ABSTRACT
Artigo publicado na Revista da Sociedade Brasileira de Medicina Tropical. Trata-se de um estudo prospectivo para avaliar a influência da infecção bacteriana secundária na evolução da leishmaniose cutânea, em Corte de Pedra (Bahia). obteve-se o isolamento de orynebacterium diphtheriae em 7(8,3%) de 84 pacientes portadores de úlceras, avaliados. Arquivo em PDF. Requer o Adobe Acrobat Reader
Subject(s)
Corynebacterium diphtheriae , Ulcer , Diphtheria , Leishmaniasis, Diffuse CutaneousABSTRACT
With the purpose of identifying risk factors for cutaneous leishmaniasis transmission in children from 0 to 5 years, a matched case-control study was carried out in Corte de Pedra, Bahia, Brazil, an endemic area of Leishmania (Viannia) braziliensis. Children with a positive leishmanin skin test and one or more active lesions or scars consistent with cutaneous leishmaniasis were defined as cases. Forty cases and 71 controls were selected and matched by age and place of residence. The presence of a family member with a history of cutaneous leishmaniasis in the year prior to the appearance of the disease in the child was found to be an important risk factor (MORMH = 17.75; 95%CI: 4.08-77.25). No evidence of association between the disease and other risk factors was found, such as child's habits inside or outside the house, domiciliary or peridomiciliary characteristics, or presence of vectors or probable reservoir animals. These findings support the hypothesis that humans serve as both the reservoir and source of infection for this age group.
Subject(s)
Endemic Diseases , Leishmania braziliensis , Leishmaniasis, Cutaneous/transmission , Age Factors , Animals , Brazil/epidemiology , Case-Control Studies , Child, Preschool , Female , Humans , Infant , Leishmaniasis, Cutaneous/diagnosis , Leishmaniasis, Cutaneous/epidemiology , Male , Risk FactorsABSTRACT
Fue realizado un estudio caso-control pareado en Corte de Pedra, Bahía, Brasil, área endémica de Leishmania (Viannia) braziliensis para evaluar los diferentes factores de riesgo asociados a la presencia de leishmaniasis cutánea en niños de 0 a 5 años. Fueron considerados como casos, los niños con prueba de leishmanina positiva y que presentaban en el examen físico, una o más lesiones clínicas, activas o cicatrizales, compatibles con leishmaniasis cutánea. Fueron seleccionados 40 casos y 71 controles que fueron pareados por edad y área de residencia. La presencia de algún otro miembro de la familia con antecedente de leishmaniasis cutánea durante el año anterior a la aparición de la enfermedad en el niño demostró ser un importante factor de riesgo (MÕR MH = 17,75; IC95 por ciento: 4,08-77,25). No se encontraron evidencias de asociación con otros factores, como hábitos del niño dentro y fuera de casa, características de la vivienda y del peridomicilio, presencia de vectores y animales como probables reservorios. Estos hallazgos apoyan la hipótesis que el ser humano podría comportarse como un posible reservorio y servir de fuente de contagio para este grupo de edad.
Subject(s)
Child , Leishmaniasis, Cutaneous/transmission , Risk FactorsABSTRACT
A serological inquiry was performed in the municipality of Sena Madureira, Acre State, Brazil, to evaluate the individual contact with Echinococcus sp. The participants were recruited from two distinct populations: residents in the urban and rural areas, the latter distributed among riverside communities of the region. A total of 1,064 individuals were evaluated: 851 from the urban zone and 213 from the rural area. The study was divided into two phases: a serological screening, in which the blood samples were collected and then sent to the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (Serology Laboratory), Ribeirão Preto, SP, Brazil, for the serological test by counterimmunoelectrophoresis technique; and secondly an epidemiological inquiry for evaluating the individuals and their dwelling conditions and customs. Comparing the results of serological tests, the prevalence in the rural area was 6% against 3.5% in the urban area. The overall prevalence was 4%. The possibility of the existence of another intermediate host in the life cycle of Echinococcus vogeli was analyzed and the findings indicated the domestic pig as being the most probable.
