Chronic hepatitis C: hepatic iron content does not correlate with response to antiviral therapy

The complex interaction between hepatitis C virus infection, iron homeostasis and the response to antiviral treatment remains controversial. The aim of this study was to evaluate the influence of hepatic iron concentration (HIC) on the sustained virological response (SVR) to antiviral therapy in patients with chronic hepatitis C. A total of 50 patients who underwent pretreatment liver biopsy with assessment of HIC by graphite furnace atomic absorption spectroscopy and were subsequently submitted to antiviral treatment with interferon/peginterferon and ribavirin were included in the study. Patients with alcoholism, history of multiple blood transfusion, chronic kidney disease, hemolytic anemia and parenteral iron therapy were excluded. The iron related markers and HIC were compared between those who achieved an SVR and non-responders (NR) patients. The mean age was 45.7 years and the proportion of patients' gender was not different between SVR and NR patients. The median serum iron was 138 and 134 µg/dL (p = 0.9), the median serum ferritin was 152.5 and 179.5 ng/mL (p = 0.87) and the median HIC was 9.9 and 8.2 µmol/g dry tissue (p = 0.51), for SVR and NR patients, respectively. Thus, hepatic iron concentration, determined by a reliable quantitative method, was not a negative predictive factor of SVR in patients with chronic hepatitis C presenting mild to moderate hepatic iron accumulation.

Cytokines and T-Lymphocute count in patients in the acute and chronic phases of Bartonella bacilliformis infection in an endemic area in peru: a pilot study

Human Bartonellosis has an acute phase characterized by fever and hemolytic anemia, and a chronic phase with bacillary angiomatosis-like lesions. This cross-sectional pilot study evaluated the immunology patterns using pre- and post-treatment samples in patients with Human Bartonellosis. Patients between five and 60 years of age, from endemic areas in Peru, in the acute or chronic phases were included. In patients in the acute phase of Bartonellosis a state of immune peripheral tolerance should be established for persistence of the infection. Our findings were that elevation of the anti-inflammatory cytokine IL-10 and numeric abnormalities of CD4+ and CD8+ T-Lymphocyte counts correlated significantly with an unfavorable immune state. During the chronic phase, the elevated levels of IFN-γ and IL-4 observed in our series correlated with previous findings of endothelial invasion of B. henselae in animal models.

Effect of bioactive compounds extracted from euphorbious plants on hematological and biochemical parameters of Channa punctatus

Channa punctatus was exposed to four different concentrations of Rutin, Taraxerol and Apigenin. Changes in some hematological parameters of Channa punctatus were assessed to determine the influence of these compounds on test fish. Fish were exposed to sublethal concentrations (80% of LC50 of 24h) of these compounds for one week. Control fish were also administered for one week. Thereafter, blood samples were obtained from the control and experimental fish. Blood was assayed for selected hematological parameters (hematocrit, hemoglobin, red blood cell count, white blood cell count total plasma protein and plasma glucose concentration). The derived hematological indices of mean corpuscular hemoglobin concentration (MCHC), mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV) were calculated. Sublethal concentrations of these compounds caused a dose dependent decrease in hemoglobin values coupled with a decrease in hematocrit values and red blood cell counts are an obvious indication of anemia. The total white blood cell counts and the differential white blood cell counts were decreased except for the lymphocytes, where there was a slight increase. Plasma protein and glucose were also lower in exposed fish when compared with control. The hematological indices MCH, MCHC, MCV were also lowered. The result from this study reveals high mortality rate and deleterious consequences on the health of fish subjected to acute exposure of Rutin, Taraxerol and Apigenin and therefore, should not be used directly in aquaculture without having the proper knowledge.

HOOKWORM AND THREADWORM INFECTIONS AND THEIR ASSOCIATION WITH HEMOGLOBIN AND EOSINOPHIL CONCENTRATIONS IN RESIDENTS OF SALVADOR-BAHIA, BRAZIL

