A relação entre soroprevalência de anticorpos contra o glicolipídeo fenólico-I entre crianças em idade escolar e endemicidade da hanseníase no Brasil

Os programas de controle da hanseníase se beneficiariam de um método fácil para estimar prevalência e avaliar o impacto das ações de controle na prevalência da doença. A determinação da soroprevalência de anticorpos contra PGL-I através de estudos com crianças em idade escolar foi sugerida como indicador útil da taxa de prevalência da hanseníase a nível municipal.Para investigar se a soropositividade estaria associada aos coeficientes de detecção da hanseníase e se poderia ser usada como indicador da prevalência em outras áreas, 7.073 crianças em três estados endêmicos de hanseníase no Brasil foram testadas. Resultados mostram uma considerável variação da distribuição de soropositividade nas comunidades, independente do número de casos de hanseníase detectados. A soroprevalência foi significativamente menor nos colégios. Nenhuma diferença na distribuição da soropositividade determinada por ELISA ou dipstick foi observada. Nenhuma correlação entre o coeficiente de detecção da hanseníase e soropositividade pôde ser estabelecida.

Estudo clínico-radiológico do esôfago e dos cólons na fase aguda da doença de Chagas com relato de três casos de remissão espontânea de aperistalse do esôfago do grupo I

INTRODUÇÃO: O esôfago e os cólons foram investigados em pacientes na fase aguda da doença de Chagas, entre 1956 e 1989. MÉTODOS: A deglutição e o exame radiológico do esôfago foram explorados em 94 (90,4%) pacientes, sendo excluídas 10 crianças em virtude de tenra idade. O enema opaco foi realizado em 59 (56,7%) pacientes. RESULTADOS: A deglutição foi referida como normal em 86 (91,5%) pacientes, 5 dos quais apresentaram aperistalse do grupo I, enquanto a disfagia incipiente foi referida por 8, dos quais 7 apresentaram exame radiológico normal e apenas um, aperistalse do grupo I. Um segundo exame radiológico, realizado em 4 dos 6 casos, 6 meses após o primeiro, mostrou-se normal em 3 e permaneceu inalterado em um, o único que recebeu tratamento (benzonidazol) e considerado como curado da infecção. O ritmo intestinal resultou normal em 96 (92,3%) pacientes, obstipado em 7 (6,7%) e diarreico em um (1%). O enema evidenciou resultado normal em 54 (91,5%) pacientes, dolicossigmoide em 4 (6,8%) e dolicorretomegassigmoide em um (1,7%), que a eletromanometria demonstrou ser de natureza funcional. CONCLUSÕES: Para explicar a regressão da aperistalse, aventaram os autores duas hipóteses que não se excluem. A primeira,é a de que o processo inflamatório intramural na fase inicial da infecção poderia interferir na motilidade esofagiana, enfraquecendo a onda peristáltica; com a regressão do processo inflamatório, o peristaltismo voltaria ao normal, desde que a desnervação fosse limitada; a segunda hipótese é a de que tenha havido real re-inervação, com recuperação normal da onda peristáltica.

Class-I human leukocyte alleles in leprosy patients from Southern Brazil

INTRODUCTION: The present study was designed to investigate a possible role of HLA (histocompatibility leucocyte antigen) class-I alleles (HLA-A, -B, and -C) in leprosy patients from Southern Brazil. METHODS: Two hundred and twenty-five patients with leprosy and 450 individuals for the control group were involved in this research. HLA genotyping was performed through PCR-SSO protocols (One Lambda, USA); the frequency of these alleles was calculated in each group by direct counting, and the frequencies were then compared. RESULTS: There was an association between HLA-A*11 (6.9% vs 4.1%, p=0.0345, OR=1.72, 95% CI=1.05-2.81), HLA-B*38 (2.7% vs. 1.1%, p=0.0402, OR=2.44, 95% CI=1.05-5.69), HLA-C*12 (9.4% vs. 5.4%, p=0.01, OR=1.82, 95% CI=1.17-2.82), and HLA-C*16 (3.1% vs. 6.5%, p=0.0124, OR=0.47, 95% CI=0.26-0.85) and leprosy per se. In addition, HLA-B*35, HLA-C*04, and HLA-C*07 frequencies were different between lepromatous (LL) and tuberculoid (TT) patients. However, after adjusting for the number of alleles compared, Pc values became nonsignificant. CONCLUSIONS: Although our results do not support the previous findings that HLA class-I alleles play a role in leprosy pathogenesis, we suggest new studies because of the importance of the association between the HLA and KIR in the innate immune response to leprosy.

