Infectious diseases associated with caves.

In recent times, caving has become increasingly popular, with almost 2 million people visiting national park caves each year in the United States. Although the 2 million tourist visits are extremely low risk, smaller numbers of sport cavers are at risk for some high risk conditions, and expedition cavers are at risk for some obscure infections. Infectious diseases like histoplasmosis, rabies, leptospirosis, and tick-borne relapsing fever may be transmitted by the underground fauna. To reduce the risk of illness or injury while caving, knowledge of potential risks before engaging in this activity is important. Caving preparation needs to be carefully planned and executed, including vaccinations, prophylactic medications, and advice regarding safe conduct and behaviors.

Intestinal parasite infections in a rural community of Rio de Janeiro (Brazil): Prevalence and genetic diversity of Blastocystis subtypes.

BACKGROUND: Intestinal parasitic infections are considered a serious public health problem and widely distributed worldwide, mainly in urban and rural environments of tropical and subtropical countries. Globally, soil-transmitted helminths and protozoa are the most common intestinal parasites. Blastocystis sp. is a highly prevalent suspected pathogenic protozoan, and considered an unusual protist due to its significant genetic diversity and host plasticity. METHODOLOGY/MAIN FINDINGS: A total of 294 stool samples were collected from inhabitants of three rural valleys in Rio de Janeiro, Brazil. The stool samples were evaluated by parasitological methods, fecal culture, nested PCR and PCR/Sequencing. Overall prevalence by parasitological analyses was 64.3% (189 out of 294 cases). Blastocystis sp. (55.8%) was the most prevalent, followed by Endolimax nana (18.7%), Entamoeba histolytica complex (7.1%), hookworm infection (7.1%), Entomoeba coli (5.8%), Giardia intestinalis (4.1%), Iodamoeba butchilii (1.0%), Trichuris trichiura (1.0%), Pentatrichomonas hominis (0.7%), Enterobius vermicularis (0.7%), Ascaris lumbricoides (0.7%) and Strongyloides stercoralis (0.7%). Prevalence of IPIs was significantly different by gender. Phylogenetic analysis of Blastocystis sp. and BLAST search revealed five different subtypes: ST3 (34.0%), ST1 (27.0%), ST2 (27.0%), ST4 (3.5%), ST8 (7.0%) and a non-identified subtype. CONCLUSIONS/SIGNIFICANCE: Our findings demonstrate that intestinal parasite infection rates in rural areas of the Sumidouro municipality of Rio de Janeiro, Brazil are still high and remain a challenge to public health. Moreover, our data reveals significant genetic heterogeneity of Blastocystis sp. subtypes and a possible novel subtype, whose confirmation will require additional data. Our study contributes to the understanding of potential routes of transmission, epidemiology, and genetic diversity of Blastocystis sp. in rural areas both at a regional and global scale.

Voice disorders in residual paracoccidioidomycosis in upper airways and digestive tract.

BACKGROUND: Paracoccidioidomycosis (PCM) is a systemic mycosis of acute and chronic evolution, caused by species belonging to the genus Paracoccidioides. It is considered the most prevalent systemic endemic mycosis in Latin America, with cases in the tropical and subtropical regions. Residual PCM refers to the fibrotic scar sequelae resulting from the disease treatment which, when associated with collagen accumulation, leads to functional and anatomic alterations in the organs. AIMS: The aim of this study was to evaluate the vocal function of patients with residual PCM in upper airways and digestive tract. METHODS: We performed a cross-sectional study in 2010 in a cohort of 21 patients with residual PCM in upper airways and digestive tract. RESULTS: The average age was 49.48±9.1 years, and only two (9.5%) patients were female. The study was performed in the 1-113 month-period (median 27) after the end of drug treatment. Five (23.8%) patients had alterations in the larynx as a sequela of the disease. However, all patients had vocal changes in vocal auditory perceptual analysis by GRBASI scale. The computerized acoustic analysis using the software Vox Metria, showed that 11 patients (52.4%) presented alterations in jitter, 15 (71.4%) in shimmer, 8 (38.1%) in F0, 4 (19%) in glottal to noise excitation (GNE), 7 (33.3%) in the presence of noise and 12 (57.1%) in the presence of vibratory irregularity. CONCLUSIONS: The great frequency of alterations in residual PCM suggests that the patients in such phase could benefit from a multidisciplinary treatment, offering them integral monitoring of the disease, including speech rehabilitation after the PCM is healed.

[Fascioliasis: report of two cases from rural areas of Rio de Janeiro]. / Fasciolíase: relato de dois casos em área rural do Rio de Janeiro.

We describe two cases of fascioliasis from rural areas of Rio de Janeiro that are endemic for schistosomiasis, both of which were found during a coprological survey. The patient from Paracambi complained of dizziness. The patient from Sumidouro complained of dizziness, tiredness and cough. She was treated with praziquantel and her stool parasitological examination became negative.

