Air pollution and its impacts on health in Vitoria, Espirito Santo, Brazil

ABSTRACT OBJECTIVE To analyze the impact of air pollution on respiratory and cardiovascular morbidity of children and adults in the city of Vitoria, state of Espirito Santo. METHODS A study was carried out using time-series models via Poisson regression from hospitalization and pollutant data in Vitoria, ES, Southeastern Brazil, from 2001 to 2006. Fine particulate matter (PM10), sulfur dioxide (SO2), and ozone (O3) were tested as independent variables in simple and cumulative lags of up to five days. Temperature, humidity and variables indicating weekdays and city holidays were added as control variables in the models. RESULTS For each increment of 10 µg/m3 of the pollutants PM10, SO2, and O3, the percentage of relative risk (%RR) for hospitalizations due to total respiratory diseases increased 9.67 (95%CI 11.84-7.54), 6.98 (95%CI 9.98-4.17) and 1.93 (95%CI 2.95-0.93), respectively. We found %RR = 6.60 (95%CI 9.53-3.75), %RR = 5.19 (95%CI 9.01-1.5), and %RR = 3.68 (95%CI 5.07-2.31) for respiratory diseases in children under the age of five years for PM10, SO2, and O3, respectively. Cardiovascular diseases showed a significant relationship with O3, with %RR = 2.11 (95%CI 3.18-1.06). CONCLUSIONS Respiratory diseases presented a stronger and more consistent relationship with the pollutants researched in Vitoria. A better dose-response relationship was observed when using cumulative lags in polynomial distributed lag models.

Estudo, ao microscópio óptico e eletrônico, do rim de caes natural e experimentalmente infectados com Leishmania (Leishmania) chagasi

Os autores estudam os rins de 4 cães infectados com Leishmania (Leishmania) chagasi. Dois animais (um macho e uma fêmea) naturalmente infectados foram sacrificados 18 meses após sua permanência no laboratório. Dois machos foram inoculados por via endovenosa, com lxlO6 promastigotas da cepa MHO/BR/70/BH46 e sacrificados após 18 meses e 2 anos, respectivamente. Em todos os animais os rins estavam lesados. As alterações encontradas foram: (1) glomerulonefrite mesangioproliferativa focal ou difusa, com pronunciada hipertrofia e hiperplasia das células mesangiais e com alargamento da matriz; (2) espessamento da membrana basal com depósitos eletrondensos; (3) nefrite intersticial intertubular crônica com exsudação plasmocitária intensa. (4) degeneração albuminosa dos túbulos renais. Baseados nos achados os autores discutem os prováveis mecanismos patogenéticos.

Histological observations on Montenegro's reaction in man

The Montenegro skin test is widely used as a diagnostic method for American cutaneous leishmaniasis (ACL) but little is known about the histological changes that occur in the skin after administration of the antigen. This report is based on histological studies of biopsied material obtained, from inoculation sites, 48 hours after individuals had been given intradermal injections with a standardized Montenegro antigen. The material examined was obtained from four distinctly different test groups: naturally infected patients with parasitologically proved ACL and with positive Montenegro's reaction; individuals without previous history of ACL and not previously tested with Montenegro antigen; participants in anti-ACL vaccine trials who developed positive reactions to Montenegro antigen after vaccination; other participants in vaccine trials who had negative Montenegro responses after vaccination or had served as controls in the trials. The histological pictures of each group are described and discussed. Histologically, the reactions of vaccinated individuals were indistinguishable from those with naturally acquired infections.

Angiostrongylus costaricensis: first record of its occurrence in the State of Espirito Santo, Brazil, and a review of its geographic distribution

Abdominal angiostrongyliasis is a parasitic disease caused by Angiostrongylus costaricensis, a metastrongylid nematode with wide geographic distribution, occurring from the United States to Argentina. In Brazil, the disease has been reported from the States of Rio Grande do Sul, Santa Catarina, Paraná, São Paulo, Federal District of Brasilia and Minas Gerais. We report here a case of abdominal angiostrongyliasis in a 9-year-old girl, from Itatiba, State of Espirito Santo, Brazil, submitted to exploratory laparotomy for acute abdomen. Extensive inflammatory lesions of terminal ileum and cecum, with perforations of the first, were present, and ileocecal resection was performed. The pathological picture was characterized by transmural inflammatory granulomatous reaction, extensive eosinophilic infiltration, eosinophilic vasculitis and the presence of worms within a mesenteric artery branch, with histological features of metastrongylid nematodes. This case report contributes to a better knowledge of the geographic distribution of this parasite in Brazil, suggesting that abdominal angiostrongyliasis may represent a disease of medical importance, more than a rarity of academic interest.