Mediastinitis and pericardial effusion in a patient with AIDS and disseminated Mycobacterium avium infection: a case report

We report the case of a 36-year-old man who had acquired immune deficiency syndrome and developed suppurative mediastinitis extending over the left lung and anterior thoracic wall around the sternum, pericardial effusions, splenomegaly, and mesenteric and periaortic lymphadenomegaly due to Mycobacterium avium (genotype I). The organism was isolated from an axillary lymph node and the bone marrow. Mediastinitis associated with disseminated M. avium complex infection is uncommon and, to the best of our knowledge, this manifestation has not reported before.

Proprioceptive neuromuscular facilitation in HTLV-I-associated myelopathy/tropical spastic paraparesis

Introduction: Human T cell lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) can impact the independence and motricity of patients. The aims of this study were to estimate the effects of physiotherapy on the functionality of patients with HAM/TSP during the stable phase of the disease using proprioceptive neuromuscular facilitation (PNF) and to compare two methods of treatment delivery. Methods: Fourteen patients with human T cell lymphotropic virus type I (HTLV-I) were randomly allocated into two groups. In group I (seven patients), PNF was applied by the therapist, facilitating the functional activities of rolling, sitting and standing, walking and climbing and descending stairs. In group II (seven patients), PNF was self-administered using an elastic tube, and the same activities were facilitated. Experiments were conducted for 1h twice per week for 12 weeks. Low-back pain, a modified Ashworth scale, the functional independence measure (FIM) and the timed up and go test (TUG) were assessed before and after the interventions. Results: In the within-group evaluation, low-back pain was significantly reduced in both groups, the FIM improved in group II, and the results of the TUG improved in group I. In the inter-group analysis, only the tone was lower in group II than in group I. Conclusions: Both PNF protocols were effective in treating patients with HAM/TSP.

Freshwater gastropods of the Baixada Maranhense Microregion, an endemic area for schistosomiasis in the State of Maranhão, Brazil: I - qualitative study

Introduction: The Baixada Maranhense Microregion currently has the highest prevalence of schistosomiasis in the State of Maranhão, likely because this parasitosis is characterized as an occupational disease, and increased contact with water increases the risk of infection by Schistosoma mansoni. This paper reports the results of the first comprehensive freshwater malacological survey performed in the Baixada Maranhense Microregion. Methods: Freshwater mollusks were collected from the twenty-one municipalities of the Baixada Maranhense Microregion and from Bacurituba and Cajapió and were evaluated for infection by trematodes. Results: A total of 9,129 mollusks were collected (sixteen species), which included the first records of six species in the State of Maranhão: Gundlachia radiata, G. ticaga, Hebetancylus moricandi, Plesiophysa guadeloupensis, Pomacea bridgesii diffusa and Omalonyx sp. Biomphalaria glabrata was found in five municipalities, whereas B. straminea was found in nine. Biomphalaria glabrata and B. straminea were observed in syntopy in Pinheiro and São Bento. Of the 990 specimens of B. glabrata and the 2,109 specimens of B. straminea that were exposed to and/or analyzed for the presence of larval trematodes, only a single specimen of B. glabrata (0.1%) from São Bento shed S. mansoni. Other larval trematodes were first observed in mollusks from the State of Maranhão. Conclusions: These results indicate that the study area is epidemiologically important due to the presence of two natural vectors of schistosomiasis and the active transmission of schistosomiasis, which was confirmed in the infected specimen that was collected in this study.

Surgical treatment of type I neuritis in a teenage boy with borderline tuberculoid leprosy

Exacerbation of the immune response against Mycobacterium leprae can lead to neuritis, which is commonly treated via immunosuppression with corticosteroids. Early neurolysis may be performed concurrently, especially in young patients with a risk of functional sequelae. We report the case of a young patient experienced intense pain in the left elbow one year after the treatment of tuberculoid-tuberculoid leprosy. The pain was associated with paresthesias in the ulnar edge and left ulnar claw. After evaluation, the diagnosis was changed to borderline tuberculoid leprosy accompanied with neuritis of the left ulnar nerve. Early neurolysis resulted in rapid reduction of the pain and recovery of motor function.

