Uso da miltefosina no tratamento clínico de cães com leishmaniose visceral: revisão de literatura / Use of miltefosin in the clinical treatment of dogs with visceral leishmaniosis / Uso de miltefosina en el tratamiento clínico de perros con leishmaniosis visceral: revisión de la literatura

A leishmaniose visceral canina é uma doença de caráter zoonótico, acometendo os seres humanos e diversas espécies de animais silvestres e domésticos. Objetivou-se com o presente estudo realizar uma revisão de literatura sobre o uso da miltefosina no tratamento clínico de cães com leishmaniose visceral. Trata- se de uma revisão de literatura, a qual foi realizada por meio de consultas à periódicos e livros presentes na biblioteca do Cesmac. Foram utilizadas bases de dados como: portal Capes, SCIELO, Google Acadêmico; pesquisa em monografias, teses e dissertações. Causada pelo protozoário Leishmania chagasi, sendo o cão doméstico o principal reservatório desse protozoário. Por representar um problema grave de saúde pública e ser considerada uma doença potencialmente fatal (quando não tratada precocemente e adequadamente), faz- se importante que o clínico esteja familiarizado com os sinais clínicos, exames complementares e principais protocolos terapêuticos, em especial a utilização da miltefosina no tratamento da leishmaniose visceral em cães. Por ser uma zoonose que causa graves problemas de saúde pública e que vem crescendo cada vez mais no Brasil, cabe aos médicos veterinários assumirem o compromisso na conscientização sobre a importância do diagnóstico precoce além de promoverem o bem-estar animal e a saúde pública.(AU)

Canine visceral leishmaniasis is a zoonotic disease, affecting humans and several species of wild and domestic animals. The objective of the present study was to carry out a literature review on the use of miltefosine in the clinical treatment of dogs with visceral leishmaniasis. This is a literature review, which was carried out through consultations with periodicals and books present in the Cesmac library. Databases such as: Capes portal, SCIELO, Google Scholar; research in monographs, theses and dissertations. Caused by the protozoan Leishmania chagasi, with the domestic dog being the main reservoir of this protozoan. As it represents a serious public health problem and is considered a potentially fatal disease (when not treated early and properly), it is important that the clinician is familiar with the clinical signs, complementary exams and main therapeutic protocols, especially the use of miltefosine in the treatment of visceral leishmaniasis in dogs. As it is a zoonosis that causes serious public health problems and that has been growing more and more in Brazil, it is up to veterinarians to make a commitment to raise awareness of the importance of early diagnosis in addition to promoting animal welfare and public health.(AU)

La leishmaniosis visceral canina es una enfermedad zoonótica que afecta a los seres humanos y a varias especies de animales salvajes y domésticos. El objetivo de este estudio fue realizar una revisión bibliográfica sobre el uso de la miltefosina en el tratamiento clínico de perros con leishmaniosis visceral. Se trata de una revisión bibliográfica, que se realizó mediante consultas a publicaciones periódicas y libros presentes en la biblioteca del Cesmac. Se utilizaron bases de datos como: portal Capes, SCIELO, Google Académico; investigación en monografías, tesis y disertaciones. Causada por el protozoo Leishmania chagasi, siendo el perro doméstico el principal reservorio de este protozoo. Dado que representa un grave problema de salud pública y se considera una enfermedad potencialmente mortal (cuando no se trata de forma temprana y adecuada), es importante que el clínico esté familiarizado con los signos clínicos, las pruebas adicionales y los principales protocolos terapéuticos, especialmente el uso de miltefosina en el tratamiento de la leishmaniosis visceral en perros. Siendo una zoonosis que causa graves problemas de salud pública y que viene creciendo cada vez más en Brasil, corresponde a los veterinarios asumir el compromiso de concienciar sobre la importancia del diagnóstico precoz y promover el bienestar animal y la salud pública.(AU)

Infección pulmonar por Strongyloides stercoralis en paciente inmunocomprometido. Reporte de caso / Pulmonary infection caused by Strongyloides stercoralis in an immunocompromised patient. Case report

El Strongyloides stercoralis es un nemátodo intestinal capaz de completar su ciclo de vida dentro del huésped humano. Se presenta el caso clínico de una mujer de 57 años con residencia en la zona amazónica por 10 años, la que presenta antecedentes patológicos personales de hiperten-sión arterial, osteoporosis y diabetes mellitus tipo 2, lo que la cataloga como inmunocomprome-tida. Esta asiste a servicios de emergencia con cuadro agudo característico de infección de vías urinarias, recibe tratamiento en la unidad de cuidados intensivos por shock séptico de origen urinario versus pulmonar. La prueba de laboratorio clínico mediante muestra tomada a través de broncoaspiración arroja la existencia de larvas activas de Strongyloides stercoralis. La paciente mejoró sus condiciones de salud luego de un mes de evolución, respondiendo satisfactoriamente a la antibioticoterapia con carbapenémicos y el antiparasitario ivermectina. Los pacientes con factores de riesgo subyacentes tienen alta probabilidad a este tipo de infección agravada. La estrongiloidásis grave tiene una alta tasa de mortalidad, por lo que un diagnóstico temprano es indispensable para mejorar el pronóstico.

