; J. E. Levi: Nothing to disclose; A. Mendrone: Nothing to disclose; A. S. Nishiya: Nothing to disclose; E. C. Sabino: Nothing to disclose; N. A. Salles: Nothing to disclose Disclosure of Grants Conflict of Interest C. S. Alencar: Nothing to disclose; C. de Almeida-Neto: Nothing to disclose; C. Di-Lorenzo-Oliveira: No Answer; J. E. Ferreira: Nothing to disclose; S. C. Ferreira: Nothing to disclose; J. E. Levi: Greiner Bio One, Grants or Research Support; A. Mendrone: Nothing to disclose; A. S. Nishiya: Nothing to disclose; E. C. Sabino: Nothing to disclose; N. A. Salles: Nothing to disclose Demographics and sexual behavior among blood donors Recent syphilis N (%) Past syphilis N (%) False-positive N (%) Gender p = 0.189 Male 58 (77.3) 52 (65) 26 (76.5) Female 17 (22.7) 28 (35) 8 (23.5) Age (years) p < 0.0001 < 39 35 (46.7) 4 (5) 12 (35.3) ≥ 39 < 60 38 (50.7) 67 (83.8) 20 (58.8) ≥ 60 2 (2.6) 9 (11.2) 2 (5.9) Education p < 0.0001 < 8 years 15 (20) 50 (62.5) 10 (29.4) Completed 8 Years 17 (22.7) 12 (15) 5 (14.7) 11 years 36 (38) 13 (16.2) 15 (44.1) College/above 7 (9.3) 5 (6.3) 4 (11.8) Marital status p = 0.004 Single 31 (41.3) 14 (17.5) 9 (26.5) Married 26 (34.7) 55 (65) 21 (61.8) Divorced 12 (16) 9 (11.3) 1 (2.9) Other 18 (24) 14 (17.6) 4 (11.7) N sexual partners (last 12 months) p = 0.021 0-1 37 (49.3) 59 (73.7) 33 (97.1) 2-5 32 (42.7) 18 (22.5) 1 (2.9) >5 6 (8) 3 (3.8) 0 (0)
  • article 6 Citação(ões) na Scopus
    Use of an automated pyrosequencing technique for confirmation of sickle cell disease
    (2019) MARTINO, Camila Cruz de; ALENCAR, Cecilia Salete; LOUREIRO, Paula; CARNEIRO-PROIETTI, Anna Barbara de Freitas; MAXIMO, Claudia de Alvarenga; MOTA, Rosimere Afonso; RODRIGUES, Daniela Oliveira Werneck; GABURO JUNIOR, Nelson; KELLY, Shannon; SABINO, Ester Cerdeira
    Background The diagnosis of sickle cell disease (SCD) is made by hemoglobin assays such as high-performance liquid chromatography (HPLC), isoelectric focusing and cellulose acetate or citrate agar electrophoresis. These assays are easy to perform and used in large-scale newborn screening in many countries. These tests however may not easily differentiate S beta(0) thalassemia from SS or identify other hemoglobin variants, and in this case, hemoglobin (HBB) gene sequencing may be necessary. Objectives To develop a high throughput DNA based confirmatory assay for SCD and to detect mutations in the HBB gene Methods We developed an automated pyrosequencing technique (PyS) based on QIAGEN technology (Hilden, Germany) to detect homozygous or heterozygous hemoglobin S mutations as well as hemoglobin C mutations. The technique was tested on 2,748 samples from patients enrolled in a multi-center SCD cohort in Brazil. Patients were previously tested using HPLC to diagnose SCD as part of routine clinical care. Any subjects with discrepant results between HPLC and PyS or with heterozygous hemoglobin S detected had Sanger sequencing of the HBB gene. Results We identified 168 samples with discrepant results between HPLC and PyS and 100 with concordant PyS = heterozygous S and HPLC, which would suggest SB-thalassemia or other heterozygous S variants. The PyS assay correctly identified 1906 (98.7%) of the 1930 HbSS and 628 (98.7%) of the 636 HbSC samples. Of the 179 remaining samples, PyS correctly indicated S heterozygosis in 165 (92.2%). Of the 165 heterozygous S samples confirmed by Sanger as consistent with S beta thalassemia genotype, 84 samples were classified as S beta(0) thalassemia and 81 as S beta(+) thalassemia. The most frequent beta thalassemia mutations of S beta(0) and S beta(+) were HBB: c.118C> T (Gln40Stop) and HBB c.92 + 6T> C, respectively. Discussion The PyS proved to be satisfactory for large-scale confirmatory testing of hemoglobin mutation. Moreover, with this study we were able to describe the most common beta(+) and beta(0) mutations in SCD patients with S beta-thalassemia in a large multi-institutional SCD cohort in Brazil.
  • article 36 Citação(ões) na Scopus
    Clinical and genetic ancestry profile of a large multi-centre sickle cell disease cohort in Brazil
    (2018) CARNEIRO-PROIETTI, Anna B. F.; KELLY, Shannon; TEIXEIRA, Carolina Miranda; SABINO, Ester C.; ALENCAR, Cecilia S.; CAPUANI, Ligia; SILVA, Tassila P. Salomon; ARAUJO, Aderson; LOUREIRO, Paula; MAXIMO, Claudia; LOBO, Clarisse; FLOR-PARK, Miriam V.; RODRIGUES, Daniela O. W.; MOTA, Rosimere A.; GONCALEZ, Thelma T.; HOPPE, Carolyn; FERREIRA, Joao E.; OZAHATA, Mina; PAGE, Grier P.; GUO, Yuelong; PREISS, Liliana R.; BRAMBILLA, Donald; BUSCH, Michael P.; CUSTER, Brian
    Approximately 3500 children with sickle cell disease (SCD) are born in Brazil each year, but the burden of SCD morbidity is not fully characterised. A large, multi-centre cohort was established to characterise clinical outcomes in the Brazilian SCD population and create the infrastructure to perform genotype-phenotype association studies. Eligible patients were randomly selected from participating sites and recruited at routine visits. A biorepository of blood samples was created and comprehensive demographic and clinical outcome data were entered in a centralized electronic database. Peripheral blood genome-wide single nucleotide polymorphism (SNP) genotyping was performed using a customized Transfusion Medicine (TM) Array. A total of 2795 participants at six Brazilian sites were enrolled between 2013 and 2015. The cohort included slight predominance of children <18 years (55.9%) and females (53.0%). Haemoglobin (Hb) SS was the most common SCD genotype (70.7%), followed by HbSC (23%), S beta 0 (3.0%) and S beta+ (2.9%). SNP data from the TM Array were analysed to evaluate the genetic ancestry of the cohort and revealed significant admixture among the population. Demographics and clinical complications, stratified by age and SCD genotype, are summarized and future studies in this cohort are discussed.