Randomized trial with itraconazole, ketoconazole and sulfadiazine in paracoccidioidomycosis.

Forty-two patients with active paracoccidioidomycosis were randomized to receive itraconazole (50-100 mg d(-1)), ketoconazole (200-400 mg d(-1)) or sulfadiazine (100-150 mg kg d(-1) up to 6 g d(-1)) for 4-6 months, followed by slow release sulfa until negativity of serological tests. All 14 patients in itraconazole and sulfadiazine groups and 13 in the ketoconazole group showed an adequate clinical response to the chemotherapy. One patient in the latter group showed treatment failure according to clinical and mycological criteria. The test of the hypothesis that the drugs reduced antibody levels up to ten months of treatment showed a p value equal to 0.0001 for itraconazole, 0.017 for ketoconazole and 0.0012 for sulfadiazine; this reduction was similar for the three groups. In this first randomized study for the treatment of paracoccidioidomycosis we could not show superiority of any one regimen over the others in the clinical and serological responses of patients with the moderately severe form of the disease.

[Evaluation by users of hospitals which participate in the hospital quality program of the State of São Paulo, Brazil]. / Avaliação pelos usuários dos hospitais participantes do programa de qualidade hospitalar no Estado de São Paulo, Brasil.

INTRODUCTION: The Hospital Quality Program (HQP) in S. Paulo State, Southeastern Brazil, has been conducted by Medical Association of the S. Paulo State--"Associação Paulista de Medicina (APM)", since 1991. General and specialised, public and private hospitals have taken part in the HQP/APM. Such hospitals are evaluated by their users by means of the HQP-06 ("users' evaluation") questionnaire, with closed and open-ended questions for observations and suggestions. The results of the HQP-06 questionnaire of the HQP/APM are evaluated. MATERIAL AND METHODOLOGY: The 23,751 questionnaires (i.e., from 5.27% of all discharged patients), received by 66 hospitals during 1994, were analysed. The questionnaire flow, the quantity and quality of answers, the data from the closed of and open-ended answers and the comparison of closed and open-ended answers, were all taken into consideration in the analysed. RESULTS AND CONCLUSIONS: The following aspects were observed:-the importance of the direct flow of questionnaires from users to HQP/APM:-the need for HQP-06 to contain general items that permit a comparison between the hospitals concerned; the importance of the hospital staff being motivated to offer explanations when giving the questionnaires to users and the latters' being motivated to answer them with a view to the greater quantity and better quality of the answers:-in the hospitals of the HQP the user's evaluation presents a median of 4.32% (25%ile = 1.83% and 75%ile = 7.92%), and the number of questionnaires containing observations about the service as compared with the total presents a median of 42.11% (25%ile = 27.28% and 75%ile = 57.82%). Finally, hospital managements are recommended to take their users opinions into consideration with a view to obtaining feed-back and the continuous quality improvement of the hospitals of the HQP/APM.

[Bone marrow involvement and eosinophilia in paracoccidioidomycosis]. / Comprometimento da medula óssea e eosinofilia na paracoccidioidomicose.

The authors described three acute paracoccidioidomycosis patients with bone marrow involvement. P. brasiliensis yeast forms were observed in bone marrow smears of all them, and in one case, culture also revealed fungus growth. The mononuclear phagocytic system involvement, the blood eosinophilia and the negative skin hypersensibility responses were emphasized in all of them, as well as the severity of the disease in one case, with disseminated bone lesions and 20.260 eosinophils/mm3 in peripheral blood. The authors discuss the possible role of eosinophil in the host-parasite interaction in paracoccidioidomycosis, suggesting that TH 2 subpopulation activation and increased IL 5 and GM-CSF secretions may be responsible by eosinophilia in the most severe case.

[Isolation of Toxoplasma gondii from the saliva of patients with acquired immunodeficiency syndrome (AIDS)]. / Pesquisa do Toxoplasma gondii na saliva de pacientes com síndrome da imunodeficiência adquirida (AIDS).

Toxoplasma gondii has been found in saliva of patients with toxoplasmosis. We tried to isolate parasites in saliva in patients with AIDS. As it is known, the finding of antitoxoplasma antibodies is not useful for diagnosis of cerebral abscess in toxoplasmosis occurring in AIDS patients in Brazil where 90% or more adults have serological evidence of past infection with Toxoplasma gondii. In 26 patients with AIDS, including six with tomographical evidence suggesting cerebral abscess caused by Toxoplasma gondii, no parasites were found in the saliva by the use of the mouse inoculation model. This trial that the search for Toxoplasma gondii in the saliva is not an alternative method for the diagnosis of toxoplasmosis in patients with AIDS.

PIP: Toxoplasma gondii has been found in the saliva of patients with toxoplasmosis. The authors attempted to isolate parasites from the saliva of those patients with AIDS. As it is known, the finding of antitoxoplasma antibodies is not useful for the diagnosis of cerebral abscess in toxoplasmosis occurring in AIDS patients in Brazil, where 90% or more of the adults have serological evidence of past infection with Toxoplasma gondii. In 26 patients with AIDS, including 6 with tomographical evidence suggesting cerebral abscess caused by Toxoplasma gondii, no parasites were found in the saliva through the use of the mouse inoculation model. This trial indicates that the search for Toxoplasma gondii in saliva is not an alternative method for the diagnosis of toxoplasmosis in patients with AIDS. (author's modified)

Doença de Chagas aguda: vias de transmissäo aspectos clínicos e resposta a terapêutica específica em casos diagnosticados em um centro urbano / Acute Chagas' disease: transmission routes, clinical aspects and response to specific therapy in diagnosed cases in an urban center

