[The electrocardiographic survey]. / O inquérito eletrocardiográfico.

In order to investigate the prevalence of chagasic heart disease in Brazil, a national electrocardiographic survey was carried out from 1977 to 1981. A total of 5,347 electrocardiograms (ECG) were performed and paired by age and gender. The results obtained in relation with the autochthonous cases, were distributed by Brazilian states, as follows: Rio Grande do Sul (1,078), Minas Gerais (760), Bahia (612), Paraná (400), Paraiba (340), Piauí (218), Sergipe (216), Goiás (176), Pernambuco (170), Ceará (136) and Alagoas 134. The higher proportions of altered ECGs among seropositive individuals were found in the States of Goiás (63.6%), Minas Gerais (57.6%), Ceará (57.3%), Paraná (54.5%), Piauí (53.2%) and Paraiba (52.3%). Among the control individuals, these proportions were respectively 25%, 25.7%, 25%, 12.5%, 22.9% and 26.5%. A significant statistical difference of altered ECGs between positive and negative individuals was verified in all the States, with a single exception (Alagoas). The estimation of the gradient showed to be higher in Paraná State (42%), followed by Goiás (38.6%), Ceará (32.3%), Minas Gerais (31.9%), Piauí (30.3%), Paraíba (25.8%), Pernambuco (22.3%), Bahia (18.9%), Sergipe (16.7%), Rio Grande do Sul (9.9%) and Alagoas (7.5%). Concerning the distribution of the electrocardiographical alterations found in the eleven states, the main alterations find among the seropositive group were: ventricular extrasystoles, complete right bundle branch block, left anterior fascicular block, the association of complete right bundle branch block with left anterior fascicular block and primary alterations of the ST segment and of the T wave. Furthermore, these ECG alterations were more prevalent in the group of infected individuals.

[The national survey of seroprevalence for evaluation of the control of Chagas disease in Brazil (2001-2008)]. / O inquérito nacional de soroprevalência de avaliação do controle da doença de Chagas no Brasil (2001-2008).

A survey for seroprevalence of Chagas disease was held in a representative sample of Brazilian individuals up to 5 years of age in all the rural areas of Brazil, with the single exception of Rio de Janeiro State. Blood on filter paper was collected from 104,954 children and screened in a single laboratory with two serological tests: indirect immunofluorescence and enzyme linked immunoassay. All samples with positive or indetermined results, as well as 10% of all the negative samples were submitted to a quality control reference laboratory, which performed both tests a second time, as well as the western blot assay of TESA (Trypomastigote Excreted Secreted Antigen). All children with confirmed final positive result (n = 104, prevalence = 0.1%) had a follow-up visit and were submitted to a second blood collection, this time a whole blood sample. In addition, blood samples from the respective mothers and familiar members were collected. The infection was confirmed in only 32 (0.03%) of those children. From them, 20 (0.025%) had maternal positive results, suggesting congenital transmission; 11 (0.01%) had non-infected mothers, indicating a possible vectorial transmission; and in one whose mother had died the transmission mechanism could not be elucidated. In further 41 visited children the infection was confirmed only in their mothers, suggesting passive transference of maternal antibodies; in other 18, both child and mother were negative; and in 13 cases both were not localized. The 11 children that acquired the infection presumably through the vector were distributed mainly in the Northeast region of Brazil (States of Piauí, Ceará, Rio Grande do Norte, Paraíba and Alagoas), in addition to one case in Amazonas (North region) and another in Parana (South region). Remarkably, 60% of the 20 cases of probably congenital transmission were from a single State, Rio Grande do Sul, with the remaining cases distributed in other states. This is the first report demonstrating regional geographical differences in the vertical transmission of Chagas disease in Brazil, which probably reflects the predominant Trypanosoma cruzi group IId and IIe (now TcV and TcVI) found in this state. Overall, these results show that the regular and systematic control programs against the transmission of Chagas disease, together with socioeconomic changes observed in Brazil in the last decades, interrupted the vectorial transmission in Brazil, resumed in the few cases found in this national survey. Furthermore they reinforce the need for maintenance of control programs for the consolidation of this major advance in public health.

