Avaliação sorológica da vacina oral, tipo Sabin, contra a poliomielite em região semi-rural: I. Formação de anticorpos em vacinados

Os autores descrevem, os resultados obtidos em um programa de avaliação sorológica da vacina oral, tipo Sabin, contra a poliomielite, em uma comunidade semi-rural, próxima a cidade do Rio de Janeiro. Em condições controladas 114 crianças, com idades entre 3 meses a 3 anos (Tabela 1) foram vacinadas, com vacinas trivalentes (500.000, 200.000, e 300.000 TCD50 por dose, dos tipos 1, 2 e 3 respectivamente), usando-se três doses, com intervalos de 8 semanas entre as doses. Amostras de sangue foram coletadas por punção venosa ou discos de papel de filtro, juntamente com a 1.ª e a 3.ª dose de vacina e 9 semanas após esta última dose de vacina. As taxas de conversão alcançaram (diluição de sôro 1/8) 82,7%, 98,5% e 75,4% para os tipos 1, 2 e 3 respectivamente, após três doses de vacina (Tabela 2). A distribuição de idade de indivíduos sem anticorpos após a vacinação (Tabela 3) mostra o grupo etário de 1 a 2 anos como o que apresenta a mais baixa taxa de conversão. Os autores acentuam que as condições de vida da população estudada correspondem àquelas de grandes partes da população brasileira, nas áreas rurais do país; e uma avaliação semelhante da vacina em áreas urbanas, seria desejável. Os autores sugerem ainda o aumento da quantidade de vírus do tipo 1 na vacina como medida provàvelmente eficaz na melhora das taxas de conversão em populações como a estudada. Estudos quantitativos sôbre anticorpos para Enterovírus, presentes na população estudada, estão sendo realizados e serão pròximamente apresentados.

Epidemiologia de um caso de doença de Chagas na Ilha do Mosqueiro - Pará

Os autores apresentam os resultados do estudo epidemiológico de um caso autóctone da fase aguda da doença de Chagas na ilha do Mosqueiro, Estado do Pará, aproximadamente 75km da capital, Belém. 0 caso já havia sido objeto de uma publicação anterior. Agora são apresentadas informações epidemiológicas. Nas proximidades da casa do paciente foram capturados em duas palmeiras de Inajá ('Maximilian regi ay e em uma de Mucajá (Acrocomia sclerocarpia) 114 triatomíneos: Rhodnius pictipes, R. robustus, Panstrongylus lignarius, P. geniculatus e Microtriatoma trinidadensis, com tripanossomas em 31 deles. Na casa do paciente foram encontrados exemplares de Rhodnius pictipes, infectados com formas metacíclicas do Trypanosoma cruzi. Em 14 marsupiais, capturados na localidade, haviam 3 infectados com organismos semelhantes ao T. cruzi. A eletroforese dos isoenzimas nos tripanossomas isolados do paciente, de R. pictipes e de Didelphis marsupialis os classificou como zimodema 1. Os autores concluem que a doença de Chagas do paciente teve origem silvestre.

Prevalência de parasitoses intestinais entre os usuários do centro de saúde do Distrito de Sousas, Campinas, SP (1986-1990)

A prevalência das parasitoses intestinais foi levantada nos usuários do Centro de Saúde do Distrito de Sousas, Campinas, SP entre 1986 e 1990. Dentre 770 prontuários observados constatou-se 114 casos positivos (14,8%) para protozoários, helmintos ou comensais. Ascaris lumbricoides (48,2%) seguido de Giardia lamblia (30,7%), Trichuris trichiura (18,4%) e Enterobius vermicularis (9,6%) foram mais prevalentes na faixa etária dos pré-escolares. Os adultos, em maior número na amostra, apresentam-se pouco parasitados. Os demais parasitos e comensais, concorrem com prevalência proporcional aos inquéritos tradicionais realizados na população brasileira, à exceção da ausência de tenídeos e baixa prevalência de Aneylostomatidae. Sugere-se a realização de exame protoparasitológico de rotina entre os pré-escolares e a utilização de dados dos postos de atendimento primário nos inquéritos parasitológicos.