Strongyloides stercoralis is an intestinal nematode capable of completing its life cycle within the human host. The clinical case of a 57-year-old woman who has lived in the Amazon region for 10 years is presented. She has a personal pathological history of arterial hypertension, osteopo-rosis, and type 2 diabetes mellitus, which classifies her as immunocompromised. She attends emergency services with acute symptoms characteristic of urinary tract infection, receives treat-ment in the intensive care unit for septic shock of urinary versus pulmonary origin. The clinical laboratory test using a sample taken through bronchial aspiration shows the existence of active larvae of Strongyloides stercoralis. The patient's health conditions improved after a month of evolution, responding satisfactorily to antibiotic therapy with carbapenems and the antiparasitic ivermectin. Patients with underlying risk factors are at high risk for this type of aggravated infection. Severe strongyloidiasis has a high mortality rate, so early diagnosis is essential to improve prognosis

Protótipos microbianos como candidatos a fármacos para protozooses negligenciadas / Microbial prototypes as drug candidates for neglected protozoa

Doenças tropicais negligenciadas atingem cerca de 1,7 bilhões de pessoas, gerando um forte impacto na economia e problemas na Saúde Pública. Dentre as endemias mais negligenciadas, encontra-se a doença de Chagas, que afeta cerca de 6 milhões de pessoas, e no Brasil, dispõe-se de apenas de um fármaco altamente tóxico contra a infecção. Sendo assim, existe uma necessidade urgente para novos tratamentos. A exploração farmacológica de compostos produzidos por microrganismos é de longa data e contribuiu até hoje, com diversos fármacos aprovados. O presente projeto avaliou o potencial anti-Trypanosoma cruzi de metabólitos de espécies bacterianas marinhas encontradas no litoral paulista. Para isto, foram coletados invertebrados e sedimentos marinhos e isoladas 32 espécies bacterianas, resultando em 12 microrganismos identificados por MALDI-TOF/MS ou sequenciamento genético. Os extratos orgânicos, contendo os metabólitos microbianos, foram avaliados quanto ao potencial anti-T. cruzi em tripomastigotas, apresentando valores de Concentração Efetiva 50% (CE50) entre 1,5 e 59,0 µg/mL. Duas cepas foram submetidas à abordagem One Strain Many Compounds (OSMAC), porém, não se observou aumento da potência antiparasitária. O pré-fracionamento do extrato da Olleya marilimosa, resultou em uma fração (FII) ativa contra os tripomastigotas (CE50 23 µg/mL), com ausência de citotoxicidade em fibroblastos e hemácias até 200 µg/mL. A análise em ressonância magnética nuclear (RMN 1H) e espectrometria de massas de alta resolução, demonstrou a presença de 4 ácidos graxos de cadeia iso, 1 (C19H37O2), 2 (C20H39O2), 3 (C21H41O2) e 4 (C22H43O2)...(AU)

Neglected tropical diseases affects about 1.7 billion people, generating a strong impact on the economy and problems in Public Health. Among the most neglected endemic diseases is Chagas disease, which affects about 6 million people, and in Brazil, only one highly toxic drug is available against it. Therefore, there is an urgent need for new treatments. The pharmacological exploitation of compounds produced by microorganisms is long-standing and has contributed to several approved drugs. The present project evaluated the anti-Trypanosoma cruzi potential of metabolites of marine bacterial species found on the coast of São Paulo. For this, invertebrates and marine sediments were collected and 32 bacterial species were isolated, resulting in 12 microorganisms identified by MALDI-TOF/MS or genetic sequencing. The organic extracts containing the microbial metabolites were evaluated for antiT. cruzi potential. crossed in trypomastigotes, presenting Effective Concentration 50% (EC50) between 1.5 and 59.0 µg/mL. Two strains were submitted to the One Strain Many Compounds (OSMAC) approach, however, there was no increase in antiparasitic potency. Prefractionation of Olleya marilimosa extract resulted in an active fraction (FII) against trypanomastigotes (EC50 23 µg/mL), with no cytotoxicity in fibroblasts or red blood cells up to 200 µg/mL. Nuclear Magnetic Resonance analysis (NMR 1H) and High-Resolution Mass Spectrometry demonstrated the presence of 4 iso chain fatty acids, 1 (C19H37O2), 2 (C20H39O2), 3 (C21H41O2) and 4 (C22H43O2). Using spectrofluorimetry, it was observed that FII induced a change in the permeability of the plasma membrane of the parasite. Analysis in mass spectrometry (MALDI-TOF/MS) also demonstrated changes in the protein profile of parasites after treatment. This study presented in an unprecedented way, the anti-T. cruzi potential metabolites of the marine bacteria studied. The isolation and characterization of these compounds may contribute to new pharmaceutical prototypes for Chagas disease. (AU)

Otimização de novos candidatos a fármacos para leishmaniose visceral canina / Optimization of new drug candidates for canine visceral leishmaniasis

A leishmaniose visceral canina se trata de enfermidade infecciosa, zoonótica, de caráter insidioso e multissistêmica. Fatores como a ineficácia dos métodos de controle aplicados sobre os reservatórios caninos (incluindo eutanásia) e a toxicidade dos fármacos atualmente disponíveis para o tratamento humano, justificam urgência na busca de novos candidatos a fármacos. O presente estudo teve por objetivo avaliar o potencial anti-Leishmania de 25 compostos sintéticos derivados do gibilimbol. Destes, quatro apresentaram atividade em amastigotas sem citotoxicidade a células de mamíferos, com o CE50 em amastigotas variando entre 5,1 e 13,5 µM, e dois (LPM-21 e LPM-22) foram submetidos à predição drug-likeness in silico e ensaios de mecanismo de ação em promastigotas de Leishmania (L.) infantum. Ambos demonstraram alta absorção gastrointestinal, permeabilidade à barreira hematoencefálica, solubilidade moderada e alta (respectivamente), ausência de moléculas de interferência, e perfil drug-likeness favorável para futuros candidatos a fármacos. Nos ensaios de mecanismo de ação, LPM-21 induziu tardiamente a permeabilização plasmática parasitária (220 minutos), além de ter ocasionado a despolarização da membrana mitocondrial, redução nos níveis de ROS, alcalinização dos acidocalcissomos e importante elevação do Ca2+ intracelular, fatos que sugerem um mecanismo de ação tendo como principal alvo de atuação os acidocalcissomos, resultando no extravasamento do Ca2+ e subsequente despolarização da membrana mitocondrial. O composto LPM-22 não alterou a permeabilidade da membrana plasmática, não atuou sobre o potencial de membrana mitocondrial, induziu a acidificação dos acidocalcissomos, elevação do Ca2+ e redução nos níveis de ROS, podendo sugerir danos à membrana mitocondrial e consequente elevação deste íon. A espectrometria de massas por MALDI-TOF revelou aumento na intensidade dos picos em promastigotas incubadas com LPM-21 e LPM-22. Logo, este trabalho concretiza o potencial anti-Leishmania dos derivados sintéticos do gibilimbol, em especial os compostos LPM-21 e LPM-22, os colocando como futuros candidatos para estudos in vivo. (AU)

