Evaluation of an rK39-based immunochromatographic test for the diagnosis of visceral leishmaniasis in human saliva.

Visceral leishmaniasis (VL) is a tropical neglected disease endemic in 98 countries and affects more than 58 000 individuals per year. Several serological tests are available for VL diagnosis, including an immunochromatographic (IC) test with the rK39 antigen and finger prick-collected blood, a rapid and low-invasive test. Here, we investigate the possibility to use saliva as a non-invasive source of biological material for the rK39 IC test. Blood samples from 84 patients with suspected VL were screened by the rK39 IC test, and 29 were confirmed as being infected by a positive rK39 IC test and the presence of amastigotes on smears slides or parasite DNA (detected using PCR-RFLP) from bone marrow aspirate. The rK39 IC test using saliva samples was positive for 17 of the 29 confirmed VL cases (58.6%). The amount of Leishmania-specific IgG or total IgG, as evaluated by an immunoenzymatic assay, was higher in the saliva of patients who had rK39 IC test positivity using saliva, whereas the amount of Leishmania-specific IgA or total IgA was similar to the healthy donors. These results suggest that saliva is not an appropriated material for diagnosing VL with this test.

Postnatal and postabortion care during adolescence in the National Health System in Rio de Janeiro, Brazil.

OBJECTIVE: To study postnatal and postabortion outpatient care for adolescents in relation to the guidelines of the Brazilian Ministry of Health. METHODS: The present cross-sectional study was conducted between 2011 and 2012 via interviews with coordinators from 147 of 148 (99.3%) National Health System facilities providing sexual and reproductive healthcare for adolescents in the city of Rio de Janeiro, Brazil. The χ(2) test or Fisher exact test was used to compare ratios, and t test to compare means, with a significance level of 5% (P<0.05). RESULTS: Postnatal care was provided by 141 (95.9%) facilities; however, only 95 (67.4%) facilities complied with the guidelines of the Ministry of Health by providing two consultations: one in the first week and one between the 30th and 42nd day postpartum. In 32 (22.7%) facilities, a consultation was not scheduled in the first week; and in 25 (17.7%), a consultation between the 30th and 42nd day postpartum was not scheduled. Furthermore, only 11 (7.8%) facilities provided care in the age bracket recommended by WHO and the Brazilian Ministry of Health. CONCLUSION: The provision of puerperal care in the Brazilian National Health System is currently far from the recommendations in government guidelines.