Cuadros tóxicos producidos por mordeduras de araña en Chile: latrodectismo y loxoscelismo / Toxic pictures produced by spider bites in Chile: latrodectism and loxoscelism

Latrodectism, produced by the bite of Latrodectus spiders, is worldwide distributed, occurs in hot seasons, and affects mostly men when carrying out agricultural activities. The main symptoms are muscular pain and tremors, profuse perspiration, increased lacrimal, nasal and salival secretions, and hypertension. Symptoms last one week. Neostigmine is a very efficient drug in the treatment of this condition. Loxoscelism, caused by the bite of Loxosceles spiders, is worldwide distributed, affects individuals of all ages. It may present two clinical forms: cutaneous loxoscelism (CL) and viscerocutaneous loxoscelism (VCL). Both forms have been registered in all seasons, with a higher incidence in hot periods, and in bedrooms, when the person is sleeping or dressing. The cutaneous surface of limbs and face are most frequently affected. Local clinical manifestations are pain, edema and livedoid plaque, most of which evolve into a necrotic scar in CL, whereas hematuria, hemoglobinuria, jaundice, fever and sensorial involvement characterize VCL. If visceral involvement does not appear within 24 hours, it is probable that the diagnosis corresponds to CL, with a good prognosis. If a VCL patient survives 48 hours, the possibilities of recovery are high. The patients are successfully treated with parenteral antihistamines or corticosteroids in CL and corticosteroids in VCL

Malaria en Chile: 1913-2001 / Malaria in Chile from 1913 to 2001

Background: Malaria was restricted to the I Region of Chile, being Anopheles pseudopunctipennis the only vector species. In 1936 the parasitosis affected more than 50 percent of the population and 62.4 percent of military recruits, proceeding from Southern regions became infected. From 1937 to 1947, an antimalaria campaign was carried out, stressing actions on the battle against the vector and the treatment of malaria infected individuals. Since April 1945 no autochthonous cases of malaria have been detected. Aim: To update the situation of malaria in Chile. Methods: 1) Imported malaria: Analysis of occasional publications on the subject (1945-1988) and the annual reports of the Ministry of Health Department of Epidemiology (1990-2001). Annual reports on the Anopheles specimens collected -mostly larvae- in the provinces of Arica and Iquique and examined in the Parasitology Unit of the School of Medicine, University of Chile, during the period 1980-2001. Results: 1) Imported malaria. A total of 24 cases were published in the period 1945-1988. In the 1980-2001 period, the Ministry of Health recorded 66 cases with 5 (8.8 percent) deaths. 2) Anophelines: Only in 1984, 1985, 1998 and 2001 A. pseudopunctipennis foci were detected. Entomological surveillance was stressed and insecticides were applied on these focuses. Conclusions: Autochthonous malaria does not exist in Chile since 1945. The detection of malaria cases in countries where the parasitosis was eradicated, can be the result of tourism or migrations. In Chile, the Environmental Programs of Arica and Iquique perform periodical surveys in localities where mosquitoes exist. When A. pseudopunctipennis is found, the entomological vigilance is stressed and insecticide applications are reiterated until the situation is controlled

Malaria en Chile: 1913-2001 / Malaria in Chile from 1913 to 2001

Background: Malaria was restricted to the I Region of Chile, being Anopheles pseudopunctipennis the only vector species. In 1936 the parasitosis affected more than 50 percent of the population and 62.4 percent of military recruits, proceeding from Southern regions became infected. From 1937 to 1947, an antimalaria campaign was carried out, stressing actions on the battle against the vector and the treatment of malaria infected individuals. Since April 1945 no autochthonous cases of malaria have been detected. Aim: To update the situation of malaria in Chile. Methods: 1) Imported malaria: Analysis of occasional publications on the subject (1945-1988) and the annual reports of the Ministry of Health Department of Epidemiology (1990-2001). Annual reports on the Anopheles specimens collected -mostly larvae- in the provinces of Arica and Iquique and examined in the Parasitology Unit of the School of Medicine, University of Chile, during the period 1980-2001. Results: 1) Imported malaria. A total of 24 cases were published in the period 1945-1988. In the 1980-2001 period, the Ministry of Health recorded 66 cases with 5 (8.8 percent) deaths. 2) Anophelines: Only in 1984, 1985, 1998 and 2001 A. pseudopunctipennis foci were detected. Entomological surveillance was stressed and insecticides were applied on these focuses. Conclusions: Autochthonous malaria does not exist in Chile since 1945. The detection of malaria cases in countries where the parasitosis was eradicated, can be the result of tourism or migrations. In Chile, the Environmental Programs of Arica and Iquique perform periodical surveys in localities where mosquitoes exist. When A. pseudopunctipennis is found, the entomological vigilance is stressed and insecticide applications are reiterated until the situation is controlled (AU)