Comparação entre o xenodiagnóstico clássico e artificial na fase crônica da doença de Chagas

O xenodiagnóstico (xeno) clássico e artificial feitos com Dipatalogaster maximus de primeiro estágio foi realizado simultaneamente em 57 pacientes com infecção chagásica crônica (22 do sexo masculino e 35 do sexo feminino, com idades entre 7 e 80 anos). Exceto dois pacientes com clínica de megaesôfago, os demais tinham dois exames sorológicos prévios positivos sendo feita nova sorológia no decorrer do estudo. Os pacientes eram provenientes do ambulatório do Hospital Universitário de Brasília (HUB) ou eram residentes no município de Mambaí, GO. Dos 57 pacientes, 24 (42%) apresentaram xenodiagnósticos positivos. Dos 114 xenodiagnósticos realizados, 36 (32%) foram positivos. A comparação das duas técnicas não mostrou diferença estatisticamente significante (p = 0,42), porém o xeno artificial apresenta vantagem porque o sangue é oferecido aos triatomíneos através de um aparelho enquanto, no xeno clássico, os triatomíneos sugam através da pele do paciente.

Serum lipids of pemphigus foliaceus patients on long-term glucocorticoid therapy

Endemic pemphigus foliaceus, and long-term corticotherapy may affect serum lipid levels. The aim of this study was to compare serum lipids of pemphigus foliaceus patients on glucocorticoid therapy to a healthy control group. Fifteen patients receiving prednisone (0.33 ± 0.22mg/kg) for at least 12 months and 15 controls were submitted to 48-h food intake records, anthropometry, and biochemical measurements. Data were compared by chi2, Mann-Whitney and Student "t" tests. The groups were matched for gender, age, weight, body mass index, arm circumference and triceps skin fold. No differences were observed in relation to energy, fat, protein and carbohydrate daily intakes, total cholesterol, HDL, LDL, uric acid, and serum creatinine levels. Pemphigus foliaceus patients had higher triglyceride [159 (64-371) vs. 100 (45-133) mg/dl], VLDL [32 (13-74) vs. 20 (9-114) mg/dl] and ESR [44 (9-87) vs. 7 (1-30) mm/h] levels than controls, probably due to metabolic effects of inflammatory disease and corticotherapy.

Adverse reactions associated with a Fuenzalida-Palacios rabies vaccine: a quasi-experimental study

The Fuenzalida-Palacios rabies vaccine has been used in South America for rabies post-exposure prophylaxis. To determine the frequency of adverse reactions associated with this vaccine compared to a control group a quasi-experimental study was carried out in Uberlândia, Brazil, from May 1997 to April 1998. Victims of bites or other injuries by dogs or other mammals and who received or not post-exposure prophylaxis with Fuenzalida-Palacios rabies vaccine were compared as to the occurrence of a list of signs and symptoms. Out of 2,440 victims of bites and other injuries from dogs and other mammals 2,114 participated in the study; 1,004 of them provided follow-up information within 10 to 15 days. Headache and pain at the injection sites were the most commonly found symptoms (125/1,000). No neuroparalytic event was detected. Patients who were given Fuenzalida-Palacios rabies vaccine and those who were not had similar incidences of symptoms (risk ratios close to 1). Regarding the occurrence of adverse reactions, Fuenzalida-Palacios rabies vaccine is a valid alternative for rabies post-exposure prophylaxis.

Envolvimento de Aeromonas em surto de doença diarréica aguda em São Bento do Una, Pernambuco

No primeiro semestre de 2004, ocorreu um surto de diarréia em São Bento do Una, Pernambuco, registrando-se 2.170 casos. Nas 582 coproculturas realizadas, 145 (25%) revelaram um enteropatógeno bacteriano, destacando 114 casos (19,5%) com a participação de Aeromonas, representadas por Aeromonas caviae (57/9,8%), Aeromonas veronii biovar sobria (23/3,9%), Aeromonas veronii biovar veronii (15/2,6%) e outras espécies (19/3,2%). Nos 31 episódios restantes (5,3%), foram detectados: V. cholerae O1 Ogawa toxigênico (18/3,1%), Salmonella spp (8/1,4%), Shigella spp (3/0,5%) e Vibrio cholerae não O1/não O139 (2/0,3%).

