Epidemiological profile of individuals with American cutaneous leishmaniasis in Jequitinhonha Valley, Brazil.

This study aimed to characterize the epidemiological profile of patients with American cutaneous leishmaniasis (ACL) in 34 municipalities in Jequitinhonha Valley, Minas Gerais, Brazil, registered from 2005 to 2010 with the Regional Health Superintendence, using data from the Brazilian Disease Notification Information System. Among 281 cases, 156 (55.5%) were included in the study. A statistically significant difference was found in ACL among men between 21 and 60 years of age (P = 0.034) in relation to women and other age groups. Analysing the male sample, a significant association was found between ACL and occupation (P = 0.04). The cutaneous form occurred in 87.3% of cases. The medication most often employed was pentavalent antimony (87.3%), with cure achieved in 91.1% of cases. The epidemiological profile of ACL in the Jequitinhonha Valley is similar to that reported for other regions of Brazil, exhibiting a rural occupational nature and affecting men with low levels of schooling within the productive age.

Selective surveillance for nosocomial infections in a Brazilian hospital.

OBJECTIVE: To devise a system for surveying the frequency of nosocomial infections in a tertiary care hospital in a developing country. DESIGN: Prospective selective surveillance by nurses of the charts of patients at high risk for nosocomial infections, as identified by a form completed by resident physicians. The sensitivity, specificity, and predictive value of this method of selective surveillance were compared with those for total prospective chart review by two infectious disease specialists. SETTING: A university hospital in northeastern Brazil. PATIENTS: All patients hospitalized for more than 72 hours with an identified risk factor for nosocomial infection. RESULTS: The ratio of nosocomial infections to 100 discharges was 13.4 and the incidence density was 11.2/1,000 patient days. The surveillance method demonstrated a sensitivity of 74% and a specificity of 99.7%. Positive predictive value was 93%, negative predictive value was 99%, and overall accuracy was 98%. CONCLUSIONS: This method of selective surveillance for nosocomial infections based on risk factors identified by physicians demonstrated excellent predictive value and overall accuracy and may be of use to other hospitals that lack a nursing care plan book such as the Kardex. The relative frequency of nosocomial infections significantly exceeded the rates reported from hospitals in developed countries.

A retrospective cohort study of nosocomial diarrhea as a risk factor for nosocomial infection.

Because most nosocomial infections are caused by enteric flora, it was undertaken to determine whether diarrhea predisposes to nosocomial infections by conducting a retrospective cohort study involving patients with and without nosocomial diarrhea who were hospitalized during a 12-month period. The rate of urinary tract infection per person-day after onset of diarrhea was significantly greater in patients with diarrhea (relative risk = 10.3; 95% confidence interval = 1.7-63.1, P = .006). When indwelling bladder catheter and duration of catheter placement were considered, diarrhea remained an independent risk factor for urinary tract infection in logistic regression analysis (P = .009). These data suggest that diarrhea and consequent urethral meatal contamination may be a cause of nosocomial urinary tract infection, especially in patients with a catheter, and that removal of the catheter should be considered whenever possible in patients with diarrhea.

Diarrhea in developed and developing countries: magnitude, special settings, and etiologies.

Diarrheal diseases are major causes of morbidity, with attack rates ranging from two to 12 or more illnesses per person per year in developed and developing countries. In addition, diarrheal illnesses account for an estimated 12,600 deaths each day in children in Asia, Africa, and Latin America. The causes of diarrhea include a wide array of viruses, bacteria, and parasites, many of which have been recognized only in the last decade or two. While enterotoxigenic Escherichia coli and rotaviruses predominate in developing areas, Norwalk-like viruses, Campylobacter jejuni, and cytotoxigenic Clostridium difficile are seen with increasing frequency in developed areas; and Shigella, Salmonella, Cryptosporidium species, and Giardia lamblia are found throughout the world. The rational management of infectious diarrhea requires the highly selective use of laboratory tests for these varied etiologic agents, depending on the clinical and epidemiologic setting. The purpose of this review is to provide an overview of the magnitude, special settings, and etiologies of diarrhea endemic to developed and developing countries. This information permits a practical approach to the diagnosis and management of common diarrheal illnesses in different settings.

