Recent trends in global insecticide use for disease vector control and potential implications for resistance management.

Insecticides have played a major role in the prevention, control, and elimination of vector-borne diseases, but insecticide resistance threatens the efficacy of available vector control tools. A global survey was conducted to investigate vector control insecticide use from 2010 to 2019. Out of 140 countries selected as sample for the study, 87 countries responded. Also, data on ex-factory deliveries of insecticide-treated nets (ITNs) were analyzed. Insecticide operational use was highest for control of malaria, followed by dengue, leishmaniasis and Chagas disease. Vector control relied on few insecticide classes with pyrethroids the most used overall. Results indicated that IRS programs have been slow to react to detection of pyrethroid resistance, while proactive resistance management using insecticides with unrelated modes of action was generally weak. The intensive use of recently introduced insecticide products raised concern about product stewardship regarding the preservation of insecticide susceptibility in vector populations. Resistance management was weakest for control of dengue, leishmaniasis or Chagas disease. Therefore, it will be vital that vector control programs coordinate on insecticide procurement, planning, implementation, resistance monitoring, and capacity building. Moreover, increased consideration should be given to alternative vector control tools that prevent the development of insecticide resistance.

Identifying urban hotspots of dengue, chikungunya, and Zika transmission in Mexico to support risk stratification efforts: a spatial analysis.

BACKGROUND: Effective Aedes aegypti control is limited, in part, by the difficulty in achieving sufficient intervention coverage. To maximise the effect of vector control, areas with persistently high numbers of Aedes-borne disease cases could be identified and prioritised for preventive interventions. We aimed to identify persistent Aedes-borne disease hotspots in cities across southern Mexico. METHODS: In this spatial analysis, geocoded cases of dengue, chikungunya, and Zika from nine endemic Mexican cities were aggregated at the census-tract level. We included cities that were located in southern Mexico (the arbovirus endemic region of Mexico), with a high burden of dengue cases (ie, more than 5000 cases reported during a 10-year period), and listed as high priority for the Mexican dengue control and prevention programme. The Getis-Ord Gi*(d) statistic was applied to yearly slices of the dataset to identify spatial hotspots of each disease in each city. We used Kendall's W coefficient to quantify the agreement in the distribution of each virus. FINDINGS: 128 507 dengue, 4752 chikungunya and 25 755 Zika clinical cases were reported between Jan 1, 2008, and Dec 31, 2016. All cities showed evidence of transmission heterogeneity, with a mean of 17·6% (SD 4·7) of their total area identified as persistent disease hotspots. Hotspots accounted for 25·6% (SD 9·7; range 12·8-43·0) of the population and 32·1% (10·5; 19·6-50·5) of all Aedes-borne disease cases reported. We found an overlap between hotspots of 61·7% for dengue and Zika and 53·3% for dengue and chikungunya. Dengue hotspots in 2008-16 were significantly associated with dengue hotspots detected during 2017-20 in five of the nine cities. Heads of vector control confirmed hotspot areas as problem zones for arbovirus transmission. INTERPRETATION: This study provides evidence of the overlap of Aedes-borne diseases within geographical hotspots and a methodological framework for the stratification of arbovirus transmission risk within urban areas, which can guide the implementation of surveillance and vector control. FUNDING: USAID, the US Centers for Disease Control and Prevention, the Canadian Institutes of Health Research, International Development Research Centre, Fondo Mixto CONACyT (Mexico)-Gobierno del Estado de Yucatan, and the US National Institutes of Health. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Management of insecticides for use in disease vector control: a global survey.