Subject(s)
Echinococcosis/epidemiology , Animals , Animals, Wild , Brazil/epidemiology , Counterimmunoelectrophoresis , Echinococcosis/blood , Feeding Behavior , Housing , Humans , Prevalence , Rodentia , Rural Population/statistics & numerical data , Seroepidemiologic Studies , Swine , Urban Population/statistics & numerical dataABSTRACT
Foi realizado no município de Sena Madureira, Acre, um inquérito soroepidemiológico para avaliar o contato de indivíduos com o Echinococcus sp. Escolheu-se duas populações distintas, uma residente na área urbana e a outra na área rural do município, distribuída em comunidades ribeirinhas da regiäo. Foram avaliados no total 1.064 indivíduos, dos quais 851 pertencentes à área urbana e 213 à área rural. O estudo foi dividido em duas partes: inquérito sorológico, no qual foram coletadas e enviadas amostras de sangue ao Laboratório de Sorologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, onde foram realizados os testes imunológicos pela técnica de contraimunoeletroforese; inquérito epidemiológico para avaliaçäo individual, além de as condições de moradia e hábitos dos indivíduos. A prevalência sorológica na área rural foi 6 por cento, enquanto na urbana fomos 3,5 por cento. A prevalência geral foi 4 por cento. Quando analisada a possibilidade da existência de outros hospedeiros intermediários no ciclo do Echinococcus vogeli, foram encontrados resultados que sugerem ser o porco doméstico o mais provável
Subject(s)
Humans , Animals , Echinococcosis , Animals, Wild , Brazil , Counterimmunoelectrophoresis , Echinococcosis , Housing , Prevalence , Rodentia , Rural Population , Seroepidemiologic Studies , Swine , Urban PopulationABSTRACT
Two cases of Polycystic hydatid disease (PH) are reported from the same municipal district of the Brazilian Amazon region (Sena Madureira, Acre). Both had a similar clinical presentation and course over two years of follow-up. Initially the patients complained of pain in the right hypochondrium or upper abdomen and presented obstructive jaundice, fever, increased abdominal volume and weight loss. By image analysis, in addition to splenomegaly, multiple and coalescent cysts were detected in the liver. Serum samples were reactive by counterimmunoelectrophoresis. Treatment with albendazole resulted in partial improvement, with symptomatic relief and reduction in size of the lesions. This report stresses the importance of performing clinical-epidemiological studies of polycystic hydatid disease in the Brazilian Amazon and especially in the municipality of Sena Madureira where many other cases of PH may remain undiagnosed.
Subject(s)
Echinococcosis, Hepatic , Echinococcus , Adolescent , Adult , Albendazole/therapeutic use , Animals , Anticestodal Agents/therapeutic use , Brazil , Echinococcosis, Hepatic/diagnosis , Echinococcosis, Hepatic/drug therapy , Female , Humans , MaleABSTRACT
We analyzed data from historical controls treated with meglumine antimoniate to compare the frequency of adverse events observed in patients with cutaneous leishmaniasis treated with the same dose of meglumine antimoniate contaminated with heavy metals in an endemic area of the State of Bahia, Brazil. Group A patients were treated in 2000 with the drug produced by Eurofarma Laborat rios Ltda., S o Paulo, Brazil (lot A) and group B patients were treated in 1996 with the reference drug produced by Rhodia Farma Ltda., S o Paulo, Brazil (lot B). We observed an unusual higher frequency of skin reactions in group A patients. However, all type of adverse events observed in group A were also observed in group B. The physico-chemical analysis of these lots revealed that lot A had lower pH and higher concentration of total and trivalent antimony, lead, cadmium, and arsenic. Our findings suggest that the skin reactions could be attributed to heavy metal contamination of lot A.
