Mycobacterium tuberculosis resistance in HIV-infected patients from a tertiary care teaching hospital in Porto Alegre, southern Brazil.

Drug-resistant Mycobacterium tuberculosis isolates are a major public health concern worldwide. There are few studies assessing tuberculosis (TB) resistance in Brazil. This study assessed the prevalence of resistance to the five first-line anti-TB drugs in TB isolates from HIV-infected patients in a tertiary care teaching hospital in southern Brazil. From September 1997 to July 2003, 398 TB complex isolates were included in the study. Resistance to one or more first-line anti-TB drugs was found in 71 (17.8%) of patients and was significantly more frequent among previously treated patients (12 [30.8%] of 39 patients) than new cases (59 [16.4%] of 359) (P=0.05). The highest resistance rates were found to isoniazid (9.9% overall; and 25.6% among previously treated patients). Multidrug-resistant TB was found in eight (2.0%) patients, with higher rates among previously treated patients than new cases: two (5.1%) patients vs. six (1.6%), respectively (P=0.18). Multidrug resistance and particularly isoniazid resistance rates among previously treated HIV patients are of great concern. Our findings indicate the need to reappraise regional TB treatment policies and support the recommendation for routine performance of in vitro TB susceptibility tests in all previously treated patients.

Validation of national algorithms for the diagnosis of sexually transmitted diseases in Brazil: results from a multicentre study.

OBJECTIVE: To validate STD flow charts for the management of genital discharge and genital ulcer currently recommended by the National STD Control Programme in Brazil. METHODS: A study was conducted in five Brazilian STD clinics from January to June 1995. After an interview, a clinical examination was performed by a physician, who recorded a presumptive diagnosis, based on his/her clinical experience. This diagnosis was compared with a gold standard laboratory diagnosis in order to calculate sensitivity, specificity, and positive predictive value of the clinical diagnosis. The validity of the simulated national flow charts was assessed using the same method. RESULTS: A total of 607 men and 348 women participated in the study. Gonorrhoea was the aetiology most frequently detected in men with urethral discharge. The sensitivity of the clinical diagnosis was far lower than the sensitivity fo the national flow chart, using the syndromic approach, for both gonococcal and chlamydial urethritis. Adding a simple laboratory test (Gram stain) to the national flow chart increased the specificity and positive predictive value for gonorrhoea. Among the women with vaginal discharge, a cervical infection was detected in 17%, a vaginal infection in 74%, and mixed infection in 9%. The sensitivity of the diagnosis for cervical infection increased from 16% (clinical aetiological approach) to 54% (when adding a syndromic approach) and to 68% when adding a risk assessment, as in the national flow charts. The cure or improved rate of genital ulcers was 96% after 1 week. CONCLUSIONS: The results of the study will help to convince policy makers and those involved in training healthcare workers in Brazil of the public health advantages of the syndromic approach, as an essential part of STD/HIV control activities.

Antibacterial and antimycotic effect of a newly discovered secretion from larvae of an endoparasitic insect, Pimpla turionellae L. (hym.).

The larvae of Pimpla turionellae, that develop in pupae of various Lepidoptera, discharged through their anus up to 8 microliters/h of a hyaline liquid, which is termed "anal secretion". It exerted a strong bacteriostatic effect on Enterobacter cloacae, a highly virulent intestinal microorganism isolated from the midgut of the host pupa, Pieris brassicae. Growth inhibition of Escherichia coli, Micrococcus luteus and Pseudomonas phaseolicola was also evident, but less pronounced. Inhibition depended upon the concentration of the anal secretion. This was also true regarding the effect on growth of Beauveria bassiana, a fungus pathogenic on insects. The antimycotic action of the anal secretion was less effective against Chaetomium pululiferum, a soil-inhabiting fungus. Growing hyphae of B. bassiana were malformed, exhibiting the so-called "curling effect", when treated with anal secretion. Parenteral injection of a low dose of Enterobacter cloacae resulted in 100% mortality of non parasitized pupae of Pieris brassicae; however, simultaneous injection of 3 microliters of anal secretion resulted in higher survival.