O inquérito eletrocardiográfico / The electrocardiographic survey

Entre 1977 e 1981, foi realizado um inquérito eletrocardiográfico nacional tendo por objetivo avaliar a prevalência da cardiomiopatia chagásica no Brasil. Foram feitos 5.347 eletrocardiogramas. Após o pareamento dos indivíduos, segundo a idade e gênero, a distribuição dos eletrocardiogramas dos autóctones, em cada estado, ficou assim constituída: Rio Grande do Sul (1.078), Minas Gerais (760), Bahia (612), Paraná (400), Paraíba (340), Piauí (218), Sergipe (216), Goiás (176), Pernambuco (170), Ceará (136) e Alagoas (134). Os maiores percentuais de alterações eletrocardiográficas entre os indivíduos com soros reagentes foram encontrados nos Estados de Goiás (63,6 por cento), Minas Gerais (57,6 por cento), Ceará (57,3 por cento), Paraná (54,5 por cento), Piauí (53,2 por cento) e Paraíba (52,3 por cento). Entre os controles, nestes estados, a prevalência das alterações eletrocardiográficas foi de 25 por cento, 25,7 por cento, 25 por cento, 12,5 por cento, 22,9 por cento e 26,5 por cento respectivamente. Observou-se diferença estatisticamente significativa em relação à prevalência das alterações eletrocardiográficas, entre os indivíduos soro reagentes e os não reagentes, em todos os estados, exceção feita para o de Alagoas. O cálculo do gradiente mostrou-se maior no Estado do Paraná (42 por cento), seguido por Goiás (38,6 por cento), Ceará (32,3 por cento) Minas Gerais (31,9 por cento), Piauí (30,3 por cento), Paraíba (25,8 por cento), Pernambuco (22,3 por cento), Bahia (18,9 por cento), Sergipe (16,7 por cento), Rio Grande do Sul (9,9 por cento) e Alagoas (7,5 por cento). Em relação à distribuição das alterações eletrocardiográficas encontradas, nos onze estados analisados, verificou-se que as extrassístoles ventriculares, o bloqueio de grau avançado do ramo direito, o bloqueio da divisão ântero-superior do ramo esquerdo, a associação do bloqueio de grau avançado do ramo direito com o bloqueio da divisão ântero-superior do ramo esquerdo e alterações primárias do segmento ST e da onda T, mostraram diferença estatisticamente significativa, entre os indivíduos com sororreagentes e os não reagentes Além disto, estas alterações eletrocardiográficas foram as de maior prevalência no grupo dos indivíduos chagásicos.

In order to investigate the prevalence of chagasic heart disease in Brazil, a national electrocardiographic survey was carried out from 1977 to 1981. A total of 5,347 electrocardiograms (ECG) were performed and paired by age and gender. The results obtained in relation with the autochthonous cases, were distributed by Brazilian states, as follows: Rio Grande do Sul (1,078), Minas Gerais (760), Bahia (612), Paraná (400), Paraiba (340), Piauí (218), Sergipe (216), Goiás (176), Pernambuco (170), Ceará (136) and Alagoas 134. The higher proportions of altered ECGs among seropositive individuals were found in the States of Goiás (63.6 percent), Minas Gerais (57.6 percent), Ceará (57.3 percent), Paraná (54.5 percent), Piauí (53.2 percent) and Paraiba (52.3 percent). Among the control individuals, these proportions were respectively 25 percent, 25.7 percent, 25 percent, 12.5 percent, 22.9 percent and 26.5 percent. A significant statistical difference of altered ECGs between positive and negative individuals was verified in all the States, with a single exception (Alagoas). The estimation of the gradient showed to be higher in Paraná State (42 percent), followed by Goiás (38.6 percent), Ceará (32.3 percent), Minas Gerais (31.9 percent), Piauí (30.3 percent), Paraíba (25.8 percent), Pernambuco (22.3 percent), Bahia (18.9 percent), Sergipe (16.7 percent), Rio Grande do Sul (9.9 percent) and Alagoas (7.5 percent). Concerning the distribution of the electrocardiographical alterations found in the eleven states, the main alterations find among the seropositive group were: ventricular extrasystoles, complete right bundle branch block, left anterior fascicular block, the association of complete right bundle branch block with left anterior fascicular block and primary alterations of the ST segment and of the T wave. Furthermore, these ECG alterations were more prevalent in the group of infected individuals.

