Simple and promising paper-based electrochemical platform for serological detection of American tegumentary leishmaniasis

BACKGROUND American tegumentary leishmaniasis (ATL) is an endemic neglected tropical disease (NTD), its conventional treatment is toxic, slow, and invasive. Rapid diagnosis is crucial for the clinical management of suspected patients, so the development and use of low-cost, miniaturised and portable devices could be the key. OBJECTIVES This work aimed to develop a simple paper-based electrochemical platform for the serological detection of ATL. METHODS Platform was fabricated in Whatman N°1 paper, contains a hydrophobic zone generated by wax printing, two pencil graphite electrodes, and uses specific crude extracts (CA) antigens for ATL immuno-determination. The platform performance was analysed by measuring the relative impedance change for different antigen-antibody combinations. Then, 10 serum human samples previously diagnosed by the gold standard (five positive ATL cases and five non-ATL cases) were evaluated. FINDINGS The platform presented a linear response for the charge transfer resistance (ΔRct) and the interface reactance (ΔXc). Also, optimal working conditions were established (1/60 serum dilution and 180 µg/mL CA concentration). Then, the platform permits to distinguish between ATL and non-ATL (p < 0.05) human serum samples. MAIN CONCLUSIONS Our platform could allow the diagnosis, management, and monitoring of leishmaniasis while being an extremely simple and environmentally friendly technology.

Conferências de saúde e a hanseníase: ditos e silenciamentos sobre a doença negligenciada e seus estigmas / Health and leprosy conferences: sayings and silences about the neglected disease and its stigmas

Resumo Vista como um sério problema de saúde pública em diferentes localidades, a hanseníase é marcada por tabus e carregada de estigmas. É uma doença negligenciada e constituída por diversas explicações ao longo da história, que atualizam marcas vivas do passado, inclusive na implementação de políticas públicas. As conferências de saúde são espaços de participação da sociedade na definição de políticas, com o objetivo de impactar o plano de cuidado de diferentes enfermidades. O objetivo deste artigo é compreender a relevância e as perspectivas apontadas às políticas públicas para a atenção às pessoas acometidas por hanseníase presentes nas etapas municipal, estadual e nacional da 16ª Conferência Nacional de Saúde. Trata-se de uma pesquisa documental baseada nos relatórios finais e na esteira do processo ascendente da 16ª Conferência Nacional de Saúde. Os resultados demonstram a falta de visibilidade da hanseníase nos relatórios das etapas municipal e estadual da conferência e, na etapa nacional, o registro tem dupla ênfase, produzir visibilidade sobre a doença e seu contexto, reivindicando atualizar a mobilização social em torno dela e ações de educação permanente voltadas aos trabalhadores.

Abstract Seen as a serious public health problem in different locations, leprosy is marked by taboos and carried by stigma. It is a neglected disease and made up of several explanations throughout history, which update living marks of the past, including in the implementation of public policies. Health conferences are spaces for society to participate in the definition of policies, aiming to impact the care plan of different illnesses. The objective of this article is to understand the relevance and perspectives pointed to public policies for the care of people affected by leprosy present in the municipal, state, and national stages of the 16th National Health Conference. This is a documentary research based on the final reports and in the wake of the ascending process of the 16th National Health Conference. The results show the lack of visibility of leprosy in the reports of the municipal and state stages of the conference and, in the national stage, the record has a double emphasis: producing visibility about the disease and its context, claiming to update social mobilization around it and permanent education actions aimed at workers.

Levantamento epidemiológico dos casos de tuberculose no Brasil e ações alternativas para auxiliar no tratamento / Epidemiological survey of tuberculosis cases in Brazil and alternative actions to aid in treatment / Estudio epidemiológico de los casos de tuberculosis en Brasil y acciones alternativas para ayudar al tratamiento

tuberculose é uma das doenças infectocontagiosas de maior importância no Brasil e no mundo. Afeta de forma importante populações em situação de vulnerabilidade social e econômica. O objetivo deste estudo foi realizar um levantamento do número de casos notificados de tuberculose no Brasil nos últimos 10 anos (2011 a 2021), avaliar os fatores que afetam a transmissão, bem como discutir o tratamento padrão e com fitoterápicos. O levantamento epidemiológico dos casos de tuberculose no Brasil de janeiro de 2011 a dezembro de 2021 foi realizado dentre os notificados pelo Sistema de Informação de Agravos de Notificação (SINAN). Os resultados indicaram um aumento linear de casos a partir de 2017 com 90.776 casos diagnosticados, em 2018 (94.720) e 2019 (96.655). Acredita-se que o aumento linear da tuberculose neste período pode estar relacionado principalmente com o aumento da pobreza, contudo o compartilhamento de utensílios durante o uso de narguilé podem representar fatores de risco para tuberculose. Seis plantas medicinais afetam diretamente as micobactérias (Chenopodium ambrosioides, Tetradenia riparia, Physalis angulata, Origanum vulgare, Eucalyptus globulus, Mikania glomerata) e cinco plantas com atividade antibacteriana auxiliam no trato respiratório (Nasturtium officinale, Allium sativum, Schinus terebinthifolius, Adiantum capillus-veneris, Allium cepa). Contudo, a tuberculose é uma doença reemergente sendo necessária a adoção de políticas públicas que intensifiquem e implementem medidas sócio-educativas para a implantação do uso de fitoterápicos como medida complementar.

Tuberculosis is one of the most important infectious diseases in Brazil and worldwide. It significantly affects populations in situations of social and economic vulnerability. This study aimed to survey the number of reported tuberculosis cases in Brazil in the last 10 years (2011 to 2021) to assess the factors that affect the transmission and discuss standard and herbal treatments. The epidemiological survey of tuberculosis cases in Brazil from January 2011 to December 2021 was carried out among those notified by the Notifiable Diseases Information System (SINAN). The results indicated a linear increase in cases from 2017, with 90,776 diagnosed cases, in 2018 (94,720) and 2019 (96,655). It is believed that the linear increase in tuberculosis in this period may be mainly related to the increase in poverty. However, the sharing of utensils during the use of hookah may represent risk factors for tuberculosis. Six medicinal plants directly affect mycobacteria (Chenopodium ambrosioides, Tetradenia riparia, Physalis angulata, Origanum vulgare, Eucalyptus globulus, Mikania glomerata), and five plants with antibacterial activity help in the respiratory tract (Nasturtium officinale, Allium sativum, Schinus terebinthifolius, Adiantum capillus-veneris, Allium cepa). However, tuberculosis is a re-emerging disease, and it is necessary to adopt public policies that intensify and implement socio-educational measures for using herbal medicines as a complementary measure.