Hydrophobic fraction of Taenia saginata metacestodes, rather than hydrophilic fraction, contains immunodominant markers for diagnosing human neurocysticercosis

INTRODUCTION: Considering that alternative antigens for diagnosing neurocysticercosis continue to be a challenge because of the increasing difficulty in obtaining parasites from naturally infected pigs for preparation of Taenia solium homologous antigen, the aim of the present study was to evaluate the detergent (D) and aqueous (A) fractions from saline extract of Taenia saginata metacestodes for diagnosing neurocysticercosis. METHODS: Taenia saginata was obtained from naturally infected bovines in the Triângulo Mineiro region, State of Minas Gerais, Brazil. The carcasses came from cold storage units and had been slaughtered in accordance with the inspection technique recommended by the Federal Inspection Service. The D and A fractions were obtained by using Triton X-114 (TX-114). Serum samples were obtained from 40 patients with a diagnosis of neurocysticercosis, 45 with other parasitic diseases and 30 from apparently normal individuals. IgG antibody levels were evaluated using the ELISA and immunoblotting assays. RESULTS: The ELISA sensitivity and specificity were 95% and 73.3%, when using saline extract; 95% and 82.6% for the D fraction; and 65% and 61.3% for the A fraction, respectively. The immunoblotting assay confirmed the ELISA results, such that the D fraction was more efficient than the other extracts, and the 70-68kDa component was immunodominant among neurocysticercosis patients. CONCLUSIONS: These results demonstrated that the D fraction from Taenia saginata metacestodes obtained using TX-114 can be used as a heterologous antigenic fraction in the immunoblotting assay for serologically diagnosing human neurocysticercosis, given its ability to select immunodominant antigens.

Avaliação de métodos comumente usados em laboratórios para a determinação da suscetibilidade à oxacilina entre amostras de Staphylococcus sp, isoladas de um hospital de Vitória, Estado do Espírito Santo

INTRODUÇÃO: O gênero Staphylococcus é de grande importância devido a sua alta prevalência em infecções hospitalares e por apresentar taxas elevadas de resistência a oxacilina e a outros antimicrobianos. Assim, a avaliação da acurácia dos métodos fenotípicos usados para determinação do perfil de suscetibilidade a antimicrobianos é essencial para garantir a escolha da terapia mais adequada. MÉTODOS: Foram usadas 114 amostras de Staphylococcus sp (53 S. aureus e 61 SCN) na avaliação da acurácia dos métodos de difusão de disco, microdiluição em agar, ágar triagem oxacilina e sistema automatizado em comparação com a PCR para verificação da resistência a oxacilina. RESULTADOS: O gene mecA foi detectado em 48 (42,1%) amostras e 27 (23,7%) amostras apresentaram discrepância de resultados em pelo menos um dos métodos (74,1% SCN, 25,9% S. aureus). Para S. aureus, com exceção do Microscan Walkaway, todos os métodos apresentaram 100% de especificidade e sensibilidade. Já para os SCN, o sistema automatizado e o disco de cefoxitina apresentaram menor acurácia. CONCLUSÕES: O uso de dois métodos deve ser a melhor opção para a melhora da acurácia, principalmente quando o laboratório de diagnóstico utiliza somente sistema automatizado ou teste de difusão do disco de oxacilina. A associação destes métodos com outros apresentaram praticamente 100% de sensibilidade e especificidade em nosso estudo.