BACKGROUND: Vector control plays a critical role in the prevention, control and elimination of vector-borne diseases, and interventions of vector control continue to depend largely on the action of chemical insecticides. A global survey was conducted on the management practices of vector control insecticides at country level to identify gaps to inform future strategies on pesticide management, seeking to improve efficacy of interventions and reduce the side-effects of chemicals used on health and the environment. METHODS: A survey by questionnaire on the management practices of vector control insecticides was disseminated among all WHO Member States. Data were analysed using descriptive statistics in MS Excel. RESULTS: Responses were received from 94 countries, or a 48% response rate. Capacity for insecticide resistance monitoring was established in 68-80% of the countries in most regions, often with external support; however, this capacity was largely lacking from the European & Others Region (i.e. Western & Eastern Europe, North America, Australia and New Zealand). Procurement of vector control insecticides was in 50-75% of countries taking place by agencies other than the central-level procuring agency, over which the central authorities lacked control, for example, to select the product or assure its quality, highlighting the importance of post-market monitoring. Moreover, some countries experienced problems with estimating the correct amounts for procurement, especially for emergency purposes. Large fractions (29-78%) of countries across regions showed shortcomings in worker safety, pesticide storage practices and pesticide waste disposal. Shortcomings were most pronounced in countries of the European & Others Region, which has long been relatively free from mosquito-borne diseases but has recently faced challenges of re-emerging vector-borne diseases. CONCLUSIONS: Critical shortcomings in the management of vector control insecticides are common in countries across regions, with risks of adverse pesticide effects on health and the environment. Advocacy and resource mobilization are needed at regional and country levels to address these challenges.

Prevention and control of Aedes transmitted infections in the post-pandemic scenario of COVID-19: challenges and opportunities for the region of the Americas.

The coronavirus disease of 2019 (COVID-19) pandemic challenges public health systems around the world. Tropical countries will face complex epidemiological scenarios involving the simultaneous transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with viruses transmitted by Aedes aegypti. The occurrence of arboviral diseases with COVID-19 in the Latin America and the Caribbean (LAC) region presents challenges and opportunities for strengthening health services, surveillance and control programs. Financing of training, equipment and reconversion of hospital spaces will have a negative effect on already the limited resource directed to the health sector. The strengthening of the diagnostic infrastructure reappears as an opportunity for the national reference laboratories. Sharing of epidemiological information for the modeling of epidemiological scenarios allows collaboration between health, academic and scientific institutions. The fear of contagion by COVID-19 is constraining people with arboviral diseases to search for care which can lead to an increase in serious cases and could disrupt the operation of vector-control programs due to the reluctance of residents to open their doors to health personnel. Promoting intense community participation along with the incorporation of long lasting innovations in vector control offers new opportunities for control. The COVID-19 pandemic offers challenges and opportunities that must provoke positive behavioral changes and encourage more permanent self-care actions.

Pesticide lifecycle management in agriculture and public health: Where are the gaps?

Pesticide lifecycle management encompasses a range of elements from legislation, regulation, manufacturing, application, risk reduction, monitoring, and enforcement to disposal of pesticide waste. A survey was conducted in 2017-2018 to describe the contemporary global status of pesticide lifecycle management, to identify where the gaps are found. A three-tiered questionnaire was distributed to government entities in 194 countries. The response rate was 29%, 27% and 48% to the first, second and third part of the questionnaire, respectively. The results showed gaps for most of the selected indicators of pesticide management, suggesting that pesticide efficacy and safety to human health and the environment are likely being compromised at various stages of the pesticide lifecycle, and at varying degrees across the globe. Low-income countries generally had the highest incidence of gaps. Particular shortcomings were deficiencies in pesticide legislation, inadequate capacity for pesticide registration, protection against occupational exposure to pesticides, consumer protection against residues in food, and environmental protection against pesticide contamination. Policy support for, and implementation of, pesticide use-reduction strategies such as integrated pest management and integrated vector management has been inadequate across regions. Priority actions for structural improvement in pesticide lifecycle management are proposed, including pesticide use-reduction strategies, targeted interventions, and resource mobilization.

Patterns of insecticide resistance in Aedes aegypti: meta-analyses of surveys in Latin America and the Caribbean.