Subject(s)
Antiprotozoal Agents/adverse effects , Arsenic/adverse effects , Leishmaniasis, Cutaneous/drug therapy , Meglumine/adverse effects , Metals, Heavy/adverse effects , Organometallic Compounds/adverse effects , Antiprotozoal Agents/chemistry , Arsenic/analysis , Cadmium/adverse effects , Cadmium/analysis , Case-Control Studies , Chi-Square Distribution , Drug Contamination , Female , Humans , Hydrogen-Ion Concentration , Lead/adverse effects , Lead/analysis , Male , Meglumine/chemistry , Meglumine Antimoniate , Metals, Heavy/analysis , Organometallic Compounds/chemistry , Osmolar Concentration , Statistics, NonparametricABSTRACT
Dois casos de hidatidose policística (HP) säo relatados, oriundos do mesmo município da regiäo amazônica brasileira (Sena Madureira, Acre). Ambos tiveram a mesma apresentaçäo e evoluçäo clínica ao longo de dois anos de acompanhamento. Inicialmente os pacientes queixaram-se de dor abdominal no andar superior ou no hipocôndrio direito e apresentaram icterícia obstrutiva, febre, aumento de volume abdominal e emagrecimento. Por exame de imagem, além de esplenomegalia, cistos múltiplos e coalescentes foram detectados no fígado. Amostras de soro foram reagentes por contraimunoeletroforese. O tratamento com albendazol resultou em melhora parcial, com alívio sintomático e reduçäo no tamanho das lesöes. Este relato reforça a importância de estudos clínico-epidemiológicos da hidatidose policística na regiäo amazônica brasileira, especialmente no município de Sena Madureira, onde outros pacientes com HP podem estar sem diagnóstico
Subject(s)
Animals , Humans , Male , Female , Adolescent , Adult , Albendazole , Anticestodal Agents , Echinococcosis, Hepatic , Echinococcus , Brazil , Echinococcosis, HepaticABSTRACT
We analyzed data from historical controls treated with meglumine antimoniate to compare the frequency of adverse events observed in patients with cutaneous leishmaniasis treated with the same dose of meglumine antimoniate contaminated with heavy metals in an endemic area of the State of Bahia, Brazil. Group A patients were treated in 2000 with the drug produced by Eurofarma Laboratórios Ltda., São Paulo, Brazil (lot A) and group B patients were treated in 1996 with the reference drug produced by Rhodia Farma Ltda., São Paulo, Brazil (lot B). We observed an unusual higher frequency of skin reactions in group A patients. However, all type of adverse events observed in group A were also observed in group B. The physico-chemical analysis of these lots revealed that lot A had lower pH and higher concentration of total and trivalent antimony, lead, cadmium, and arsenic. Our findings suggest that the skin reactions could be attributed to heavy metal contamination of lot A
Subject(s)
Humans , Male , Female , Antiprotozoal Agents , Arsenic , Leishmaniasis, Cutaneous , Meglumine , Metals, Heavy , Organometallic Compounds , Antiprotozoal Agents , Arsenic , Cadmium , Case-Control Studies , Chi-Square Distribution , Drug Contamination , Hydrogen-Ion Concentration , Lead , Meglumine , Metals, Heavy , Organometallic Compounds , Osmolar Concentration , Statistics, NonparametricABSTRACT
In a prospective study to evaluate the influence of secondary bacterial infection on the evaluation of cutaneous leishmaniasis, in Corte de Pedra (Bahia), we isolated Corynebacterium diphtheriae in 7 (8.3%) out of 84 patients with ulcers studied. Due to the small number of patients with the presence of the bacteria in the ulcer, we could not conclude whether Corynebacterium diphtheriae behaves only as a colonizer nor its influence on the healing of the leishmaniotic ulcer.
Subject(s)
Corynebacterium diphtheriae/isolation & purification , Leishmaniasis, Cutaneous/microbiology , Skin Ulcer/microbiology , Adolescent , Adult , Child , Child, Preschool , Humans , Prospective StudiesABSTRACT
In a prospective study to evaluate the influence of secondary bacterial infection on the evaluation of cutaneous leishmaniasis, in Corte de Pedra (Bahia), we isolated Corynebacterium diphtheriae in 7 (8.3) out of 84 patients with ulcers studied. Due to the small number of patients with the presence of the bacteria in the ulcer, we could not conclude whether Corynebacterium diphtheriae behaves only as a colonizer nor its influence on the healing of the leishmaniotic ulcer.
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Adult , Corynebacterium diphtheriae , Leishmaniasis, Cutaneous/microbiology , Skin Ulcer/microbiology , Prospective StudiesABSTRACT
Eighty Leishmania isolates from patients who contracted cutaneous leishmaniasis in the Manaus region, Amazonas State, Brazil, were identified as Leishmania (Viannia) guyanensis by the electrophoretic profiles of six enzymes. None reacted with the species-specific monoclonal antibody B19. Two L. (V.) guyanensis subpopulations were detected with the monoclonals B2 and B12. The lack of B19 expression by the L. (V.) guyanensis strains in the present study contrasts with that of the vast majority of the strains of the same parasite from eastern Amazonia and French Guyana that express the epitope.