Genetic variability among Anopheles species belonging to the Nyssorhynchus and Anopheles subgenera in the Amazon region

INTRODUCTION: Isoenzymatic analyses were performed involving species of the Nyssorhynchus and Anopheles subgenera in order to estimate the intra and interspecies genetic variability. METHODS: Mosquitoes were caught at different localities in the Amazon region. The collection and rearing of mosquitoes in the laboratory followed specific protocols. For the genetic variability analyses, the technique of horizontal electrophoresis on starch and starch-agarose gel with appropriate buffer systems was used. The alloenzyme variation was estimated using the Biosys-1 software. RESULTS: Out of the 13 loci, eight were polymorphic. Anopheles nuneztovari presented the largest number of alleles per locus, while the smallest number was detected in Anopheles marajoara from Macapá. The largest number of polymorphic loci was found for Anopheles marajoara from Maruanum and the smallest for Anopheles benarrochi (Guayará Mirim). Anopheles darlingi (Macapá) presented the greatest heterozygosity (Ho = 0.167 ± 0.071), while the lowest heterozygosity (Ho = 0.045 ± 0.019) was observed in Anopheles intermedius (Pacoval) of the subgenus Anopheles. Wright's F coefficient revealed considerable genetic structuring between the populations of Anopheles darlingi (Fst = 0.110) and between the populations of Anopheles marajoara (Fst = 0.082). CONCLUSIONS: Considering all the species studied, the genetic distance ranged from 0.008 to 1.114. The greatest distance was between Anopheles mattogrossensis and Anopheles oswaldoi, while the smallest was between the Anopheles benarrochi populations.

Nutritional assessment and lipid profile in HIV-infected children and adolescents treated with highly active antiretroviral therapy

INTRODUCTION: HIV-infected children and adolescents treated with highly active antiretroviral therapy (HAART) regimens that include a protease inhibitor (PI) can show significant improvements in clinical outcomes, nutritional status and quality of life. The study aimed to report nutritional and metabolic alterations for pediatric patients continuously exposed to HAART and for healthy controls for up to 1 year. METHODS: Clinical, anthropometric, lipid profile and food intake data were collected prospectively over approximately 12-months for each patient. RESULTS: Fifty-one individuals were studied, of these, 16 were healthy. After 12 months follow-up, HIV-positive individuals remained below the healthy control group parameters. No change was observed concerning food intake. Triglyceride serum levels were higher in patients using protease inhibitor at the onset of the study [PI groups: 114 (43 - 336), and 136 (63 - 271) versus control group: 54.5 (20 - 162); p = 0.003], but after twelve months follow-up, only the group using protease inhibitor for up to two months presented higher values [140 (73 - 273) versus 67.5 (33 - 117); p = 0.004]. HDL-cholesterol was lower in HIV-positive individuals [HIV-positive groups: 36 (27 - 58) and 36 (23 - 43); control 49.5 (34 - 69); p = 0.004]. CONCLUSIONS: HIV-infected children and adolescents treated with highly active antiretroviral therapy showed compromised nutritional parameters compared to a paired healthy control group. Individuals using protease inhibitor presented worse triglyceride serum levels compared to their healthy counterparts.

Performance of a rapid diagnostic test for the detection of visceral leishmaniasis in a large urban setting

Introduction Rapid diagnostic tests (RDTs) may improve the early detection of visceral leishmaniasis (VL), but their real-world performance requires additional study. Therefore, we evaluated the performance of an rK39-based RDT (Kalazar Detect™) for the detection of VL in an endemic, large urban area. Methods Data were collected from a registry of rK39 RDT performed at 11 emergency care units in Belo Horizonte, Brazil, and from a national database of reportable communicable diseases of the Sistema de Informação de Agravos de Notificação (SINAN). Results The rapid rK39 test was performed in 476 patients, with 114 (23.9%) positive results. The analysis of rK39 RDT performance was based on 381 (80%) cases reported to the SINAN database, of which 145 (38.1%) were confirmed cases. Estimates for sensitivity and specificity were 72.4% (95% CI: 64.6-79%) and 99.6% (95%CI: 97.6-99.9%), respectively. Positive and negative predictive values were estimated at 99.1% (95%CI: 94.9-99.8%) and 85.5% (95%CI: 80.8-89.1%), respectively. In addition, close agreement between the rK39 RDT and indirect immunofluorescence was observed. Conclusions In summary, the rK39 RDT showed a high specificity but only moderate sensitivity. In endemic areas for VL, treatment may be considered in cases with clinical manifestations and a positive rK39 RDT, but those with a negative test should be subjected to further investigation.