Canine visceral leishmaniasis is an infectious, zoonotic, insidious and multisystemic disease. Factors such as the ineffectiveness of the control methods applied to canine reservoirs (including euthanasia) and the toxicity of the drugs currently available for human treatment, brings the urgency in search for new drug candidates. The present study aimed to evaluate the anti-Leishmania potential of 25 synthetic compounds derived from gibilimbol, a phenolic isolate extracted from the leaves of Piper malacophyllum. Four compounds showed activity in amastigotes without cytotoxicity to mammalian cells, with EC50 in amastigotes ranging between 5.1 and 13.5 µM, and two (LPM-21 and LPM-22) were submitted to the in silico drug-likeness prediction, and mechanism of action assays in Leishmania (L.) infantum promastigotes. Both demonstrated high gastrointestinal absorption, permeability to the blood-brain barrier, moderate and high solubility (respectively), and favorable drug-likeness profile for future drug candidates, without revealing PAINS molecules. In the mechanism of action assays, LPM-21 induced parasitic plasmatic permeabilization only at later times (220 minutes), in addition to depolarization of the mitochondrial membrane, reduction in ROS levels, acidocalcisomes alkalinization and significant increase in intracellular Ca2+, suggesting a mechanism of action targetting acidocalcisomes, resulting in extravasation of Ca2+ and subsequent depolarization of the mitochondrial membrane. In contrast, LPM-22 did not alter the permeability of the plasma membrane and the mitochondrial membrane potential, resulting in acidification of acidocalcisomes, elevation of Ca2+ and reduction in ROS levels, which may suggest damage to the mitochondrial membrane and consequent calcium elevation. Mass spectrometry by MALDI-TOF revealed an increase in peak intensity in promastigotes incubated with LPM-21 and LPM-22. Finally, this work realizes the anti-Leishmania potential of synthetic gibilimbol derivatives, especially the compounds LPM-21 and LPM-22, placing them as future candidates for in vivo studies. (AU)

Leishmaniasis cutánea americana: Índices epidemiológicos en Valle Hermoso de la provincia Santo Domingo de Los Tsachilas / American cutaneous leishmaniasis: Epidemiological indices in Valle Hermoso, Santo Domingo de Los Tsachilas province

Las leishmaniasis son causadas por aproximadamente 15 especies de protozoos del género Leishmania. Prevalecen en áreas tropicales y subtropicales del Viejo y Nuevo Mundo, la movilidad humana también los convierte en un problema médico en áreas no endémicas. Las manifestaciones clínicas pueden comprender formas cutáneas que pueden ser localizadas. El diagnóstico y el tratamiento varían según las manifestaciones clínicas, el área geográfica y la especie involucrada. Este artículo destaca aspectos epidemiológicos y clínicos en la provincia de Santo Domingo de los Tsachilas, Ecuador. Se utilizaron fichas clínicas y epidemiológicas de pacientes que presentaron lesiones ulceradas o no, con un tiempo de evolución igual o mayor a 2 semanas. El mayor número de casos están entre los grupos sucesivos de adolescentes de 11 a 19 años y los adultos jóvenes entre 20 y 39 años. El 81,79% de los positivos procedían de áreas rurales o periurbanas. Dos terceras partes de los pacientes eran masculinos. Hubo predominio de lesiones únicas (87,79%); ubicadas en cuello y región cervical, y extremidades inferiores (24,84 y 24,20%, respectivamente). Cerca del 88% de los pacientes no presentaron ningún tipo de sintomatología asociada a la infección parasitaria. El 97,86% de los diagnósticos de laboratorio fueron por observación microscópica directa. 81,80% obtuvieron cura total de las lesiones y el 22% de los pacientes abandonaron la terapia antiparasitaria. Se requieren pruebas rápidas y accesibles que puedan definir las especies de Leishmania, ya que la discriminación tiene una importancia significativa para el pronóstico y tratamientos específicos de la especie(AU)

Leishmaniases are caused by approximately 15 species of protozoa of the genus Leishmania. They prevail in tropical and subtropical areas of the Old and New World human mobility also makes them a medical problem in nonendemic areas. Clinical manifestations may comprise cutaneous forms that may be localized. Diagnosis and treatment vary according to the clinical manifestations, geographic area, and species involved. This article highlights epidemiological and clinical aspects in the province of Santo Domingo de los Tsachilas, Ecuador. Clinical and epidemiological records of patients who presented ulcerated lesions or not, with an evolution time equal to or greater than 2 weeks were used. The largest numbers of cases are between the successive groups of adolescents from 11 to 19 years old and young adults between 20 and 39 years old. 81.79% of the positives came from rural or peri-urban areas. Two thirds of the patients were male. There was a predominance of single lesions (87.79%); located in the neck and cervical region, and lower extremities (24.84 and 24.20%, respectively). About 88% of the patients did not present any type of symptomatology associated with the parasitic infection. 97.86% of laboratory diagnoses were by direct microscopic observation. 81.80% obtained complete cure of the lesions and 22% of the patients abandoned antiparasitic therapy. Rapid and accessible tests that can define Leishmania species are required, as discrimination is of significant importance for species-specific prognosis and treatment(AU)