BACKGROUND: The re-emergence of worldwide concern with arthropod-borne viruses (arboviruses) draws increasing attention to their mosquito vectors, particularly Aedes aegypti, whose control heavily rely on insecticide use. As a consequence, insecticide resistance is frequent, but the general patterns of occurrence, cross-resistance and prevailing mechanisms remain unrecognized in some areas such as the Neotropical region. Thus, we sought here to recognize the general trends and patterns of insecticide resistance in Latin America and the Caribbean. A systematic literature review (2008-2018) aimed the data-gathering for the region and meta-analyses to address the stated knowledge gap. RESULTS: A high incidence of insecticide resistance prevails in the mosquito populations of the region. Dichlorodiphenyltrichloroethane (DDT), temephos and deltamethrin were the main insecticides evaluated and the meta-analyses indicate a high frequency of DDT-resistant populations (86.7 ± 0.1%), followed by temephos (75.7 ± 0.1%) and deltamethrin (33.0 ± 0.1%). No evidence of cross-resistance was detected among these three insecticides, and the V1016I knockdown (KDR) site mutation does not explain the patterns of deltamethrin resistance in the region. CONCLUSION: Resistance to DDT, temephos and deltamethrin is serious and widespread, and there is no cross-resistance among them. Altered target site sensitivity is not the main pyrethroid resistance mechanism, which is likely due to a mix of mechanisms. Therefore, the replacement of deltamethrin and particularly temephos in the region by alternative insecticides is an important resistance management recommendation, but should be done with compounds out of the cross-resistance spectrum for these populations and insecticides. Nonetheless, the non-recognition of the prevalent resistance mechanisms in the region makes this suggestion more difficult to apply and invites more broad-scale studies of resistance mechanisms to fill this knowledge gap and improve the resistance management recommendations. © 2020 Society of Chemical Industry.

Prevention and control of Aedes transmitted infections in the post-pandemic scenario of COVID-19: challenges and opportunities for the region of the Americas

The coronavirus disease of 2019 (COVID-19) pandemic challenges public health systems around the world. Tropical countries will face complex epidemiological scenarios involving the simultaneous transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with viruses transmitted by Aedes aegypti. The occurrence of arboviral diseases with COVID-19 in the Latin America and the Caribbean (LAC) region presents challenges and opportunities for strengthening health services, surveillance and control programs. Financing of training, equipment and reconversion of hospital spaces will have a negative effect on already the limited resource directed to the health sector. The strengthening of the diagnostic infrastructure reappears as an opportunity for the national reference laboratories. Sharing of epidemiological information for the modeling of epidemiological scenarios allows collaboration between health, academic and scientific institutions. The fear of contagion by COVID-19 is constraining people with arboviral diseases to search for care which can lead to an increase in serious cases and could disrupt the operation of vector-control programs due to the reluctance of residents to open their doors to health personnel. Promoting intense community participation along with the incorporation of long lasting innovations in vector control offers new opportunities for control. The COVID-19 pandemic offers challenges and opportunities that must provoke positive behavioral changes and encourage more permanent self-care actions.

The decline of dengue in the Americas in 2017: discussion of multiple hypotheses.

OBJECTIVE: Since the 1980s, dengue incidence has increased 30-fold. However, in 2017, there was a noticeable reduction in reported dengue incidence cases within the Americas, including severe and fatal cases. Understanding the mechanism underlying dengue's incidence and decline in the Americas is vital for public health planning. We aimed to provide plausible explanations for the decline in 2017. METHODS: An expert panel of representatives from scientific and academic institutions, Ministry of Health officials from Latin America and PAHO/WHO staff met in October 2017 to propose hypotheses. The meeting employed six moderated plenary discussions in which participants reviewed epidemiological evidence, suggested explanatory hypotheses, offered their expert opinions on each and developed a consensus. RESULTS: The expert group established that in 2017, there was a generalised decreased incidence, severity and number of deaths due to dengue in the Americas, accompanied by a reduction in reported cases of both Zika and chikungunya virus infections, with no change in distribution among age groups affected. This decline was determined to be unlikely due to changes in epidemiological surveillance systems, as similar designs of surveillance systems exist across the region. Although sudden surveillance disruption is possible at a country or regional level, it is unlikely to occur in all countries simultaneously. Retrospective modelling with epidemiological, immunological and entomological information is needed. Host or immunological factors may have influenced the decline in dengue cases at the population level through immunity; however, herd protection requires additional evidence. Uncertainty remains regarding the effect on the outcome of sequential infections of different dengue virus (DENV) types and Zika virus (ZIKV), and vice versa. Future studies were recommended that examine the epidemiological effect of prior DENV infection on Zika incidence and severity, the epidemiological effect of prior Zika virus infection on dengue incidence and severity, immune correlates based on new-generation ELISA assays, and impact of prior DENV/other arbovirus infection on ZIKV immune response in relation to number of infections and the duration of antibodies in relation to interval of protection. Follow-up studies should also investigate whether increased vector control intensification activities contributed to the decline in transmission of one or more of these arboviruses. Additionally, proposed studies should focus on the potential role of vector competence when simultaneously exposed to various arboviruses, and on entomological surveillance and its impact on circulating vector species, with a goal of applying specific measures that mitigate seasonal occurrence or outbreaks. CONCLUSIONS: Multifactorial events may have accounted for the decline in dengue seen in 2017. Differing elements might explain the reduction in dengue including elements of immunity, increased vector control, and even vector and\or viruses changes or adaptations. Most of the results of this expert consensus group meeting are hypothetical and based on limited evidence. Further studies are needed.