Voice disorders in residual paracoccidioidomycosis in upper airways and digestive tract / Trastornos de la voz en paracoccidioidomicosis residual en las vías respiratorias superiores y el tubo digestivo

Background. Paracoccidioidomycosis (PCM) is a systemic mycosis of acute and chronic evolution, caused by species belonging to the genus Paracoccidioides. It is considered the most prevalent systemic endemic mycosis in Latin America, with cases in the tropical and subtropical regions. Residual PCM refers to the fibrotic scar sequelae resulting from the disease treatment which, when associated with collagen accumulation, leads to functional and anatomic alterations in the organs. Aims. The aim of this study was to evaluate the vocal function of patients with residual PCM in upper airways and digestive tract. Methods. We performed a cross-sectional study in 2010 in a cohort of 21 patients with residual PCM in upper airways and digestive tract. Results. The average age was 49.48±9.1 years, and only two (9.5%) patients were female. The study was performed in the 1-113 month-period (median 27) after the end of drug treatment. Five (23.8%) patients had alterations in the larynx as a sequela of the disease. However, all patients had vocal changes in vocal auditory perceptual analysis by GRBASI scale. The computerized acoustic analysis using the software Vox Metria, showed that 11 patients (52.4%) presented alterations in jitter, 15 (71.4%) in shimmer, 8 (38.1%) in F0, 4 (19%) in glottal to noise excitation (GNE), 7 (33.3%) in the presence of noise and 12 (57.1%) in the presence of vibratory irregularity. Conclusions. The great frequency of alterations in residual PCM suggests that the patients in such phase could benefit from a multidisciplinary treatment, offering them integral monitoring of the disease, including speech rehabilitation after the PCM is healed (AU)

Antecedentes. La paracoccidioidomicosis (PCM) es una micosis sistémica de evolución aguda y crónica causada por especies que pertenecen al género Paracoccidioides. Se considera que es la micosis sistémica endémica de mayor prevalencia en América Latina, con casos en las regiones tropicales y subtropicales. La PCM residual se refiere a las secuelas de las cicatrices fibróticas que provoca el tratamiento de la enfermedad; cuando se asocia con la acumulación de colágeno, conduce a alteraciones funcionales y anatómicas en los órganos. Objetivos. El objetivo de este estudio fue evaluar la función vocal de los pacientes con PCM residual en las vías respiratorias superiores y el tubo digestivo. Métodos. En 2010 se realizó un estudio transversal con una cohorte de 21 pacientes con PCM residual en las vías respiratorias superiores y el tubo digestivo. Resultados. La media de edad fue 49,48±9,1 años y solo dos pacientes (9,5%) eran mujeres. El estudio se realizó durante un período entre 1 y 113 meses (mediana: 27) después de finalizado el tratamiento farmacológico. Cinco pacientes (23,8%) presentaban alteraciones en la laringe como secuela de la enfermedad. Sin embargo, se encontró que todos los pacientes tenían alteraciones vocales en el análisis de percepción auditiva vocal por la escala GRBASI. El análisis acústico computarizado con el software Vox Metria mostró que 11 pacientes (52,4%) presentaron alteraciones en la variación ciclo a ciclo de la frecuencia fundamental (parámetro denominado jitter), 15 (71,4%) en la variación ciclo a ciclo de la amplitud de la señal vocal (shimmer), 8 (38,1%) en la frecuencia fundamental (F0), 4 (19%) en la relación señal-ruido (glottal to noise excitation - GNE), 7 (33,3%) en la existencia de ruido y 12 (57,1%) en la existencia de irregularidad vibratoria. Conclusiones. La gran frecuencia de alteraciones en la PCM residual indica que los pacientes en dicha fase podrían beneficiarse de un tratamiento multidisciplinario con vigilancia integral de la enfermedad que incluyera la rehabilitación del habla tras la curación de la PCM (AU)

Pre-travel health advice for human immunodeficiency virus-infected travelers, from Rio de Janeiro.

Counseling for human immunodeficiency virus infected travelers is becoming increasingly specialized. Previous studies have reported the experience of HIV-infected travelers from temperate-climate countries but little is known about HIV-infected travelers from tropical countries. A retrospective study was conducted on HIV-infected travelers presenting at a travel health clinic in Rio de Janeiro. Eleven journeys by ten people were recorded. Brazil (Amazon region and Northeast) was the destination for six journeys. Other destinations were Peru, Angola, Europe and Asia. Nine attendees were undergoing antiretroviral therapy. Few HIV-infected people from Rio de Janeiro consulted a travel medicine specialist before traveling. Since they travel to destinations in Brazil and abroad where there are endemic diseases not encountered in Rio de Janeiro, careful pre-travel planning needs to be undertaken. Strategies for increasing the frequency of pre-travel consultations need to be developed, such as closer collaboration between HIV clinics and travel health clinics.