O inquérito nacional de soroprevalência de avaliação do controle da doença de Chagas no Brasil (2001-2008) / The national survey of seroprevalence for evaluation of the control of Chagas disease in Brazil (2001-2008)

Um inquérito de soroprevalência de doença de Chagas foi realizado em amostra representativa da população com idade até cinco anos de toda a área rural brasileira, exceto o Estado do Rio de Janeiro. Foram estudadas 104.954 crianças, que tiveram amostras de sangue coletadas em papel de filtro e submetidas a testes de screening pelas técnicas de imunofluorescência indireta (IFI) e ELISA em um único laboratório. Todas as amostras com resultados positivos ou indeterminados, juntamente com 10 por cento daquelas com resultados negativos, foram enviadas para um laboratório de referência e aí submetidas a novos testes por IFI e ELISA, além de western blot TESA (Trypomastigote Excreted Secreted Antigen). Para as crianças com resultado final positivo foi agendada uma re-visita para coleta de sangue venoso do próprio participante e das suas mães e familiares. Da avaliação do conjunto de testes resultaram 104 (0,1 por cento) resultados positivos, dos quais apenas 32 (0,03 por cento) foram confirmadas como infectadas. Destas, 20 (0,02 por cento) com positividade materna concomitante (sugerindo transmissão congênita), 11 (0,01 por cento) com positividade apenas na criança (indicativo de provável transmissão vetorial), e uma criança positiva cuja mãe havia falecido. Em 41 situações ocorreu confirmação apenas nas mães, sugerindo transferência passiva de anticorpos maternos; em 18 a positividade não se confirmou nem nas crianças nem nas suas mães; e em 13 não foi possível a localização de ambas. As 11 crianças que adquiriram a infecção por provável via vetorial distribuíram-se predominantemente na região nordeste (Piauí, Ceará, Rio Grande do Norte, Paraíba e Alagoas), acrescidas de um caso no Amazonas e um no Paraná. Dos 20 casos com provável transmissão congênita sobressaiu-se o Rio Grande do Sul, com 60 por cento deles, representando este o primeiro relato de diferenças regionais na transmissão congênita da doença de Chagas no Brasil, possivelmente relacionada à existência de Trypanosoma cruzi grupo IId e IIe, atualmente classificados como TcV e TcVI. Os resultados deste inquérito apontam para a virtual inexistência de transmissão de doença de Chagas por via vetorial no Brasil em anos recentes, resultante da combinação dos programas regulares e sistemáticos de combate á moléstia e de mudanças de natureza socioeconômica observadas no país ao longo das últimas décadas. Por outro lado, reforçam a necessidade de manutenção de um programa de controle que garanta a consolidação deste grande avanço.