SUMMARY Parasitic infections are responsible for substantial mortality and morbidity worldwide. In most healthy individuals, little overt pathology is observed during infection with S. stercoralis. However, the symptoms in advanced cases may include gastrointestinal bleeding. Anemia is most commonly associated with hookworm infection, especially when several hundred worms are present. Our study evaluates the relationship between the hookworm or S. stercoralis infection status and the hemoglobin concentration of individuals examined by a private network of laboratories in Salvador, Bahia, Brazil. We examined 374,120 samples from middle-class individuals living in Salvador City from January 2004 to April 2008. The stool samples were analyzed by the Lutz and Baermann-Moraes methods, and the blood samples were analyzed for hemoglobin concentration and eosinophil counting. The prevalence of hookworm and S. stercoralis were 0.27% (1,027) and 0.34% (1,286), respectively. The prevalence of hookworm and S. stercoralis infection was significantly higher in males than in females and increased with age. Eosinophilia was a common laboratorial finding in individuals infected with hookworm and S. stercoralis. The hemoglobin concentration was lower in the hookworm-infected individuals than in non-infected ones, but none of the examined patients were anemic. Lack of anemia could be a consequence of the socioeconomic status of these patients.

SEROPREVALENCE OF Toxoplasma gondii (Nicole & Manceaux, 1909) AND RETROVIRAL STATUS OF CLIENT-OWNED PET CATS (Felis catus, Linnaeus, 1758) IN RIO DE JANEIRO, BRAZIL

Cats, as definitive host, play an important role in the transmission of Toxoplasma gondii. This study aimed to establish the seroprevalence of anti-T. gondii immunoglobulins G and M, and determine the frequency of oocysts in the feces of the domestic cat population in Rio de Janeiro, Brazil. We also aimed to study the association between T. gondii infection and age, sex, breed, lifestyle, diet and retroviral infection. A total of 108 cats were included in the study and fecal samples of 54 of those cats were obtained. Only 5.6% of the cats were seropositive for anti-T. gondii immunoglobulins using the indirect hemagglutination test. None of the 54 cats presented oocysts in their fecal samples. Although not statistically significant, males, mixed-breed, free-roaming and cats aged two years and older were found to be more exposed. Age, lifestyle and the use of litter boxes were found to play an important role as risk factors. Anemia and retroviral infections were independent of T. gondii infection. No antibodies were detected in the majority of cats (94.4%), indicating that those cats had never been exposed to the parasite and, therefore, once infected, they could present the risk of shedding large numbers of oocysts into the environment.

THE EFFECT OF HOOKWORM INFECTION AND URINARY SCHISTOSOMIASIS ON BLOOD HEMOGLOBIN CONCENTRATION OF SCHOOLCHILDREN LIVING IN NORTHERN MOZAMBIQUE

This study aims to assess the association between schistosomiasis and hookworm infection with hemoglobin levels of schoolchildren in northern Mozambique. Through a cross-sectional survey, 1,015 children from five to 12 years old in the provinces of Nampula, Cabo Delgado and Niassa were studied. Hookworm infection and urinary schistosomiasis were diagnosed, through Ritchie and filtration methods, with a prevalence of 31.3% and 59.1%, respectively. Hemoglobin levels were obtained with a portable photometer (Hemocue®). The average hemoglobin concentration was 10.8 ± 1.42 g/dL, and 62.1% of the children presented levels below 11.5 g/dL, of which 11.8% of the total number of children had hemoglobin levels below 9 g/dL. A multiple linear regression analysis demonstrated negative interactions between hemoglobin levels and ancylostomiasis, this being restricted to the province of Cabo Delgado (β = -0.55; p < 0.001) where an independent interaction between hemoglobin levels and urinary schistosomiasis was also observed (β = -0.35; p = 0.016). The logistical regression model indicated that hookworm infection represents a predictor of mild (OR = 1.87; 95% CI = 1.17-3.00) and moderate/severe anemia (OR = 2.71; 95% CI = 1.50 - 4.89). We concluded that, in the province of Cabo Delgado, hookworm and Schistosoma haematobium infections negatively influence hemoglobin levels in schoolchildren. Periodical deworming should be considered in the region. Health education and improvements in sanitary infrastructure could achieve long-term and sustainable reductions in soil-transmitted helminthiases and schistosomiasis prevalence rates.

