[Myiasis associated with some socioeconomic factors in five urban areas of the State of Rio de Janeiro]. / Miíases associadas com alguns fatores sócio-econômicos em cinco áreas urbanas do Estado do Rio de Janeiro.

This was a descriptive epidemiological study with the aim of evaluating the occurrence of human myiasis in urban areas of four municipalities in the State of Rio de Janeiro. Seventy-one patients who spontaneously sought attendance at primary healthcare units between October 1999 and October 2003 were examined. The disease was more prevalent among adults, including in individuals more than 51 years old (42.3%), and among children less than 10 years old (33.8%). From all the cases studied, 62% were of low socioeconomic level; 60.6% were male; and 33.8% of the infested individuals were unemployed. In the cases analyzed, the bioagent species were Cochliomyia hominivorax (Coquerel, 1858), Dermatobia hominis (Linnaeus Jr, 1781) and Cochliomyia macellaria (Fabricius, 1775). The results point towards an association between the disease and the patients living and hygiene conditions. This indicates the need for more specific healthcare among more vulnerable groups.

IFNG +874T/A polymorphism is not associated with American tegumentary leishmaniasis susceptibility but can influence Leishmania induced IFN-gamma production.

BACKGROUND: Interferon-gamma is a key cytokine in the protective responses against intracellular pathogens. A single nucleotide polymorphism (SNP) located in the first intron of the human IFN-gamma gene can putatively influence the secretion of cytokine with an impact on infection outcome as demonstrated for tuberculosis and other complex diseases. Our aim was to investigate the putative association of IFNG+874T/A SNP with American tegumentary leishmaniasis (ATL) and also the influence of this SNP in the secretion of IFN-gamma in vitro. METHODS: Brazilian ATL patients (78 cutaneous, CL, and 58 mucosal leishmaniasis, ML) and 609 healthy volunteers were evaluated. The genotype of +874 region in the IFN-gamma gene was carried out by Amplification Refractory Mutational System (ARMS-PCR). Leishmania-induced IFN-gamma production on peripheral blood mononuclear cell (PBMC) culture supernatants was assessed by ELISA. RESULTS: There are no differences between +874T/A SNP frequency in cases and controls or in ML versus CL patients. Cutaneous leishmaniasis cases exhibiting AA genotype produced lower levels of IFN-gamma than TA/TT genotypes. In mucosal cases, high and low IFN-gamma producers were clearly demonstrated but no differences in the cytokine production was observed among the IFNG +874T or A carriers. CONCLUSION: Our results suggest that +874T/A polymorphism was not associated with either susceptibility or severity to leishmaniasis. Despite this, IFNG +874T/A SNP could be involved in the pathogenesis of leishmaniasis by influencing the amount of cytokine released by CL patients, although it could not prevent disease development. On the other hand, it is possible that in ML cases, other potential polymorphic regulatory genes such as TNF-alpha and IL-10 are also involved thus interfering with IFN-gamma secretion.

Miíases associadas com alguns fatores sócio-econômicos em cinco áreas urbanas do Estado do Rio de Janeiro / Myiasis associated with some socioeconomic factors in five urban areas of the State of Rio de Janeiro

Trata-se de um estudo epidemiológico descritivo com o objetivo de avaliar a ocorrência de miíases humanas em áreas urbanas de quatro municípios do Estado do Rio de Janeiro. Foram analisados 71 pacientes que procuraram espontaneamente o atendimento em Postos de Saúde, no período de outubro de 1999 a outubro de 2003. Maior prevalência da doença foi encontrada em adultos e idosos acima de 51 anos (42,3 por cento) e em menores de 10 anos (33,8 por cento). Do total dos casos estudados, 62 por cento incluíam-se no nível sócio-econômico baixo; 60,6 por cento eram do sexo masculino e 33,8 por cento dos indivíduos infestados, sem profissão. Nos casos analisados as espécies bioagentes foram Cochliomyia hominivorax (Coquerel, 1858); Dermatobia hominis (Linnaeus Jr, 1781) e Cochliomyia macellaria (Fabricius, 1775). Os resultados apontam para a associação da doença com as condições de vida e de higiene dos pacientes, sinalizando para a necessidade de atenção mais específica à saúde dos grupos mais vulneráveis.