La tuberculosis es una de las enfermedades infecciosas más importantes en Brasil y en el mundo. Afecta significativamente a las poblaciones en situación de vulnerabilidad social y económica. El objetivo de este estudio fue realizar una encuesta sobre el número de casos notificados de tuberculosis en Brasil en los últimos 10 años (2011 a 2021), para evaluar los factores que afectan a la transmisión, así como para discutir el tratamiento estándar y con fitoterapias. La encuesta epidemiológica de los casos de tuberculosis en Brasil desde enero de 2011 hasta diciembre de 2021 se realizó entre los notificados por el Sistema de Informação de Agravos de Notificação (SINAN). Los resultados indicaron un aumento lineal de casos desde 2017 con 90.776 casos diagnosticados, en 2018 (94.720) y 2019 (96.655). Se cree que el aumento lineal de la tuberculosis en este periodo puede estar relacionado principalmente con el aumento de la pobreza, aunque el hecho de compartir los utensilios durante el uso de la shisha puede representar factores de riesgo para la tuberculosis. Seis plantas medicinales afectan directamente a las micobacterias (Chenopodium ambrosioides, Tetradenia riparia, Physalis angulata, Origanum vulgare, Eucalyptus globulus, Mikania glomerata) y cinco plantas con actividad antibacteriana ayudan a las vías respiratorias (Nasturtium officinale, Allium sativum, Schinus terebinthifolius, Adiantum capillus-veneris, Allium cepa). Sin embargo, la tuberculosis es una enfermedad reemergente siendo necesaria la adopción de políticas públicas que intensifiquen e implementen medidas socioeducativas para la implementación del uso de fitoterápicos como medida complementaria.

Hanseníase em menores de 15 anos: caracterização sociodemográfica e clínica dos casos em um município hiperendêmico / Hansen`s disease in children under 15 years old: sociodemographic and clinical characterization of the cases in a hyperendemic municipality / La lepra en menores de 15 años: caracterización sociodemográfica y clínica de los casos en un municipio hiperendémico

RESUMO Objetivo: analisar o perfil sociodemográfico e clínico dos casos notificados de hanseníase em menores de 15 anos, no município de São Luís - Maranhão - Brasil. Método: estudo descritivo realizado com 826 casos notificados no Sistema de Informação de Agravos de Notificação, em São Luís - Maranhão, no período de 2010 a 2019. Os dados foram analisados por meio de estatística descritiva e foram expressos em frequências absolutas e relativas. Resultados: faixa etária entre 10 e 14 anos (60,29%), masculino (51,09%), cor parda (69,59%), ensino fundamental incompleto (39,58%), multibacilar (62,71%), forma clínica dimorfa (54,24%), até cinco lesões (74,45%), zero a dois nervos afetados (83,23%), sem baciloscopia (46,28%), casos novos (93,70%), demanda espontânea (46,38%) e grau zero de incapacidade no diagnóstico (78,98%). Conclusão: foram demostrados parâmetros hiperendêmicos com elevado risco para a doença. Destaca-se a importância de criar estratégias de controle e prevenção para reduzir a transmissão da hanseníase em crianças.

ABSTRACT Objective: to analyze the sociodemographic and clinical profile of reported cases of Hansen´s disease in children under 15 years old in the municipality of São Luís - Maranhão - Brazil. Method: descriptive study conducted with 826 cases reported in the Notifiable Diseases Information System, in São Luís - Maranhão, in the period from 2010 to 2019. Data were analyzed using descriptive statistics and were expressed in absolute and relative frequencies. Results: age group between 10 and 14 years (60.29%), male (51.09%), brown (69.59%), incomplete elementary education (39.58%), multibacillary (62.71%), dimorphic clinical form (54.24%), up to five lesions (74.45%), zero to two nerves affected (83.23%), no bacilloscopic (46.28%), new cases (93.70%), spontaneous demand (46.38%) and zero degree of disability at diagnosis (78.98%). Conclusion: hyper-endemic parameters with high risk for the disease were demonstrated. It is important to create control and prevention strategies to reduce Hansen´s disease transmission in children.

RESUMEN Objetivo: analizar el perfil sociodemográfico y clínico de los casos notificados de lepra en niños menores de 15 años, en el municipio de São Luís - Maranhão - Brasil. Método: estudio descriptivo realizado con 826 casos notificados en el Sistema de Información de Enfermedades de Declaración Obligatoria, en São Luís - Maranhão, en el período de 2010 a 2019. Los datos se analizaron mediante estadísticas descriptivas y se expresaron en frecuencias absolutas y relativas. Resultados: edad entre 10 y 14 años (60,29%), sexo masculino (51,09%), color marrón (69,59%), educación elemental incompleta (39,58%), multibacilar (62,71%), forma clínica dimórfica (54,24%), hasta cinco lesiones (74,45%), de cero a dos nervios afectados (83,23%), sin baciloscopia (46,28%), casos nuevos (93,70%), demanda espontánea (46,38%) y cero grado de discapacidad en el momento del diagnóstico (78,98%). Conclusión: se demostraron parámetros hiperendémicos con alto riesgo de enfermedad. Destaca la importancia de crear estrategias de control y prevención para reducir la transmisión de la lepra en los niños.