Pre-travel health advice for human immunodeficiency virus-infected travelers, from Rio de Janeiro / Aconselhamento pré-viagem para os viajantes infectados pelo vírus da imunodeficiência humana no Rio de Janeiro

Counseling for human immunodeficiency virus infected travelers is becoming increasingly specialized. Previous studies have reported the experience of HIV-infected travelers from temperate-climate countries but little is known about HIV-infected travelers from tropical countries. A retrospective study was conducted on HIV-infected travelers presenting at a travel health clinic in Rio de Janeiro. Eleven journeys by ten people were recorded. Brazil (Amazon region and Northeast) was the destination for six journeys. Other destinations were Peru, Angola, Europe and Asia. Nine attendees were undergoing antiretroviral therapy. Few HIV-infected people from Rio de Janeiro consulted a travel medicine specialist before traveling. Since they travel to destinations in Brazil and abroad where there are endemic diseases not encountered in Rio de Janeiro, careful pre-travel planning needs to be undertaken. Strategies for increasing the frequency of pre-travel consultations need to be developed, such as closer collaboration between HIV clinics and travel health clinics.

O aconselhamento para os viajantes infectados pelo vírus da imunodeficiência humana está se especializando cada vez mais. Estudos prévios relatam a experiência dos viajantes infectados pelo vírus da imunodeficiência humana dos países de clima temperado, mas pouco se sabe sobre os viajantes infectados pelo vírus da imunodeficiência humana dos países tropicais. Foi realizado um estudo retrospectivo dos viajantes infectados pelo vírus da imunodeficiência humana que consultaram um serviço de medicina de viagem no Rio de Janeiro. Dez viajantes realizaram onze viagens. O Brasil (Amazônia e Nordeste) foi o destino de seis viagens. Outros destinos foram Peru, Angola, Europa e Ásia. Nove pacientes estavam sob terapia anti-retroviral. No Rio de Janeiro, poucas pessoas infectadas pelo vírus da imunodeficiência humana consultaram um especialista em medicina de viagem antes de viajar. Como elas viajam para destinos no Brasil e no exterior aonde existem doenças endêmicas não encontradas no Rio de Janeiro, deve-se realizar um planejamento cuidadoso antes da viagem. Devem ser desenvolvidas estratégias para aumentar a freqüência das consultas pré-viagem, como, por exemplo, uma colaboração mais próxima entre as clínicas de vírus da imunodeficiência humana e de medicina de viagem.

Fasciolíase: relato de dois casos em área rural do Rio de Janeiro / Fascioliasis: report of two cases from rural areas of Rio de Janeiro

São descritos dois casos de fasciolíase em áreas rurais do Rio de Janeiro, endêmicas para esquistossomose, sendo ambos surpreendidos durante inquéritos coprológicos. O paciente de Paracambi queixava-se de tonteira. A paciente de Sumidouro queixava-se de tonteira, cansaço e tosse, tendo sido tratada com praziquantel; seus exames de controle foram negativos.

Malária no Estado de Säo Paulo: avaliaçäo de aspectos de vigilância epidemiológica / Malaria in the state of Säo Paulo: an evaluation of epidemiological surveillance

Säo apresentadas informaçöes epidemiológicas da malária no Estado de Säo Paulo referentes aos anos de 1985 e 1986. Selecionou-se, através das fichas de investigaçäo epidemiológica, um indicador pra a avaliaçäo do tempo decorrido entre o início dos primeiros sintomas/data da coleta da lâmina e início do tratamento, que foi agrupado segundo categorias denominadas tipo de procura. Foram consideradas nesta avaliaçäo as seguintes variáveis: a espécie de plasmódio diagnosticada, a existência de passado malárico e a utilizaçäo de serviços de saúde anteriores a confirmaçäo do diagnóstico pela SUCEN. Os autores concluem que entre as variáveis estudadas a existência de malária anterior se constitui no principal fator explicativo para os diferentes tempos decorridos entre os primeiros sintomas e comprovaçäo diagnóstica

Manifestações endócrinas e metabólicas da Síndrome de Imunodeficiência Adquirida / Endocrine and metabolic manifestations of Acquired Immunodeficiency Syndrome

Os autores revisam os principais distúrbios endócrinos e metabólicos associados à síndrome da imunodeficiência adquirida (Sida/Aids).

In the present paper the endocrine compromising in acquired immunodificiency syndrome (Aids) is reviewed.

Profilaxia das infecçöes oportunistas na Síndrome de Imunodeficiência Adquirida (Sida/Aids) / Opportunistic infections prophylaxis in acquired immunodeficiency syndrome (AIDS)

Os autores discutem a profilaxia das infecções oportunistas nos pacientes com síndrome de imunodeficiência adquirida (Sida/Aids), enfatizando os principais fármacos, seus esquemas posológicos e os efeitos adversos mais freqüentes

Síndrome hemorrágica de Altamira / Altamiras' hemorragic syndrome

Este artigo tem como objetivo discutir as principais características da síndrome hemorrágica de Altamira, enfocando aspectos etiopatogênicos, epidemiológicos, manifestações clínicas, diagnóstico laboratorial, tratamento e prevenção

Infecções por helmintos do gênero Echinococcus / Helminths infections of Echinococcus

Neste artigo são revisados os aspectos mais importantes das infecções por Echinococcus spp., com ênfase nos aspectos epidemiológicos, etiológicos, imunopatogênicos, clínicos e terapêuticos, como forma de delinear a situação atual.