OBJECTIF: Depuis les années 1980, l'incidence de la dengue a été multipliée par 30. Cependant, en 2017, il y a eu une réduction notable du nombre de cas d'incidence de dengue rapportés dans les Amériques. Nous voulions fournir des explications plausibles à la baisse en 2017. MÉTHODES: Un groupe d'experts constitué de représentants d'institutions scientifiques et académiques, d'officiels des Ministères de la Santé d'Amérique Latine et de membres du personnel de l'OPS/OMS s'est réuni en octobre 2017 pour proposer et évaluer des hypothèses. RÉSULTATS: En 2017, il y a eu une baisse généralisée de l'incidence, de la sévérité et du nombre de décès dus à la dengue dans les Amériques, accompagnée d'une réduction des cas rapportés d'infections par le virus Zika et par le virus du chikungunya, sans modification dans la répartition entre les groupes d'âge affectés. Il a été déterminé que ce déclin était peu probablement dû aux changements dans les systèmes de surveillance épidémiologique, étant donné que des systèmes de surveillance similaires existaient dans toute la région. Bien que des perturbations soudaines dans la surveillance soient possibles au niveau national ou régional, il est peu probable que cela se produise simultanément dans tous les pays. Une modélisation rétrospective avec des informations épidémiologiques, immunologiques et entomologiques est nécessaire. Des facteurs liés à l'hôte ou immunologiques peuvent avoir influencé le déclin des cas de dengue au niveau de la population par le biais de l'immunité; cependant, l'évidence d'une protection conférée par l'effet du troupeau nécessite des données supplémentaires. Une incertitude subsiste quant à l'effet sur le résultat des infections séquentielles de différents types du virus de la dengue (DENV) et du virus Zika (ZIKV), et vice-versa. Les études à venir devraient examiner (1) l'effet épidémiologique d'une infection antérieure par le DENV sur l'incidence et la sévérité du virus Zika, (2) l'effet épidémiologique d'une infection antérieure par le virus Zika sur l'incidence et la sévérité de la dengue, (3) les corrélats immunitaires basés sur des tests ELISA de nouvelle génération, (4) l' impact d'une infection antérieure à DENV/autres arbovirus sur la réponse immunitaire au ZIKV en fonction du nombre d'infections et de la durée des anticorps en fonction de l'intervalle de protection, (5) si des activités d'intensification de la lutte antivectorielle ont contribué à la diminution de la transmission d'un ou plusieurs de ces arbovirus, (6) le rôle potentiel de la compétence vectorielle lorsqu'ils sont exposés simultanément à différents arbovirus, (7) la surveillance entomologique et son impact sur la circulation d'espèces de vecteurs, dans le but d'appliquer des mesures spécifiques qui réduisent l'occurrence saisonnière d'épidémies. CONCLUSIONS: Des événements multifactoriels pourraient expliquer le déclin observé de la dengue en 2017. La plupart des résultats de cette réunion du groupe de consensus d'experts sont hypothétiques, reposent sur des données limitées et requièrent des investigations supplémentaires.