A survey for seroprevalence of Chagas disease was held in a representative sample of Brazilian individuals up to 5 years of age in all the rural areas of Brazil, with the single exception of Rio de Janeiro State. Blood on filter paper was collected from 104,954 children and screened in a single laboratory with two serological tests: indirect immunofluorescence and enzyme linked immunoassay. All samples with positive or indetermined results, as well as 10 percent of all the negative samples were submitted to a quality control reference laboratory, which performed both tests a second time, as well as the western blot assay of TESA (Trypomastigote Excreted Secreted Antigen). All children with confirmed final positive result (n = 104, prevalence = 0.1 percent) had a follow-up visit and were submitted to a second blood collection, this time a whole blood sample. In addition, blood samples from the respective mothers and familiar members were collected. The infection was confirmed in only 32 (0.03 percent) of those children. From them, 20 (0.025 percent) had maternal positive results, suggesting congenital transmission; 11 (0.01 percent) had non-infected mothers, indicating a possible vectorial transmission; and in one whose mother had died the transmission mechanism could not be elucidated. In further 41 visited children the infection was confirmed only in their mothers, suggesting passive transference of maternal antibodies; in other 18, both child and mother were negative; and in 13 cases both were not localized. The 11 children that acquired the infection presumably through the vector were distributed mainly in the Northeast region of Brazil (States of Piauí, Ceará, Rio Grande do Norte, Paraíba and Alagoas), in addition to one case in Amazonas (North region) and another in Parana (South region). Remarkably, 60 percent of the 20 cases of probably congenital transmission were from a single State, Rio Grande do Sul, with the remaining cases distributed in other states. This is the first report demonstrating regional geographical differences in the vertical transmission of Chagas disease in Brazil, which probably reflects the predominant Trypanosoma cruzi group IId and IIe (now TcV and TcVI) found in this state. Overall, these results show that the regular and systematic control programs against the transmission of Chagas disease, together with socioeconomic changes observed in Brazil in the last decades, interrupted the vectorial transmission in Brazil, resumed in the few cases found in this national survey. Furthermore they reinforce the need for maintenance of control programs for the consolidation of this major advance in public health.

[Assessment of an entomological surveillance system for Chagas disease with community participation in Mambaí and Buritinópolis, State of Goiás]. / Avaliação do sistema de vigilância entomológica da doença de Chagas com participação comunitária em Mambaí e Buritinópolis, Estado de Goiás.

Entomological surveillance of Chagas disease in Mambaí and Buritinópolis, in the State of Goiás, Brazil, has been kept up through the local population's participation, consisting of reporting the presence of vectors inside their homes. A long time has elapsed since instituting these control measures and it has now been certified that vector transmission has been halted. Thus, this study sought to evaluate the population's knowledge and practices in this situation. The results show that there has been progressive indifference towards the topic of 'Chagas disease', which can be attributed to the reduction in the magnitude of the problem that this disease represented, little participation in surveillance among schools, low epidemiological importance of secondary and native vectors and, consequently, limited control interventions from health services in response to notifications. It is proposed that direct search activities by means of sampling should be carried out periodically, and that there should be greater involvement among teaching institutions.

Avaliação do sistema de vigilância entomológica da doença de Chagas com participação comunitária em Mambaí e Buritinópolis, Estado de Goiás / Assessment of an entomological surveillance system for Chagas disease with community participation in Mambaí and Buritinópolis, State of Goiás

A vigilância entomológica da doença de Chagas em Mambaí e Buritinópolis, no Estado de Goiás, Brasil, tem sido mantida com participação da população, notificando a presença de vetores nas habitações. Passado longo tempo após instituídas as ações de controle e tendo-se já certificado a interrupção da transmissão vetorial, buscou-se avaliar o conhecimento e as práticas da população nessa situação. Os resultados apontam progressivo desinteresse pelo tema doença de Chagas, atribuível à redução da magnitude do problema representado pela enfermidade, a pouca participação das escolas na vigilância, à pequena importância dos vetores secundários e nativos e, em conseqüência, às limitadas intervenções dos serviços de controle em resposta às notificações. Propõe-se, que atividades de busca direta por amostragem sejam periodicamente realizadas e maior envolvimento das instituições de ensino.

Entomological surveillance of Chagas disease in Mambaí and Buritinópolis, in the State of Goiás, Brazil, has been kept up through the local population's participation, consisting of reporting the presence of vectors inside their homes. A long time has elapsed since instituting these control measures and it has now been certified that vector transmission has been halted. Thus, this study sought to evaluate the population's knowledge and practices in this situation. The results show that there has been progressive indifference towards the topic of "Chagas disease", which can be attributed to the reduction in the magnitude of the problem that this disease represented, little participation in surveillance among schools, low epidemiological importance of secondary and native vectors and, consequently, limited control interventions from health services in response to notifications. It is proposed that direct search activities by means of sampling should be carried out periodically, and that there should be greater involvement among teaching institutions.

