Infecção subclínica

Uma infecção subclínica é o carreamento assintomático (sem sinais aparentes) de um agente infeccioso (micróbio, parasita intestinal ou vírus) que geralmente é um patógeno causador de doenças, pelo menos em alguns indivíduos. Muitos patógenos se espalham por serem silenciosamente carregados dessa forma por uma população de hospedeiros. Tais infecções ocorrem tanto em humanos quanto em outros animais. Um exemplo de uma infecção assintomática é um resfriado leve, o qual não é notado pelo indivíduo infectado. Como essas infecções subclínicas frequentemente não despertam sintomas, sua existência é identificada apenas pela cultura microbiológica ou por técnicas de DNA como a reação em cadeia da polimerase (PCR).

Os patógenos a seguir (juntamente de suas doenças sintomáticas) são conhecidos por serem carreados assintomaticamente, frequentemente em uma maior porcentagem pela população de potenciais hospedeiros:

Bordetella pertussis (coqueluche)^[1]
Chlamydia pneumoniae^[2]
Chlamydia trachomatis (clamídia)^[3]^[4]^[5]
Clostridium difficile^[6]
Cyclospora cayetanensis^[7]
Vírus da dengue^[8]
Dientamoeba fragilis^[9]
Entamoeba histolytica^[10]
Escherichia coli enterotoxigênica (ETEC)^[11]
Vírus Epstein-Barr^[12]
Infecção estreptocócica do Grupo A^[13]
Helicobacter pylori^[14]
Herpes simplex (herpes oral, herpes genital etc.)^[15]
HIV-1 (AIDS)^[16]
Legionella pneumophila (doença do legionário)^[17]
Vírus do sarampo^[18]
Mycobacterium leprae (hanseníase)^[19]
Mycobacterium tuberculosis (tuberculose)^[20]
Neisseria gonorrhoeae (gonorreia)^[3]^[4]
Neisseria meningitidis (meningite) ^[21]
Salmonella não tifoide^[22]
Norovírus^[23]
Poliovírus (poliomielite)
Rinovírus (resfriado)^[24]
Salmonella enterica serovar Typhi (febre tifoide)^[25]
Staphylococcus aureus^[26]
Streptococcus pneumoniae (pneumonia bacteriana)^[27]
Treponema pallidum (sífilis)^[28]

