Enteroparasite and vivax malaria co-infection on the Brazil-French Guiana border: Epidemiological, haematological and immunological aspects.

Malaria-enteroparasitic co-infections are known for their endemicity. Although they are prevalent, little is known about their epidemiology and effect on the immune response. This study evaluated the effect of enteroparasite co-infections with malaria caused by Plasmodium vivax in a border area between Brazil and French Guiana. The cross sectional study took place in Oiapoque, a municipality of Amapá, on the Amazon border. Malaria was diagnosed using thick blood smears, haemoglobin dosage by an automated method and coproparasitology by the Hoffman and Faust methods. The anti-PvMSP-119 IgG antibodies in the plasma were evaluated using ELISA and Th1 (IFN-γ, TNF-α and IL-2), and Th2 (IL-4, IL-5 and IL-10) cytokine counts were performed by flow cytometry. The participants were grouped into those that were monoinfected with vivax malaria (M), vivax malaria-enteroparasite co-infected (CI), monoinfected with enteroparasite (E) and endemic controls (EC), who were negative for both diseases. 441 individuals were included and grouped according to their infection status: [M 6.9% (30/441)], [Cl 26.5% (117/441)], [E 32.4% (143/441)] and [EC 34.2% (151/441)]. Males prevailed among the (M) 77% (23/30) and (CI) 60% (70/117) groups. There was a difference in haemoglobin levels among the different groups under study for [EC-E], [EC-Cl], [E-M] and [Cl-M], with (p < 0.01). Anaemia was expressed as a percentage between individuals [CI-EC (p < 0.05)]. In terms of parasitaemia, there were differences for the groups [CI-M (p < 0.05)]. Anti-PvMSP-119 antibodies were detected in 51.2% (226/441) of the population. The level of cytokines evaluation revealed a large variation in TNF-α and IL-10 concentrations in the co-infected group. In this study we did not observe any influence of coinfection on the acquisition of IgG antibodies against PvMSP119, as well as on the profile of the cytokines that characterize the Th1 and Th2 patterns. However, co-infection increased TNF-α and IL-10 levels.

Prevalência de uropatógenos no laboratório de saúde pública de Macapá ­ AP entre 2009 e 2012 / Uropathogens prevalence in public health laboratory Macapá ­ AP between 2009 and 2012

Objetivo: Investigar a prevalência de uropatógenos de usuários atendidos no Laboratório Central de Saúde Pública de Macapá no período de 2009 a 2012. Métodos: Trata-se de um estudo retrospectivo de corte transversal, realizado no Laboratório Central de Saúde Públicade Macapá no período de 2009 a 2012, identificando os principais microrganismos responsáveis por infecções do trato urinário. O universo amostral foi composto pela população ambulatorial e hospitalar atendida no laboratório, sendo realizado o teste qui-quadrado. Os resultados foram expressos em números absolutos e em porcentagens utilizando-se o Programa Bioestat (5.0) e Excel Windows (2010). Resultados: Os resultados foram avaliados pela frequência das variáveis e analisados pelo teste qui-quadrado, destacando-se comocritérios: ocorrência, gênero, idade e o tipo de microrganismo causador e apresentados por meio de tabelas e gráficos. Das 10.026 (100%) uroculturas, observaram-se 7.758 (77,38%) com resultado negativo e 2.268 (22,62%) com resultado positivo. Os casos positivos foram separados em quatro grandes grupos: Enterobactérias ­ 1.422 (62,70%); Cocos Gram positivos ­ 663 (29,23%); Bacilo Gram negativo não fermentador ­102 (4,50%) e Fungo ­ 81 (3,57%). Os patógenos isolados mais prevalentes foram: Escherichia coli ­ 67,09%, Staphylococcus coagulase negativa ­ 20,8%, Acinetobacter baumanii ­ 38,23% e Candida albicans ­ 44,45%. Conclusão: O perfil epidemiológico de microrganismos e suas variáveis torna-se uma ferramenta imprescindível às investigações direcionadas à população susceptível. Tal conhecimento é relevante para a Saúde prestar maior assistência aos pacientes contribuindo para o planejamento, execução e avaliação das ações de prevenção, controle e tratamento

Objective: To investigate the prevalence of uropathogens of users served at the Central Laboratory of Public Health Macapá the period 2009 to 2012. Methods: This is a retrospective cross-sectional study, carried out at the Central Laboratory of Public Health Macapá the period 2009 to 2012, identifying key microorganisms responsible for urinary tract infections. The sample was composed of the Universe out patient population treated at the hospital and laboratory, which performed the chi-square test. Results were expressed in absolute numbers and in percentage using the Program Bioestat (5.0) and Windows Excel (2010). Results: The results were evaluated by variable frequency and analyzed by chi-square test, especially as criteria: occurrence, gender, age and type of causative microorganism and were presented descriptively and analytically through tables and graphs. Of 10.026 (100%) urine culture, there was 7.758 (77.38%) with negative and 2.268 (22.62%) with positive results. Positive cases were separated into four groups: Enterobacteria 1.422 (62.70%); Cocos Gram positive 663 (29.23%), Gram negative bacillus not fermentor 102 (4.50%) and Fungus 81 (3, 57%). The most prevalent pathogens isolated were Escherichia coli ­ 67.09%, 20.8% coagulase-negative Staphylococcus, Acinetobacter baumannii ­ 38.23% and 44.45% Candida albicans. Conclusion: The epidemiological profile of microorganisms and their variables becomes an indispensable tool for investigations directed at susceptible population. Such knowledge is relevant to health provide greater patient care by contributing to the planning, implementation and evaluation of prevention, control and treatment

Recurrence of Plasmodium falciparum after treatment with quinine and doxycycline in the Amazon basin.

