Acute schistosomiasis mansoni: revisited and reconsidered

Acute schistosomiasis is a systemic hypersensitivity reaction against the migrating schistosomula and eggs. A variety of clinical manifestations appear during the migration of schistosomes in humans: cercarial dermatitis, fever, pneumonia, diarrhoea, hepatomegaly, splenomegaly, skin lesions, liver abscesses, brain tumours and myeloradiculopathy. Hypereosinophilia is common and aids diagnosis. The disease has been overlooked, misdiagnosed, underestimated and underreported in endemic areas, but risk groups are well known, including military recruits, some religious congregations, rural tourists and people practicing recreational water sports. Serology may help in diagnosis, but the finding of necrotic-exudative granulomata in a liver biopsy specimen is pathognomonic. Differentials include malaria, tuberculosis, typhoid fever, kala-azar, prolonged Salmonella bacteraemia, lymphoma, toxocariasis, liver abscesses and fever of undetermined origin. For symptomatic hospitalised patients, treatment with steroids and schistosomicides is recommended. Treatment is curative in those timely diagnosed.

Comparative randomised trial of high and conventional doses of praziquantel in the treatment of schistosomiasis mansoni

The efficacy of oral praziquantel in the treatment of schistosomiasis has been considered low by most public health institutions. In this paper, we compared the efficacy of two dosages of praziquantel (80 mg/kg vs. 50 mg/kg) in patients with chronic schistosomiasis mansoni. Two hundred eighty-eight patients with schistosomiasis from a community in Brazil were randomly divided into two groups: 145 patients (Group 1) received 80 mg/kg body weight of oral praziquantel divided in two equal doses with 1 h interval and 143 patients (Group 2) received 50 mg/kg body weight of oral praziquantel. To keep the study masked, patients in Group 2 received placebo 1 h after the first dose. All patients were subjected to clinical and ultrasonographic examination. Cure assessment was performed by repeating two stool examinations, by a quantitative method, at 30, 90 and 180 days after treatment. The morbidity of schistosomiasis was low, with a few cases of light periportal thickening and 16 cases of mild splenomegaly. The cure rates were 89.7% for Group 1 and 83.9% for Group 2. There was no difference in the efficacy of both therapeutic dosages of praziquantel assayed. The adverse reactions were more frequent with higher dosage.

Schistosoma mansoni: magnetic resonance analysis of liver fibrosis according to WHO patterns for ultrasound assessment of schistosomiasis-related morbidity

For the last two decades, ultrasound (US) has been considered a surrogate for the gold standard in the evaluation of liver fibrosis in schistosomiasis. The use of magnetic resonance imaging (MRI) is not yet standardised for diagnosing and grading liver schistosomal fibrosis. The aim of this paper was to analyse MRI using an adaptation of World Health Organization (WHO) patterns for US assessment of schistosomiasis-related morbidity. US and MRI were independently performed in 60 patients (42.1 ± 13.4 years old), including 37 men and 23 women with schistosomiasis. Liver involvement appraised by US and MRI was classified according to the WHO protocol from patterns A-F. Agreement between image methods was evaluated by kappa index (k). The correlation between US and MRI was poor using WHO patterns [k = 0.14; confidence interval (CI) 0.02; 0.26]. Even after grouping image patterns as "A-D", "Dc-E" and "Ec-F", the correlation between US and MRI remained weak (k = 0.39; CI 0.21; 0.58). The magnetic resonance adaptation used in our study did not confirm US classification of WHO patterns for liver fibrosis.

Serum hyaluronan and collagen IV as non-invasive markers of liver fibrosis in patients from an endemic area for schistosomiasis mansoni: a field-based study in Brazil

Non-invasive markers of fibrosis have been used to diagnose liver fibrosis in a variety of diseases. Hyaluronic acid (HA) and collagen IV (C-IV) levels were measured in the sera of patients from an endemic area for schistosomiasis in Brazil to diagnose and to rank the intensity of liver fibrosis. Seventy-nine adult patients with schistosomiasis, in the age range of 21-82 years (49 ± 13.4) were submitted to clinical and ultrasonographic examinations. Ultrasound was employed to diagnose and categorise liver fibrosis according to World Health Organization patterns. Serum HA and C-IV levels were measured using commercial ELISA kits. Ultrasound revealed six patients with intense liver fibrosis, 21 with moderate, 23 with light and 29 without. Serum HA was able to separate individuals with fibrosis from those without (p < 0.001) and light from intense fibrosis (p = 0.029), but C-IV was not (p = 0.692). The HA diagnostic accuracy for fibrosis was 0.89. The 115.4 ng/mL cut-off level diagnosed patients with fibrosis (sensitivity 0.98, specificity 0.64). HA correlated positively with portal hypertension. Periportal fibrosis (subjective evaluation), age and collateral circulation predicted HA increase. In conclusion, we propose that serum HA can be used to identify patients with liver fibrosis in an endemic area for schistosomiasis mansoni in Brazil.

Ultrasound in schistosomiasis mansoni

We reviewed ultrasound features in patients with schistosomiasis mansoni. The alterations that we observed in acute and hepatosplenic schistosomiasis are described. The advantages and disadvantages of using ultrasound patterns in the evaluation of liver fibrosis are discussed. Other diseases that are important in the differential diagnosis of schistosomal liver fibrosis are presented. Ultrasound is an effective and flexible diagnostic tool in the evaluation of a variety of diseases. It presents no harmful effects to patients, allowing non-invasive studies in hospitalized patients and in other facilities.