Situación epidemiológica actual de la triquinosis en Chile 1991-2000 / Epidemiology of trichinosis in Chile from 1991 to 2000

Background: Human and animal trichinosis has been recorded in Chile since the late XIX century and is irregularly distributed along the country. From high rates of infection in the early 1900, the frequency of this parasitosis in man has progressively decreased. Aim: To describe and discuss the epidemiological situation of trichinosis in Chile during the decade 1991 - 2000. Material and methods: Human infection was assessed using annual incidence and lethality reports provided by the Ministry of Health, periodic photostrichinoscopies in corpses of non selected individuals autopsied at the Medico Legal Service and periodic national serologic surveys. The advise of one of the authors in an epidemic that occurred in 1999 in the VIII Region was also used. Animal infection was assessed using the annual prevalence of infection in pigs slaughtered in abattoirs, furnished by the Ministry of Health. Results: A total of 631 clinical cases with 4 deaths (0.6 percent) was recorded. A decline in the incidence, from 0.7 x 100,000 in 1991 to 0.2 x 100,000 in 2000 was recorded. The higher frequency of the parasitosis was observed in the Metropolitan, VI, VIII and X regions. Although human trichinosis has been observed in all seasons, its frequency increases in close relation with the higher pork consumption in cold seasons (45.8 percent in winter and 37.5 percent in spring). There has been a decrease of infection rates in pigs from 0.17 percento in 1991 to 0.04 percento in 1998 - 2000. Conclusions: The incidence and prevalence of trichinosis shows a constant decline in Chile. Considering the geographical characteristics of Chile, it is possible that an undetermined number of pigs are home reared and butchered without veterinary control, constituting an important source of human trichinosis

Inmunodiagnóstico de la triquinosis humana / Inmunodiagnosis of human trichinosis

An indirect hemagglutination test (IHAT) and an ELISA test for trichinosis using as antigen a larvae soluble fraction from Trichinella spiralis was carried out for the detection of IgG, IgM and IgA specific antibodies in 113 serum samples from patients confirmed or suspected to have trichinosis by strong clinical and epidemiological evidences (Group 1). The same test were also performed on 110 serum samples corresponding to patients without strong enidences of having trichinosis (Group II). In Group 1 the correponding sensitivities for RHAI, ELISA IgG, ELISA IgM, ELISA IgA were: 82.3-85.8-88.5 and 88.5 percent respectively. Seventeen patients were tested again a week after the first analysis (10 of them corresponded to negative ones), increasing the positivity: 23.5-100.0;35.3-100.0;41.2-100.0 and 41.2-100.0 percent for RHAI, ELISA IgG, ELISA IgM and ELISA IgA, respectively. Other two patients were followed-up for 5 years. IHAT and ELISA IgG remained positive, whereas ELISA IgM and ELISA IgA were constantly negative betweeen 17 and 32 months in one case, and between 48 and 60 months in the other (this last one had presented a severe clinic disease). In the group II, four patients were positive with IHAT, however only one for ELISA IgA, the latter also presented ELISA IgM near the cut off. The use of ELISA IgG, ELISA IgM and ELISA IgA in the immunodiagnosis of trichinosis is discussed

Fragmentos de entomología y parasitología en la literatura de occidente: desde Cervantes a Samarago / Fragments of entomology and parasitology in the western literature: from Cervantes to Samarago