Determinación de la persistencia y diagnóstico tardío de lepra en el Valle del Cauca de 2010 a 2016 / Determination of persistence and delayed diagnosis of leprosy in Valle del Cauca from 2010 to 2016 / Determinação da persistência e diagnóstico tardio de lepra no Valle del Cauca de 2010 a 2016

Resumen Objetivo: Describir la frecuencia, las características clínico-demográficas y los factores relacionados con el retraso diagnóstico, con tratamientos incompletos y con el desarrollo de discapacidad entre el ingreso y el egreso de pacientes inscritos en el "Programa de Control de la Enfermedad de Hansen del Valle del Cauca", de 2010 a 2016. Metodología: Se realizó un estudio observacional descriptivo de una cohorte retrospectiva de pacientes con lepra. Resultados: La incidencia promedio fue de 0,99 casos / 100 000 habitantes. La mediana de edad fue 54 años (rango intercuartílico: 39-65); el 58,82 % fueron hombres, el 49,73 % pertenecía al régimen subsidiado. El 83,68 % fueron casos nuevos, de los cuales, el 76,47 % eran multibacilares (47,9 % con lepra lepromatosa). El 59,54 % manifestó discapacidad y el 10,54 % tuvo leprorreacciones. El 50% presentó retraso diagnóstico, y el 9,09 %, abandonó tratamiento. Se encontró dependencia significativa entre retraso diagnóstico y discapacidad al ingreso (or: 2,09, ic 95 %: 1,28-3,41, p= 0,003), y entre la no finalización del tratamiento y ser previamente tratado (or: 2,82, ic 95 %: 1,28-6,18, p= 0,009). Conclusión: La lepra continúa siendo frecuente en el Valle del Cauca. El retraso diagnóstico y el ingreso con alguna discapacidad connotan captación tardía de los pacientes y en estadios avanzados. El abandono y la discapacidad al egreso se suman a la complejidad de la situación. Se evidencia la necesidad de fortalecer las intervenciones actuales dirigidas hacia el paciente, sus contactos domiciliarios, el personal de salud y la comunidad en general.

Abstract Objective: To describe the frequency, clinical-demographic characteristics and factors related to delayed diagnosis, incomplete treatments, and development of disability from admission to discharge of patients enrolled in the "Hansen's Disease Control Program of Valle del Cauca", from 2010 to 2016. Methodology: A descriptive observational study of a retrospective cohort of patients with leprosy was conducted. Results: The average incidence was 0.99 cases / 100 000 inhabitants. The median age was 54 years (interquartile range: 39-65); 58.82% were men, 49.73 % belonged to the subsidized regime. 83.68% were new cases, of which 76.47% were multibacillary (47.9% with lepromatous leprosy). 59.54% were disabled, and 10.54% experienced leprotic reactions. 50% had a delayed diagnosis, and 9.09 % abandoned treatment. Significant dependence was found between delayed diagnosis and disability at admission (OR: 2.09, CI 95 %: 1.28-3.41, p = 0.003), and between non-completion of treatment and prior treatment (OR: 2.82, CI 95 %: 1.28-6.18, p = 0.009). Conclusion: Leprosy continues to be frequent in Valle del Cauca. Delayed diagnosis and disability at admission imply late identification of patients in advanced stages. Abandonment and disability are additional factors in this complex situation. It is evident the need to strengthen current interventions aimed at the patient, their home contacts, healthcare workers, and the community.

Resumo Objetivo: Descrever a frequência, as características clínico-demográficas e os fatores relacionados com o atraso do diagnóstico, com tratamentos incompletos e com o desenvolvimento de incapacidade entre a ingresso e o egresso de pacientes inscritos no "Programa de Controle da Enfermidade de Hansen do Valle del Cauca", de 2010 a 2016. Metodologia: Foi realizado um estudo observacional descritivo de uma coorte retrospectiva de pacientes com lepra. Resultados: A incidência média foi de 0,99 casos/100000 habitantes. A média de idade foi de 54 anos (intervalo interquartil: 39-65); 58,82% foram homens, 49,73% pertenciam ao regime subsidiado. Um total de 83,68% foram de novos casos, dos quais, 76,47% eram multibacilares (47,9% com lepra lepromatosa). Um 59,54% manifestaram incapacidade e 10,54% tiveram lepro-reações. Um 50% apresentaram atraso no diagnóstico e 9,09% abandonaram o tratamento. Encontrou-se significativa dependência entre atraso no diagnóstico e incapacidade no ingresso (OR: 2,09, IC95%: 1,28-3,41, p= 0,003), e entre a não-finalização do tratamento e ser previamente tratado (OR: 2,82, IC95%: 1,28-6,18, p= 0,009). Conclusão: A lepra continua sendo frequente no Valle del Cauca. O atraso no diagnóstico e o ingresso com alguma incapacidade indicam captação tardia dos pacientes e em estágios avançados. O abandono e a incapacidade ao ingresso são somados à complexidade da situação. É evidente a necessidade de fortalecer as intervenções atuais dirigidas ao paciente, seus contatos domiciliares o pessoal de saúde e a comunidade em geral.

Clinical, epidemiological and climatic factors related to the occurrence of cutaneous leishmaniasis in an endemic area in northeastern Brazil / Fatores clínicos, epidemiológicos e climáticos relacionados à ocorrência de leishmaniose cutânea em área endêmica no nordeste do Brasil

Abstract Cutaneous leishmaniasis (CL) is a neglected tropical disease with a wide distribution in the Americas. Brazil is an endemic country and present cases in all states. This study aimed to describe the occurrence, the underlying clinical and epidemiological factors, and the correlation of climatic variables with the frequency of reported CL cases in the municipality of Caxias, state of Maranhão, Brazil. This is a retrospective and descriptive epidemiological study based on data extracted from the Brazilian Information System of Diseases Notification, from 2007 to 2017. Maximum and minimum temperature, precipitation, and relative air humidity data were provided by the Brazilian National Institute of Meteorology. A total of 201 reported autochthonous CL cases were analyzed. The predominance of cases was observed in males (70.1%). The age range between 31 and 60 years old was the most affected, with 96 cases (47.9%). Of the total number of registered cases, 38.8% of the affected individuals were engaged in agriculture-related activities. The georeferenced distribution revealed the heterogeneity of disease occurrence, with cases concentrated in the Western and Southern regions of the municipality. An association was detected between relative air humidity (monthly mean) and the number of CL cases per month (p = 0.04). CL continues to be a concerning public health issue in Caxias. In this context, there is a pressing need to strengthen measures of prevention and control of the disease through the network of health services of the municipality, considering local and regional particularities.