[1]
Klement E, Grotto I, Srugo I, Orr N, Gilad J, Cohent D (2005). «Pertussis in soldiers, Israel». Emerging Infect. Dis. 11 (3): 506–8. PMID 15789494
[2]
Müller J, Møller DS, Kjaer M, Nyvad O, Larsen NA, Pedersen EB (2003). «Chlamydia pneumoniae DNA in peripheral blood mononuclear cells in healthy control subjects and patients with diabetes mellitus, acute coronary syndrome, stroke, and arterial hypertension». Scand. J. Infect. Dis. 35 (10): 704–12. PMID 14606608. doi:10.1080/00365540310016538
[3]
Cecil JA, Howell MR, Tawes JJ; et al. (2001). «Features of Chlamydia trachomatis and Neisseria gonorrhoeae infection in male Army recruits». J. Infect. Dis. 184 (9): 1216–9. PMID 11598849. doi:10.1086/323662
[4]
Korenromp EL, Sudaryo MK, de Vlas SJ; et al. (2002). «What proportion of episodes of gonorrhoea and chlamydia becomes symptomatic?». Int J STD AIDS. 13 (2): 91–101. PMID 11839163. doi:10.1258/0956462021924712
[5]
Sutton TL, Martinko T, Hale S, Fairchok MP (2003). «Prevalence and high rate of asymptomatic infection of Chlamydia trachomatis in male college Reserve Officer Training Corps cadets». Sex Transm Dis. 30 (12): 901–4. PMID 14646638. doi:10.1097/01.OLQ.0000091136.14932.8B
[6]
Rivera EV, Woods S (2003). «Prevalence of asymptomatic Clostridium difficile colonization in a nursing home population: a cross-sectional study». J Gend Specif Med. 6 (2): 27–30. PMID 12813999
[7]
Chacin-Bonilla L, Mejia de Young M, Estevez J (2003). «Prevalence and pathogenic role of Cyclospora cayetanensis in a Venezuelan community». Am. J. Trop. Med. Hyg. 68 (3): 304–6. PMID 12685635
[8]
Burke DS, Nisalak A, Johnson DE, Scott RM (1988). «A prospective study of dengue infections in Bangkok». Am. J. Trop. Med. Hyg. 38 (1): 172–80. PMID 3341519
[9]
Peek R, Reedeker FR, van Gool T (2004). «Direct Amplification and Genotyping of Dientamoeba fragilis from Human Stool Specimens». J. Clin. Microbiol. 42 (2): 631–5. PMC 344490. PMID 14766828. doi:10.1128/JCM.42.2.631-635.2004
[10]
Blessmann J, Ali IK, Nu PA; et al. (2003). «Longitudinal Study of Intestinal Entamoeba histolytica Infections in Asymptomatic Adult Carriers». J. Clin. Microbiol. 41 (10): 4745–50. PMC 294961. PMID 14532214. doi:10.1128/JCM.41.10.4745-4750.2003
[11]
Wennerås C, Erling V (2004). «Prevalence of enterotoxigenic Escherichia coli-associated diarrhoea and carrier state in the developing world». J Health Popul Nutr. 22 (4): 370–82. PMID 15663170
[12]
Pegtel DM, Middeldorp J, Thorley-Lawson DA (2004). «Epstein-Barr Virus Infection in Ex Vivo Tonsil Epithelial Cell Cultures of Asymptomatic Carriers». J. Virol. 78 (22): 12613–24. PMC 525079. PMID 15507648. doi:10.1128/JVI.78.22.12613-12624.2004
[13]
Ozturk CE, Yavuz T, Kaya D, Yucel M (2004). «The rate of asymptomatic throat carriage of group A Streptococcus in school children and associated ASO titers in Duzce, Turkey». Jpn. J. Infect. Dis. 57 (6): 271–2. PMID 15623954. Consultado em 13 de março de 2013. Arquivado do original em 21 de janeiro de 2005
[14]
Kul S, Sert B, Sari A; et al. (2008). «Effect of subclinical Helicobacter pylori infection on gastric wall thickness: multislice CT evaluation». Diagn Interv Radiol. 14 (3): 138–42. PMID 18814135
[15]
Wald A, Zeh J, Selke S, Ashley RL, Corey L (1995). «Virologic characteristics of subclinical and symptomatic genital herpes infections». N. Engl. J. Med. 333 (12): 770–5. PMID 7643884. doi:10.1056/NEJM199509213331205
[16]
Mummidi S, Ahuja SS, Gonzalez E; et al. (1998). «Genealogy of the CCR5 locus and chemokine system gene variants associated with altered rates of HIV-1 disease progression». Nat. Med. 4 (7): 786–93. PMID 9662369. doi:10.1038/nm0798-786
[17]
Flournoy DJ, Guthrie PJ, Lawrence CH, Silberg SL, Beaver S (1990). «Incidence of Legionella pneumophila infections among Oklahoma pulmonary disease patients». J Natl Med Assoc. 82 (1): 25–9. PMC 2625929. PMID 2304095
[18]
Anlar B, Ayhan A, Hotta H; et al. (2002). «Measles virus RNA in tonsils of asymptomatic children». J Paediatr Child Health. 38 (4): 424–5. PMID 12174013. doi:10.1046/j.1440-1754.2002.t01-1-00029.x^{[ligação inativa]}
[19]
Beyene D, Aseffa A, Harboe M; et al. (2003). «Nasal carriage of Mycobacterium leprae DNA in healthy individuals in Lega Robi village, Ethiopia». Epidemiol. Infect. 131 (2): 841–8. PMC 2870027. PMID 14596524. doi:10.1017/S0950268803001079
[20]
Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC (1999). «Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project». JAMA. 282 (7): 677–86. PMID 10517722. doi:10.1001/jama.282.7.677
[21]
Yazdankhah SP, Caugant DA (2004). «Neisseria meningitidis: an overview of the carriage state». J. Med. Microbiol. 53 (Pt 9): 821–32. PMID 15314188. doi:10.1099/jmm.0.45529-0^{[ligação inativa]}
[22]
Sirinavin S, Pokawattana L, Bangtrakulnondh A (2004). «Duration of nontyphoidal Salmonella carriage in asymptomatic adults». Clin. Infect. Dis. 38 (11): 1644–5. PMID 15156460. doi:10.1086/421027
[23]
Gallimore CI, Cubitt D, du Plessis N, Gray JJ (2004). «Asymptomatic and Symptomatic Excretion of Noroviruses during a Hospital Outbreak of Gastroenteritis». J. Clin. Microbiol. 42 (5): 2271–4. PMC 404621. PMID 15131210. doi:10.1128/JCM.42.5.2271-2274.2004
[24]
van Benten I, Koopman L, Niesters B; et al. (2003). «Predominance of rhinovirus in the nose of symptomatic and asymptomatic infants». Pediatr Allergy Immunol. 14 (5): 363–70. PMID 14641606. doi:10.1034/j.1399-3038.2003.00064.x^{[ligação inativa]}
[25]
Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ (2002). «Typhoid fever». N. Engl. J. Med. 347 (22): 1770–82. PMID 12456854. doi:10.1056/NEJMra020201
[26]
Kenner J, O'Connor T, Piantanida N; et al. (2003). «Rates of carriage of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in an outpatient population». Infect Control Hosp Epidemiol. 24 (6): 439–44. PMID 12828322. doi:10.1086/502229
[27]
Malfroot A, Verhaegen J, Dubru JM, Van Kerschaver E, Leyman S (2004). «A cross-sectional survey of the prevalence of Streptococcus pneumoniae nasopharyngeal carriage in Belgian infants attending day care centres». Clin. Microbiol. Infect. 10 (9): 797–803. PMID 15355410. doi:10.1111/j.1198-743X.2004.00926.x^{[ligação inativa]}
[28]
Singh AE, Romanowski B (1999). «Syphilis: Review with Emphasis on Clinical, Epidemiologic, and Some Biologic Features». Clin. Microbiol. Rev. 12 (2): 187–209. PMC 88914. PMID 10194456