In an attempt to amplify the perspective of allusions made to entomological and parasitological situations in the 20th century Latin American narrative, a total of 25 books written by Jorge Amado (1912-2001), Miguel Angel Asturias (1989-1974), Albert Camus (1913-1960), Camilo José Cela (1916), Miguel de Cervantes (1547-1616), Julio Cortazar (1914-1984), Fedor Dostoievski (1821-1881), Jorge Edwards (1931), William Faulkner (1897-1962), Gustave Flaubert (1821-1880), Gabriel García Marquez (1928), Herman Hesse (1877-1962), Victor Hugo (1802-1885), Franz Kafka (1883-1924), Patricio Manns (1937), Benito Perez Galdos (1843-1920), Luigi Pirandello (1867-1936), Marcel Proust (1871-1922), Francisco de Quevedo (1580-1645), Ernesto Sabato (1911), Jose Samarago (1922), Alexander Soljenitsin (1918) and Leon Tolstoy (1828-1910) has been reviewed. We have selectively extracted paragraphs and fragments from them, in which in a direct or metaphoric form varied entomological or parasitological situations are quoted, by thematic affinity, in an ordered presentation

Miasis importada: siete casos de parasitación cutánea por larvas de la mosca dermatobia hominis / Imported myasis: 7 cases of cutaneous parasitism caused by dermatobia hominis

Myasis is the parasitism of organs and tissues of warm-blooded vertebrates by flies larvae. D hominis is a flie geographically restricted to tropical America from Mexico to northern Argentina. The adult flie, which is not hematophagous, needs to put its eggs on the abdominal surface of hematophagous arthropods which serve as carriers of future larvae which are deposited on the skin of the hosts (mammals, birds and accidentally men) when biting. Seven patients (two females) aged 7 to 35 years old, of different nationalities, recalled receiving mosquito bites, after staying in tropical American areas in the previous forty days. They presented furuncle-like lesions in exposed surfaces of the body. These lesions, 2-3 cm long, pruritic and mildly tender, broke and released a serous or serohematic fluid. Through the resulting opening, it was possible to partially observe the larva. Larvae were extracted by manual pressure (4) or surgical incision (3) and identified as D hominis larvae. Diagnosis of dermatobiasis, an imported myasis, must be based on the characteristics of lesions and the previous residence in endemic areas of America

Loxoscelismo en pediatría: Región Metropolitana Chile / Loxoscelism in paediatrics: Región Metropolitana Chile

Loxoscelismo es el cuadro tóxico producido por veneno que arañas del género Loxosceles L. Iaeta, en Chile, inyectan en el momento de la mordedura. Puede presentarse en dos formas clínica: loxoscelismo cutáneo-visceral (LCV). El objetivo del presente trabajo es exponer y analizar los aspectos clínico-epidemiológicos de 56 casos pediátrico -38 LC y 18 LCV- atendidos en la Región Metropolitana. En los últimos 45 años se ha encontrado una mayor incidencia de ambas formas en primavera-verano, en dormitorios cuando el niño dormía o se estaba vistiendo, siendo las áreas cutáneas más frecuentemente afectadas las extremidades y cara, con sensación de lancetazo urente como síntoma inicial. Manifestaciones clínicas más frecuentes: dolor, edema y placa livedoide que derivó a escara necrótica. Manifestaciones clínicas del LCV fueron hematuria, hemoglobinuria, ictericia, fiebre y compromiso de conciencia; letalidad 22,2 por ciento. El LCV no tuvo relación con el sitio de mordedura, extensión de la lesión local ni época del año. Si el compromiso visceral no aparece en las primeras 24 h es muy probable que se trate de un LC cuyo pronóstico es bueno. Si el paciente con LCV ha sobrepasado las 48 h, sus posibilidades de recuperación son altas. El tratamiento fue parental: antihistamínicos o corticoides en LC y corticoides en LCV. Conclusiones: En esta serie se observa una predominancia en el sexo femenino, sin diferencias estacionales ni de edad. En su gran mayoría los casos se originaron en el domicilio, afectando en especial las extremidades. El LCV fue más frecuente en mujeres, y sus principales manifestaciones fueron la hematuria y hemoglobinuria, y la precocidad del diagnóstico y su manejo son factores fundamentales en el pronóstico