PREVALENCE OF ANTIBODIES AGAINST INFLUENZA VIRUS IN NON-VACCINATED EQUINES FROM THE BRAZILIAN PANTANAL

The prevalence of antibodies against Equine Influenza Virus (EIV) was determined in 529 equines living on ranches in the municipality of Poconé, Pantanal area of Brazil, by means of the hemagglutination inhibition test, using subtype H3N8 as antigen. The distribution and possible association among positive animal and ranches were evaluated by the chi-square test, spatial autoregressive and multiple linear regression models. The prevalence of antibodies against EIV was estimated at 45.2% (95% CI 30.2 - 61.1%) with titers ranging from 20 to 1,280 HAU. Seropositive equines were found on 92.0% of the surveyed ranches. Equine from non-flooded ranches (66.5%) and negativity in equine infectious anemia virus (EIAV) (61.7%) were associated with antibodies against EIV. No spatial correlation was found among the ranches, but the ones located in non-flooded areas were associated with antibodies against EIV. A negative correlation was found between the prevalence of antibodies against EIV and the presence of EIAV positive animals on the ranches. The high prevalence of antibodies against EIV detected in this study suggests that the virus is circulating among the animals, and this statistical analysis indicates that the movement and aggregation of animals are factors associated to the transmission of the virus in the region.

Inquérito hematológico em 100 crianças da Fundação Romão de Mattos Duarte, Estado da Guananabara

Os AA. relatam os achados hematológicos em 100 crianças, 96 das quais se apresentavam com anemia de diversos graus, sendo 79% ferropênicas, 2% macrocíticas e 15% normocrômicas, a maioria das quais associadas à hipoproteinemia, havendo concomitância no aumento da eritrossedimentação em 45%. No quadro leucocitário, 38% apresentaram entre 10.000 e 20.000 leucócitos por mm3. As eosinofilias atingiram 89% dos exames, senão 44% de Grau II e 15% de Grau III.

O período toxêmico da esquistossomose

O A. apresenta seis casos de pacientes observados durante o período toxêmico da esquistosomose mansônica. Dêstes, um foi de mulher cuja sintomatologia datava de um ano. Concebeu e deu à luz durante a enfermidade. Apresentava sinais de fibrose hepática quando do primeiro exame, ainda na vigência de sintomas do período agudo da enfermidade. Todos êstes pacientes apresentavam febre, dores abdominais, hepatoesplenomegalia e outras manifestações que têm sido descritas neste período da parasitose. Como notas dominantes no hemograma, leucocitose com eosinofilia, como ocorre nas infecções por helmintos com ciclo textrino, e anemia. Esta, nem todos apresentavam. Além de alterações do equilíbrio proteico e de resultados da exploração funcional do fígado, o A. chamou a atenção para a hípoglicemia e hipocolesterolemia encontradas em alguns dos observados. Foi digno de registro, também, a positividade tardia da intradermorreação para diagnóstico da esquistosomose. Todos os pacientes foram submetidos a tratamento antimonial, com bom resultado. Como reação colateral devemos mencionar a exacerbação da febre forçando, por vêzes à interrupção do mesmo. O A. faz referências a outros recursos terapêuticos empregados no Oriente: o F30.066, um nitrofurano de uso oral, e as sementes de Cucurbita moshata. Sugere a investigação em animais e no homem com sementes de abóbora outrora empregadas como tenifugo

Associação da sulfametoxazol ao trimethoprim no tratamento da malária por Plasmodium falciparum

A associação da suljametoxazol (SMZ) ao Trimelhoprim (TMP) foi ensaiada em 40 portadores de malária pelo Plasmodium falciparum, em duas etapas. Na primeira, foram observados 20 pacientes resistentes às 4-aminoquinoleinas. oligossintomáticos e com densidade parasitária baixa. A administração de 800 mg de SMZ + 160 mg de TMP a dez pacientes, em dose única, bem como, diariamente, durante 2 dias, a 10 outros, se mostrou capaz de promover o desaparecimento dos trofozitos do sangue periférico em todos os 20 casos. Seis dentre 13 pacientes deste grupo apresentaram recrudescência da parasitemia assexuada durante o período de controle, de 30 dias. Não foram observadas manifestações de intolerância. Na segunda etapa foram observados mais 20 pacientes também, em sua maioria, resistentes às 4-aminoquinoleinas, incluindo agora casos com quadro clínico severo. A administração de 1.600 mg SMZ + 320 mg de TMP, diariamente, durante 4 dias. promoveu a negativação de parasitemia assexuada em todos os pacientes dentro de um período de 82 a 96 horas. Deste grupo, 2 dentre os 20 pacientes apresentaram recrudescência clinica e parasitária no período de controle. Apenas 1 teve discreta anemia megaloblastica após o tratamento, que desapareceu espontâneamente.

