Clinical and laboratory evidence of Haff disease - case series from an outbreak in Salvador, Brazil, December 2016 to April 2017.

We describe a series of 15 Haff disease cases from an outbreak in Salvador, Brazil, starting early December 2016. Eleven cases were grouped in four family clusters of two to four individuals, four were isolated cases. All but one patient consumed cooked fish; 11 within 24h before symptoms onset. Cases consumed 'Olho de Boi' (Seriola spp.) and 'Badejo' (Mycteroperca spp.). A total of 67 cases were detected, the last case was reported on 5 April 2017.

Acute Chagas disease outbreak associated with oral transmission.

Seven individuals living in a town in the Southwest of Bahia developed sudden signs of cardiac and systemic impairment, with lethality of 28.6%. Serological tests were positive at least in one test in the five patients examined. Forty percent of the Triatoma sordida mynphs found inside or around Trypanosoma cruzi were found by blood culturig in there out five cases the homes of these cases were positive for Trypanosoma cruzi. Transmission probably occurred through consumption of water contaminated with triatomine feces. These findings emphasize the necessity to evaluation the importance of vectors like Triatoma sordida in maintaining the endemicity of this disease.

[Clinical and therapeutics aspects of heart failure due to Chagas disease]. / Aspectos clínicos e terapêuticos da insuficiência cardíaca por doença de Chagas.

OBJECTIVE: Describe the clinical and therapeutic characteristics of patients with heart failure (HF) secondary to chronic chagasic cardiomyopathy and evaluate if these characteristics are different from those found in other etiologies. METHODS: A prospective analysis of the patients treated between August 2003 and June 2004 at a HF referral outpatient clinic was conducted. RESULTS: Three hundred and fifty six patients diagnosed with HF were included in the study. Chagasic cardiomyopathy was the most common etiology (48% of the cases). Other etiologies included hypertensive cardiomyopathy in 19% of the patients, idiopathic dilated in 11% and ischemic in 9%. Patients with HF secondary to chagasic cardiomyopathy were more frequently from non-white ethnic groups (88 vs. 75%; p = 0.002), had a family history of Chagas disease (57 vs. 21%; p = 0.001), had the disease for a longer length of time (71 vs. 56 months; p = 0.034), had lower levels of education (4.4 +/- 4.1 vs. 5.7 +/- 4.2 years of study; p = 0.004), had a lower heart rate (69 +/- 12 vs. 73 +/- 13; p = 0.03) and a lower systolic blood pressure (121 +/- 25 vs. 129 +/- 28 mmHg; p = 0.006). There was also a higher incidence of the use of amiodarone (22 vs. 13%; p = 0.036) and artificial pacemakers (15 vs. 1%; p = 0.001). There was a lower usage of beta-blockers (39 vs. 59%; p = 0.001). CONCLUSION: In this sample of HF outpatients, in a state with a high prevalence of Chagas disease, chagasic cardiomyopathy was the most common etiology and they presented some unique clinical and therapeutic characteristics in comparison to other heart failure patients.

[Clinical and demographic characteristics of 99 episodes of rheumatic fever in Acre, the Brazilian Amazon]. / Características clínicas demográficas em 99 episódios de febre reumática no Acre, Amazônia Brasileira.

OBJECTIVE: To report clinical manifestations and demographic characteristics of patients with rheumatic fever treated in a public hospital in the state of Acre. METHODS: A cross-sectional study was conducted of patients consecutively seen in the Cardiology Ward at FUNDHACRE Demographic, clinical and laboratory data were assessed through a questionnaire. The diagnosis of rheumatic fever was made based on Jones' criteria, associated with laboratory data, electrocardiography, chest X-ray, and bi-dimensional echocardiography. Patients with other heart diseases, diabetes, obesity, inflammatory disease, and infections were excluded. Those who smoked, were pregnant, or used anti-inflammatory medication or hormone therapy were also excluded. RESULTS: From July 2003 to February 2004, 99 patients with rheumatic fever were assessed (mean age, 11 years, SD= +/- 10.18) with a predominance of females (59.6%), and a racial phenotype of a mixture of Caucasian and Indian (60.6%). Three individuals were excluded because they did not meet the diagnostic criteria. Mean age was 9.1 years old, and in 30.4% of the patients, the disease was diagnosed at the first episode of rheumatic fever. The most frequent clinical manifestations were carditis (69.7%), arthritis (21.4%), and chorea (6.1%). Mitral regurgitation was the most common lesion (36.4%) followed by the association of mitral regurgitation and aortic regurgitation (9.1%). CONCLUSION: Rheumatic carditis was the most common manifestation of rheumatic fever, predominant in the group with a racial mixture of Caucasian and Indian (60.6%). Low compliance with antibiotic therapy contributed to the recurrence of the disease and to cardiac sequelae.