PIP: Diarrhea is the 2nd most frequent illness in the world. In a study done in Cleveland, Ohio from 1948-1957, researchers learned that people had diarrhea an average of 1.52 times annually. The age specific attack rates climbed from 1 episode/child 1 year old/years to 2-2.2 episodes/child 1-10 years old/year. In similar study in Charlottesville, Virginia between August 1975-July 1977, the overall diarrhea attack rate stood at 1.9 episodes/person/year and, for children 3 years old, it was 2.5 episodes/year. The incidence of diarrhea peaked in the winter months, unlike developing countries where it peaks in the summer months. In developing countries, attack rates range from 5-12 episode/child/year with the highest rates in the 1st 2 years of life (e.g., in India among the urban poor, 18.6 episodes/child/year. diarrhea stands as the leading cause of death in developing areas. Even though oral rehydration therapy is reducing the morality rate from acute diarrhea in developing countries, prolonged episodes of diarrhea of 14- 20 days continue to claim children's lives. In developed countries, diarrhea poses a distinct problem to hospitals, nursing homes., and day care enters. For example, researchers revealed 7.7 cases of nosocomial diarrhea/100 admissions in the medical intensive care unit at the University of Virginia Hospital. About 33% of the elderly patient in extended care facilities have a serious diarrheal illness each year. Reports show that attack rates among children in child care facilities range from 17-100% with considerable secondary attack rates in the children's families. People with AIDS often experience diarrhea which for them is often fatal. In the United State, 50-60% of them have it at diagnosis while in Africa and Haiti the percentage is 95%.

Molecular epidemiology of multiply antibiotic-resistant Shigella flexneri in Fortaleza, Brazil.

In northeastern Brazil, strains of Shigella flexneri resistant to multiple antibiotics are often found in patients in both urban areas and community hospitals. This study used pulsed-field gel electrophoresis (PFGE) and plasmid analysis to further analyze the molecular epidemiology of Shigella flexneri strains isolated from hospitals and an urban community in Fortaleza, Brazil. Twenty-six strains of S. flexneri from three distinct areas in the city of Fortaleza, Brazil, were examined: 14 strains from people with diarrhea who lived in an urban community of 2,000 persons, 5 strains from patients in the university hospital, and 7 strains from children in a pediatric hospital. PFGE identified six unique groups of S. flexneri circulating among patients during the 45-month study. Seven strains were further studied for antibiotic resistance plasmid profiles. Three unique antibiotic resistance plasmid profiles were found. Strains collected from the hospitalized patients demonstrated the variety of PFGE and antibiotic resistance patterns in the area. Strains collected from the patients living in the urban community setting demonstrated the persistence of certain PFGE patterns as well as the acquisition of multiple antibiotic resistance plasmids. Effective interventional strategies for such geographic locations as Fortaleza, Brazil, will be more complex than those for single-strain outbreak situations.

High frequency of strains multiply resistant to ampicillin, trimethoprim-sulfamethoxazole, streptomycin, chloramphenicol, and tetracycline isolated from patients with shigellosis in northeastern Brazil during the period 1988 to 1993.

The occurrence and antimicrobial resistance pattern of Shigella isolates obtained from persons in community and hospital-based studies of diarrhea and matched controls in northeastern Brazil were studied. The isolation rate of Shigella spp. from patients with diarrhea during 1988 to 1993 varied from 4.5% (26 of 575) for the urban community of Gonçalves Dias to 6.7% (12 of 179) and 5.9% (7 of 119) for Hospital Infantil and Hospital Universitário, respectively. Of the 55 Shigella isolates (45 from patients with diarrhea, 8 from controls, and 2 undetermined) 73% (40 of 55) were Shigella flexneri, 16% (9 of 55) were S. sonnei, 7% (4 of 55) were S. boydii, and 4% (2 of 55) were S. dysenteriae. Of 39 S. flexneri strains, over half were resistant to ampicillin, trimethoprim-sulfamethoxazole, or both. Over 64% were resistant to streptomycin, chloramphenicol, and tetracycline. Overall, 82% of all S. flexneri isolates were resistant to four or more antimicrobial agents tested. As elsewhere, in the northeast of Brazil, ampicillin and trimethoprim-sulfamethoxazole are no longer reliable for treatment of S. flexneri infection. Most Shigella strains were resistant to four or more antimicrobial agents. Nalidixic acid was still useful for treatment of infections due to S. flexneri.

Epidemiological profile of individuals with American cutaneous leishmaniasis in Jequitinhonha Valley, Brazil

This study aimed to characterize the epidemiological profile of patients with American cutaneous leishmaniasis [ACL] in 34 municipalities in Jequitinhonha Valley, Minas Gerais, Brazil, registered from 2005 to 2010 with the Regional Health Superintendence, using data from the Brazilian Disease Notification Information System. Among 281 cases, 156 [55.5%] were included in the study. A statistically significant difference was found in ACL among men between 21 and 60 years of age [P = 0.034] in relation to women and other age groups. Analysing the male sample, a significant association was found between ACL and occupation [P = 0.04]. The cutaneous form occurred in 87.3% of cases. The medication most often employed was pentavalent antimony [87.3%], with cure achieved in 91.1% of cases. The epidemiological profile of ACL in the Jequitinhonha Valley is similar to that reported for other regions of Brazil, exhibiting a rural occupational nature and affecting men with low levels of schooling within the productive age