[Seroprevalence of American trypanosomiasis in adults in an area of the western Brazilian Amazon region]. / Soroprevalência de tripanossomíase americana em adultos de uma área da Amazônia ocidental Brasileira.

From January to March 2001 a seroepidemiological survey for American trypanosomiasis (Chagas disease) was carried out among urban and rural human populations in areas of the Upper Purus basin, in the western Brazilian Amazon region, using serial testing with three different serological techniques. The sample was composed of 1,055 individuals: 844 from urban and 211 from rural areas. Autochthonous infection was identified in nine individuals aged 16 to 72 years: five from urban and four from rural areas. The estimated prevalences of Chagas infection for the urban and rural areas were 0.6% (95% CI: 0.2-1.4) and 1.9% (95% CI: 0.6-4.5) respectively. An apparent clustering trend was noted: seven were born along the Purus river: three lived at the same locality and two of them in the same dwelling.

Soroprevalência de tripanossomíase americana em adultos de uma área da Amazônia ocidental Brasileira / Seroprevalence of American trypanosomiasis in adults in an area of the western Brazilian Amazon region

Foi realizado no período de janeiro a março de 2001 um inquérito soroepidemiológico para tripanossomíase americana (doença de Chagas) em populações humanas, urbana e rural, de áreas da bacia do alto Purus, Amazônia Ocidental Brasileira, através de testagem em série utilizando três técnicas sorológicas. A amostra foi constituída de 1. 055 indivíduos, 844 da área urbana e 211 da área rural. Foi identificada a infecção autóctone em nove indivíduos, cinco da área urbana e quatro da área rural, com idades variando entre 16 e 72 anos. As prevalências estimadas de infecção chagásica foram: 0,6 por cento (IC95 por cento 0,2-1,4) e 1,9 por cento (IC95 por cento 0,6-4,5) para as áreas urbana e rural respectivamente. Observou-se aparente tendência à aglomeração: sete eram naturais do rio Purus, três residiam na mesma localidade, dois habitavam o mesmo domicílio.

From January to March 2001 a seroepidemiological survey for American trypanosomiasis (Chagas disease) was carried out among urban and rural human populations in areas of the Upper Purus basin, in the western Brazilian Amazon region, using serial testing with three different serological techniques. The sample was composed of 1,055 individuals: 844 from urban and 211 from rural areas. Autochthonous infection was identified in nine individuals aged 16 to 72 years: five from urban and four from rural areas. The estimated prevalences of Chagas infection for the urban and rural areas were 0. 6 percent (95 percent CI: 0. 2-1. 4) and 1. 9 percent (95 percent CI: 0. 6-4. 5) respectively. An apparent clustering trend was noted: seven were born along the Purus river: three lived at the same locality and two of them in the same dwelling.

[Radiographic study of the oesophagus of chagasic patients in 25 years of the Mambaí Project]. / Estudo radiológico do esôfago de chagásicos, em 25 anos do Projeto Mambaí

This work describes radiography studies of the esophagus in chagasic patients of the Mambaí project over a 25 year period. Each person realized two radiographs in four different periods (1975-1976, 1980-1982, 1988-1991 and 1998-2000). The first radiograph was realized in the right anterior oblique position after swallowing 75 ml of barium sulphate solution and another 60 seconds later. In all periods the same methodology was used. The radiographs were read by the same researcher, and the megaesophagus was classified in four groups according to Rezende and colleagues. The prevalence of megaesophagus was 5.2%; 5.0%; 18.6% and 13.9% in 1975-1976, 1980-1982, 1988-1991 and 1998-2000 respectively. The incidence of megaesophagus from 1975 to 2000 was 11.5% (51/445). During 25 year, 394 (84.2%) patients presented radiographs normal of esophagus, 11 (2.3%) diagnosed as megaesophagus in 1975-1976 did not progress, 61 (13%) that were normal, doubtful or already presented megaesophagus in 1975-1976, progressed and 2 (0.4%) presented regression of group I megaesophagus, diagnosed in previous studies.