Relata-se o quadro clínico de 27 pacientes com doença de Chagas aguda, acompanhados no ambulatório da Clínica de Doenças Infecciosas e Parasitárias do Hospital das Clínicas da FM-USP no período de 1974 a 1987. As vias de transmissäo envolvidas foram: vetorial em 7 casos, transfusional em 9, transplante de rim e/ou transfusional em 4, acidental em 1, via oral em 3, provável alcitamento materno em 1, congênita ou aleitamento materno em 1, congênita ou transfusional em 1. Pacientes com infecçäo por via vetorial eram procedentes da Bahia e Minas Gerais, infectados por via transfusional adquiriram a doença na Grande Säo Paulo, 7 deles após 1983. O quadro clínico foi oligossintomático ou assintomático em 4 pacientes, sendo 3 deles imunodeprimidos por doença de base ou por medicamentos. Em outros 2 pacientes imunodeprimidos ocorreu miocardite grave com insuficiência cardíaca congetiva. O quadro clínico foi também mais grave em 5 de 6 crianças menores de dois anos de idade, qualquer dque fosse a via de transmissäo

[Acute Chagas' disease: transmission routes, clinical aspects and response to specific therapy in diagnosed cases in an urban center]. / Doença de Chagas aguda: vias de transmissão, aspectos clínicos e resposta à terapêutica específica em casos diagnosticados em um centro urbano.

The authors report clinical features and therapeutic response of 24 outpatients with acute Chagas' disease, and 3 in the initial chronic phase, referred to the Clinic for Infectious and Parasitic Diseases of the FMUSP "Clínicas" Hospital between 1974 and 1987. The following transmission routes were involved: triatominae in 7 cases, blood transfusion in 9, kidney transplantation and/or blood transfusion in 4, accidental in 1, oral route in 3, probably breast feeding in 1, congenital or breast feeding in 1, and congenital or blood transfusion in 1. Six patients infected by triatominac acquired the disease between 1974 and 1980 and one in 1987. The blood transfusion infected patients acquired the disease in Greater São Paulo, seven of whom after 1983. The acute phase Chagas' disease was oligosymptomatic in 4 patients: three of such patients being immunocompromised by drugs or other diseases. Another two adult immunocompromised patients developed myocarditis and congestive heart failure. Clinical features were severe in 5 from 6 children under two years, irrespective of the transmission route. Evaluation of the acute phase patients treated with benznidazol (4-10 mg/kg/day) showed: therapeutic failure in 4/16 (25.0%); possible cure in 9/16 (53.2%) and inconclusive results in 3/16 (18.8%). The antibody and complement-mediated lysis reaction was in keeping with the xenodiagnosis in 18/22 cases, having shown negative results after treatment earlier than classical serological reactions. One aplastic anaemia patient receiving corticosteroid presented lymphoproliferative disease 6 years after being treated with benznidazol for acute Chagas' disease.

Infecçäo por Clonorchis sinensis em imigrantes asiáticos no Brasil: tratamento com praziquantel / Clonorchis sinensis infections in Asian immigrants in Brazil: treatment with praziquantel

Estudaram-se quinze pacientes com infecçäo assintomática por Clonorchis sinensis, revelada através de exame parasitológico de fezes. Todos eram de origem asiática e procuraram o Laboratório Central do Instituto Adolfo Lutz para se submeterem a exames laboratoriais necessários a regularizaçäo de sua situaçäo, face a nova legislaçäo sobre imigrantes. Eram todos indivíduos adultos, seis pertencendo ao sexo feminino e nove ao masculino. Os quinze pacientes comn clonorquíase foram internados no Hospital das Clínicas da FMUSP e tratados com Praziquantel, na dosagem de 60 mg/Kg de peso corporal, dividida em duas tomadas. Foram realizados exames coprológicos quantitativos (método de Kato-Katz), antes do tratamento específico e no 15§, 30§ e 60§ dias após a terapêutica. Na última avaliaçäo (60§ dias após terapêutica), em nove pacientes (60,0%) näo se encontraram ovos do treamatódeo nas fezes e nos seis (40,0%), que continuavam eliminando ovos, notou-se reduçäo na quantidade eliminada (superior a 90% em cinco e a 30% no paciente restante). Os pacientes foram também submetidos a exames subsidiários, para avaliaçäo do estado geral e funçäo hepática, antes da administraçäo de Praziquantel e, posteriormente, no seguimento ambulatorial. A medicaçäo foi relativamente bem tolerada pelos pacientes, verificando-se a ocorrência de efeitos colaterais representados por náuseas e vômitos (dois casos), vertigens e tonturas (dois casos), epigastralgia (dois casos) e diarréia no 3§ dia após tratamento (um caso)

[Infection by Clonorchis sinensis in Asian immigrants in Brazil. Treatment with praziquantel]. / Infecção por Clonorchis sinensis em imigrantes asiáticos no Brasil. Tratamento com praziquantel.

Fifteen adult patients with assymptomatic infection due to Clonorchis sinensis, diagnosed by coprological examination, were studied. They all came from Asia (twelve from Taiwan, two from South Korea and one from Hong Kong) and were examined at the Adolfo Lutz Institute and the Department of Infectious Diseases, School of Medicine, University of São Paulo, in São Paulo, Brazil. Six patients were women and nine men. All studied patients were admitted to hospital and treated with praziquantel (60 mg/kg). Previous to treatment and on the 15th, 30th and 60th days after praziquantel administration, patients were submitted to quantitative stool examinations, according to Kato-Katz's technique and to hematological and biochemical serum analysis. After a 60 day follow-up nine patients (60%) were negative for C. sinensis eggs in stools. Those not cured after praziquantel administration (six patients, 40%) revealed a sharp decline in faecal elimination of C. sinensis eggs.