Subject(s)
Leishmania guyanensis/classification , Leishmaniasis, Cutaneous/parasitology , Animals , Antibodies, Monoclonal , Antibodies, Protozoan , Antigens, Protozoan , Brazil , Electrophoresis , Epitopes , Humans , Leishmania guyanensis/immunology , Leishmaniasis, Cutaneous/immunologyABSTRACT
Foi realizado um inquérito visando identificar condiçöes sócio-econômicas e atitudes de uma populaçäo em relaçäo à prevençäo domiciliar da LTA, na localidade de Corte de Pedra, Município de Tancredo Neves, área endêmica do sul da Bahia, Brasil. O questionário foi aplicado em julho de 1997, com perguntas sobre aspectos sociais e econômicos, hábitos e atitudes da populaçäo em relaçäo à prevençäo contra a picada de artrópodos. Foram entrevistadas 100 por cento das famílias habitantes da área selecionada, distribuídas em 168 moradias, correspondendo a 851 pessoas. Cerca de 66,7 por cento das famílias percebem um ou menos de um salário mínimo mensal para o sustento de uma média de 5,1 moradores por residência. A maioria das famílias (57,2 por cento) näo usa qualquer tipo de proteçäo. O meio de prevençäo mais comum é a fumegaçäo pela incineraçäo de diversos tipos de materiais. As medidas de proteçäo individual säo raramente usadas. Uma vez que na área de estudo têm sido relatadas evidências de transmissäo intra e peridomiciliar de LTA, o uso de mosquiteiros impregnados com inseticida seria uma alternativa à proteçäo intradomiciliar.
Subject(s)
Health Knowledge, Attitudes, Practice , Leishmaniasis, Cutaneous/prevention & control , Social Conditions , Socioeconomic FactorsABSTRACT
Foi avaliada a toxicidade de dois antimoniais pentavalentes em 111 pacientes com leishmaniose cutânea. Quarenta e sete pacientes receberam antimoniato de meglumina (Grupo I) B 64 pacientes, estibogluconato de sódio BP 88© (Grupo II), 20mg Sbv/kg/dia por 20 dias. Realizou-se a avaliaçäo de aminotransferases, fosfatase alcalina, amilase, creatinina, uréia, exame de urina e eletrocardiograma, antes do tratamento e no décimo e vigésimo dias. Observou-se maior freqüência de valores anormais de aminotransferases no décimo e vigésimo dias de tratamento no grupo II (p < 0,001) e maior proporçäo de valores anormais de amilase no décimo dia no mesmo grupo (p < 0, 00 1). Houve maior variaçäo dos níveis de aminotransferases, fosfatase alcalina e amilase nos primeiros dez dias no grupo II (p < 0,01). No vigésimo dia observou-se maior variaçäo nos níveis de aminotransferases no grupo II (p = 0,02 e p = 0,03, respectivamente). Quarenta e três porcento dos pacientes do grupo I e 54 por cento dos pacientes do grupo II apresentaram alteraçöes eletrocardiográficas (p = 0,30)
Subject(s)
Humans , Child , Adolescent , Adult , Middle Aged , Antimony Sodium Gluconate/adverse effects , Leishmaniasis, Cutaneous/drug therapy , MeglumineABSTRACT
O objetivo deste trabalho foi avaliara eficácia da mefloquina numa regiäo endêmica de leishmaniose cutânea por Leishmania (Viannia) braziliensis, considerando que esta droga de administraçäo oral, eficaz no tratamento da malária, com meia vida prolongada e efeitos colaterais pouco freqüentes poderia ser menos tóxica e de mais fácil administraçäo, quando comparadas com os antimoniais pentavalentes. Em Corte de Pedra, no litoral sul do Estado da Bahia, foram tratados, aleatoriamente, dez pacientes portadores de lesöes leishmanióticas, subdivididos em dois grupos. O primeiro grupo recebeu mefloquina pela via oral, dose de 250mg/dia, durante seis dias, repetindo-se o mesmo esquema após intervalo de três semanas. O segundo grupo recebeu antimoniato de meglumina (Glucantime©) diariamente, pela via endovenosa, na dose de 20mg/kg por20 dias. Do grupo da mefloquina só um paciente apresentou cicatrizaçäo depois do segundo ciclo. Um desses, com quatro lesöes apresentou nova lesöo durante o primeiro ciclo de tratamento. A evoluçäo dos outros três foi lenta sendo que em nove semanas nenhum deles tinha cicatrizado as úlceras que permaneciam com grande infiltraçäo e sinais evidentes de atividade. O grupo tratado com Glucantime© apresentou evidente melhora
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Antimony/therapeutic use , Leishmaniasis, Mucocutaneous/drug therapy , Mefloquine/therapeutic use , Antiprotozoal Agents/therapeutic use , Brazil/epidemiology , Skin Diseases, Parasitic/drug therapy , Follow-Up Studies , Leishmania braziliensis , Random AllocationABSTRACT