Evaluation of the predictive indices for candidemia in an adult intensive care unit

INTRODUCTION: To evaluate predictive indices for candidemia in an adult intensive care unit (ICU) and to propose a new index. METHODS: A prospective cohort study was conducted between January 2011 and December 2012. This study was performed in an ICU in a tertiary care hospital at a public university and included 114 patients staying in the adult ICU for at least 48 hours. The association of patient variables with candidemia was analyzed. RESULTS: There were 18 (15.8%) proven cases of candidemia and 96 (84.2%) cases without candidemia. Univariate analysis revealed the following risk factors: parenteral nutrition, severe sepsis, surgical procedure, dialysis, pancreatitis, acute renal failure, and an APACHE II score higher than 20. For the Candida score index, the odds ratio was 8.50 (95% CI, 2.57 to 28.09); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.78, 0.71, 0.33, and 0.94, respectively. With respect to the clinical predictor index, the odds ratio was 9.45 (95%CI, 2.06 to 43.39); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.89, 0.54, 0.27, and 0.96, respectively. The proposed candidemia index cutoff was 8.5; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.77, 0.70, 0.33, and 0.94, respectively. CONCLUSIONS: The Candida score and clinical predictor index excluded candidemia satisfactorily. The effectiveness of the candidemia index was comparable to that of the Candida score.

Characterization of a foodborne outbreak caused by Salmonella Enteritidis in Aracaju, State of Sergipe, Brazil

INTRODUCTION: In December 2001, an outbreak of foodborne gastroenteritis infected 114 of 161 people who ate at a restaurant in Aracaju, State of Sergipe, Brazil. METHODS: The epidemiological and microbiological aspects of the outbreak were characterized. RESULTS: Potato salad made with homemade mayonnaise and stored at unsuitable temperatures was associated with increased risk of foodborne infection. Salmonella Enteritidis was isolated from the diarrheal stools of the hospitalized patients, and genotyping of the fecal samples generated identical randomly amplified polymorphic deoxyribonucleic acid (DNA) profiles. CONCLUSIONS : To the best of our knowledge, this is the first and the only record of a gastrointestinal outbreak in Sergipe.

Polymerase chain reaction-based method for the identification of Leishmania (Viannia) braziliensis and Leishmania (Viannia) guyanensis in mucosal tissues conserved in paraffin

ABSTRACTINTRODUCTION: In the Americas, mucosal leishmaniasis is primarily associated with infection by Leishmania (Viannia) braziliensis. However, Leishmania (Viannia) guyanensis is another important cause of this disease in the Brazilian Amazon. In this study, we aimed at detecting Leishmaniadeoxyribonucleic acid (DNA) within paraffin-embedded fragments of mucosal tissues, and characterizing the infecting parasite species.METHODS: We evaluated samples collected from 114 patients treated at a reference center in the Brazilian Amazon by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analyses.RESULTS: Direct examination of biopsy imprints detected parasites in 10 of the 114 samples, while evaluation of hematoxylin and eosin-stained slides detected amastigotes in an additional 17 samples. Meanwhile, 31/114 samples (27.2%) were positive for Leishmania spp. kinetoplast deoxyribonucleic acid (kDNA) by PCR analysis. Of these, 17 (54.8%) yielded amplification of the mini-exon PCR target, thereby allowing for PCR-RFLP-based identification. Six of the samples were identified as L. (V.) braziliensis, while the remaining 11 were identified as L. (V.) guyanensis.CONCLUSIONS: The results of this study demonstrate the feasibility of applying molecular techniques for the diagnosis of human parasites within paraffin-embedded tissues. Moreover, our findings confirm that L. (V.) guyanensisis a relevant causative agent of mucosal leishmaniasis in the Brazilian Amazon.