Eficacia antiparasitaria in vitro del extracto de quebracho (Schinopsis balansae) sobre larvas infectantes de Haemonchus contortus de ovinos / In vitro antiparasitic efficacy of the quebracho extract (Schinopsis balansae) on infecting larvae of Haemonchus contortus of sheep

RESUMEN El objetivo de este trabajo fue evaluar in vitro la eficacia del extracto de quebracho (Schinopsis spp.), rico en taninos condensados, en el control de H. contortus de ovinos, ya que existen evidencias de que estos taninos pueden reducir la excreción de huevos, la fecundidad de las hembras y la carga de parásitos adultos. Para evaluar el efecto antihelmíntico in vitro sobre larvas infectantes de H. contortus susceptibles a todos los grupos químicos, se utilizó el test de inhibición de migración larval (IML) a 3 concentraciones diferentes (5 mg/ml, 15 mg/ml y 30 mg/ml). El efecto de los tratamientos fue analizado mediante un análisis de varianza y la estimación de las diferencias entre grupos se realizó por medio de la prueba LSD Fisher. Los resultados del test in vitro demostraron una reducción de la migración larval que varió entre el 74% y el 80%, a las concentraciones de entre 5 mg/ml y 30 mg/ml. Del análisis de varianza surgen diferencias significativas entre tratamientos (p = 0,0494). Al realizar la prueba de comparación de medias se evidenciaron diferencias significativas (p < 0,05) entre los promedios de migración a las diluciones de 5 mg/ml y 15 mg/ml, y de 5 mg/ml y 30 mg/ml, mientras que no se detectaron diferencias significativas entre la dilución de 15 mg/ml y 30 mg/ml. Estos resultados señalaron que el extracto de quebracho, a las diluciones evaluadas in vitro, presentó actividad antihelmíntica sobre larvas L3 susceptibles de H. contortus. Sin embargo, se requiere ampliar los estudios in vivo para demostrar un efecto antihelmíntico en ovinos.

ABSTRACT The objective of this work was to evaluate in vitro efficacy of the quebracho extract (Schinopsis spp.), rich in condensed tannins, against H. contortus in sheep, since there is evidence that this tanninsthese tannins can reduce egg excretion, fecundity of females and the burden of adult parasites. A larval migration inhibition (IML) test with 3 different concentration (5 mg/ml, 15 mg/ml, and 30 mg/ml) was used to evaluate the in vitro anthelmintic effect upon iInfective H. contortus larvae,from a susceptible strain to all chemical groupswere utilized with 3 diferentconcentration (5mg/ml, 15mg/ml, and 30mg/ml). The effect of the treatments was submitted to a variance analysis and the estimation of the differences between groups was evaluated using LSD Fisher test. Results from the in vitro test, revealed a reduction of the larval migration that varies from 74% to 80%, at the concentrations between 5 mg/ml to 30 mg/ml. From the analysis of variance, significant differences appear between treatments (p = 0,0494). After When performing the mean comparison test were performed, significant differences (p < 0,05) were found between the migration averages at dilutions of 5 mg/ml and 15 mg/ml, and between 5 mg/ml and 30 mg/ml, while were no't detected significant differences between the dilution of 15 mg/ml and 30 mg/ml. These results indicated that quebracho extract at the dilutions evaluated in vitro showed anthelmintic activity on L3 susceptible to H. contortus. However, it is necessary to conduct further studies in vivo to demonstrate an anthelmintic effect in sheep.

Pancreatitis necrotizante por áscaris lumbricoides: causas, diagnóstico y tratamiento actual / Necrotizing pancreatitis due to Ascaris lumbricoides: Causes, diagnosis, and current treatment

Resumen La necrosis en la pancreatitis aguda muestra una mortalidad muy alta a pesar de los avances en cuidados críticos. Después de la etiología biliar y alcohólica, la tercera causa más común de pancreatitis es la idiopática, con un 10 % de los casos secundarios a parásitos, y el áscaris es el parásito más común implicado en la necrosis e inflamación del páncreas. Teniendo en cuenta la alta mortalidad que representa la pancreatitis necrotizante, se describe un reporte de caso por ascariasis, destacando su creciente epidemiología, sus causas, su diagnóstico clínico e imagenológico, y su tratamiento antiparasitario según la evidencia actual.

Abstract Necrosis in acute pancreatitis presents a high mortality rate despite advances in critical care. After biliary and alcoholic etiology, the third most common cause of pancreatitis is idiopathic etiology, with 10% of cases related to parasites, being Ascaris the most common parasite involved in pancreas necrosis and inflammation. Considering the high rates of mortality related to necrotizing pancreatitis, a case of ascariasis is analyzed, including its growing epidemiology, its causes, its clinical and imaging diagnosis, and its antiparasitic treatment based on current evidence.