[1] [1]
Klement E, Grotto I, Srugo I, Orr N, Gilad J, Cohent D (2005). «Pertussis in soldiers, Israel». Emerging Infect. Dis. 11 (3): 506–8. PMID 15789494

[2] [2]
Müller J, Møller DS, Kjaer M, Nyvad O, Larsen NA, Pedersen EB (2003). «Chlamydia pneumoniae DNA in peripheral blood mononuclear cells in healthy control subjects and patients with diabetes mellitus, acute coronary syndrome, stroke, and arterial hypertension». Scand. J. Infect. Dis. 35 (10): 704–12. PMID 14606608. doi:10.1080/00365540310016538

[Cecil01-3] [3]
Cecil JA, Howell MR, Tawes JJ; et al. (2001). «Features of Chlamydia trachomatis and Neisseria gonorrhoeae infection in male Army recruits». J. Infect. Dis. 184 (9): 1216–9. PMID 11598849. doi:10.1086/323662

[Korenromp02-4] [4]
Korenromp EL, Sudaryo MK, de Vlas SJ; et al. (2002). «What proportion of episodes of gonorrhoea and chlamydia becomes symptomatic?». Int J STD AIDS. 13 (2): 91–101. PMID 11839163. doi:10.1258/0956462021924712

[5] [5]
Sutton TL, Martinko T, Hale S, Fairchok MP (2003). «Prevalence and high rate of asymptomatic infection of Chlamydia trachomatis in male college Reserve Officer Training Corps cadets». Sex Transm Dis. 30 (12): 901–4. PMID 14646638. doi:10.1097/01.OLQ.0000091136.14932.8B

[6] [6]
Rivera EV, Woods S (2003). «Prevalence of asymptomatic Clostridium difficile colonization in a nursing home population: a cross-sectional study». J Gend Specif Med. 6 (2): 27–30. PMID 12813999

[7] [7]
Chacin-Bonilla L, Mejia de Young M, Estevez J (2003). «Prevalence and pathogenic role of Cyclospora cayetanensis in a Venezuelan community». Am. J. Trop. Med. Hyg. 68 (3): 304–6. PMID 12685635

[8] [8]
Burke DS, Nisalak A, Johnson DE, Scott RM (1988). «A prospective study of dengue infections in Bangkok». Am. J. Trop. Med. Hyg. 38 (1): 172–80. PMID 3341519

[9] [9]
Peek R, Reedeker FR, van Gool T (2004). «Direct Amplification and Genotyping of Dientamoeba fragilis from Human Stool Specimens». J. Clin. Microbiol. 42 (2): 631–5. PMC 344490. PMID 14766828. doi:10.1128/JCM.42.2.631-635.2004

[10] [10]
Blessmann J, Ali IK, Nu PA; et al. (2003). «Longitudinal Study of Intestinal Entamoeba histolytica Infections in Asymptomatic Adult Carriers». J. Clin. Microbiol. 41 (10): 4745–50. PMC 294961. PMID 14532214. doi:10.1128/JCM.41.10.4745-4750.2003

[11] [11]
Wennerås C, Erling V (2004). «Prevalence of enterotoxigenic Escherichia coli-associated diarrhoea and carrier state in the developing world». J Health Popul Nutr. 22 (4): 370–82. PMID 15663170

[12] [12]
Pegtel DM, Middeldorp J, Thorley-Lawson DA (2004). «Epstein-Barr Virus Infection in Ex Vivo Tonsil Epithelial Cell Cultures of Asymptomatic Carriers». J. Virol. 78 (22): 12613–24. PMC 525079. PMID 15507648. doi:10.1128/JVI.78.22.12613-12624.2004