Cryptococcosis in Atlántico, Colombia: an approximation of the prevalence of this mycosis and the distribution of the etiological agent in the environment

ABSTRACTINTRODUCTION:Cryptococcosis is an invasive disease acquired by inhalation of infectious propagules from the environment. Currently, compulsory notification of the spread of this disease is not required in Colombia. However, reporting of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome cases to the National Surveillance System has suggested that there is a growing population at risk of contracting cryptococcosis. Few studies have described the occurrence of cryptococcosis in Colombia. Therefore, in this study, we examined the pathology of this disease in Atlántico, Colombia and determined the distributions of Cryptococcus neoformans and Cryptococcus gattii in the environment.METHODS:Clinical samples/isolates were gathered from cases of cryptococcosis previously diagnosed at health institutions in Atlántico, and surveys were completed by clinicians. The environmental study considered 32 sampling points and three tree species, i.e., Quickstick ( Gliricidia sepium ), Almond ( Terminalia catappa ), and Pink trumpet ( Tabebuia rosea ). Environmental and clinical samples/isolates were analyzed for phenotypic and genotypic confirmation.RESULTS:From 1997-2014, 41 cases of cryptococcosis were reported. The mean patient age was 40.5 years (range: 18-63 years); 76% were men, and 78% were HIV positive. Isolation was possible in 38 cases ( C. neoformans , molecular type VNI in 37 cases and C. gattii , molecular type VGI in one case). In 2012-2014, 2,068 environmental samples were analyzed with a positivity of 0.4% ( C. neoformans , molecular type VNI) in Almond and Pink trumpet trees.CONCLUSIONS:Cryptococcus neoformans , molecular type VNI had a higher prevalence than C. gattii and was associated with human exposure and the pathogenesis of cryptococcosis in this geographical region.

Risk-benefit assessment of Bacillus Calmette-Guérin vaccination, anti-phenolic glycolipid I serology, and Mitsuda test response: 10-year follow-up of household contacts of leprosy patients

Abstract: INTRODUCTION: Despite multidrug therapy, leprosy remains a public health issue. The intradermal Bacillus Calmette-Guérin (BCG) vaccine, Mitsuda test (lepromin skin test), and anti-phenolic glycolipid I (PGL-I) serology are widely used in leprosy studies and have shown great epidemiological value. METHODS: This longitudinal study evaluated the relative risks and benefits of these three tools by comparing results observed in household contacts (HHCs) of leprosy patients who developed leprosy with those of HHCs who did not in a population of 2,992 individuals monitored during a 10-year period. RESULTS : Seventy-five (2.5%) new leprosy cases were diagnosed, including 28 (0.9%) co-prevalent cases. Therefore, for the risk-benefit assessment, 47 (1.6%) HHCs were considered as truly diagnosed during follow-up. The comparison between healthy and affected contacts demonstrated that not only did BCG vaccination increase protection, but boosters also increased to 95% relative risk (RR) reduction when results for having two or more scars were compared with having no scars [RR, 0.0459; 95% confidence interval (CI), 0.006-0.338]. Similarly, Mitsuda reactions >7mm in induration presented 7-fold greater protection against disease development compared to reactions of 0-3mm (RR, 0.1446; 95% CI, 0.0566-0.3696). In contrast, anti-PGL-I ELISA seropositivity indicated a 5-fold RR increase for disease outcome (RR, 5.688; 95% CI, 3.2412-9.9824). The combined effect of no BCG scars, Mitsuda reaction of <7mm, and seropositivity to anti-PGL-I increased the risk for leprosy onset 8-fold (RR, 8.109; 95% CI, 5.1167-12.8511). CONCLUSIONS: The adoption of these combined assays may impose measures for leprosy control strategies.

Infection of the central nervous system with dengue virus 3 genotype I causing neurological manifestations in Brazil

Abstract: A case of dengue virus 3 (DENV-3) genotype I infection with neurological manifestations occurred in Belo Horizonte, Minas Gerais in October 2012. The serotype was detected by PCR, and the genotype was assessed by sequencing and phylogenetic analysis of the C-prM region. The virus causing neurological manifestations clustered with other sequences of DENV-3 genotype I. Because neurological manifestations of DENV are possibly misdiagnosed in Brazil, this study serves as an alert of the importance of DENV diagnoses in CNS infections.