Clinical outcomes of thirteen patients with acute chagas disease acquired through oral transmission from two urban outbreaks in northeastern Brazil.

BACKGROUND: Outbreaks of orally transmitted Trypanosoma cruzi continue to be reported in Brazil and are associated with a high mortality rate, mainly due to myocarditis. METHODS: This study is a detailed report on the disease progression of acute Chagas disease in 13 patients who were infected during two micro-outbreaks in two northeastern Brazilian towns. Clinical outcomes as well as EKG and ECHO results are described, both before and after benznidazole treatment. RESULTS: Fever and dyspnea were the most frequent symptoms observed. Other clinical findings included myalgia, periorbital edema, headache and systolic murmur. Two patients died of cardiac failure before receiving benznidazole treatment. EKG and ECHO findings frequently showed a disturbance in ventricular repolarization and pericardial effusion. Ventricular dysfunction (ejection fraction <55%) was present in 27.3% of patients. After treatment, EKG readings normalized in 91.7% of patients. Ventricular repolarization abnormalities persisted in 50% of the patients, while sinus bradycardia was observed in 18%. The systolic ejection fraction normalized in two out of three patients with initially depressed ventricular function, while pericardial effusion disappeared. CONCLUSIONS: Myocarditis is frequently found and potentially severe in patients with acute Chagas disease. Benznidazole treatment may improve clinical symptoms, as well as EKG and ECHO findings.

Perfil biossocial dos indivíduos portadores de doença de chagas atendidos no ambulatório de infectologia do Hospital Couto Maia, Salvador, Bahia / Biosocial profile of patients with chagas disease addmitted at the department of infectious diseases at Couto Maia Hospital, Salvador, Bahia / Perfil biosocial de los individuos portadores de la enfermedad de chagas atendidos en el ambulatorio de enfermedades infecciosas del hospital Couto Maia, Salvador, Bahia

A doença de Chagas é uma zoonose causada pelo protozoário Trypanosoma cruzi, endêmica nas Américas Central e do Sul. O presente estudo teve como objetivo avaliar o perfil biossocial dos pacientes portadores da Doença de Chagas Humana (DCH) atendidos no ambulatório de infectologia do Hospital Couto Maia, unidade de referência localizado em Salvador, Bahia. Trata-se de um estudo de corte transversal, descritivo, realizado de março a junho de 2012, com aplicação de questionário respondido em um único momento por doentesprovenientes de Itaberaba, Bahia. Os resultados evidenciam que, dentre os 28 pacientes estudados, 53,6por cento eram do sexo feminino, com idade de 38 a 84 anos; 42,9por cento eram analfabetos; 87,5por cento responderam receber menos que dois salários mínimos, sendo a agricultura a principalfonte de renda (nenhum paciente referiu ter carteira assinada); 78,6por cento tinham familiares com doença. Encontrou-se ainda a falta assistência sanitária, educação, moradia e saúde para a população estudada. Concluiu-se que a pesquisa pôde reforçar a sustentação dos dados daliteratura a respeito do perfil biossocial dos portadores da doença de Chagas.

Chagas disease is a zoonosis caused by the protozoan Trypanosoma cruzi, endemic in Central and South Americas. The present study aimed to evaluate the bio-social profile of patients with Chagas disease admitted at the Infectious Disease sector at Hospital Couto Maia, a reference hospital located in Salvador, Bahia. This research was conducted between March and June 2012, a questionnaire answered in a single moment was used as method with patients from Itaberaba, Bahia, Brazil. The results show that 28 patients 53.6percent of females aged 38-84 years, 42.9percent were illiterate, 87.5percent answered they received less than two minimum wages (agriculture was their main source of their income), none of the patientsmade any reference to full time jobs with contracts and 78.6percent of respondents has family and relatives affected by the Chagas disease. It can be concluded that this research can reinforce the literature data regarding the socio-cultural profile of patients with Chagas disease.Key words: Chagas disease. Social profile. Epidemiology.