La parasitología y la entomología en la narrativa latinoamericana del siglo XX / Parasitology and entomology in the 20th century latin american narrative

In the present reviev of twelve pieces produced by distinguished 20th century Latin American writers _ Jorge Luis Borges from Argentina, Jorge Amado and João Ubaldo Ribeiro from Brazil, José Donoso from Chile, Gabriel García Márquez fron Colombia, Alejo Carpentier from Cuba, Miguel Angel Asturias from Guatemala, Octavio Paz from Mexico, Mario Vargas Llosa from Perú, Horacio Quiroga and Mario Benedetti from Uruguay and Arturo Uslar-Pietri from Venezuela - paragraphs or parts of paragraphs in which extracted in a selective form. Sometimes in these descriptions appear, local or regional expressions, without ignoring colorful folkloric representations. For a easier interpretation these or part of these paragraph sentences have been arraged by thematic similarities. In a varied and kaleidoscopic vision, it will be possible to find protozooses (malaria, Chagas diseases, leishmaniasis, amibiasis), helminthiases (ascariasis, hydatidosis, trichinosis, schistosomiasis, cysticercosis, onchocerciasis), parasitose produced by arthropods (pediculosis, scabies, tungiasis, myiasis), passing progressivelly to hemaphagous arthropods (mosquitoes, gnats, horse flies, bedbugs, ticks), venomous arthropods (Latrodectus spiders, scorpion, wasps, bees), mechanical vectors (flies and cockroaches), culminating with a conjuction of bucolic arthropods (butterflies, crickets, grasshoppers cicadas, ants, centipedes, beethes, glowworms, dragonflies)

Estudio comparativo de la sensibilidad y mortalidad de las ninfas III y IV de triatoma infestans usadas en el xenodiagnóstico de pacientes chagásicos crónicos / Comparative study on sensivity and mortality of triatoma infestans nymphs III and IV used in the xenodiagnosis of chronic chagasic patients

Triatoma infestans nymphs have shown a good sensitivity for detecting trypanosoma cruzi in the bood stream of infected hosts when are used in the xenodiagnosis (XD). This method, with its natural limitations, using seven nymphs III of T. infestans, has been routinely utilized with a satisfactory yield. With the aim of an eventual improving of the yield of XD (with 7 nymphs), two series of 54 XD boxes each, containing a total of 378 nymphs III and 378 nymphs IV respectively, were applied one of each during three consecutive days to nine chronic chagasic patients. Each of the nymphs was weighted before an after the application of the boxes, and the intestinal content of them was examined 30, 60 and 90 days later. The main comparative results obtained with nymphs III and IV of T. infestans were: blood ingestion 40 versus 107 mg (2,7 higher), positivity of insects 35,8 percent versus 50,6 percent (15,8 percent higher), positivity of XD boxes (7 nymphs each) 46,3 percent versus 55,6 percent (9,3 percent higher), and mortality rates 28,6 percent versus 12,2 percent (16,4 percent lower). All these results demonstrate that nymphs IV of T. infestans, because their higher capacity of ingesting blood and higher tolerance to examination manipulations, are more suitable for been used in XD

Infestación de los párpados de un niño por phthirus pubis / Eyelids infestation by phthirus pubis in a boy

A clinical case of phthirus pubis infestation of the eyelids in an eight year old boy is presented. He complained of a bilateral eyelids inflammation for the last two weeks which had not healed with a daily application of a collyrium. Physical examination showed the presence of small dark spheres, of approximately 1 mm. attached to the proximal extreme of the eyelashes. A microscopical examination of these elements permitted to identify adults and eggs of P. pubis. Neither insects nor eggs were found in the scalp of the patient. Treatment consisted in the extraction of the parasite elements by means of a fine forceps after the application of liquid vaseline in the eyelashes. A total of 23 adults insects and 32 eggs was removed. The boy proceeded from a boarding school, where none of the other 27 children was found infested and stayed there form monday to friday, going home for week ends. It was impossible to contact the mother, the most probable source the patient infestation, for epidemiological and prophylactical purposes

Comparación de la infección por trypanosoma cruzi en niños menores de 10 años de la V Región Chile: 1982-1995 / Comparison of trypanosoma cruzi infection in less than 10 year old children from the V Región Chile: 1982-1995