Estudo radiológico do esôfago de chagásicos, em 25 anos do Projeto Mambaí / Radiographic study of the oesophagus of chagasic patients in 25 years of the Mambaí Project

Este trabalho relata os estudos do esôfago através da abreugrafia, de chagásicos do projeto Mambaí no período de 25 anos. Cada indivíduo realizou duas abreugrafias, em quatro períodos (1975-1976, 1980-1982, 1988-1991 e 1998-2000). A primeira abreugrafia foi realizada em posicão obliqua anterior direita imediatamente após a ingestão de 75ml de sulfato de bário e a segunda um minuto após. Em todos os períodos foi utilizada a mesma metodologia, as abreugrafias foram lidas pelo mesmo pesquisador e os megaesôfagos foram classificadas em quatro grupos, segundo os critérios de Rezende e colaboradores. A prevalência de megaesôfago foi 5,2 por cento; 5 por cento; 18,6 por cento e 13,9 por cento em 1975-1976, 1980-1982, 1988-1991 e 1998-2000, respectivamente. A incidência de megaesôfago no período de 1975 a 2000 foi 11,5 por cento (51/445). Durante 25 anos, 394 (84,2 por cento) chagásicos permaneceram com o esofagograma normal, 11 (2,3 por cento) diagnosticados com megaesôfago em 1975-1976, não progrediram, 61 (13 por cento) que eram normais, duvidosos ou já tinham megaesôfago em 1975-1976, progrediram e 2 (0,4 por cento) tiveram regressão do megaesôfago grupo I, diagnosticado em estudos anteriores.

[Clinical findings of tegumentary leishmaniasis in children under five years of age in an endemic area of Leishmania (Viannia) braziliensis]. / Características clínicas da leishmaniose tegumentar em crianças de 0 a 5 anos em uma área endêmica de Leishmania (Viannia) braziliensis.

A retrospective study was performed in a field clinic to characterize the clinical findings of tegumentary leishmaniasis in children from 0 to 5 years old. The clinical records of 4,464 patients were analyzed at the Primary Health Center of Corte de Pedra, Presidente Tancredo Neves, Bahia, Brazil, from May 1987 to December 1995. Four hundred and ninety one (11.8%) children were identified among 4,275 new cases of tegumentary leishmaniasis registered at this Unit. The gender ratio (M:F) for children under six years was 1.1:1. Cutaneous lesions predominated (98%), mainly skin ulcers (99%) located above the waist (p<0.05). Thirty five percent had multiple lesions. The observed magnitude of the disease in children, the similar proportion of cases in both genders and the location of the lesions suggest the possibility of peri or intradomiciliary transmission.

Características clínicas da leishmaniose tegumentar em criancas de 0 a 5 anos em uma área endêmica de Leishmania (Viannia) braziliensis / Clinical findings of tegumentary leishmaniasis in children under five years of age in an endemic area of Leishmania (Viannia) braziliensis

Para caracterizar a clínica da leishmaniose tegumentar em criancas de 0 a 5 anos de idade, foram avaliadas, retrospectivamente, 4.464 fichas clínicas do Centro de Saúde de Corte de Pedra, Presidente Tancredo Neves, Bahia, Brasil, área endêmica de leishmaniose tegumentar americana, entre maio de 1987 e dezembro de 1995. Foram registrados neste período 4.275 casos novos de leishmaniose, dos quais, 491 (11,5 por cento) correspondiam a criancas de 0 a 5 anos. A razão entre gênero masculino e feminino nas criancas foi 1,1:1. A forma clínica predominante foi a cutânea (98 por cento) e as lesões ulceradas foram as mais freqüentes (99 por cento). A localizacão das lesões ocorreu, principalmente, acima da cintura (p<0,05), e 35,5 por cento apresentaram lesões múltiplas. A magnitude da doenca em criancas, a freqüência semelhante observada em ambos os gêneros e a localizacão das lesões sugere a possibilidade de transmissão vetorial no domicílio ou peridomicílio.