La enfermedad de Chagas es una zoonosis causada por el protozooTrypanosoma cruzi, que es endémica en América Central y del Sur. Este estudio tuvo como objetivo evaluar el perfil biosocial de los pacientes portadores de la Enfermedad de Chagas humana (ECH), atendido en un ambulatorio de enfermedades infecciosas del Hospital Couto Maia, unidad de referencia localizado en Salvador, Bahia. Estudio de enfoque transversal, descriptivo, realizado de marzo a Junio de 2012, con la aplicación de cuestionario respondido en un único momento, por enfermos provenientes de Itaberaba, Bahia. Los resultados muestran que de los 28 pacientes, el 53,6por ciento eran mujeres, con edad entre 38 a 84 años; el42,9por ciento era analfabeto, el 87,5por ciento respondió que reciben menos de dos sueldos base, teniendo la agricultura como principal fuente de renta (ningún paciente refirió poseer registro formal de trabajo) y el 78,6por ciento de los encuestados estaban familiarizados con la enfermedad. Se encontró, aún, que la población estudiada carece de asistencia sanitaria, educación, habitación y salud. Se concluye que la investigación refuerza lo que sostenido por la literatura, con respecto al perfil biosocial de los portadores de la enfermedad de Chagas.

Avaliação clínica na atenção primária e infectologia dos pacientes com doença de chagas na forma crônica / Clinical assessment in primary and infectious disease care in patients with cardiac form of chagas diseases / Evaluación clínica en primaria y infecciosas de pacientes com enfermedad de las heridas crónicas en forma

A doença de chagas é a terceira doença parasitária mais prevalente no mundo e ocorre, muitas vezes, em indivíduos mais jovens, implicando em incapacidade, aposentadoria precoce e morte. O objetivo deste artigo é descrever alterações clínicas, laboratoriais, eletrocardiográficas e de bioimagem de pacientes com doença de Chagas na forma crônica cardíaca na atenção primária e infectologia. A metodologia adotada é o corte transversal, com análise retrospectiva de prontuários dos pacientes atendidos em ambulatórios de Clínica Médica e Infectologia de janeiro a dezembro de 2008. Os resultados apontam que os dados demográficosdos 21 pacientes foram: 57,1 por cento do sexo feminino; 42,9 por cento do sexo masculino; idade média de 58,5 anos; comorbidades 57,1 por cento. A maior parte apresentava a forma crônica cardíaca recente e leve (B1) baseada no Consenso Brasileiro de Doença de Chagas da Sociedade Brasileira de Medicina Tropical. As alterações mais frequentes no Eletrocardiograma foram: bloqueio do ramo direito, alteração de repolarização ventricular, bloqueio divisional anterossuperior esquerdo e bradicardia sinusal. Na radiografia de tórax, 35,3 por cento apresentaram aumento do índice cardiotorácico. Ao Ecocardiograma bidimensional com doppler foi observada uma fração de ejeção média de 66,7 por cento; 64,7 por cento deles apresentaram as seguintes alterações: disfunção diastólica de ventrículo esquerdo e insuficiência de válvula mitral. Ao comparar os pacientes com e sem comorbidades, foi observado que os achados dos exames complementares não apresentaram diferenças significativas entre os grupos. Concluiu-se que os pacientes com Doença de Chagas na forma crônica cardíaca leve apresentam idade mais avançada. Houve uma elevada porcentagem de comorbidades, podendo-se inferir que as alterações eletrocardiográficas, ecocardiográficas e radiográficas podem não sofrer influência das comorbidades.