[Trachoma in patients with allergic conjunctivitis]. / Tracoma em pacientes com conjuntivite alérgica.

PURPOSE: The aim of this paper was to identify a possible association between allergic conjunctivitis and Chlamydia trachomatis infection. METHODS: A prospective study was carried out in 104 eyes of 52 patients with diagnosis of vernal conjunctivitis and atopic keratoconjunctivitis. Conjunctival cytology was performed in all the 52 patients, once it can evidence eosinophils presence and inclusions corpuscles in the conjunctival scraping smear, as well as the direct immunofluorescence that is the choice exam for Chlamydia trachomatis infection confirmation. All procedures were approved by the Institutional Review Board Ethics Committee. RESULTS: Of the 52 patients, 41 (78.8%) presented vernal conjunctivitis and 11 (21.2%) atopic keratoconjunctivitis. Forty-one patients (78.8%) were male and 11 (21.2%) female. The ages varied from 3 to 19 years, with an average of 9.8 years. Regarding racial distribution, 16 (30.8%) patients were caucasian, 14 (26.9%) were black and 22 (42.3%) were brown. Regarding systemic allergic diseases, it was observed that 25 (48.1%) patients presented asthma, 20 (38.5%) allergic rhinitis and 5 (9.6%) atopic dermatitis. The main symptoms complained by the patients were coryza (59.6%), ocular itching (98.1%), burning (61.5%), tearing (65.3%) and photophobia (61.5%). The main clinical signs were: ocular hyperemia (100%), bilaterality (100%), superior tarsal papilla (92.3%) and mucous secretion (82.7%). The cytology of the conjunctival scrapings found eosinophil in 86.5% of the cases. Only seven patients did not present eosinophils in the conjunctival scrapings. Three patients (5.8%) presented positive immunofluorescence for Chlamydia, evidencing an association between allergic conjunctivitis and trachoma. CONCLUSION: It is important to determine the simultaneous coexistence of Chlamydia trachomatis and allergic conjunctivitis, due to the possibility to change the visual prognostic and of symptoms potentiation in case of double attack. Therefore, it is necessary to perform direct immunofluorescence for the correct diagnosis in patients with allergic conjunctivitis.

Tracoma em pacientes com conjuntivite alérgica / Trachoma in patients with allergic conjunctivitis

Objetivos: Este trabalho teve o objetivo de identificar possível associação entre conjuntivite alérgica e infecção por Chlamydia trachomatis. Método: Realizamos um estudo prospectivo em 104 olhos de 52 pacientes com hipótese diagnóstica de conjuntivite alérgica primaveril e atópica. Os pacientes foram examinados no Núcleo Especializado em Oftalmologia de João Pessoa - NEO. Foi realizada em todos os 52 pacientes, a citologia conjuntival, uma vez que pode evidenciar a presença de eosinófilos e corpúsculos de inclusões no esfregaço do raspado conjuntival, como também a imunofluorescência direta por ser o exame de escolha para confirmação de infecção por Chlamydia trachomatis. Todos os procedimentos foram aprovados pelo Comitê de Ética em pesquisa. Resultados: Dos 52 pacientes, 41 (78,8 por cento) apresentou conjuntivite primaveril e 11 (21,2 por cento) conjuntivite atópica. Quarenta e um (78,8 por cento) eram do sexo masculino e 11 (21,2 por cento) do feminino. As idades variaram de 3 a 19 anos, com uma média de 9,8 anos. Quanto à distribuição racial, 16 (30,8 por cento) pacientes eram brancos, 14 (26,9 por cento) eram negros e 22 (42,3 por cento) eram pardos. Pacientes com doença alérgica sistêmica observou-se que 25 (48,1 por cento) pacientes apresentaram asma brônquica, 20 (38,5 por cento) rinite alérgica e 5 (9,6 por cento) dermatite atópica. Os principais sintomas relatados pelos pacientes foram coriza (59,6 por cento), prurido ocular (98,1 por cento), ardor ou queimação (61,5 por cento), lacrimejamento (65,3 por cento) e fotofobia (61,5 por cento). Os principais sinais clínicos foram: hiperemia ocular (100 por cento), bilateralidade (100 por cento), papilas no tarso (92,3 por cento) e secreção mucosa (82,7 por cento). A citologia do raspado conjuntival encontrou o eosinófilo em 86,5 por cento dos casos. Apenas 7 pacientes não apresentaram eosinófilos no raspado conjuntival. Observamos que 3 pacientes (5,8 por cento) apresentou imu...