Resumo A leishmaniose cutânea (CL) é uma doença tropical negligenciada, com ampla distribuição nas Américas. O Brasil é um país endêmico e apresenta casos em todos os estados. Este estudo teve como objetivo descrever a ocorrência, os fatores clínicos e epidemiológicos subjacentes e a correlação de variáveis climáticas com a frequência de casos de CL notificados no município de Caxias, estado do Maranhão, Brasil. Este é um estudo epidemiológico retrospectivo e descritivo, com base em dados extraídos da Notificação do Sistema Brasileiro de Informação de Doenças, de 2007 a 2017. Dados máximos e mínimos de temperatura, precipitação e umidade relativa do ar foram fornecidos pelo Instituto Nacional de Meteorologia. Foram analisados 201 casos de CL autóctones relatados. A predominância de casos foi observada no sexo masculino (70,1%). A faixa etária entre 31 e 60 anos foi a mais afetada, com 96 casos (47,9%). Do número total de casos registrados, 38,8% dos indivíduos afetados estavam envolvidos em atividades relacionadas à agricultura. A distribuição georreferenciada revelou a heterogeneidade da ocorrência da doença, com casos concentrados nas regiões oeste e sul do município. Foi detectada associação entre a umidade relativa do ar (média mensal) e o número de casos de CL por mês (p = 0,04). O CL continua sendo uma questão preocupante de saúde pública em Caxias. Nesse contexto, há uma necessidade premente de fortalecer medidas de prevenção e controle da doença por meio da rede de serviços de saúde do município, considerando as particularidades locais e regionais.

Leucemia asociada al virus linfotrópico T humano tipo 1 (HTLV-1) y transmisión intrafamiliar de la infección en Santiago del Estero / Leukemia associated to human T cell lymphotropic virus type 1 (HTLV-1) infection and intrafamily transmission in Santiago del Estero

Resumen La leucemia/linfoma a células T del adulto (ATLL) es una enfermedad hematológica causada por el virus linfotrópico T humano tipo 1 (HTLV-1) que se desarrolla luego de 20 años de incubación, preferencialmente cuando la infección se adquiere por transmisión vertical. Este tiempo se reduce de 3 meses a 3 años cuando la transmisión del virus es por transfusión o trasplante de órganos. La ATLL aguda es de difícil diagnóstico por ser inusual y tener una rápida progresión a la muerte. En el Noroeste argentino, donde el virus es endémico, la ATLL es más frecuente, sin embargo, también se la detecta continuamente en el resto del país. El tratamiento de elección, en primera instancia, es el uso combinado de antivirales. Presentamos un caso de ATLL aguda desarrollada en un hombre de 59 años de Santiago del Estero a partir del cual se identificó transmisión intrafamiliar de la infección por HTLV-1.

Abstract Adult T-cell leukemia/lymphoma (ATLL) is an hematological disease caused by human T-cell lymphotropic virus type 1 (HTLV-1) that develops after 20 years of incubation preferentially when the infection is acquired by vertical transmission. In cases of transmission by transfusion or organ transplant, this time is reduced from 3 months to 3 years. Acute ATLL is difficult to diagnose because it is unusual and has a rapid progression to death. In the Argentine Northwest, where the virus is endemic, ATLL is more frequent, however it is also detected continuously in the rest of the country. The treatment of choice, in the first instance, is the combined use of antivirals. We present a case of acute ATLL developed in a 59-year-old man from Santiago del Estero from which intrafamilial transmission of HTLV-1 infection was identified.

Molecular detection of visceral leishmaniasis in dogs from Barão de Melgaço, Pantanal region of Mato Grosso, Brazil

ABSTRACT: The increasing expansion of visceral leishmaniasis (VL) in the Brazilian territory evidences the need for studies focused on the main reservoir of this parasite: the dog. This study aimed to conduct an epidemiological survey in the municipality of Barão de Melgaço, Pantanal region of the state of Mato Grosso (MT), Brazil. Conventional polymerase chain reaction (PCR) and qualitative SYBR®Green real-time PCR (qPCR) were used to diagnose canine VL (CVL) and characterize the factors associated with this infection. Of the 402 dogs that had blood samples collected, 31 presented the parasite DNA, representing a prevalence of 7.71% in the population studied. Positivity indices for PCR and qPCR were 3.48 (14/402) and 7.21% (29/402), respectively. Comparison of the results obtained by both techniques showed moderate agreement (Kappa = 0.5364). Of the independent variables analyzed, presence of clinical signs (p0.05) was the only one associated with CVL. Based on this study, we conclude that VL is a circulating disease, with relatively low prevalence, in dogs of Barão de Melgaço/MT, and that the presence of clinical signs is the only variable associated with canine infection.

RESUMO: A crescente expansão da leishmaniose visceral (LV) no território brasileiro evidencia a necessidade de estudos voltados ao principal reservatório doméstico do parasito: o cão. Sendo assim, o objetivo deste estudo foi realizar um inquérito epidemiológico no município de Barão de Melgaço, região do Pantanal Mato-grossense, utilizando as técnicas de reação em cadeia pela polimerase convencional (PCR) e teste qualitativo SYBR®Green real-time PCR (qPCR) para o diagnóstico da LV canina (LVC), além de caracterizar os fatores associados a infecção. Do total de 402 cães que tiveram amostras sanguíneas coletadas, 31 apresentaram o DNA do parasito, perfazendo uma prevalência de 7,71% na população estudada. Os índices de positividade para a PCR e qPCR foram de 3,48% (14/402) e 7,21% (29/402), respectivamente. A comparação dos resultados obtidos por ambas técnicas apresentou moderada concordância (Kappa = 0,5364). Das variáveis independentes analisadas, a presença de sinais clínicos (p0,05) foi a única associada a ocorrência de LVC. Com base neste estudo, concluímos que a LV está circulando, com prevalência relativamente baixa, em cães de Barão de Melgaço/MT, sendo a presença de sinais clínicos a única variável associada à infecção canina.