Chagas disease is the third most prevalent parasitic disease in the world and it often occurs in younger individuals, resulting in disability, early retirement, and death. The aim of this study was to describe clinical, laboratory, electrocardiographic and bioimage changes in patients with Chronic Chagas heart disease. The methodology adopted is a cross-sectional study with retrospective analysis of records of patients from the infectious disease and parasitological hospitals centers, between January and December of 2008. The results indicate that the demographic data of 21 patients were: female (57.1 percent), male (42.9 percent), the average agewas 58.5 years, and 57.1 percent with co-morbidities. Most of the population studied had recent and/or mild chronic cardiac (B1) manifestations based on the Brazilian Consensus on Chagas disease from the Brazilian Society of Tropical Medicine. The most frequent changes in the electrocardiogram (ECG) were: Right bundle branch block (RBBB), ST-T changes, Left BundleBranch Block and Sinus Bradycardia. The most frequent change in chest radiography was the enlargementf cardiothoracic index (35.3 percent). Through the bidimensional echocardiography we observed an ejection fraction with 66.7 percent average and 64.7 percent of the patients presented the following changes: Left Ventricular Diastolic Dysfunction and Mitral Valve Insufficiency. When comparing the patients with and without co-morbidities, the findings of the electrocardiogram, echocardiogram and chest radiography, did not provide significant difference between thegroups. It can be concluded that the patients with heart Chagas disease patients presented a higher age. There was a high percentage of co- morbidities in the studied population and it can be inferred that the electrocardiographic, echocardiographic and radiographic changesmay not be impacted by the co-morbidities.

La enfermedad de Chagas es la tercera enfermedad parasitaria más frecuente en el mundo y, con frecuencia, afecyta a individuos más jóvenes, resultando en incapacidad, jubilación anticipada y la muerte. El objetivo de este artículo es describir alteraciones clínicas, de laboratorio, electrocardiográficas y de bioimagen de pacientes con enfermedad deChagas en su forma crónica cardiaca en la atención primaria e infectología. La metodología adoptada es de enfoque transversal con análisis retrospectiva de los históricos clínicos de los pacientes atendidos, de enero a diciembre de 2008, en una Clínica Médica ambulatorial y Enfermedades Infecciosas. Con relación a datos demográficos, los resultados muestran que de los 21 pacientes: 57,1 por ciento eran del sexo femenino, el 42,9 por ciento del sexo masculino con edad media de 58,5 años, y el 57,1 por ciento, co-mórbidos. Co base en el Consenso brasileñobasado en Enfermedad de Chagas de la Sociedad Brasileña de Medicina Tropical, la mayor parte presentaba la forma crónica cardiaca, reciente y leve (B1). Las alteraciones más frecuentes en el electrocardiograma fueron: bloqueo de la rama derecha, alteraciones de la repolarización ventricular, bloqueo divisional anterosuperior izquierdo y bradicardiasinusal.

Acute Chagas disease outbreak associated with oral transmission / Surto de doença de Chagas aguda associada à transmissão oral

Seven individuals living in a town in the Southwest of Bahia developed sudden signs of cardiac and systemic impairment, with lethality of 28.6 percent. Serological tests were positive at least in one test in the five patients examined. Forty percent of the Triatoma sordida mynphs found inside or around Trypanosoma cruzi were found by blood culturig in there out five cases the homes of these cases were positive for Trypanosoma cruzi. Transmission probably occurred through consumption of water contaminated with triatomine feces. These findings emphasize the necessity to evaluation the importance of vectors like Triatoma sordida in maintaining the endemicity of this disease.

Sete indivíduos que viviam em uma cidade do sudoeste da Bahia desenvolveram sinais súbitos de envolvimento cardíaco e sistêmico com letalidade de 28,6 por cento Trypanosoma cruzi foi isolado por hemocultura em três de cinco casos examinados. Testes sorológicos foram positivos em mais de um teste nos cinco pacientes, que os realizaram. Qinquenta por cento dos Triatoma sordida encontrados na residência ou no peridomicilio dos casos estavam positivos para Trypanosoma cruzi. A transmissão provavelmente foi devido à ingestão de água contaminada por fezes de triatomíneos. Estes achados enfatizam a necessidade de se avaliar a importância de vetores como Triatoma sordida na manutenção da endemicidade da doença.

Aspectos clínicos e terapêuticos da insuficiência cardíaca por doença de Chagas / Clinical and therapeutics aspects of heart failure due to Chagas disease