Purpose: The aim of this paper was to identify a possible association between allergic conjunctivitis and Chlamydia trachomatis infection. Methods: A prospective study was carried out in 104 eyes of 52 patients with diagnosis of vernal conjunctivitis and atopic keratoconjunctivitis. Conjunctival cytology was performed in all the 52 patients, once it can evidence eosinophils presence and inclusions corpuscles in the conjunctival scraping smear, as well as the direct immunofluorescence that is the choice exam for Chlamydia trachomatis infection confirmation. All procedures were approved by the Institutional Review Board Ethics Committee. Results: Of the 52 patients, 41 (78.8 percent) presented vernal conjunctivitis and 11 (21.2 percent) atopic keratoconjunctivitis. Forty-one patients (78.8 percent) were male and 11 (21.2 percent) female. The ages varied from 3 to 19 years, with an average of 9.8 years. Regarding racial distribution, 16 (30.8 percent) patients were caucasian, 14 (26.9 percent) were black and 22 (42.3 percent) were brown. Regarding systemic allergic diseases, it was observed that 25 (48.1 percent) patients presented asthma, 20 (38.5 percent) allergic rhinitis and 5 (9.6 percent) atopic dermatitis. The main symptoms complained by the patients were coryza (59.6 percent), ocular itching (98.1 percent), burning (61.5 percent), tearing (65.3 percent) and photophobia (61.5 percent). The main clinical signs were: ocular hyperemia (100 percent), bilaterality (100 percent), superior tarsal papilla (92.3 percent) and mucous secretion (82.7 percent). The cytology of the conjunctival scrapings found eosinophil in 86.5 percent of the cases. Only seven patients did not present eosinophils in the conjunctival scrapings. Three patients (5.8 percent) presented positive immunofluorescence for Chlamydia, evidencing an association between allergic conjunctivitis and trachoma. Conclusion: It is important to determine the simultaneous coexistence ...

Utilização da albumina na citologia esfoliativa em pacientes com conjuntivite alérgica / Use of albumin in exfoliative cytology in patients with allergic conjunctivitis

OBJETIVO: Avaliar a albumina como fixador de material obtido de raspado conjuntival para citologia esfoliativa. MÉTODOS: Foi realizada citologia esfoliativa conjuntival por meio de estudo prospectivo em quarenta e seis olhos de vinte e três pacientes com conjuntivite alérgica. Foram realizadas três colheitas: (1) na fase aguda, (2) após uso de corticosteróides (tratamento A) e (3) após uso de estabilizador de membrana de mastócitos (tratamento B); em dois tipos de lâminas, com e sem albumina, sendo submetidas à coloração pelo método de Giemsa. RESULTADOS: Dos vinte e três pacientes, cinco (21,7 por cento) eram do sexo feminino e dezoito (78,3 por cento) do sexo masculino, com média de 10,8 anos. Dezoito (78,3 por cento) apresentaram conjuntivite primaveril e cinco (21,7 por cento) ceratoconjuntivite atópica. Após análise estatística da citologia conjuntival, as lâminas tratadas com albumina apresentaram maior número de células epiteliais íntegras em relação às não tratadas, apenas nos grupos pré-tratamento e no grupo do tratamento B. A contagem de neutrófilos foi significativamente maior no grupo de tratamento B nas lâminas não tratadas com albumina em relação às tratadas. Na contagem de eosinófilos não houve diferença entre as lâminas tratadas com albumina em relação às não tratadas, já no grupo de tratamento B houve diferença estatística entre olho direito e esquerdo na lâmina sem albumina. CONCLUSAO: Não houve diferenças estatísticas entre as lâminas tratadas com albumina e as não tratadas para a maioria das células pesquisadas, além disso, a albumina adere muco dificultando a observação das lâminas, não sendo indicada na citologia esfoliativa de conjuntiva.