Molecular detection of visceral leishmaniasis in dogs from Barão de Melgaço, Pantanal region of Mato Grosso, Brazil / Detecção molecular de leishmaniose visceral em cães do município de Barão de Melgaço, Pantanal Mato-Grossense, Brasil

The increasing expansion of visceral leishmaniasis (VL) in the Brazilian territory evidences the need for studies focused on the main reservoir of this parasite: the dog. This study aimed to conduct an epidemiological survey in the municipality of Barão de Melgaço, Pantanal region of the state of Mato Grosso (MT), Brazil. Conventional polymerase chain reaction (PCR) and qualitative SYBR®Green real-time PCR (qPCR) were used to diagnose canine VL (CVL) and characterize the factors associated with this infection. Of the 402 dogs that had blood samples collected, 31 presented the parasite DNA, representing a prevalence of 7.71% in the population studied. Positivity indices for PCR and qPCR were 3.48 (14/402) and 7.21% (29/402), respectively. Comparison of the results obtained by both techniques showed moderate agreement (Kappa = 0.5364). Of the independent variables analyzed, presence of clinical signs (p≤0.05) was the only one associated with CVL. Based on this study, we conclude that VL is a circulating disease, with relatively low prevalence, in dogs of Barão de Melgaço/MT, and that the presence of clinical signs is the only variable associated with canine infection.(AU)

A crescente expansão da leishmaniose visceral (LV) no território brasileiro evidencia a necessidade de estudos voltados ao principal reservatório doméstico do parasito: o cão. Sendo assim, o objetivo deste estudo foi realizar um inquérito epidemiológico no município de Barão de Melgaço, região do Pantanal Mato-grossense, utilizando as técnicas de reação em cadeia pela polimerase convencional (PCR) e teste qualitativo SYBR®Green real-time PCR (qPCR) para o diagnóstico da LV canina (LVC), além de caracterizar os fatores associados a infecção. Do total de 402 cães que tiveram amostras sanguíneas coletadas, 31 apresentaram o DNA do parasito, perfazendo uma prevalência de 7,71% na população estudada. Os índices de positividade para a PCR e qPCR foram de 3,48% (14/402) e 7,21% (29/402), respectivamente. A comparação dos resultados obtidos por ambas técnicas apresentou moderada concordância (Kappa = 0,5364). Das variáveis independentes analisadas, a presença de sinais clínicos (p≤0,05) foi a única associada a ocorrência de LVC. Com base neste estudo, concluímos que a LV está circulando, com prevalência relativamente baixa, em cães de Barão de Melgaço/MT, sendo a presença de sinais clínicos a única variável associada à infecção canina.(AU)

Análisis de datos basados en evidencia para la caracterización epidemiológica de leishmaniasis en Paraguay: I - Leishmaniasis tegumentaria

Resumen La leishmaniasis es una enfermedad desatendida, transmitida por dípteros de los géneros Phlebotomus y Lutzomyia. Existen tres formas clínicas principales de leishmaniasis: una visceral, y dos tegumentarias, las cuales se dividen en leishmaniasis cutánea (LC) y leishmaniasis mucocutánea (LM), todas presentes en Paraguay. El objetivo de este trabajo es describir las características epidemiológicas de la leishmaniasis tegumentaria en Paraguay. Aquí analizamos datos epidemiológicos de leishmaniasis tegumentaria (incluyendo LC y ML), tomados desde el 2006 hasta el 2017. La identidad de los pacientes se mantuvo confidencial. Un total de 2.918 casos positivos de leishmaniasis fueron estudiados. El pico de casos reportados se dio en el 2007. Una vista general muestra una disminución en la tendencia de leishmaniasis tegumentaria, donde los varones son más afectados que las mujeres, y el área endémica está localizada en las zonas este y noreste de Paraguay. Los casos en el Chaco (al oeste del Río Paraguay) están en aumento. La incidencia de leishmaniasis tegumentaria para el país es de 4 personas por 100.000 habitantes. Esta es considerada una enfermedad ocupacional ya que el 67% de los pacientes infectados fueron trabajadores rurales. Durante el periodo de estudio, la LC fue más común que la LM, excepto en los años 2010, 2014 y 2017. La mayoría de los pacientes afectados por LM son de avanzada edad. Conclusión. Remarcamos que la leishmaniasis no está restringida a las áreas húmedas del este de Paraguay, debido a que está también presente en zonas xerofíticas de Paraguay y Bolivia. Los trabajadores rurales de sexo masculino comprenden el grupo más susceptible. La alta frecuencia de LM en algunos años indica que es necesario que las agencias nacionales lleven a cabo más programas de educación en salud para prevenir o reducir la carga de LC (y por consiguiente también de LM) en el país.

Abstract Leishmaniasis is a neglected disease transmitted by sandflies of the genera Phlebotomus and Lutzomyia. There are three main clinical forms of leishmaniasis: one visceral and two tegumentary, differentiated between cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (ML), all present in Paraguay. The objective of this work is to describe the epidemiologic characteristics of tegumentary leishmaniasis in Paraguay. Here we analyzed epidemiological data of tegumentary leishmaniasis (including CL and ML), taken from 2006 to 2017. Patients' identities were kept confidential. A total of 2,918 cases of positive leishmaniasis infection were studied. The peak of reported cases was in 2007. An overview shows a decrease in the trend of tegumentary leishmaniasis, where males are more affected than females, and the endemic area located on the east and north-eastern parts of Paraguay. Cases in the Chaco (west of Paraguay river) are increasing. The incidence of tegumentary leishmaniasis for the country is 4 persons per 100,000 inhabitants. This is considered an occupational disease since 67% of the infected patients were rural workers. During the period of study CL was more common than ML, except for the years 2010, 2014, and 2017. Most of the patients affected by ML are elders. Conclusion. We remark that leishmaniasis is not only restricted to the humid area of eastern Paraguay, since it is also present in xerophytic areas of Paraguay and Bolivia. Male rural workers are the most susceptible group. The high frequency of ML in some years indicates that more educational programs have to be carried out by national agencies to prevent and reduce the burden of CL (and thus also ML) in the country.