Úlceras leishmanióticas cutâneas com presença de Corynebacterium diphtheriae

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

Talidomida no tratamento do eritema nodoso hansênico: revisão sistemática dos ensaios clínicos e perspectivas de novas investigações / Thalidomide in the treatment of erythema nodosum leprosum (ENL): systematic review of clinical trials and prospects of new investigations

FUNDAMENTOS: A hanseníase persiste como problema de saúde pública, e episódios de ENH são eventos agudos que ocorrem antes, durante e após PQT. Na última década, o uso da talidomida como agente imunomodulador foi expandido a outras doenças. OBJETIVOS: realizar revisão sistemática dos ensaios clínicos publicados sobre a eficácia e efeitos colaterais da talidomida no ENH. Descrever metodologia e resultados da triagem para recrutamento de ensaio clínico visando avaliar dose-resposta da talidomida seguida de desmame no ENH moderado e grave, realizado no Brasil. MÉTODOS: Analisaram-se ensaios publicados sobre talidomida no ENH. Foi delineado um ensaio clínico duplo-cego randomizado para avaliar dose de 100 thalid 300mg/dia de talidomida durante fase aguda de ENH, seguida de desmame da talidomida, thalid placebo. Para este ensaio clínico descreve-se metodologia e dados de recrutamento de pacientes, com ênfase na gravidade dos episódios de ENH. RESULTADOS: Os seis ensaios clínicos publicados nas décadas de 1960 e 1970 apontam para o benefício da talidomida no ENH, embora diferenças metodológicas dificultem a comparação. Na fase de recrutamento do ensaio brasileiro, dos 143 pacientes de ENH triados, 65 por cento eram potencialmente elegíveis. A associação com neurite em 56,4 por cento dos ENH moderados e graves exigiu co-intervenção com corticosteróide. CONCLUSÃO: O padrão de recrutamento dos pacientes evidenciou alta freqüência de neurite nos episódios de ENH. O esquema de talidomida isolada no ENH foi avaliado como infreqüente na prática clínica brasileira. O desafio atual é acumular evidências sobre a eficácia e efeitos colaterais da talidomida em associação com corticosteróides.

[Risk factors for cutaneous leishmaniasis transmission in children aged 0 to 5 years in an endemic area of Leishmania (Viannia) braziliensis]. / Factores de riesgo para la transmisión de leishmaniasis cutánea en niños de 0 a 5 años en un área endémica de Leishmania (Viannia) braziliensis.

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.

[The influence of the parasitemia on the evolution of the chronic Chagas' disease]. / Influência da parasitemia na evolução da doença de Chagas crônica.

During 13 years, 190 individuals with chagasic infection were submitted to clinical and parasitological examinations to investigate the relationship between parasitemia and the evolution of chronic chagasic infection. Fifty-six patients with positive xenodiagnosis and 134 with negative exams were compared from 1988 to 91, it was found that 22 (39.3%) and 50 (37.3%), respectively, presented disease progression. The parasitemia was stratified into high, medium and low and the relation with the disease evolution showed that 5 (62.5%), 10 (41.7%) and 57 (36.1%), respectively, presented progressive disease, though without a statistically significant difference (p>0.05). When 20 patients with persistent parasitemia in 1976/91, were compared with 59 with negative xenodiagnosis, a progressive evolution was observed in 6 (30%) and 17 (28.8%), respectively. Comparing six patients with high parasitemia and 59 with negative exams, it was verified that 3 (50%) and 17 (28.8%), respectively, showed progressive disease, but this was not statistically significant, (p>0.05). Mean age with high, medium and low parasitemia were 39.6, 45.3 and 41.5 years, respectively, (p>0.05). Mean age in patients showing progressive, unaltered and regressive evolution was 46.4, 39.8 and 32.6 years, respectively, with a statistically significant difference between progressive and regressive evolution (p<0.05). It is suggested that high parasitemia did not have an influence on the evolution of the chronic infection.