Avaliação da resposta terapêutica nas alergias oculares por meio da citologia esfoliativa / Evaluation of the therapeutic response in ocular allergies through exfoliative cytology

OBJETIVO: Avaliar a resposta terapêutica das alergias oculares por meio da citologia esfoliativa de material obtido de raspado conjuntival. MÉTODO: Foi realizada citologia esfoliativa conjuntival mediante estudo prospectivo em quarenta e seis olhos de vinte e três pacientes com conjuntivite alérgica. Foram realizadas três colheitas: (1) na fase aguda (pré-tratamento), (2) após uso de corticosteróides (tratamento A) e (3) após uso de estabilizador de membrana de mastócitos (tratamento B), e que foram submetidas à coloração pelo método de Giemsa. RESULTADOS: Dos vinte e três pacientes, cinco (21,7 por cento) eram do sexo feminino e dezoito (78,3 por cento) do sexo masculino, com média de 10,8 anos. Dezoito (78,3 por cento) apresentaram conjuntivite primaveril e cinco (21,7 por cento) ceratoconjuntivite atópica. Após análise estatística da citologia conjuntival, o número de células epiteliais degeneradas foi maior para os dois grupos de tratamento em relação à citologia pré-tratamento. A contagem de neutrófilos foi estatisticamente menor no grupo de tratamento A em relação ao tratamento B e pré-tratamento. Quanto aos eosinófilos, os dois tratamentos apresentaram distribuição percentual estatisticamente menor do que o pré-tratamento. O número de monócitos foi estatisticamente menor após o tratamento A do que o grupo B e o pré-tratamento. CONCLUSÃO: A citologia esfoliativa conjuntival mostrou-se um teste apropriado para avaliar a resposta terapêutica nas alergias oculares.

Deltamethrin-impregnated dog collars have a potent anti-feeding and insecticidal effect on Lutzomyia longipalpis and Lutzomyia migonei

Deltamethrin-impregnated PVC dog collars were tested to assess if they were effective in protecting dogs from sand fly bites of Lutzomyia longipalpis and Lu. migonei. A protective effect against Old World species Phlebotomus perniciosus was demonstrated before. Four dogs wearing deltamethrin collars and three dogs wearing untreated collars (not impregnated with deltamethrin) were kept in separate kennels for over eight months in a village on the outskirts of Fortaleza in Cearß, Brazil. Periodically, a dog from each group was sedated, placed in a net cage for 2 h in which 150 female sand flies had been released 10-15 min before. Lu. longipalpis were used 4, 8, 12, 16, 22, 27, and 35 weeks after the attachment of the collars. Lu. migonei were used 3, 7, 11, 15, 22, 26, and 36 weeks after attachment. During 35 weeks, only 4.1 percent (81 of 2,022) Lu. longipalpis recovered from the nets with the deltamethrin collared dogs were engorged, an anti-feeding effect of 96 percent. Mortality initially was over 90 percent and at 35 weeks was 35 percent with half of the sand flies dying in the first 2 h. In contrast, 83 percent of the 2,094 Lu. longipalpis recovered from the nets containing the untreated collared dogs were engorged and the mortality ranged from zero to 18.8 percent on one occasion with 1.1 percent dying in the first 2 h. Similar findings were found with Lu. migonei: of 2,034 sand flies recovered over this period, only 70 were engorged, an anti-feeding effect of 96.5 percent, and mortality ranged from 91 percent initially to 46 percent at 36 weeks. In contrast, engorgement of controls ranged from 91 to71 percent and a mortality ranged from 3.5 to 29.8 percent. These studies show that deltamethrin impregnated collars can protect dogs against Brazilian sand flies for up to eight months. Thus, they should be useful in a program to control human and canine visceral leishmaniasis