Normal bone density in male pseudohermaphroditism due to 5alpha- reductase 2 deficiency

Bone is an androgen-dependent tissue, but it is not clear whether the androgen action in bone depends on testosterone or on dihydrotestosterone. Patients with 5alpha-reductase 2 deficiency present normal levels of testosterone and low levels of dihydrotestosterone, providing an in vivo human model for the analysis of the effect of testosterone on bone. OBJECTIVE: To analyze bone mineral density in 4 adult patients with male pseudohermaphroditism due to 5alpha-reductase 2 deficiency. RESULTS: Three patients presented normal bone mineral density of the lumbar column (L1-L4) and femur neck, and the other patient presented a slight osteopenia in the lumbar column. CONCLUSION: Patients with dihydrotestosterone deficiency present normal bone mineral density, suggesting that dihydrotestosterone is not the main androgen acting in bone.

Involvement of C4 allotypes in the pathogenesis of human diseases

The complement system is an important humoral defense mechanism that plays a relevant role against microbial agents, inflammatory response control, and immunocomplex clearance. Classical complement pathway activation is antibody-dependent. The C4 component participates in the initial step of activation, and C4 expression is determined by 2 pairs of allotypes: C4A and C4B. Deficiencies in C4 allotypes have been associated with several diseases. The aim of the present review is evaluate the reported data in the literature regarding specific C4A and C4B deficiencies and characterize their clinical relevance. We searched the MEDLINE and LILACS databases. Papers referring to total C4 deficiency without allotype evaluation and case reports of primary C4 deficiency were not included. Deficiencies in C4 allotypes have been associated with Mycobacterium leprae infection, erythema nodosum, systemic sclerosis with anti-topoisomerase I antibodies, intermediate congenital adrenal hyperplasia with DR5 genotype, diabetes mellitus type 1 with DR3,4 genotype, and diabetes mellitus with antibodies against islet cells. C4 allotype deficiency is also related to C4B deficiency and autoimmune-associated diseases, such as systemic lupus erythematosus, or diseases with an autoimmune component, such as autism. Some reports associate C4A with thyroiditis after delivery as well as limited and systemic sclerosis without anti-topoisomerase I antibodies. However, the studies with C4A and C4B have been concentrated in isolated populations, and some of the studies could not be reproduced by other authors.

Rios da Bacia Amazônica. I. Afluentes do rio Negro

Foram analisadas e comparadas neste trabalho, quanto às qualidades físico-químicas, amostras de água de 29 (vinte e nove) afluentes do rio Negro, A maioria das águas e muito pobre em sais dissolvidos, e por outro lado bastante ácida, sendo observado que. as substâncias coloridas exercem influencia sobre algum parâmetros químicos isto bem demonstrado pelos resultados de coeficiente, de correlação a 5%. Os rios da margem esquerda provenientes das, montanhas localizadas ao norte são mais férteis em substâncias nutritivas minerais. Já os da margem direita, que em sua maioria nascem em terras alagadiças e em campinas, são considerados extremamente pobres. De um modo geral, são as condições físico-químicas e biológicas que influenciam os resultados de nitrogênio. Discute-se também a hipótese da fertilização de pequenas áreas inundáveis que atualmente estão de formando no baixo rio Negro, bem como o aparecimento de macrófitas aquáticas.

Ecologia dos Oligoghaeta da Amazônia. I. Estudo da migração horizontal e vertical de Chibui bari (Glossoscolecidae, Oligochaeta) através de observações de campo.

Trabalhando na área do Parque Zoobotânico da uFAc e em outras duas áreas no município de Rio Branco, AC, estudamos de dezembro de 1982 a março de 1984 a migração de Chibui bari (Glossoscoleclidae, Oligochaeta). Foram determinadas a temperatura, o pH e a umidade do solo bem como a precipitação mensal durante o período do estudo. As médias do pH e da temperatura do solo não apresentara diferenças estatisticamente entre o verão e o inverno. Verificamos que esta espécie se mantém ativa durante o inverno e é durante este que realiza os dois tipos de migração, vertical e horizontal. Durante o verão os animais permaneceram em estivação a aproximadamente 96,o cm de profundidade em contraste com a profundidade máxima de atividade que foi de 42,0 cm. As migrações foram limitadas pela umidade do solo e também pela disponibilidade de alimento'neste.

Determination of fat soluble vitamins from amazonian fresh-water fishes. I. HPLC analysis of tambaqui, pirarucu and cuiu-cuiu livers .

It was found that fish livers from the Amazon have considerable amounts of vitamins A, D and E compared with the values of the standartized cod-liver oil. Tambaqui liver oil has high concentration of vitamin A1(retinol) and vitamin A2 (degidroretinol) whereas the liver oils of pirarucu and cuiu-cuiu have preferently the vitamin A2. The contents of the vitamins D and E observed in the liver oils of tambaqui and cuiu-cuiu was extremely high.