Evaluation of desinsectation programs carried out in the two health services from the V region, was undertaken by comparing serologic prevalences of T. cruzi infection age groups exposed to the risk of infection in rural areas during the antivectorial campaign activities (1982 vs 1995). Thus, were studied 2,193 blood samples from children under 10 years of age, proceeding from six chagasic endemic provinces in which antitriatomic domiciliary insecticide sprayings had been performed. Indirect hemagglutination and ELISA tests were carried out to each of the blood samples. A total de 42 (1,9 percent) children resulted positive. As an five counties no positive cases were detected in the last five years it is possible to assume that vector trasmission of T. cruzi should have been interrupted in them. When comparing prevalences existing in 1982 with the present ones, it is possible to observe a 63,5 percent of reduction of transmission in the V region, been this reduction higher in the Aconcagua Health services with 79,6 percent and lower in the Viña del Mar - Quillota Health Service with 55,6 percent. According to these results, comparison of prevalence of T. cruzi infection in children less than 10 year old in diverse periods, allows evaluate the vectorial control of Triatoma infestans programs

La parasitología y la entomología en la narrativa latinoamericana del siglo XX / Parasitology and entomology in the 20th century Latin American narrative

Review of twelve pieces produced by distinguished 20th century Latin American writers - Jorge Luis Borges from Argentina, Jorge Amado and Joäo Ubaldo Ribeiro from Brazil, José Donoso from Chile, Gabriel García Márquez fron Colombia, Alejo Carpentier from Cuba, Miguel Angel Asturias from Guatemala, Octavio Paz from Mexico, Mario Vargas Llosa from Perú, Horacio Quiroga and Mario Benedetti from Uruguay and Arturo Uslar-Pietri from Venezuela. Sometimes in the descriptions appear, local or regional expressions, without ignoring colorful folkloric representations. For an easier interpretation, these or part of these paragraph sentences have been arranged by thematic similarities. In a varied and kaleidoscopic vision, it will be possible to find protozooses (malaria, Chagas diseases, leishmaniasis, amibiasis), helminthiases (ascariasis, hydatidosis, trichinosis, schistosomiasis, cysticercosis, onchocerciasis), parasitoses produced by arthropods (pediculosis, scabies, tungiasis, myiasis), passing progressively to hemaphagous arthropods (mosquitoes, gnats, horse flies, bedbugs, ticks), venomous arthropods (Latrodectus spiders, scorpion, wasps, bees), mechanical vectors (flies and cockroaches), culminating with a conjunction of bucolic arthropods (butterflies, crickets, grasshoppers cicadas, ants, centipedes, beethes, glowworms, dragonflies) (AU)

Hidatidosis en Chile: seroprevalencia y estimación del número de personas infectadas / Human hydatidosis in Chile: seroprevalence and an estimate of the number of infected people

Chile is located in the southwestern border of South America. The country is 4,329 km long and 96-342 wide. From north to south it is divided into five marked different biogeographical zones: deserts, steppes, bushes, forests (cattle raising) and austral (sheep raising). Population (june 1999) 15,017,760 (14,6 percent rural). Human hydatidosis is endemic in Chile. According to Ministry of Health information about 320 cases are registered each year. In order to find out the likely prevalence of human hydatidosis in Chile, a series of serosurveys was carried out in 1988-1997 throughout the total country. By using the indirect hemagglutination reaction and ELISA for hydatidosis (test with good sensibility and specificity) 60,790 unselected apparently healthy persons: 41,399 from urban areas (16,428 blood donors, 13,894 delivering mothers and 11,077 middle grade schoolchildren) and 19,361 from rural areas from randomly selected family groupings were studied. A total individuals 82 (136/100,000) resulted positive: 36 (87/100,000) urban and 46 (241/100,000) rural, being the prevalence higher in rural areas, particularly in the southern austral zone (mean 1068/100,00). These figures agree with those observed in clinical epidemiological studies. In conformity with the present results, in the whole country 17,002 individuals should have hydatidosis: 10,318 urban and 6,784 rural. All these possible infected people, not necessarily should present pathology in the future, as it has been observed in autopsies from unselected individuals, performed at the Medico Legal Service in Santiago, in whom 71,3 percent of diagnosed hydatidosis with hydatid cysts in many different locations, was an autopsy finding