Intoxicación por adelfa, un caso poco frecuente / Oleander poisoning, a rare case

Introducción: Las intoxicaciones por plantas son infrecuentes, de complicada orientación diagnóstica, que en general, se dificulta la identificación de la planta, su potencial tóxico y el tratamiento específico. Entre ellas la adelfa, capaz de producir cuadros de intoxicación grave, como un caso consultado a la guardia del Centro Nacional de Toxicología. Objetivos: Presentar un caso clínico de intoxicación grave por adelfa. Caso clínico: Paciente adulto, con intranquilidad, vómitos, dolores abdominales, tensión arterial 150/90 mmHg, frecuencia cardiaca y respiratoria normales, refirió que había consumido vía oral y rectal una poción elaborada con una planta, como tratamiento antiparasitario. El médico de guardia decidió comunicarse con el Centro Nacional de Toxicología. Se identificó la planta como adelfa. A pesar de la aplicación de reposición de volumen, lavado gástrico y la administración de carbón activado; presentó bloqueo auriculoventricular, extrasístoles aisladas y bradicardia. Se suministró atropina endovenosa, luego se trasladó hacia la unidad de cuidados intensivos y posteriormente egresó. Conclusiones: El caso presentó una intoxicación aguda grave por adelfa, con un correcto diagnóstico y tratamiento, que requirió de la labor conjunta de los médicos del cuerpo de guardia del hospital, la terapia intensiva y del Centro Nacional de Toxicología(AU)

Introduction: Poisoning by plants is infrequent, with a complicated diagnostic orientation, which in general makes it difficult to identify the plant, its toxic potential and specific treatment. Among them the oleander, capable of producing serious intoxication, as a case consulted to the National Toxicology Center. Objectives: To present a clinical case of severe oleander poisoning. Clinical case: Adult patient with restlessness, vomiting, abdominal pain, blood pressure 150/90 mmHg, normal heart and respiratory rates, and reported that he had consumed orally and rectally a potion made with a plant, as an antiparasitic treatment. The doctor who assisted him decided to communicate with the National Toxicology Center. The plant was identified as oleander. Despite the application of volume replacement, gastric lavage and the administration of activated charcoal; the patient presented atrioventricular block, isolated extrasystoles and bradycardia, intravenous atropine was administered, and subsequent transfer to the intensive care unit, and later he was discharged. Conclusions: The case presented a severe acute oleander poisoning, there was correct diagnosis and treatment, which required the joint work of the doctors from hospital emergency, the intensive care unit and the National Toxicology Center(AU)

Anthelmintic resistance in Creole horses in the South of Rio Grande do Sul, Brazil / [Resistência anti-helmíntica em equinos da raça Crioula no sul do Rio Grande do Sul, Brasil]

The objective of the study was to evaluate the antiparasitic resistance against horse nematodes in the South of Rio Grande do Sul, Brazil. The results concerning the tests of anthelmintic efficacy on horses, stored in the database of the Parasitic Diseases Study Group (GEEP) - Veterinary Faculty, at the Federal University of Pelotas (UFPel), were carried out in the laboratory from 2018 to 2019. Stool samples were received from farms with breeding of adult female and male Criollo horses naturally infected, located in municipalities in the country's southern region. The antiparasitic agents tested were Triclorfon + Fenbendazole, Closantel + Albendazole, Ivermectin + Praziquantel, Fenbendazole, Ivermectin, Doramectin, Mebendazole and Moxidectin. Techniques such as Gordon and Whitlock, Coproculture and Fecal Egg Count Reduction Test were performed. Of all the antiparasitic drugs tested, it was observed that only treatments with Ivermectin 2% showed desired values. The observed results indicate that resistance to macrocyclic lactones is usual in equine parasites in this Brazilian region, despite the results with isolated Ivermectin.(AU)

O objetivo deste estudo é avaliar a resistência antiparasitária contra nematodeos de equinos no sul do Rio Grande do Sul, Brasil. Os resultados referentes aos testes de eficácia anti-helmíntica em cavalos, armazenados no banco de dados do Grupo de Estudos de Doenças Parasitárias (GEEP) - Faculdade de Veterinária, da Universidade Federal de Pelotas (UFPel), foram realizados em laboratório, no período de 2018 a 2019. Amostras de fezes foram recebidas de fazendas com criação de cavalos Crioulos adultos fêmeas e machos naturalmente infectados, localizadas em municípios da região Sul do país. Os agentes antiparasitários testados foram triclorfon + fenbendazol, closantel + ivermectina + praziquantel, fenbendazol, ivermectina, doramectina, mebendazol e moxidectina. Técnicas como Gordon e Whitlock, coprocultura e teste de redução da contagem de ovos fecais foram realizadas. De todos os antiparasitários testados, observou-se que apenas os tratamentos com ivermectina 2% apresentaram os valores desejados. Os resultados indicam que a resistência às lactonas macrocíclicas é comum em parasitas equinos nessa região brasileira, apesar dos resultados com ivermectina isolada.(AU)

Síndrome larva migrans cutánea en pediatría / Cutaneous Larva Migrans Syndrome in Pediatrics

La dermatosis denominada larva migrans cutánea: (LMC) es una infección cutánea secundaria a infestación parasitaria por la migración de larvas de anquilostomas animales a la epidermis humana, frecuentemente por contacto directo con suelos contaminados, especialmente en zonas tropicales. Se caracteriza por la aparición de lesiones induradas, eritematosas con patrón irregular o serpiginoso acompañado de prurito. Describimos un caso de LMC en una niña, adquirido durante unas vacaciones en Colombia y tratado inicialmente como celulitis con antibióticos (AU)

Cutaneous larva migrans (CLM) is an infection secondary to parasitic infestation due to the migration of animal hookworm larvae into the human skin, frequently by direct contact with contaminated grounds, especially in the tropics. Clinically, it is characterized by the appearance of indurated, erythematous lesions with irregular or "creeping eruption" pattern and pruritus. This article describes a case of CLM infection in a pediatric patient, it was acquired during the holidays in Colombia, diagnosed as cellulitis and treated accordingly with antibiotics without success (AU)