This was a descriptive epidemiological study with the aim of evaluating the occurrence of human myiasis in urban areas of four municipalities in the State of Rio de Janeiro. Seventy-one patients who spontaneously sought attendance at primary healthcare units between October 1999 and October 2003 were examined. The disease was more prevalent among adults, including in individuals more than 51 years old (42.3 percent), and among children less than 10 years old (33.8 percent). From all the cases studied, 62 percent were of low socioeconomic level; 60.6 percent were male; and 33.8 percent of the infested individuals were unemployed. In the cases analyzed, the bioagent species were Cochliomyia hominivorax (Coquerel, 1858), Dermatobia hominis (Linnaeus Jr, 1781) and Cochliomyia macellaria (Fabricius, 1775). The results point towards an association between the disease and the patientsÆ living and hygiene conditions. This indicates the need for more specific healthcare among more vulnerable groups.

An alternative antimonial schedule to be used in cutaneous leishmaniasis when high doses of antimony are undesirable.

Despite more than half a century of use in leishmaniasis, antimony therapy still presents serious problems concerning dosage and toxicity. Low and high doses have been shown to be equally effective. In this paper, the feasibility of injecting one ampoule of meglumine antimoniate intramuscularly every other day until clinical cure is demonstrated, while studying a series of 40 cutaneous leishmaniasis cases. Total dose used varied from 1,822.5 to 12,150 mg of pentavalent antimony and total time of treatment varied from 3 to 10 weeks, with 86% efficacy. Thirty-six out of the 40 patients are still on follow-up with a mean time of 10.7 +/- 7 months and a median of 9 months. No relapse or mucosal lesions have been noted so far. The schedule showed good tolerance and easy application and its efficacy was comparable to the officially recommended WHO schedule. Therefore, such a schedule represents a valuable alternative for the cases with high toxicicity to antimony or daily injections are an obstacle to the treatment.

Successful therapeutic response of resistant cases of mucocutaneous leishmaniasis to a very low dose of antimony.

Two mucocutaneous leishmaniasis cases resistant to therapy are reported here. After the failure of initial therapies (antimony, amphotericin B and/or pentamidine) patients received a low-dose schedule: one ampoule of meglumine antimoniate (405 mg of pentavalent antimony [Sb v]) by intramuscular injection, three times a week until complete healing of the lesions. One patient was cured with a total of 30 ampoules in 10 weeks and the other received 36 ampoules in 12 weeks. Both remain clinically cured after one year of follow-up.

An alternative antimonial schedule to be used in cutaneous leishmaniasis when high doses of antimony are undesirable

Despite more than half a century of use in leishmaniasis, antimony therapy still presents serious problems concerning dosage and toxicity. Low and high doses have been shown to be equally effective. In this paper, the feasibility of injecting one ampoule of meglumine antimoniate intramuscularly every other day until clinical cure is demonstrated, while studying a series of 40 cutaneous leishmaniasis cases. Total dose used varied from 1,822.5 to 12,150mg of pentavalent antimony and total time of treatment varied from 3 to 10 weeks, with 86 percent efficacy. Thirty-six out of the 40 patients are still on follow-up with a mean time of 10.7 ± 7 months and a median of 9 months. No relapse or mucosal lesions have been noted so far. The schedule showed good tolerance and easy application and its efficacy was comparable to the officially recommended WHO schedule. Therefore, such a schedule represents a valuable alternative for the cases with high toxicicity to antimony or daily injections are an obstacle to the treatment.

