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Master's Dissertation
DOI
10.11606/D.23.2017.tde-06032017-114357
Document
Author
Full name
Marilia Andrade Figueiredo
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2016
Supervisor
Committee
Ortega, Karem Lopez (President)
Eduardo, Fernanda de Paula
Fink, Maria Cristina Domingues da Silva
Silva, Paulo Henrique Braz da
Title in Portuguese
Detecção dos poliomavirus humano JC e BK em pacientes no pré transplante de fígado
Keywords in Portuguese
BKV
Hepatopatias
JCV
Pacientes Cirróticos
Vírus
Abstract in Portuguese
Pacientes no pré-transplante de fígado podem apresentar diversas complicações da cirrose. Uma importante complicação é o hiperesplenismo, que pode resultar no sequestro de leucócitos e na consequente diminuição de neutrófilos e linfócitos, tornando o paciente, teoricamente, mais suscetível a infecções pelos vírus BKV e JCV. Por outro lado, esses pacientes também podem apresentar comprometimento renal (síndrome hepatorrenal) e de sistema nervoso central (encefalopatia hepática). Com complicações como essas e como esses pacientes apresentam-se com a resposta celular imune circulante comprometida, pode ser interessante investigar a presença dos poliomavirus nesses pacientes. O objetivo deste trabalho foi identificar e quantificar os poliomavirus BKV e JCV em saliva, lavado bucal, sangue e urina, de pacientes no pré-transplante de fígado. Para o grupo de estudo foram selecionados, 21, pacientes cirróticos, em fila de transplante de fígado, de ambos os sexos, com idade superior a 18 anos e para o grupo controle foram selecionados 20 pacientes normorreativos, de ambos os sexos, maiores de 18 anos. Nesses pacientes foram realizadas coletas de fluídos, urina, saliva, lavado bucal, e sangue. Após a coleta e congelamento das amostras, foram realizadas pesquisas de detecção e quantificação do poliomavírus humano dos subtipos BK e JC através do método de PCR em tempo real. Quinze pacientes (71,42%) do GE apresentaram-se positivos para o BKV em pelo menos uma amostra, mas nenhum dos pacientes desse grupo apresentou síndrome hepatorrenal. Por outro lado, 66,66% desses pacientes apresentaram encefalopatia hepática, mas, apesar de 10 pacientes serem positivos para o JCV, em nenhum deles foi possível quantificar a carga viral ou associar a presença do vírus com a doença clínica. Quanto às amostras, no GE, 21 (25%) foram positivas para BKV e 10 (11,90%) para JCV e no GC 27 (34,61%) foram positivas para BKV e 6 (7,69%) para JCV. Não houve diferença estatisticamente significante entre os grupos (p=0,52 e p=0,25). No GE encontramos um panorama semelhante ao GC, referente a presença do vírus em lavado, sangue e urina. A maior diferença entre as amostras apresentou-se na identificação do BKV em saliva. Assim foi possível concluir que pacientes cirróticos em fila de transplante hepático não apresentam maior prevalência de BKV ou JCV do que pacientes normorreativos e as complicações da cirrose (encefalopatia hepática e síndrome hepatorrenal) não estão associadas à presença desses vírus. Em pacientes normorreativos os fluídos bucais são equivalentes a urina na detecção do BKV, mas a saliva não é um bom fluido para detecção do BKV em pacientes cirróticos
Title in English
Detection of human polyomavirus JC and BK in patients undergoing liver transplantation
Keywords in English
BKV
Cirrhotic patients
JCV
Liver Diseases
Virus
Abstract in English
Patients in the liver pre-transplantation can present several complications of cirrhosis. A major complication is hypersplenism, which can result in sequestration of leukocytes and the consequent decrease of neutrophils and lymphocytes, making the patient theoretically more susceptible to infection by BKV and JCV virus. Furthermore, these patients may also have renal impairment (hepatorenal syndrome) and central nervous system (hepatic encephalopathy). With complications like these and how these patients present with impaired current cellular immune response, it may be interesting to investigate the presence of polyomavirus in these patients. The objective of this study was to identify and quantify BKV and JCV polyomavirus in saliva, oral lavage, blood and urine of patients before liver transplantation. For the study group were selected, 21 cirrhotic patients, liver transplant waiting list, of both sexes, aged over 18 and for the control group were selected 20 normorreativos patients of both sexes, older than 18 years. In these patients fluid collections were performed, urine, saliva, oral lavage and blood. After collecting and freezing the samples were carried out research of detection and quantification of human polyomavirus BK and JC subtypes using the PCR method in real time. Fifteen patients (71.42%) of GE were positive for BKV in at least one sample, but none of the patients in this group had hepatorenal syndrome. Moreover, 66.66% of patients had hepatic encephalopathy, but while 10 patients were positive for JCV, none of them has been able to quantify the viral load or the presence of virus associated with clinical disease. As regards the samples, the GE 21 (25%) were positive for BKV and 10 (11.90%) for JCV and CG 27 (34.61%) were positive for BKV and 6 (7.69%) for JCV . There was no statistically significant difference between groups (p = 0.52 and p = 0.25). The GE find an overview similar to GC concerning the presence of the virus in washed blood and urine. The major difference between samples submitted to the BKV ID saliva. Thus it was concluded that patients with cirrhosis on liver transplant waiting list do not have a higher prevalence of BKV and JCV than normorreativos patients and complications of cirrhosis (hepatic encephalopathy and hepatorenal syndrome) are not associated with the presence of these viruses. In the oral fluid normorreativos patients are equivalent to detection of BKV urine, saliva but is not a good fluid for detection of BKV in cirrhotics
 
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Publishing Date
2017-03-22
 
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