PREVALENCE OF ANTI- Toxocara ANTIBODIES IN A RANDOM SAMPLE OF INPATIENTS AT A CHILDREN'S HOSPITAL IN VITÓRIA, ESPÍRITO SANTO, BRAZIL

In the streets of Vitória, in the State of Espírito Santo, Brazil, are large number of stray dogs, many of which are infected with Toxocara canis, suggesting a high risk for human infection. In order to investigate the prevalence of Toxocara infection in children in Espírito Santo we studied the prevalence of anti-Toxocara antibodies in 100 random inpatients over one year of age, at the Children's Hospital N.S. da Glória, the reference children's hospital for the State.All the sera were collected during the period between October 1996 and January 1997. The mean age was 6.6±4.1 yrs. (1 to 14 yrs., median 6yrs.) and there were patients from all of the different wards of the hospital. Sixty-eigth patients came from the metropolitan area of Vitória and the other 32 from 17 other municipalities. The anti-Toxocara antibodies were investigated by ELISA-IgG using a secretory-excretory antigen obtained from second stage larvae. All sera were adsorbed with Ascaris suum antigen before the test. Thirty-nine sera (39%) were positive, predominantly from boys, but the gender difference was not statistically significant (boys:25/56 or 44.6%; girls:14/44 or 31.8%; p=0.311). The prevalence of positive sera was higher, but not statistically significant, in children from the urban periphery of metropolitan Vitória (formed by the cities of Vitória, Cariacica, Vila Velha, Serra and Viana) than in children from 17 other municipalities (44.1% and 28.1% respectively, p=0.190). Although the samples studied do not represent all children living in the State of Espírito Santo, since the Children's Hospital N.S. da Glória admits only patients from the state health system, it is probable that these results indicate a high frequency of Toxocara infection in children living in Espírito Santo. Further studies of population samples are necessary to ascertain the prevalence of Toxocara infection in our country.

The present situation regarding lymphatic filariasis in Cabo de Santo Agostinho, Pernambuco, Northeast Brazil

A cross-sectional population-based survey on the occurrence of lymphatic filariasis was carried out in the municipality of Cabo de Santo Agostinho, Pernambuco, Northeast Brazil. 7,650 individuals of both sexes were examined (from 1,416 households) of whom six tested positive for microfilaria according to the thick blood diagnostic test. The age of the individuals examined varied from 0 to 98 (averaging 26.6 years), whilst the age of the microfilaria-positive individuals varied from 11 to 29, averaging 22.5 years. Five of the six positive cases were male. These cases were residents of the following areas: Pista Preta (one case); Ponte dos Carvalhos (four cases); and Pontezinha (one case). This last case from Pontezinha was autochthonous. Of the individuals examined, 109 (1.4%) cited complaints relating to filariasis. These results suggest that filariasis is being transmitted in the municipality of Cabo de Santo Agostinho, a finding that establishes the need to carry out disease control activities, and to collaborate with the planning of the national programme for the elimination of filariasis.

Epidemiologic features of HIV infection in three municipalities of inner Rio de Janeiro State, Brazil

In Brazil relatively little attention is being paid to the study of the features of the spread of the AIDS epidemic towards small cities and rural areas. We report a descriptive study on the epidemiological features of HIV infection among 208 adult patients seen between July 1999 and May 2006 in the municipal HIV/AIDS Programs of three cities of inner Rio de Janeiro State: Saquarema, Santo Antonio de Pádua and Miracema. A portrait of a heterosexual epidemic emerged, with an overall male to female ratio of 1.1. More than 90% were residents of the studied cities, demonstrating a local demand for HIV-related assistance and the importance of municipal HIV/AIDS Programs. Past or current use of snorted cocaine was reported by a quarter of the patients. Older age and male gender were independent predictors of having a diagnosis of AIDS at presentation. The latter is in accordance with a more recent wave of epidemic spread towards female gender. A low frequency of male circumcision, an important determinant of heterosexual HIV transmission, was recorded. Almost 60% of the patients first presented in advanced stages of HIV infection, suggesting the existence of a large pool of undiagnosed cases in the community.

First record of Anopheles (Anopheles) costai Fonseca & Ramos, 1939 in Espírito Santo State, Brazil

Field collections of immatures and adults of Culicidae were carried out in the Rio Doce Valley, Espírito Santo State, aiming to increase knowledge on the anopheline species of that region. Considering all Culicidae species collected, among other anopheline it is noteworthy the presence of Anopheles darlingi, An. oswaldoi and An. costai. Regarding to An. darlingi, responsible for malaria outbreak in the low lands in that state, it was expected to confirm its presence in the area. The register of specimens of An. costai in the field collections is relevant, increasing the geographical distribution of the species and representing better knowledge of the Series Arribalzagia of the subgenus Anopheles.