OBJETIVO: Descrever as características clínicas e terapêuticas de pacientes com insuficiência cardíaca (IC) secundária a miocardiopatia chagásica crônica, bem como avaliar se estas são diferentes nas demais etiologias. MÉTODOS: Foram analisados prospectivamente pacientes atendidos no período de agosto de 2003 a junho de 2004, em um ambulatório de referência para IC. RESULTADOS: Foram incluídos 356 pacientes com o diagnóstico de IC. Miocardiopatia chagásica foi a etiologia mais freqüente, (48 por cento dos casos). Outras etiologias foram miocardiopatia hipertensiva em 19 por cento, dilatada idiopática em 11 por cento, e isquêmica em 9 por cento. Pacientes com IC secundária a miocardiopatia chagásica tinham com maior freqüência etnia não-branca (88 x 75 por cento; p = 0,002), história familiar de doença de Chagas (57 x 21 por cento; p = 0,001), maior tempo de doença (71 x 56 meses; p = 0,034), menor escolaridade (4,4 ± 4,1 x 5,7 ± 4,2 anos de estudo; p = 0,004), menor freqüência cardíaca (69 ± 12 x 73 ± 13; p = 0,03) e pressão arterial sistólica (121 ± 25 x 129 ± 28 mmHg; p = 0,006). Utilizavam com maior freqüência amiodarona (22 x 13 por cento; p = 0,036) marcapassos artificiais (15 x 1 por cento; p = 0,001) e com menor freqüência drogas betabloqueadoras (39 x 59 por cento; p = 0,001). CONCLUSÃO: Nessa amostra de pacientes ambulatoriais com IC, em um estado com alta prevalência de doença de Chagas, miocardiopatia chagásica foi a etiologia mais freqüente, apresentando algumas características clínicas e terapêuticas diferentes dos demais pacientes.

Características clínicas demográficas em 99 episódios de febre reumática no Acre, Amazônia Brasileira / Clinical and demographic characteristics of 99 episodes of rheumatic fever in Acre, the Brazilian Amazon

OBJETIVO: Relatar as manifestações clínicas e características demográficas de pacientes com febre reumática atendidos em serviço público no Estado do Acre. MÉTODOS: Estudo de corte transversal em pacientes atendidos consecutivamente no Ambulatório de Cardiologia da FUNDHACRE, avaliados através de questionário contendo dados demográficos, clínicos e laboratoriais. O diagnóstico de febre reumática foi realizado através da aplicação dos critérios de Jones, em associação com dados laboratoriais, eletrocardiograma, radiografia de tórax e ecocardiograma bidimensional. Excluídos portadores com outras cardiopatias, diabetes, obesidade, doenças inflamatórias, processos infecciosos, tabagismo, gestantes, uso de drogas anti-inflamatórias ou reposição hormonal. RESULTADOS: De julho/2003 a fevereiro/2004, foram avaliados 99 pacientes com febre reumática aguda (idade média de 11 anos, dp= ± 10,18) com predominância feminina (59,6 por cento) e fenótipo racial mestiço de índio (60,6 por cento). Excluídos 3 indivíduos, por não preencherem os critérios diagnósticos. A idade média de início foi de 9,1 anos, sendo que em 30,4 por cento dos pacientes a doença foi diagnosticada no primeiro episódio de atividade reumática. As manifestações clínicas mais freqüentes foram cardite (69,7 por cento), artrite (21,4 por cento) e coréia (6,1 por cento) e a regurgitação mitral (36,4 por cento) a lesão mais comum seguida da associação de regurgitação mitral com aórtica (9,1 por cento). CONCLUSÃO: Cardite reumática foi a manifestação mais freqüente de febre reumática, predominando no grupo racial mestiço de índio (60,6 por cento), A baixa aderência à antibioticoprofilaxia contribuiu para recorrências e seqüelas cardíacas.

Once daily fleroxacin and twice daily ciprofloxacin are both effective in the treatment of complicated urinary tract infections

In a multicenter randomized double-blind, trial, 90 patients received either fleroxacin 400mg po once/day or ciprofloxacin 500mg po twice/day for treatment of complicated urinary tract infections (UTI). Treatment was administered orally and presumptively. Bacteriological efficacy was assessed 7 days post-treatment. In total, 78 patients were available for efficacy testing: 40 in the fleroxacin group and 38 in the ciprofloxacin group. The bacteriological cure rate was 92.5 percent and 94.7 and in the fleroxacin and ciprofloxacin groups, respectively. The most commonly isolated pathogen (E. coli) was erradicated in 94.1 percent and 95.8 percent of the cases in fleroxacin and ciprofloxacin groups, respectively. Eight patients in the fleroxacin group had some adverse events, two of them severe (insomnia and photodermatitis). In the ciprofloxacin group, 11 patients had adverse events of mild to moderate intensity, mainly affecting the digestive system. In conclusion, fleroxacin 400mg po once/day and ciprofloraxin 500mg po twice/day were both effective in the treatment of complicated urinary tract infections.