Influência da parasitemia na evolução da doença de Chagas crônica / The influence of the parasitemia on the evolution of the chronic Chagas' disease

Estudou-se clínica e parasitologicamente, durante 13 anos, 190 indivíduos com infecção chagásica objetivando investigar a relação entre parasitemia e a evolução da doença de Chagas crônica. Comparou-se a parasitemia de 56 indivíduos xenopositivos e 134 xenonegativos, em 1988/91 com a evolução clínica encontrado-se 22 (39,3 por cento) e 50 (37,3 por cento), respectivamente, com evolução progressiva. Estratificou-se a parasitemia em 1988/91, em alta, média e baixa e a correlação clínica mostrou que 5 (62,5 por cento), 10 (41,7 por cento) e 57 (36.1 por cento) indivíduos, respectivamente, apresentaram evolução progressiva, sem diferença estatística significante, (p>0,05). No período de 1976/91, houve 20 pacientes com parasitemia constante e 59 sem parasitemia, observando-se evolução progressiva em 6 (30 por cento) e 17 (28,8 por cento), respectivamente. Houve seis pacientes com alta parasitemia e, 59 sem parasitemia, verificado-se que 3 (50 por cento) e 17 (28,8 por cento), respectivamente, apresentaram evolução progressiva, sem diferença estatística significante, (p>0,05). As médias das idades daqueles com alta, média e baixa parasitemias foram 39,6; 45,3 e 41,5 anos, respectivamente, (p>0,05). As médias das idades dos pacientes com evolução progressiva, inalterada e regressiva foram respectivamente, 46,4; 39,8 e 32,6 anos, com diferença estatística significante entre aqueles com evolução progressiva e regressiva, (p<0,05). Sugere-se que a alta parasitemia não influenciou na evolução da doença crônica.

Factores de riesgo para la transmisión de leishmaniasis cutánea en niños de 0 a 5 años en un área endémica de Leishmania (Viannia) braziliensis / Risk factors for cutaneous leishmaniasis transmission in children aged 0 to 5 years in an endemic area of Leishmania (Viannia) braziliensis

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.

Antibody response in patients with cutaneous leishmaniasis infected by Leishmania (Viannia) braziliensis or Leishmania (Viannia) guyanensis in Brazil.

The antibody response against Leishmania (Leishmania) amazonensis crude antigen was measured through the indirect immunofluorescent assay (IFA) and the immunoenzymatic assay (ELISA) in 114 patients with cutaneous leishmaniasis (CL) in Brazil. Fifty-four patients were infected by Leishmania (Viannia) braziliensis, and 60 patients had L. (V.) guyanensis infection. Patients were comparable by age, sex, disease duration and the Montenegro skin test diameter. L. (V.) braziliensis-infected patients showed significant lower number of ulcerated lesions, greater ulcerated area and higher proportion of lymph node enlargement. Sensitivity of IFA was 79.6% (95% CI 66.1-88.9) and 71.7% (95% CI 58.4-82.2) for L. (V.) braziliensis and L. (V.) guyanensis-infected patients, respectively (P=0.324). Sensitivity of ELISA was 98.2% (95% CI 88.8-99.9) and 85.0% (95% CI 72.9-92.5) for L. (V.) braziliensis and L. (V.) guyanensis-infected patients, respectively (P=0.018). Significant differences were observed in the magnitude of the antibody response before treatment with higher levels detected in L. (V.) braziliensis-infected patients by both serologic techniques. Eighty-four patients had serologic evaluations before and 12 weeks after treatment with meglumine antimoniate, 20 mg/kg/day for 20 days. Significant lower optic density values were observed after treatment with both species independent of cure or failure. Our data showed that L. (V.) braziliensis induces a higher antibody response against L. (L.) amazonensis antigens than L. (V.) guyanensis and that down-modulation of the antibody response occurs shortly during disease evolution after treatment. Moreover the data support the use of ELISA as a better tool for detection of antibodies in CL.

[A serological survey of the infection by Echinococcus sp. in the municipality of Sena Madureira, AC]. / Inquérito sorológico da infecção pelo Echinococcus sp no município de Sena Madureira, AC.

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.