Brotes epizoóticos de triquinosis en dos criaderos de cerdos de la Región Metropolitana, Chile / Epizootic outbreaks of trichinosis in 2 pig farms from the Metropolitan Region, Chile

In Chile swine trichinosis has presented a progressive decreasing in the last two decades of XX century. T. spiralis pig infection descended from an average of 0,683 per 1000 in 1980-1984 to 0,315 in 1985-1989 and to 0,115 in 1990-1996. In the particular case of Metropolitan Region this decreasing has been more marked: from an average of 0,058 per 1000 in 1990-1994 to 0,003 in 1995-1999. Between the end of june 1999 and middle january 2000 in Metropolitan Region abattoirs T. spiralis was detected in 15 (4,9 percent) out of 306 swine from two pigsties located in El Monte (E.M) and Padre Hurtado (P.H) 45 and 30 km south-west from Santiago. In the same period another four pigs from the same premises were found infected in abattoirs of other regions. During inspection visits it was stated that both pig farms had deficient sanitary conditions. Phototrichinoscopy was positive in three out of five rattus norvegicus collected in E.M. In pigsty PH the examination of diaphragm samples of 25 dogs and 17 cats resulted negative. In the premises originating T. spirali infected swine the Metropolitan Environmetal Health Service Abattoirs Program carries out and epidemiological vigilance consisting in the follow-up of animls destined for slaughtering in order to initiate prophylactic actions oriented to eliminate eventual sources of trichinosis infection for human and rearing pigs

Situación epidemiológica de la enfermedad de Chagas en el área endémica de la II Región de Antofagasta, Chile / Epidemiological situation of Chagasï disease in the endemic area from the II Region of Antofagasta, Chile

During 1997 a seroepidemiological study on Chagas' disease was carried out in 18 localities of three provinces (Tocopilla,El Loa and Antofagasta) of Region II (20º 56'-26º south lat.; 70º 38'- 67º west long.), in order to asses the impact of the control program against triatoma infestans launched in 1988, based on insecticide spraying of dwellings. By means of ELISA and an indirect hemagglutination test for chagas' disease blood samples from 1,034 children under 10 years of age were examined, arising a 0.5 por ciento (3 cases) positivity. Test resulted positivite in 2 (0.9 percent) children from the locality of San Pedro de Atacama and 1 (0.4 percent) from Calama city, all in the age group 6-10 year -old. However, none of their dwellings were found infested with T.infestants. These result indicate that the control program has a good possibility to prevent new human infections. It is advisable to continue the seroepidemiological and entomological vigilance and remark the necessity of increasing the effort in the study of transmission through other routes, to adopt or reinforce the pertinent preventive measures

Estudio longitudinal, mediante el xenodiagnóstico, de la parasitemia en pacientes con infección por trypanosoma cruzi crónica / Longitudinal study, by means of xenodiagnosis, of parasitemia in patients with chronic trypanosoma cruzi infection

A 2-5 years follow-up of parasitemia, by the use of xenodiagnosis (XD) was carried out in nine patients with chronic T. cruzi infection who proceeded from chagasic endemic areas of Chile. The patients (mean age 55 years) were hospitalized in the chronic section of a psychiatry institution sited in a permanent triatomines free urban area. Clinical examination, x-rays images (cardiovascular, esophagus and colon) and electrocardiogram resulted normal in all the patients. Basic study unit of parasitemia was a XD box which contained 7 nymphs III of triatoma infestans which was used in a serial XD consisting in the simultaneous application of a pair of boxes a day during three consecutive days, making a total of six boxes (42 nymphs). The minimal time of duration of infection (MDI.) for each patient was estimated that this was adquired close to hospitalization. The MDI. varied between 6 and 45 years. The global positivity of XD boxes ranged between 6.3 and 84.7 percent, being three patients lower than 12 percent and six patients higher than 52 percent. In considering the yield of XD it is important to stress that during all the study of the mine patients with chronic chagasic infection 1282 XD boxes were applied resulting positive 582 (45,4 percent). At the end of the follow-up all patients received specific treatment for chagasic infection with nifurtimox at the daily dose of 10 mg/kg of body weight during 60 days. According to the result, two main conclusions arise: 1.- serial XD has a hight efficiency for detecting, evaluate and evolve parasitemia in patients with chronic chagasic infection. 2.- parasitemia may present low, medium or high levels in different individuals and has a variable and fluctuating character