OBJECTIVE: To investigate whether the recurrence of infection by Plasmodium falciparum in patients from the Brazilian Amazon was caused by an inadequate exposure to quinine. METHODS: A retrospective study was carried out using blood samples from patients with slide-confirmed infection by P. falciparum, classified according to the parasitological response after 28 days of follow-up. Quinine and doxycycline were measured in plasma samples by high-performance liquid chromatography. A statistical model was used to estimate parasite clearance rates. RESULTS: Six of 40 patients who met the criteria for inclusion in the study showed recurrence of parasitaemia within 28 days after the commencement of treatment. A group of six patients with adequate parasitological response was formed to avoid bias when the variables were compared. Parasitaemia at admission was similar in both groups. Plasma quinine concentrations were similar in both groups on days 1, 2 and 3 and ranged from 1.07 to 4.35 µg/ml in cured patients and from 1.1 to 3.2 µg/ml in patients with parasite recurrence. Concentrations of doxycycline were similar in both groups on day 3. The parasite clearance rate constant was 0.131 ± 0.16 h in the cured patients and 0.117 ± 0.02 h in those showing recurrence. The slope half-life in the cured patients was 4.8 h and 5.4 h in recurrence cases. The hillslope of the cured group (14.24) increased sharply compared to the recurrence group (4.13). CONCLUSION: There is evidence of a decreased in vivo sensitivity to quinine of P. falciparum strains in the Brazilian Amazon basin.

EVALUATION OF CIRCUMSPOROZOITE PROTEIN OF Plasmodium vivax TO ESTIMATE ITS PREVALENCE IN OIAPOQUE , AMAPÁ STATE, BRAZIL, BORDERING FRENCH GUIANA.

Malaria is a major health problem for people who live on the border between Brazil and French Guiana. Here we discuss Plasmodium vivax distribution pattern in the town of Oiapoque, Amapá State using the circumsporozoite (CS) gene as a marker. Ninety-one peripheral blood samples from P. vivax patients have been studied. Of these, 64 individuals were from the municipality of Oiapoque (Amapá State, Brazil) and 27 patients from French Guiana (August to December 2011). DNA extraction was performed, and a fragment of the P. vivax CS gene was subsequently analyzed using PCR/RFLP. The VK210 genotype was the most common in both countries (48.36% in Brazil and 14.28% in French Guiana), followed by the P. vivax-like (1.10% in both Brazil and French Guiana) and VK247 (1.10% only in Brazil) in single infections. We were able to detect all three CS genotypes simultaneously in mixed infections. There were no statistically significant differences either regarding infection site or parasitaemia among individuals with different genotypes. These results suggest that the same genotypes circulating in French Guiana are found in the municipality of Oiapoque in Brazil. These findings suggest that there may be a dispersion of parasitic populations occurring between the two countries. Most likely, this distribution is associated with prolonged and/or more complex transmission patterns of these genotypes in Brazil, bordering French Guiana.

Malária em regiäo extra-Amazônica: situaçäo no Estado de Santa Catarina / Malaria outside the Brazilian Amazonian region: the situation in Santa Catarina State

Este estudo objetiva conhecer o perfil epidemiológico da malária no Estado de Santa Catarina, analisando dados disponibilizados pela Fundaçäo Nacional de Saúde, relativos ao período de 1996/2001. Das 4.707 lâminas examinadas, 5,5 por cento evidenciaram-se positivas. As infecçöes por Plasmodium vivax foram 69 por cento, por Plasmodium falciparum 25,6 por cento, infecçöes mistas por ambos foram 5 por cento e, somente 0,4 por cento por Plasmodium malariae. Foi observado 67,4 por cento casos importados e 32,6 por cento casos autóctones. Nos últimos anos houve um aumento de casos importados. A maioria destes veio da regiäo Amazônica brasileira e o restante de países africanos. Identificou-se os municípios de Joinville, Blumenau, Säo Francisco do Sul e Florianópolis com maior número de autoctonia no biênio 1996/97. Medidas de controle e vigilância fazem-se necessárias, no sentido de prevenir a reintroduçäo do plasmódio, favorecendo a autoctonia. Será útil o mapeamento das áreas de risco, já que é contínua a expectativa de sua reemergência em áreas hoje consideradas sob controle

Epidemiologia da febre amarela no estado do Pará, 1989 - 1998 / Epidemiology of yellow fever in Pará State, 1989 - 1998

Objetivos: Descrever, com base numa série histórica de dez anos, correspondente ao período de 1989 a 1998, o perfil epidemiológico da Febre amarela no Estado do Pará, enfatizando a epidemia do ano de 1998. Proceder uma avaliação sobre a dispersão do Aedes aegypti nos municípios paraenses e a relação deste fato com o risco de reurbanizaçào da doença. E, finalmente, avaliar as ações de controle que têm sido executadas. Método: Os dados foram obtidos junto ao Núcleo Estadual de Epidemiologia (NUEPI/SESPA) e Núcleo de informaçãoe Saúde (NIS/SESPA); a partir dos quais foram realizadas as análises de interesse do trabalho. Resultados: Registraram-se 38 casos distribuídos em 20 dos 13 municípios; dois importantes picos epidêmicos, um em 1993 e o outro em 1998 e elevada proporção de letalidade, chegando a cem por cento de 1991, 1993, 1995 e 1997, reduzindo para 34,7 por cento em 1998. Determinou-se a prevalência da doença em indivíduos do sexo masculino e maiores de 15 anos (71 por cento) desenvolvendo atividade de lavravador (36,8 por cento). Conclusão: Identifica-se a necessidade do fortalecimento do processo de vigilância e controle da doença, bem como a necessidade do aumento da cobertura vacinal na população exposta, objetivando a redução do número de casos e o impedimento de uma possível reurbanização da Febre Amarela