Brazilian Theraphosidae: a toxicological point of view

The Theraphosidae family includes the largest number of species of the Mygalomorphae infraorder, with hundreds of species currently catalogued. However, there is a huge lack on physiologic and even ecologic information available, especially in Brazil, which is the most biodiverse country in the world. Over the years, spiders have been presented as a source of multiple biologically active compounds with basic roles, such as primary defense against pathogenic microorganisms or modulation of metabolic pathways and as specialized hunters. Spider venoms also evolved in order to enable the capture of prey by interaction with a diversity of molecular targets of interest, raising their pharmaceutical potential for the development of new drugs. Among the activities found in compounds isolated from venoms and hemocytes of Brazilian Theraphosidae there are antimicrobial, antifungal, antiparasitic and antitumoral, as well as properties related to proteinase action and neuromuscular blockage modulated by ionic voltage-gated channel interaction. These characteristics are present in different species from multiple genera, which is strong evidence of the important role in spider survival. The present review aims to compile the main results of studies from the last decades on Brazilian Theraphosidae with special focus on results obtained with the crude venom or compounds isolated from both venom and hemocytes, and their physiological and chemical characterization.(AU)

Antiparasitic and immunomodulating effects of nitazoxanide, ivermectin and selenium on Cryptosporidium infection in diabetic mice / Efeitos antiparasitários e imunomodulantes da nitazoxanida, ivermectina e selênio sobre a infecção por Cryptosporidium em camundongos diabéticos

Abstract The present work aims to investigate the antiparasitic and the immunomodulating effects of nitazoxanide (NTZ) and ivermectin (IVC) alone or combined together or combined with selenium (Se), on Cryptosporidium infection in diabetic mice. The results revealed that the combined NTZ and IVC therapy achieved the highest reduction of fecal oocysts (92%), whereas single NTZ showed the lowest reduction (63%). Also, adding Se to either NTZ or IVC resulted in elevation of oocyst reduction from 63% to 71% and from 82% to 84% respectively. All treatment regimens, with the exception of NTZ monotherapy, showed a significant improvement in the intestinal histopathology, the highest score was in combined NTZ and IVC therapy. The unique results of immunohistochemistry in this study showed reversal of the normal CD4/CD8 T cell ratio in the infected untreated mice, however, following therapy it reverts back to a normal balanced ratio. The combined (NTZ+ IVC) treatment demonstrated the highest level of CD4 T cell expression. Taken together, NTZ and IVC combined therapy showed remarkable anti-parasitic and immunostimulatory effects, specifically towards the CD4 population that seem to be promising in controlling cryptosporidiosis in diabetic individuals. Further research is required to explore other effective treatment strategies for those comorbid patients.

Resumo O presente trabalho tem como objetivo investigar os efeitos anti-parasitários e imunomodulantes da nitazoxanida (NTZ) e ivermectina (IVC), isoladas ou em associação, e do selênio (SE), associado à NTZ ou à IVC, sobre a infecção por Cryptosporidium em camundongos diabéticos. Os resultados revelaram que a terapia combinada com NTZ e IVC resultou em maior redução de oocistos fecais, enquanto a NTZ isolada mostrou a menor redução de oocistos fecais (63%). Além disso, a associação do SE com a NTZ ou IVC resultou em redução do número de oocistos fecais de 63% para 71% e de 82% para 84%, respectivamente. Todos os tratamentos, com exceção da monoterapia com NTZ, mostraram uma melhora significativa nos índices relacionados à histopatologia intestinal. Os resultados da imuno-histoquímica mostraram reversão da razão celular CD4/CD8 T normal nos camundongos infectados não tratados, no entanto, após a terapia, houve retorno à razão celular CD4/CD8 T normal. O tratamento combinado (NTZ+ IVC) demonstrou o mais alto nível de expressão celular CD4 T. Em conclusão, a terapia combinada com NTZ e IVC mostrou efeitos anti-parasitários e imunoestimuladores notáveis, especificamente para a população CD4, que parecem ser promissores para o controle da criptosporidiose em indivíduos diabéticos.

Complexos imínicos de cobre com atividade antiparasitária frente à doença de chagas / Imine copper complexes with antiparasitic activity against Chagas disease

Neste trabalho foram sintetizados e caracterizados três complexos de cobre com ligantes imínicos, com o objetivo de avaliar sua atividade tripanocida. Esses complexos foram caracterizados por diversas técnicas espectroscópicas, como UV-Vis, Infravermelho e EPR, além de análise elementar e espectrometria de massa. Juntamente com outros complexos similares previamente sintetizados pelo nosso grupo, tiveram suas atividades avaliadas frente à forma tripomastigota do parasita T. cruzi, responsável pela fase aguda da doença de Chagas, por ensaios de viabilidade celular, com determinação do valor de seus IC50, concentração em que observamos a morte de 50% da cultura celular, pela metodologia denominada MTT. Todos os complexos mostraram-se eficientes frente a tripomastigotas, apresentando valores de IC50 abaixo de 10 µM, com quatro deles obtendo índice de seletividade maior que 10, fator importante para definir agentes promissores antichagásicos. Complexos selecionados também tiveram sua atividade verificada frente à forma amastigota do parasita, responsável pela fase crônica da doença, utilizando método de imageamento por microscópio de fluorescência e contagem celular. Estudos de inibição da cruzaína, uma cisteíno-protease importante para o metabolismo do parasita foram conduzidos em colaboração com o laboratório do Prof. Wagner Alves de Souza Júdice, da Universidade de Mogi das Cruzes. Quatro dos compostos testados apresentaram atividade inibitória frente a cruzaína, sendo dois de cobre, um de zinco e um ligante livre. Os estudos também permitiram diferenciar os mecanismos de inibição dos compostos, com os complexos de cobre apresentando um mecanismo de inibição clássico e o composto de zinco e o ligante livre apresentando o mecanismo de inibição competitiva parabólica com cooperatividade