Loxoscelismo cutáneo de predominio edematoso / Cutaneous loxoscelism with edema predominance

Loxoscelism in the clinical condition produced by the venom of spiders belonging to the genus loxosceles, human cases of loxoscelism have been observed in diverse countries of different continents in temperate and tropical regions. In Chile loxoscelism is caused by loxosceles laeta, spider with domestic habits. Loxoscelism can be observed into two well definited clinical variants: cutaneous loxoscelism (CL) and systemic or viscerocutaneous loxoscelism (VCL) which occur in around 83,3 and 16,7 percent cases respectively. Within the universe of CL patients a clinical modality in which necrotic lesion is not present or is insignificant, but presenting a remarkable edema, particularly when the bite is on the face, which as received the name of CL with an edematous predominance (CLEP). In this paper the individual description and the assambled analysis of 10 cases, four males and six females, age ranging from 6 to 68 years, of CLEP are presented. Nine cases occurred in warm periods spring through fall and one in winter. In six cases the accident causing spider was seen and two of these were identified as L. laeta adult females. In all cases the patients went or were transported to emergency medical services 4-24 h after the bite. The predominant initial symptom was a burning stinging sensation at the site of the bite, followed by intensive pain which expanded the neighbour areas concomitantly with the emerging and progressive edema. In four of the nine patients in who the bite was on the face, the edema envolved all of it, closed both eyelids and expanded to the neck and upper part of the thorax. In three cases the enormous edema was the only signicant clinical manifestation, whereas in the remaining seven conjunctly with the edema, a small violaceous plaque or a blister of serous content gave place to a little livedoid plaque (diameter 0,3-0,8 cm) which evolved to desquamation without leaving any scarring. The edema was characterized by its brilliant rose color, painful and hard which is not accompanied by regional adenopathy. Treatment of the 10 patients depended on the moment in they were seen by us. It consisted on parenteral administration, according to age and weight, of 5-10 mg of chloroprofenpyridamine maleate every 8 hours for be continued every 12-24 hours until the patient was discharged. Parenteral route was preferred in order that it was going to be adequately absorbed

Programa especial para investigación y adiestramiento en enfermedades tropicales (TDR) / Special programme in research and training in tropical diseases

A description of the six tropical diseases involved in the programme and the achierement of research goals are evaluated. The author points out the important accomplishment of these aims in the impact in the malaria and filiariasis control, in the elimination of leprosy and the future erradication of Chagas disease in the Americas. At the same time the relevance of the manpower training were imphasized in the strenghtening on the research infrastructure of the member countries

Infección humana por trypanosoma cruzi en Chile: algunas estimaciones epidemiológicas y de los costos de la atención y tratamiento del paciente chagásico / Trypanosoma cruzi human infection in Chile: some estimates on epidemiology and care and treatment costs of the chagasic patient

According to the gathered information from the 1992 Chile census and an extensive epidemiological field study of Chagasïdisease in rural-periurban sections of the seven most northern regions where this malady is endemic, the following epidemiological outline arises: Total population in the country 13,348,401. Population in endemic regions 8,824,205 (urban 8,050,700 rural 773,505). Number of infected 142,000 (16,7 percent). Total number of cardiopathies 26,554 (18,7 percent). In considering the regime of fees for health attentions of the National Health Funds- including hospitalization, laboratory test and surgical interventions- in its minimal prices plus the value of medicaments, it is posible to produce some estimates onf the cost of attention and treatment, in U.S. dollars, of the chagasic patient. Average annual cost of a patient with chronic chagasic cardiopathy U.S.$ 439,29 to U.S.$ 584,25 If these values are multiplied by 26,554 give rise to a figure ranging from U.S.$ 11,644,906 to U.S.$ 15,514,474