Apesar de utilizado há mais de meio século no tratamento da leishmaniose, o antimônio apresenta ainda problemas quanto a sua toxicidade e dose ideal. Doses baixas têm se mostrado tão eficazes quanto doses altas. Neste trabalho, apresentamos o resultado do emprego de uma ampola de antimoniato de meglumina intramuscular, em dias alternados, até a cura clínica, numa série de 40 casos. A dose total utilizada, por paciente, variou de 1.822,5 a 12.150mg de antimônio pentavalente e o tempo de tratamento de 3 a 10 semanas com eficácia de 86 por cento. Dos 40 pacientes estudados, 36 ainda estão em acompanhamento, com um tempo médio de 10,7 ± 7 meses e média de 9 meses. Não houve recidivas nem lesões mucosas. O esquema utilizado foi bem tolerado, de fácil aplicação, eficácia comparável ao esquema oficialmente preconizado pela OMS, mostrando-se como valiosa alternativa para os casos com potencial toxicidade ao antimônio ou cuja aplicação de injeções diárias represente um obstáculo ao tratamento.

Successful therapeutic response of resistant cases of mucocutaneous leishmaniasis to a very low dose of antimony

Two mucocutaneous leishmaniasis cases resistant to therapy are reported here. After the failure of initial therapies (antimony, amphotericin B and/or pentamidine) patients received a low-dose schedule: one ampoule of meglumine antimoniate (405mg of pentavalent antimony [Sb v]) by intramuscular injection, three times a week until complete healing of the lesions. One patient was cured with a total of 30 ampoules in 10 weeks and the other received 36 ampoules in 12 weeks. Both remain clinically cured after one year of follow-up.

São relatados dois casos de leishmaniose mucocutânea resistentes ao tratamento. Depois das terapêuticas iniciais (antimônio, anfotericina B e/ou pentamidina), os pacientes receberam um esquema alternativo: uma ampola de antimoniato de meglumina (405mg de antimônio pentavalnte [Sb v]) por via intramuscular, três vezes por semana até a cura completa das lesões. Um paciente recebeu um total de 30 ampolas durante 10 semanas e o outro, 36 ampolas durante 12 semanas. Ambos permanecem clinicamente curados até um ano após o tratamento.

Determinação de parâmetros clínicos e prognósticos para o controle de cura da Leishmaniose Tegumentar Americana / Determination of clinical parameters and prognostics for the control and cure of the Leishmaniose American Tegumentar

O controle de cura na leishmaniose tegumentar americana (LTA) é eminentemente clínico. Não existe um consenso estabelecido de quais parâmetros seriam os mais representativos da resposta terapêutica. Para identificar os parâmetros clínicos com valor prognóstico na LTA do Rio de Janeiro, analisamos o tempo de cura pelo método de análise de sobrevida através do modelo de incidência em tempo discreto com ligação log-log complementar, sendo a cura o evento de interesse. Foram incluídos e estudados 161 pacientes de LTA, todos com diagnóstico parasitológico confirmado, à exceção de sete crianças que tiveram diagnóstico clínico-epidemiológico com reação de Montenegro positiva. Todos eram portadores de lesões ulceradas e haviam recebido tratamento antimonial no período de 1996 a 2000. Os pacientes foram examinados por um mesmo observador no pré-tratamento, ao final do tratamento, no intervalo de 1 mês pós-tratamento, com 3 meses, 6 meses, 1 ano e 2 anos pós-tratamento. A cura clínica foi definida como o desaparecimento de todos os parâmetros estudados, ou seja, epitelização completa da lesão, ausência de eritema, induração, descamação, crosta, envolvimento linfático, lesões novas ou lesões satélites. Pacientes que terminaram o estudo sem ter curado, ou cuja falta à consulta que precedeu o evento não permitiu identificar o intervalo em que se deu a cura, foram censurados. Noventa e seis pacientes foram curados (59,6 por cento) e 65 foram censurados (40,4 por cento). A maioria das curas foi observada nos intervalos de 1 mês e três meses pós-tratamento (56 pacientes). O tempo mostrou ter influência crescente sobre a cura, como variável independente no modelo univariado, e até o 3º. mês pós-tratamento no modelo multivariado final (p<0,01). Os principais parâmetros clínicos, identificados como fatores prognósticos para a cura no modelo multivariado final, foram o eritema central e periférico, que revelou uma redução de 80 (por cento) no potencial de cura (p = 0,03) e a epitelização da lesão (p=0,05)...