[13] [13]
Ozturk CE, Yavuz T, Kaya D, Yucel M (2004). «The rate of asymptomatic throat carriage of group A Streptococcus in school children and associated ASO titers in Duzce, Turkey». Jpn. J. Infect. Dis. 57 (6): 271–2. PMID 15623954. Consultado em 13 de março de 2013. Arquivado do original em 21 de janeiro de 2005

[14] [14]
Kul S, Sert B, Sari A; et al. (2008). «Effect of subclinical Helicobacter pylori infection on gastric wall thickness: multislice CT evaluation». Diagn Interv Radiol. 14 (3): 138–42. PMID 18814135

[15] [15]
Wald A, Zeh J, Selke S, Ashley RL, Corey L (1995). «Virologic characteristics of subclinical and symptomatic genital herpes infections». N. Engl. J. Med. 333 (12): 770–5. PMID 7643884. doi:10.1056/NEJM199509213331205

[16] [16]
Mummidi S, Ahuja SS, Gonzalez E; et al. (1998). «Genealogy of the CCR5 locus and chemokine system gene variants associated with altered rates of HIV-1 disease progression». Nat. Med. 4 (7): 786–93. PMID 9662369. doi:10.1038/nm0798-786

[17] [17]
Flournoy DJ, Guthrie PJ, Lawrence CH, Silberg SL, Beaver S (1990). «Incidence of Legionella pneumophila infections among Oklahoma pulmonary disease patients». J Natl Med Assoc. 82 (1): 25–9. PMC 2625929. PMID 2304095

[18] [18]
Anlar B, Ayhan A, Hotta H; et al. (2002). «Measles virus RNA in tonsils of asymptomatic children». J Paediatr Child Health. 38 (4): 424–5. PMID 12174013. doi:10.1046/j.1440-1754.2002.t01-1-00029.x^{[ligação inativa]}

[19] [19]
Beyene D, Aseffa A, Harboe M; et al. (2003). «Nasal carriage of Mycobacterium leprae DNA in healthy individuals in Lega Robi village, Ethiopia». Epidemiol. Infect. 131 (2): 841–8. PMC 2870027. PMID 14596524. doi:10.1017/S0950268803001079

[20] [20]
Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC (1999). «Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project». JAMA. 282 (7): 677–86. PMID 10517722. doi:10.1001/jama.282.7.677

[21] [21]
Yazdankhah SP, Caugant DA (2004). «Neisseria meningitidis: an overview of the carriage state». J. Med. Microbiol. 53 (Pt 9): 821–32. PMID 15314188. doi:10.1099/jmm.0.45529-0^{[ligação inativa]}

[22] [22]
Sirinavin S, Pokawattana L, Bangtrakulnondh A (2004). «Duration of nontyphoidal Salmonella carriage in asymptomatic adults». Clin. Infect. Dis. 38 (11): 1644–5. PMID 15156460. doi:10.1086/421027

[23] [23]
Gallimore CI, Cubitt D, du Plessis N, Gray JJ (2004). «Asymptomatic and Symptomatic Excretion of Noroviruses during a Hospital Outbreak of Gastroenteritis». J. Clin. Microbiol. 42 (5): 2271–4. PMC 404621. PMID 15131210. doi:10.1128/JCM.42.5.2271-2274.2004

[24] [24]
van Benten I, Koopman L, Niesters B; et al. (2003). «Predominance of rhinovirus in the nose of symptomatic and asymptomatic infants». Pediatr Allergy Immunol. 14 (5): 363–70. PMID 14641606. doi:10.1034/j.1399-3038.2003.00064.x^{[ligação inativa]}

[25] [25]
Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ (2002). «Typhoid fever». N. Engl. J. Med. 347 (22): 1770–82. PMID 12456854. doi:10.1056/NEJMra020201

[26] [26]
Kenner J, O'Connor T, Piantanida N; et al. (2003). «Rates of carriage of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in an outpatient population». Infect Control Hosp Epidemiol. 24 (6): 439–44. PMID 12828322. doi:10.1086/502229

[27] [27]
Malfroot A, Verhaegen J, Dubru JM, Van Kerschaver E, Leyman S (2004). «A cross-sectional survey of the prevalence of Streptococcus pneumoniae nasopharyngeal carriage in Belgian infants attending day care centres». Clin. Microbiol. Infect. 10 (9): 797–803. PMID 15355410. doi:10.1111/j.1198-743X.2004.00926.x^{[ligação inativa]}

[28] [28]
Singh AE, Romanowski B (1999). «Syphilis: Review with Emphasis on Clinical, Epidemiologic, and Some Biologic Features». Clin. Microbiol. Rev. 12 (2): 187–209. PMC 88914. PMID 10194456

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Infecção subclínica

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Referências