In this work, three copper complexes with iminic ligands were synthesized and characterized, with the objective of evaluating their trypanocidal activity. These complexes were characterized by several spectroscopic techniques, such as UV-Vis, Infrared and EPR, in addition to elementary analysis and mass spectrometry. Together with other similar complexes previously synthesized by our group, their activities were evaluated against the trypomastigote form of the parasite T. cruzi, responsible for the acute phase of Chagas disease, by cell viability tests, with determination of the value of their IC50, concentration in that we observed the death of 50% of the cell culture, by the methodology called MTT, all presenting IC50 values below 10 µM, with four of them obtaining a selectivity index greater than 10, important factor for defining promising antichagasic agents. Selected complexes also had their activity verified against the amastigote form of the parasite, responsible for the chronic phase of the disease, using a fluorescence microscope and cell counting imaging method. Inhibition studies of cruzain, a cysteine protease important for the metabolism of the parasite, were conducted in collaboration with the laboratory of Professor Wagner Alves de Souza Júdice at the University of Mogi das Cruzes. Four of the tested compounds showed inhibitory activity against cruzain, two of copper, one of zinc and a free ligand. The studies also allowed to differentiate the mechanisms of inhibition of the compounds, with the copper complexes presenting a classic inhibition mechanism and the zinc compound and the free ligand presenting the competitive parabolic inhibition mechanism with cooperativity

Enfermedad de Chagas y el binomio madre-hijo / Chagas disease and the mother-son binomy

La infección por Trypanosoma cruzi está garantizada por la presencia del parásito en muchos géneros animales incluido el hombre. Este a su vez, no solo adquiere el parásitoa través del vector (cutánea, por mucosas, oral) o por secreciones de didelfidos o accidentalmente por manipulación de material biológico infectante,sino también por la trasmisión hombre-hombre la cual aumenta la diseminación de la Enfermedad de Chagas aunque en menor proporción (trasmisión congénita, transfusional o por trasplante de tejidos). El parásito alcanza al feto in utero principalmente por su capacidad de atravesar la placenta especialmente después de la semana 20 cuando la barrera placentaria se adelgaza progresivamente. Sin embargo solo del 1 al 10% de los niños nacidos de madres con Enfermedad de Chagas desarrollan infección aguda variando de acuerdo al país, edad gestacional, al genotipo y carga del parásito entre varios factores. La clínica del neonato con T. cruzi va desde casos asintomáticos, bajo peso, prematuridad, hepatoesplenomegalia, dificultad respiratoria,hastael desenlace fatal. La prevención se basa en la detección por serología y tratamiento oportuno en niñas y mujeres antes del embarazo ya que los antiparasitarios específicos producen efectos adversos y en principio están contraindicados durante el embarazo. En cambio el tratamiento está indicado en el niño en cualquier momento cuando se demuestre la patología. El despistaje de la infección por T. cruzi debería ser obligatorio en toda Latinoamérica y en toda mujer latinoamericana en el mundo a fin de estar preparado para la atención postparto al infante y a la madre(AU)

Infection with Trypanosoma cruzi is guaranteed by the presence of the parasite in many animal genera including man. This in turn, not only acquires the parasite by contact with a vector (skin, mucoses and oral transmission) or by secretions of didelfides or accidentally by manipulation of infecting biological material, but also by man-man transmission which increases the spread of Chagas disease (congenital, transfusion or tissue transplant transmission). The parasite reaches the fetus in utero mainly due to its ability to cross the placenta especially after week 20 when the placental barrier becomes progressively thinner. However, only 1 to 10% of children born from mothers with Chagas disease develop acute infection, varying according to country, gestational age, genotype, and parasite load among various factors. The clinic of the neonate with T. cruzi ranges from asymptomatic cases, low weight, prematurity, hepatosplenomegaly, respiratory distress to the fatal outcome. Prevention is based on the detection by serology and timely treatment in girls and women before pregnancy since specific antiparasitic drugs produce adverse effects and are in principle contraindicated during pregnancy. Instead, treatment is indicated in the child at any time when the pathology is demonstrated. The screening of T. cruzi infection should be mandatory in all Latin America and in all Latin American women in the world in order to be prepared for the postpartum care of the infant and the mother(AU)

Avaliação hematológica e hepática de ovinos sob tratamento com torta de neem (Azadirachta indica) / Hematological and liver evaluation of sheep under treatment with neem pie (Azadirachta indica)

Devido aos altos índices de resistência dos parasitas aos diferentes princípios ativos comerciais, novas alternativas de controle vêm sendo estudadas, entre elas a fitoterapia. Essas medidas visam a busca de métodos auxiliares no controle das parasitoses, entretanto, muitos produtos estão disponíveis no mercado e não têm comprovação científica de sua eficácia ou de possíveis efeitos colaterais. O objetivo deste estudo foi avaliar os efeitos hematológicos e hepáticos após a administração de torta de Neem (Azadirachta indica) em ovinos. Foram testadas três dosagens da torta de Neem adicionada ao sal mineral (1, 2 e 4%), administradas por 126 dias para 32 ovinos da raça Lacaune, divididos em quatro grupos sendo três grupos para os diferentes tratamentos e um controle, o qual recebeu somente sal mineral. Amostras de sangue foram colhidas a cada 21 dias para realização do hemograma completo, dosagem de proteína plasmática total e fibrinogênio e avaliação da bioquímica clínica hepática. Nestas mesmas ocasiões, amostras de fezes foram coletadas para a quantificação de ovos por grama de fezes (OPG). Foram observadas diferenças estatísticas entre momentos e grupos para diversas variáveis, porém sem estarem relacionadas à administração de torta de Neem. Os resultados obtidos de hemograma completo, dosagem de proteína plasmática total, fibrinogênio e de bioquímica clínica hepática indicaram que a administração de torta de Neem nas concentrações de 1, 2 e 4%, não interfere nos valores hematológicos, nem sobre a integridade e função hepática de ovinos da raça Lacaune.