Intestinal parasites in a quilombola community of the Northern State of Espírito Santo, Brazil

The aim of this study was to determine the occurrence of intestinal parasites in a quilombola community from the northern Espírito Santo, Brazil. Descendants of slaves who arrived in Brazil in the sixteenth century, this population settled in the municipality of São Mateus in 1858. Fresh fecal samples from 82 individuals who agreed to participate in the study were collected between August 2009 and July 2010, and immediately sent to the Clinical Laboratory of the Centro Universitário Norte do Espírito Santo of the Universidade Federal do Espírito Santo for analysis. Out of all the participants, 36 (43.9%) were male and 46 (56.1%) were female, whose ages ranged from six to 85 years. The study of the occurrence of intestinal parasites indicated that 35 individuals (42.7%) were infected with at least one intestinal parasite. Among helminths, the most frequent were hookworms, with a rate of 14.6%. With regard to protozoa, Entamoeba coli, Entamoeba histolytica/Entamoeba dispar and Endolimax nana stood out, with frequencies of 23.2%, 8.5% and 4.9%, respectively. The occurrence of biparasitism was observed in 13 of the 82 subjects, accounting for 15.8%, and no cases of multiple parasitic infections were observed. It was concluded that the reduction of cases of intestinal diseases due to parasites will only be achieved with the improvement of basic sanitation and quality of life of quilombola populations.

Distribuição geográfica da leishmaniose tegumentar americana no Estado do Espírito Santo - Brasil

Com base nos registros de 730 pacientes portadores de Leishmaniose Tegumentar Americana (LTA) referentes ao período de janeiro de 1972 a dezembro de 1982, os autores realizaram um estudo da distribuição geográfica dessa parasitose no Estado do Espírito Santo. Os pacientes procediam de 36 dos 53 municípios que compõem o Estado, destacando-se Viana e Cariacica como os de maior prevalência, somando juntos 442 casos (60,54%), com 259 destes residindo numas poucas localidades, contínuas entre si, formando uma área endêmica, com transmissão ocorrendo provavelmente no peri e intra-domicílio. Esta área de alta endemicidade, pertencente principalmente ao vale do rio Formate, estende-se também ao município de Domingos Martins através da localidade de Biriricas. Nos demais municípios a LTA caracterizou- se como uma doença profissional de ocorrência antiga no Estado.

Labrea-like hepatitis in Vitoria, Espirito Santo state, Brazil: report of a case

A case of fulminat hepatitis with microvesicular steatosis resembling Labrea 's fever, diagnosed in Vitoria (ES) is reported. The 16 year old bcy presented with severe epistaxis, agitation, jaundice and hemorrhagic vomiting and died two days after admission to the emergency unit of the Vnivesity Hospital. The disease started five days before with fever, myalgias, dark urine and jaundice andprogressed withpsychic agitation, torpor and coma. The liver andspleen were notpalpable. HBsAg was negative in the serum. The autopsy showed acute hepatitis with tylic necrosis confluent in the midizonal and periportal areas with massive microvesicular steatosis in the remaining hepatocytes. Mononuclear cellspredominated in the exudate. The reticulum showed condensation in the necrotic areas without typical bands of collapse. The portal tracts were edematous with mononuclear infiltration and mild bile duct proliferation. Absence of cholestasis. Exceptfor the confluent midzonalandperiportal necrosis this case showed several clinical and morphological aspects of the Labreafever describedfrom the East Amazon, demonstrating that the anatomical picture of this disease probabty is not in related to afactor peculiar to the Amazon region.

Abscesso piogênico do fígado e esquistossomose mansônica: observações no Estado do Espírito Santo

Recentemente, foi demonstrado que a forma toxêmica da esquistossomose mansônica em crianças pode serfator predisponente para abscesso piogênico do fígado (APF). Como no Estado do Espírito Santo, a esquistossomose é endêmica em grande parte do estado e os APF são freqüentemente diagnosticados no Hospital Infantil Nossa Senhora da Glória de Vitória, realizou-se revisão dos casos de APF diagnosticados entre maio de 1991 e abril de 1994, com a finalidade de identificar-se os casos com infecção esquistossomótica e a sua procedêitcia. Identificaram-se 65 casos de APF e 39 apresentavam exame de fezes registrado no prontuário, sendo 3 positivos para Schistosoma mansoni e 29 positivos para outros helmintos intestinais, principalmente áscaris e tricocéfalo. A procedência dos pacientes mostrou que 7 (10,6%) eram provenientes de zona endêmica da esquistossomose. A associação APF e esquistossomose mostrou-se pequena e não há grande sobreposição na distribuição geográfica das duas doenças. Por outro lado a alta prevalência de infecção por outros helmintos intestinais e o grande número de abscessos piogênicos criptogenéticos diagnosticados, faz pensar que as infecções helmínticas com larvas que podem migrar para o fígado e formar granulomas, possam também ser um fator predisponente para o abscesso hepático em crianças.