Enfermedad de Chagas-Mazza congenita en Salta

Se estudió la infección por T. cruzi en mujeres embarazadas en la localidad de General Güemes, provincia de Salta. La misma fue del 12,3 %. El 8,8% de los recién nacidos estudiados tuvieron diagnóstico de Enfermedad de Chagas utilizando la técnica directa (microhematocrito). Todos fueron tratados con benznidazol a razón de 5mg/kg/día durante 30 dias. Todos presentaron anemia, que fue interpretada como reacción adversa medicamentosa. Se estima que la técnica directa representa la mejor opción para llevar a cabo el diagnóstico de esta enfermedad en el recién nacido. Se ha propuesto un flujograma para el seguimiento de la infección por T. cruzi en el recién nacido.

Resposta de fase aguda, subnutrição e estado nutricional do ferro em adultos com AIDS

Foram comparados o estado nutricional e parâmetros do metabolismo do ferro de adultos HIV-positivos, com ou sem resposta de fase aguda (RFA). Adultos HIV-positivos (n = 29) submeteram-se a antropometria, recordatório alimentar e determinação sérica de albumina, proteína C reativa (PCR), ferritina e capacidade total de ligação do ferro (CTLF), além de creatinina urinária. Infecção mais PCR > 7mg/dl foram critérios de positividade da RFA. Índice de massa corporal (IMC < 18,5kg/m2) e índice creatinina-altura (ICA < 70%) definiram subnutrição. Subnutrição (77,8 vs 40%) e tuberculose pulmonar (44,4 vs 9,5%) foram mais freqüentes nos pacientes RFA-positivos, que também apresentaram menores níveis de albumina (3,7 ± 0,9 vs 4,3 ± 0,9g/dl), CTLF (165,8 ± 110,7 vs 265,9 ± 74,6mg/dl) e hemoglobina (10,5± 1,8 vs 12,6 ± 2,3g/dl). A ingestão de ferro foi adequada e similar entre RFA-positivos e RFA-negativos, o mesmo ocorrendo, respectivamente, quanto à ferritina sérica (mediana; variação, 568; 45,3-1814 vs 246; 18,4-1577ng/ml). Pacientes HIV-positivos com resposta de fase aguda são nutricionalmente mais comprometidos e têm anemia que parece não depender da ingestão recente de ferro.

Estudo clínico da malária falciparum em crianças em Manaus, AM, Brasil

As características clínicas da malária falciparum foram estudadas em 61 crianças com idade de 0 a 14 anos, atendidas em centro de referência em Manaus, entre outubro e dezembro de 1997. Os sintomas encontrados foram febre (98,4%), cefaléia (80,3%), calafrios (68,9%), sudorese (65,6%), mialgia (59%), náuseas (54,1%), lombalgia (49,2%), vômitos (49,2%), tosse (45,9%), artralgia (31,1%), diarréia (34,4%), dispnéia (8,2%), convulsões (8,2%) e tonturas (4,9%). Palidez cutâneo-mucosa e anemia foram observadas mais freqüentemente nas crianças menores de 5 anos. A anemia esteve asssociada aos maiores níveis de parasitemia. Cinqüenta e oito (91,5%) pacientes apresentaram malária não complicada, 3 (4,9%) malária grave e a letalidade foi 1,6%.

Aplastic crisis caused by parvovirus B19 in an adult patient with sickle-cell disease

We describe a case of aplastic crisis caused by parvovirus B19 in an adult sickle-cell patient presenting with paleness, tiredness, fainting and dyspnea. The absence of reticulocytes lead to the diagnosis. Anti-B19 IgM and IgG were detected. Reticulocytopenia in patients with hereditary hemolytic anemia suggests B19 infection.

Abscesso cerebral por Nocardia sp em paciente imunossuprimido

Paciente portadora de anemia hemolítica autoimune e púrpura trombocitopênica idiopática (Síndrome de Evans) em uso de terapia imunossupressora (predinisona e azatioprina), desenvolveu quadro de abscesso cerebral não responsivo a 23 dias de terapia antimicrobiana. O diagnóstico de nocardiose foi possível após coleta de material de abscesso peribulbar e observação deste material por período superior há uma semana.