Sixty eight patients with localized cutaneous leishmaniasis from an area with Leishmania (Viannia) braziliensis transmission had cultures performed with a modified Marzochi's vacuum aspiratory puncture technique to establish sensitivity and contamination rate with this new method. Overall sensitivity of three aspirates was 47.1 percent; (CI95 percent 39.4; 59.4) significantly greater than the sensitivity of a single one aspirate. Fungal contamination was observed in 6/204 (2.9 percent) inoculated culture tubes. We recommend that this useful technique should be adopted as routine for primary isolation of L. (V.) braziliensis from localized cutaneous ulcers
Subject(s)
Adult , Humans , Male , Female , Leishmania braziliensis/isolation & purification , Leishmaniasis, Cutaneous/diagnosis , Antibodies, Monoclonal , Biopsy, Needle , Brazil , Culture Media , Leishmaniasis, Cutaneous/parasitology , Retrospective Studies , Rural Population , Sensitivity and SpecificityABSTRACT
Twenty nine patients with localized cutaneous leishmaniasis had lymph node and skin ulcer aspirations for culture of Leishmania with the modified Marzochi's vacuum aspiratory technique. Sensitivity of lymph node aspiration was 58.6 percent and 34.5 percent for skin ulcer aspiration (P=0.06). Combined sensitivity of the two methods was 79.3 percent. There was no agreement between methods (Kappa Index = -0.084; CI95 percent -0,45; 0,28) showing the potential complementary roles in diagnostic approach
Subject(s)
Adult , Humans , Male , Female , Biopsy, Needle , Leishmania braziliensis/isolation & purification , Leishmaniasis, Cutaneous/diagnosis , Lymphatic Diseases/etiology , Culture Media , Leishmaniasis, Cutaneous/parasitology , Lymph Nodes/pathology , Lymphatic Diseases/pathology , Sensitivity and SpecificityABSTRACT
A eficácia e segurança do antimoniato de meglumina e do estibogluconato de sódio BP 88R forarn comparadas no tratamento da leishmaniose cutânea em Carte de Pedra, Bahia, área endêmica de leishmaniose causada por Leishmania (Viannia) braziliensis. Realizou-se um estudo quase-experimental que incluiu 127 pacientes cujo diagnóstico baseou-se na observaçäo clínica e a intradermorreaçäo de Montenegro. Cinquenta e oito pacientes receberam antimoniato de meglumina e 69 estibogluconato de sódio. Utilizou-se a dose de 20 mg/Sbv/kg/dia por 20 dias, em ambos os grupos. Os pacientes foram acompanhados a cada dez dias durante o tratamento e mensalmente por três meses. Observou-se a cura em 62 por cento dos pacientes tratados com antimoniato de meglumina e em 55 por cento daqueles tratados com estibogluconato de sódio (p = 0,42). A cefaléia foi mais freqüente na primeira metade do tratamento no grupo tratado com estibogluconato de sódio (p = 0,026). Na segunda metade do tratamento, os pacientes tratados com estibogluconato de sódio apresentaram maior freqüência de mialgia/artralgia (p = 0, 004) e dor abdominal/anorexia (p = 0,004). Três pacientes tratados com o estibogluconato de sódio apresentaram efeitos colaterais graves
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Antimony Sodium Gluconate/therapeutic use , Leishmaniasis, Cutaneous/drug therapy , Meglumine/therapeutic use , Antiprotozoal Agents , Skin Diseases, Parasitic/drug therapy , Leishmania braziliensis , Treatment OutcomeABSTRACT
The histopathology of the heart is described in an acute case of Chagas' disease (DC). Lesions involving the conducting system (SC) and the autonomic intracardiac nervous system (SNAIC) are emphasized. Light microscopy showed acute pan-carditis with plenty of Trypanosoma cruzi amastigotes within heart muscle cells. Multiple inflammatory foci were found in the SC with parasitic nests within the atrioventricular node and left his bundle. There were also severe atrial periganglionitis and perineuritis with or without peripheral involvement of those structures. Apparently there was no cardiac neuronal depopulation. The epidemiological study suggested transmission through Rhodnius pictipes. To the best of our knowledge, this is the first reported case of acute DC from the Amazonian basin with systematized microscopy study of the SC and SNAIC.