Prevalence of trachoma and associated factors in students from the Jequitinhonha Valley, Minas Gerais, Brazil

Abstract INTRODUCTION: Trachoma is the leading cause of blindness in the world, especially in undeveloped countries, due to its association with poor socioeconomic and sanitation conditions. This study aimed to estimate the prevalence of trachoma among students from the Jequitinhonha Valley, Minas Gerais, one of the poorest regions in Brazil, and to identify associated factors. METHODS: This is a cross-sectional study that utilized clinical evaluation and a socioeconomic questionnaire applied to a random and representative sample of elementary school students from the Jequitinhonha Valley, Minas Gerais, Brazil. Participants underwent conjunctival scraping and direct immunofluorescence was used to confirm the presence of the bacteria. Five or more elementary bodies in the conjunctival scrape was considered a positive result. In the study, 36.6% positive samples were detected. A culture of the conjunctival scrape, considered to be the "gold standard", was not performed due to cost and complexity. Bivariate analyses were performed, followed by binary logistic regression analysis to define the associated variables. RESULTS: In the present study, 478 students comprised the sample. The prevalence of trachoma was 6.3% and was higher among students who lived in unfinished houses (no plastering, painting, flooring, and unfinished bathrooms) (OR, 2.27; 95% CI, 1.12-6.48) without sewage systems (OR = 9.49; 95% CI = 3.52-25.60) and studied in rural areas (OR, 3.37; 95% CI, 1.53-7.35). CONCLUSIONS: The prevalence of trachoma among the students aged 7 to 16 years old, from public and private schools, is not negligible and is especially associated with inadequate living conditions.

Hiperinfección por Strongyloides en paciente de la Patagonia con co-infección por HTLV-1 / Strongyloides hyperinfection in patient from Patagonia with HTLV-1 co-infection

La estrongiloidiasis es una afección desatendida causada por el parásito Strongyloides stercoralis. En los individuos inmunosuprimidos, fundamentalmente en los que tienen depresión de la inmunidad celular, puede desarrollarse el síndrome de hiperinfección por Strongyloides. La coinfección con virus linfotrópico de células T humanas (HTLV) es un factor de riesgo para el desarrollo de formas graves de estrongiloidiasis. Presentamos el caso de un hombre de 50 años con hiperinfección por Strongyloides y coinfección con HTLV. Se demoró el diagnóstico debido a su epidemiología inusual y a la sospecha inicial de enfermedad inflamatoria intestinal. El diagnóstico se confirmó mediante la identificación del parásito en muestras de lavado bronquio-alveolar y biopsias de mucosa duodenal y colónica. Se utilizó ivermectina subcutánea como tratamiento antihelmíntico con adecuada respuesta terapéutica.

Strongylodiasis is an unattended condition caused by the parasite Strongyloides stercoralis. The Strongyloides hyperinfection syndrome can develop in immunosuppressed hosts, mainly in those with depression of cellular immunity. Co-infection with human T-cell lymphotropic virus (HTLV) is a risk factor for the development of severe forms of strongyloidiasis. We present the case of a 50-year-old man with Strongyloides hyperinfection and coinfection with HTLV. The diagnosis was delayed owing to its unusual epidemiology and an initial suspicion of inflammatory bowel disease. Identification of the parasite in bronchioalveolar lavage and duodenal and colonic mucosa biopsies confirmed the diagnosis. Subcutaneous ivermectin was used as an anthelmintic treatment with an adequate therapeutic response.

In vitro activities of glycoalkaloids from the Solanum lycocarpum against Leishmania infantum

ABSTRACT Leishmania infantum is an etiologic agent of visceral leishmaniasis. This disease is a neglected disease that can be fatal if not treated and additionally, the few therapeutic option present several drawbacks, including difficult route of administration and toxicity, which turn the search for new therapeutic alternatives necessary. Herein, we evaluated the leishmanicidal in vitro activity of the solanum extract from Solanum lycocarpum A. St.-Hil., Solanaceae, and the isolated alkaloids solasodine, solamargine and solasonine against promastigotes and intracellular amastigotes of L. infantum. Solasodine (IC50-pro = 4.7 µg/ml; IC50-ama = 10.8 µg/ml) and solamargine (IC50-pro = 8.1 µg/ml; IC50-ama = 3.0 µg/ml) exhibited interesting leishmanicidal ativity. Solasonine was approximately four-times (Selective Index 3.7) more selective to the parasite than to the host cells. This data suggest that solasonine might be considered as a potential drug candidate for leishmaniasis treatment.

Epidemiological study of snakebite cases in Brazilian Western Amazonia

Abstract INTRODUCTION Brazil has the largest number of snakebite cases in South America, of which the large majority is concentrated in the Midwest and North. METHODS In this descriptive observational study, we assessed the epidemiological and clinical snakebite cases referred to the Centro de Medicina Tropical de Rondônia from September 2008 to September 2010. RESULTS We followed up 92 cases from admission until discharge, namely 81 (88%) men and 11 (12%) women, with a mean age of 37 years, and mainly from rural areas (91.3%). The snakebites occurred while performing work activities (63%) during the Amazon rainy season (78.3%). The vast majority of individuals presented from the Porto Velho microregion (84.7%). Approximately 95.6% of the snakebites were caused by snakes of the genus Bothrops, followed by two lachetics and two elapidics cases. Surgery was performed in 10 cases (9 fasciotomies in the lower limb and 1 amputation). No deaths were reported in this study, but 4 cases (4.3%) developed sequelae in the lower limb. CONCLUSIONS This study can contribute to a better understanding of envenomation in the state of Rondônia and thus can be useful for identifying real conditions that can increase the incidence of snakebites in this region. Moreover, the study results can serve as a basis for improving educational campaigns designed to prevent these types of snakebites, as well as for preserving snakes.