Effect of Lutzomyia whitmani (Diptera: Psychodidae) salivary gland lysates on Leishmania (Viannia) braziliensis infection in BALB/c mice

Previous reports showed that Lutzomyia longipalpis saliva exacerbate Leishmania braziliensis infection in mice. The sand fly Lu. whitmani is one of the vectors of L. (Viannia) braziliensis (LVb), a causative agent of cutaneous leishmaniasis in the State of Ceará, Brazil. To determine whether saliva of Lu. whitmani could increase the infectivity of LVb in mice, we inoculated groups of BALB/c mice with LVb promastigotes in the presence or absence of the salivary glands lysate from Lu. whitmani. We found that coinjection with Lu. whitmani saliva increased size but not longevity of cutaneous LVb lesions in BALB/c mice, since the formed lesions gradually resolved. The mechanism(s) by which Lu. whitmani saliva might exacerbate LVb infection in BALB/c mice is speculated

Avaliaçäo da resposta terapêutica nas alergias oculares através da citologia / The role of cytology evaluation on diagnosis and follow up of the response ti therapy for allergic conjunctivitis

Esta tese teve o objetivo de avaliar o papel da citologia na resposta terapêutica de pacientes com conjuntivite alérgica. Realizamos um estudo prospectivo em quarenta e seis olhos de vinte e três pacientes, sendo que dezoito tinham conjuntivite primaveril e cinco conjuntivite atópica. Dezoito eram do sexo masculino e cinco do feminino. As idades variaram de seis a dezessete anos. Foi realizada citologia do raspado conjuntival em três fases de colheita: fase aguda, sem uso de qualquer medicamento tópico ou sistêmico, após o uso de corticosteróides e de estabilizador de membrana de mastócitos. Os esfregaços foram colocados em lâminas com e sem albumina com o objetivo de se avaliar o poder de fixação desta última. Houve redução significativa nos números de eosinófilos e neutrófilos conjuntivais após o uso de corticosteróides e de estabilizadores de membrana de mastócitos, detectados tanto na coleta em lâminas com albumina quanto nas sem albumina (p

Síndrome de Vogt-koyanagi-harada: revisäo de 89 casos / Vogt-Koyanagi-Harada Syndrome: a review of 89 cases

Foram analisados em estudo retrospectivo 89 pacientes com hipótese diagnóstica de Síndrome de Vogt-Koyanagi-Harada, com o objetivo de descrever e analisar suas manifestaçöes clínicas e oculares. Sessenta e oito (76,4 por cento) pacientes eram do sexo feminino e 21 (23,6 por cento) do sexo masculino. A média de idade foi de 34 anos. Houve um predomínio da raça branca (59,6 p/cento). O envolvimento ocular foi bilateral em 100 p/cento dos casos. Doença do tipo I esteve presente em 25 pacientes (28,1 p/ cento), tipo II em 36 (40,4 p/cento) e tipo III em 28 (31,5 p/cento). No tipo I encontramos uma menor incidência de manifestaçöes neurológicas (p<0,01). Dentre as manifestaçöes extra-oculares a cefaléia (56,2 por cento), zumbido (41,6 por cento), hipoacusia (28,1 por cento) e alopecia

Avaliaçäo do teste de aglutinaçäo direta na detecçäo da infecçäo por Leishmania (Viannia) braziliensis em possíveis reservatórios de leishmaniose tegumentar americana no estado do Ceará / Evaluation of the direct agglutination test for detecting of the Leishmania (Viannia) braziliensis infection reservoir hosts of american cutaneous leishmaniasis in the State of Ceará

In order to evaluate the aplicability of the Direct Agglutination Test (DAT) as a method of detection of the natural canine infection for Leishmania (Viannia) braziliensis, it was realized a study involving the serum of naive dogs from Serra de Baturite, Ceara State, an endemic area of cutaneous leishmaniasis, and others from Curitiba, Parana State, a non endemic area. The results indicate the possibility of using this sorologic test to the epidemiologic research of the infection in the reservoir host; in this case, the dog.