Due to high levels of parasite resistance to different commercial active ingredients, new control alternatives are being studied, including the phytotherapy. These measures aim to search for auxiliary methods in the control of parasitic diseases. However, there are many products available in the market and there are no scientific proof of its efficacy. The objective of this study was to evaluate the hematological and hepatic effects following administration of Neem pie (Azadirachta indica) in sheep. Three concentrations of Neem cake was added to the mineral salt (1, 2 and 4%) and administered during 126 days to 32 Lacaune breed sheeps, divided into four groups: three groups for different treatments and a and a control were tested, the ladder receiving only mineral salt. Blood samples were taken every 21 days to perform the complete blood count, serum total plasma protein and fibrinogen and liver biochemical evaluation. In those same times, fecal samples were collected for quantification of eggs per gram of feces (EPG). Statistical differences between times and groups for several variables were observed, but without being related to the administration of Neem pie. The results of complete blood count, measurement of total plasma protein, fibrinogen and hepatic clinical biochemistry indicated that administration of Neem pie at concentrations of 1, 2 and 4%, does not interfere in hematological values, or on the integrity and liver function Lacaune sheep breed.

Ascariasis hepatobiliar en una lactante con desnutrición severa: reporte de caso / Hepatobiliary ascariasis in severely malnourished infant: case report

Resumen La Ascariasis es la geohelminitiasis más común del mundo, catalogándose como una enfermedad tropical desatendida, que puede causar compromiso pulmonar, gastrointestinal, hepatobiliar y nutricional. Se presenta el caso inusual de una lactante procedente de una zona de extrema pobreza quien consultó por fiebre, vómito, ausencia de deposiciones, distensión y dolor abdominal. Fue diagnosticada con pseudoobstrucción intestinal, desnutrición severa, choque séptico de origen intraabdominal, retraso del neurodesarrollo y deprivación psicoafectiva, cuyas imágenes reportaron ascariasis hepatobiliar y granulomas hepáticos calcificados y abscedados, con infestación severa por Ascaris lumbricoides. Recibió manejo antibiótico y antiparasitario con recuperación exitosa. En nuestro medio, las infecciones por helmintos son causa frecuente de anemia, retraso cognitivo y del crecimiento en niños en edad escolar. Sin embargo, la infestación y complicaciones hepatobiliares como colangitis, colecistitis, pancreatitis, litiasis biliar y hepatitis abscedada son inusuales en menores de dos años. A través de este caso se pretende resaltar la presentación atípica de la enfermedad en lactantes e incitar al fortalecimiento de las intervenciones en salud pública. MÉD.UIS.2020;33(1):67-72.

Abstract Ascariasis is the most common geohelminitiasis in the world. It is categorized as an unattended tropical disease, which can cause pulmonary, gastrointestinal, hepatobiliary and nutritional compromise. We present the unusual case of an infant from an extreme poverty area presenting fever, vomiting, absence of bowel movements, bloating and abdominal pain. She was diagnosed with intestinal pseudoobstruction, severe malnutrition, abdominal septic shock, neurodevelopmental delay and emotional deprivation. The images reported hepatobiliary ascariasis and calcified and abscessed hepatic granulomas, with severe infestation by Ascaris lumbricoides and Trichuris trichiura. She was treated with antibiotics and antiparasitic agents with successful recovery. In our environment, helminth infections are a frequent cause of anemia, stunting and neurodevelopmental delay in school-age children. However, infestation and hepatobiliary complications such as cholangitis, cholecystitis, pancreatitis, biliary lithiasis and hepatic abscess are unusual in children under two years old. Through this case, it is intended to highlight the atypical presentation of this disease at the age of this patient and encourage the strengthening of public health interventions. MÉD.UIS.2020;33(1):67-72.

Miasis por Cochliomyia hominivorax en la Argentina / Myiasis by Cochliomyia hominivorax in Argentina

Miasis es la infestación de humanos y animales por larvas de dípteros ciclorrafos con invasión y destrucción tisular. Cochliomyia hominivorax es responsable del 80% de las miasis en la Argentina. Es importante realizar el diagnóstico etiológico específico debido a la agresividad de las larvas de esta especie, las que pueden provocar cuadros clínicos graves. Presentamos cuatro casos de miasis por C. hominivorax. Dos de los pacientes residían en la ciudad de Buenos Aires y trabajan en zona rural, y los otros dos residían en el Gran Buenos Aires.

Miasis is the infestation of man and animals by larvae of flies belonging to the order Diptera, suborder Cyclorrapha. Eighty percent of miasis in Argentina is caused by Cochliomyia hominivorax, a species that induces pronounced tissue invasion and destruction, and results in severe clinical forms. Because of the aggressiveness of its larvae, it is important to reach a specific etiological diagnosis. We present four cases of miasis by C. hominivorax in two patients living in the city of Buenos Aires but working in a rural area and two patients living in the Greater Buenos Aires.