Paracoccidioidomicosis: crónica de una enfermedad olvidada / Paracoccidioidomycosis: chronicle of a neglected disease

La paracoccidioidomicosis (PCM) es una de las micosis sistémicas que son endémicas exclusivamente en América Latina. Está causada por hongos termodimorfos del género Paracoccidoides: P. brasiliensis (S1), P. americana (PS2), P. restrepiensis (PS3), P. venezuelensis (PS4) y P. lutzii. Paracoccidioides habita y produce conidios infecciosos en suelos de zonas subtropicales húmedas. En Argentina está presente al norte del paralelo 34.5° S. Poco se sabe sobre su nicho ecológico específico, lo que dificulta el diseño de medidas de control de la PCM. La infección ocurre en hospederos susceptibles cuando inhalan conidios aerosolizados. Los trabajadores rurales varones son el grupo más expuesto a contraer PCM. La primoinfección puede ser asintomática o causar un cuadro respiratorio leve; este, a su vez, puede autolimitarse o progresar a enfermedad, ya sea pulmonar o diseminada. Existen dos formas de presentación: (i) aguda/subaguda, en niños, adolescentes y personas con sistemas inmunes comprometidos; y (ii) crónica progresiva, en adultos. La cicatrización de las lesiones resulta en secuelas fibróticas que pueden causar disfagia, disfonía, insuficiencia suprarrenal y obstrucción intestinal. Aunque existen herramientas para su diagnóstico, la PCM es rara vez sospechada precozmente porque sus manifestaciones clínicas iniciales son inespecíficas. Sumados, el diagnóstico tardío y la baja adherencia a los efectivos pero largos tratamientos antimicóticos permiten el avance de la enfermedad y el desarrollo de fibrosis tisular extensa, lo que compromete gravemente la función respiratoria y suprarrenal, altera permanentemente la calidad de vida del paciente y puede causar su muerte.

Paracoccidioidomycosis (PCM) is among the systemic mycoses which are endemic only in Latin America. In Argentina, the vast majority of the cases are reported at north of latitude 34.5° S. The disease is produced by thermodimorphic fungi of the genus Paracoccidoides: P. brasiliensis (S1), P. americana (PS2), P. restrepiensis (PS3), P. venezuelensis (PS4) y P. lutzii. The natural habitat of members of this genus is the soil, where they produce infectious conidia. Little is known, however, about their specific ecologic niche(s), and this knowledge gap hampers the design of measures to control the infection. Rural male workers are the group most at risk of developing PCM. Infection occurs by inhalation of aerosolized conidia and may either be asymptomatic or cause mild respiratory symptoms. In turn, this primary infection may be self-limited or progress to severe pulmonary or disseminated disease. The disease has two clinical presentations: (i) acute or subacute (juvenile), frequent in children, adolescents and people with immunodeficiencies; and (ii) chronic progressive, in adults. Active lesions often resolve into fibrotic scars which can cause dysphagia, dysphonia, adrenal insufficiency, and intestinal obstruction. Although efficient tools are available for diagnosis and treatment, the nonspecific nature of PCM clinical manifestations frequently delay the diagnosis. In addition, the poor adherence to long antifungal treatments allows the advance of the disease and the development of extensive fibrosis compromising severely and permanently respiratory and adrenal functions, thus altering the patient´s quality of life and even causing his/her death.

Genome of Leptospira borgpetersenii strain 4E, a highly virulent isolate obtained from Mus musculus in southern Brazil

A previous study by our group reported the isolation and characterisation of Leptospira borgpetersenii serogroup Ballum strain 4E. This strain is of particular interest because it is highly virulent in the hamster model. In this study, we performed whole-genome shotgun genome sequencing of the strain using the SOLiD sequencing platform. By assembling and analysing the new genome, we were able to identify novel features that have been previously overlooked in genome annotations of other strains belonging to the same species.

Leishmanicidal compounds of Nectria pseudotrichia, an endophytic fungus isolated from the plant Caesalpinia echinata (Brazilwood)

BACKGROUND In a screen of extracts from plants and fungi to detect antileishmanial activity, we found that the ethyl acetate extract of the fungus Nectria pseudotrichia, isolated from the tree Caesalpinia echinata (Brazilwood), is a promising source of bioactive compounds. OBJECTIVES The aims of this study were to isolate and determine the chemical structures of the compounds responsible for the antileishmanial activity of the organic extract from N. pseudotrichia. METHODS Compounds were isolated by chromatographic fractionation using semi-preparative high-performance liquid chromatography, and their chemical structures were determined by analytical and spectral data and by comparison with published data. The antileishmanial activity of the isolated compounds was evaluated in intracellular amastigote forms of Leishmania (Viannia) braziliensis expressing firefly luciferase as reporter gene, and cytotoxicity was determined in Vero and THP-1 mammalian cell lines by MTT assay. FINDINGS Fractionation of the extract yielded seven compounds: 10-acetyl trichoderonic acid A (1), 6′-acetoxy-piliformic acid (2), 5′,6′-dehydropiliformic acid (3), piliformic acid (4), hydroheptelidic acid (5), xylaric acid D (6), and cytochalasin D (7). Compounds 1, 2 and 3 are reported here for the first time. Compounds 1, 2, and 5 were more active, with IC50 values of 21.4, 28.3, and 24.8 µM, respectively, and showed low toxicity to Vero and THP-1 cells. MAIN CONCLUSIONS N. pseudotrichia produces secondary metabolites that are more toxic to intracellular amastigote forms of L. (V.) braziliensis than to mammalian cells.

Dia Mundial do HTLV - 10 de Novembro / World HTLV Day - November 10th

O dia 10 de novembro foi instituído como Dia Mundial do HTLV pela Associação Internacional de Retrovirologia (IRVA – International Retrovirology Association). O objetivo deste ato foi de informar e mobilizar a sociedade e o poder público para o significado da infecção ocasionada pelo primeiro retrovírus humano descrito, o vírus linfotrópico de células T humanas do tipo 1 (HTLV1), as doenças a ele associadas, seu impacto na saúde pública e os meios de contê-lo. Como o Brasil é o país da América Latina com o maior número absoluto de casos desta infecção viral, foi elaborado o presente texto que traz as informações relevantes sobre o HTLV-1 para a comunidade científica.

The November 10th was instituted as the World HTLV Day by the International Retrovirology Association (IRVA), aiming informing and mobilizing the society and the public authorities on the significance of this infection caused by the first known human retrovirus, the human T-cell lymphotropic virus type 1 (HTLV-1). The associated diseases, the impact in the public health, and the means to block its transmission were reviewed. Considering that Brazil, the country in the Latin America, has been presenting the highest number of HTLV-1-infected individuals, this text was written for giving the relevant information concerning the HTLV-1 infection to the scientific community.

La Hidatidosis infantil en el Chile de hoy, un problema de desigualdad social / Child Hidatidosis in Chile today: a problem of social inequality

Resumen Introducción: la hidatidosis en menores de edad representa una infección relativamente reciente, donde cada nueva infección significa el fracaso de las medidas preventivas y de control, donde a la vez se refleja una desigualdad en la presentación de esta infección. Objetivo: caracterizar y evaluar la desigualdad de la hidatidosis en menores entre 0 y 18 años de edad en Chile en el periodo 2001 al 2011. Materiales y método: se emplearon los datos nacionales de egresos hospitalarios para el cálculo de las tasas absolutas, diferencias de tasas y riesgos atribuibles. La desigualdad se evaluó con el Coeficiente de Gini. Como indicadores socioeconómicos se emplearon los PIB per capita regional (2008 al 2011) y el Índice de Desarrollo Humano regional (2003). Resultados: si se pudiesen igualar las condiciones socioeconómicas a nivel regional se podrían evitar entre 37 a 68 egresos hospitalarios extras por hidatidosis. Conclusiones: existe un impacto de la gradiente social sobre la presentación de esta enfermedad en menores de 18 años en Chile para el período en estudio. mÉD.uIs. 2017;30(2):29-36.

Abstract Introduction: hydatid disease in minors represent relatively recent infections, with each new infection means the failure of preventive and control measures, where both an inequality is reflected in the presentation of this infection. Objective: to characterize and evaluate the inequality of hydatid disease in children aged 0 to 18 years in Chile in the period 2001 to 2011. Materials and methods: hospital discharges for analysis of the rate ratio, rate difference, population attributable risk percentage and Gini coefficient were used. As economic indicators of regional GDP per capita (2008 to 2011) and the Regional Human Development Index 2003 were used. Results: if they could match the socio-economic conditions at the regional level could be avoided between 37 to 68 extra per hydatid disease hospital discharges. Conclusions: there is an effect of the social gradient on the presentation of this disease.in children under 18 years in Chile for the period under study. mÉD.uIs. 2017;30(2):29-36.

Clinical, epidemiological and climatic factors related to the occurrence of cutaneous leishmaniasis in an endemic area in northeastern Brazil

Abstract Cutaneous leishmaniasis (CL) is a neglected tropical disease with a wide distribution in the Americas. Brazil is an endemic country and present cases in all states. This study aimed to describe the occurrence, the underlying clinical and epidemiological factors, and the correlation of climatic variables with the frequency of reported CL cases in the municipality of Caxias, state of Maranhão, Brazil. This is a retrospective and descriptive epidemiological study based on data extracted from the Brazilian Information System of Diseases Notification, from 2007 to 2017. Maximum and minimum temperature, precipitation, and relative air humidity data were provided by the Brazilian National Institute of Meteorology. A total of 201 reported autochthonous CL cases were analyzed. The predominance of cases was observed in males (70.1%). The age range between 31 and 60 years old was the most affected, with 96 cases (47.9%). Of the total number of registered cases, 38.8% of the affected individuals were engaged in agriculture-related activities. The georeferenced distribution revealed the heterogeneity of disease occurrence, with cases concentrated in the Western and Southern regions of the municipality. An association was detected between relative air humidity (monthly mean) and the number of CL cases per month (p = 0.04). CL continues to be a concerning public health issue in Caxias. In this context, there is a pressing need to strengthen measures of prevention and control of the disease through the network of health services of the municipality, considering local and regional particularities.

Resumo A leishmaniose cutânea (CL) é uma doença tropical negligenciada, com ampla distribuição nas Américas. O Brasil é um país endêmico e apresenta casos em todos os estados. Este estudo teve como objetivo descrever a ocorrência, os fatores clínicos e epidemiológicos subjacentes e a correlação de variáveis climáticas com a frequência de casos de CL notificados no município de Caxias, estado do Maranhão, Brasil. Este é um estudo epidemiológico retrospectivo e descritivo, com base em dados extraídos da Notificação do Sistema Brasileiro de Informação de Doenças, de 2007 a 2017. Dados máximos e mínimos de temperatura, precipitação e umidade relativa do ar foram fornecidos pelo Instituto Nacional de Meteorologia. Foram analisados 201 casos de CL autóctones relatados. A predominância de casos foi observada no sexo masculino (70,1%). A faixa etária entre 31 e 60 anos foi a mais afetada, com 96 casos (47,9%). Do número total de casos registrados, 38,8% dos indivíduos afetados estavam envolvidos em atividades relacionadas à agricultura. A distribuição georreferenciada revelou a heterogeneidade da ocorrência da doença, com casos concentrados nas regiões oeste e sul do município. Foi detectada associação entre a umidade relativa do ar (média mensal) e o número de casos de CL por mês (p = 0,04). O CL continua sendo uma questão preocupante de saúde pública em Caxias. Nesse contexto, há uma necessidade premente de fortalecer medidas de prevenção e controle da doença por meio da rede de serviços de saúde do município, considerando as particularidades locais e regionais.