Schistosomiasis control program in the state of Minas Gerais in Brazil

The Schistosomiasis Control Program (PCE) was implemented in Minas Gerais (MG) in 1984. In 1999, the state started the investigation and control of schistosomiasis in 470 municipalities. The aim of the present paper is to report the evolution of this Program from 1984-2007. The program included a coproscopic survey carried out in the municipalities of known endemic areas using a quantitative method. Positives were treated with praziquantel and given a program of health education. The information for this study was obtained from data collected and stored by the Health State Department. From 2003-2007, 2,643,564 stool examinations resulted in 141,284 positive tests for Schistosoma mansoni (5.3%). In the first evaluation after treatment, a decrease in the number of municipalities with prevalence over 10% was documented. In one village, selected for a more detailed evaluation, the percentage of positive tests decreased from 14.9% in the baseline survey to 5.3% after treatment. A reference centre for patients with severe schistosomiasis was created in Belo Horizonte, MG. Based on our findings, we believe that the implementation of PCE in MG is on the right path and in due time these new initiatives will provide desirable results.

Attraction of Chagas disease vectors (Triatominae) to artificial light sources in the canopy of primary Amazon rainforest

Adult triatomines occasionally fly into artificially lit premises in Amazonia. This can result in Trypanosoma cruzi transmission to humans either by direct contact or via foodstuff contamination, but the frequency of such behaviour has not been quantified. To address this issue, a light-trap was set 45 m above ground in primary rainforest near Manaus, state of Amazonas, Brazil and operated monthly for three consecutive nights over the course of one year (432 trap-hours). The most commonly caught reduviids were triatomines, including 38 Panstrongylus geniculatus, nine Panstrongylus lignarius, three Panstrongylus rufotuberculatus, five Rhodnius robustus, two Rhodnius pictipes, one Rhodnius amazonicus and 17 Eratyrus mucronatus. Males were collected more frequently than females. The only month without any catches was May. Attraction of most of the known local T. cruzi vectors to artificial light sources is common and year-round in the Amazon rainforest, implying that they may often invade premises built near forest edges and thus become involved in disease transmission. Consequently, effective Chagas disease prevention in Amazonia will require integrating entomological surveillance with the currently used epidemiological surveillance.

A integralidade sob a ótica dos profissionais dos Serviços de Saúde de Belo Horizonte

Trata-se de estudo de caso qualitativo, com o objetivo de apresentar a compreensão sobre integralidade para os profissionais e gestores que atuam em serviços de saúde de Belo Horizonte. Foram entrevistados 32 profissionais a partir de um roteiro semiestruturado. A análise dos dados mostrou que os diferentes níveis de atenção perpassam à integralidade, agregando a noção de promoção à saúde. O trabalho interdisciplinar emerge como elemento fundamental para esta prática, que se concretiza por meio de compartilhamento de sentimentos. Em contrapartida, os dados mostram que as práticas de integralidade só se concretizam em condições básicas, que os serviços muitas vezes não oferecem. Conclui-se que é preciso eliminar as fragmentações presentes tanto na forma de organização dos serviços de saúde quanto nas práticas cotidianas dos profissionais que atuam nesses serviços, para oferecer uma assistência integral, resolutiva, e humanizar as práticas de saúde, visando sempre a qualidade de vida da população.

Description of the larva and pupal case of Ommatius orenoquensis Bigot (Diptera, Asilidae, Ommatiinae)

Description of the larva and pupal case of Ommatius orenoquensis Bigot (Diptera, Asilidae, Ommatiinae). The last instar larva and the pupal case of Ommatius orenoquensis Bigot, 1896 from a Cerrado (Brazilian Savanna) area in São Paulo, southeastern Brazil, are for the first time described and illustrated.

Espécies de flebotomíneos (Diptera, Psychodidae) coletadas em ambiente urbano em municípios com transmissão de Leishmaniose Visceral do Estado de Mato Grosso do Sul, Brasil

Os flebotomíneos são os vetores naturais de alguns agentes etiológicos de doenças humanas e de animais, tais como protozoários do gênero Leishmania Ross, 1903. A fauna flebotomínica no Mato Grosso do Sul é relativamente bem conhecida e até o momento compõe-se de 54 espécies. O presente estudo baseia-se no levantamento de flebotomíneos em área urbana de 18 municípios com transmissão de leishmaniose visceral no Estado do Mato Grosso do Sul, com objetivo de verificar as principais espécies e fornecer subsídios para o programa de controle das leishmanioses. As coletas foram realizadas com armadilhas automáticas luminosas, instaladas mensalmente durante três noites consecutivas, das 18:00 horas às 6:00, no período de dois anos. Foram coletadas 36 espécies dentre os 34.799 exemplares identificados. Lutzomyia longipalpis (Lutz & Neiva, 1912) e Nyssomyia whitmani (Antunes, 1939) foram as espécies mais dispersas, a primeira foi encontrada em 16 e a segunda em 15 dos 18 municípios investigados, contudo, Lu. longipalpis foi predominante em todos esses municípios Ny. whitmani não predominou em nenhum deles. Corumbá contribuiu com 40.92% de todos flebotomíneos capturados e nesse município Lutzomyia cruzi (Mangabeira, 1938) respondeu por 92.50% dos exemplares coletados. Ressalta-se que as espécies do gênero Lutzomyia e Nyssomyia whitmani podem estar envolvidas com a transmissão de leishmanioses no Mato Grosso do Sul.

Revisão das espécies neotropicais de Empididae (Diptera) descritas por Mario Bezzi: VI. As espécies descritas em Rhamphomyia Meigen e as descrições de Chilerhamphomyia gen. nov. e Bolrhamphomyia gen. nov

Dois gêneros novos são descritos: Chilerhamphomyia gen. nov., baseado em Rhamphomyia carenifera Bezzi, 1909 (espécie-tipo) do Chile, Valdivia, e Bolrhamphomyia gen. nov., baseado em R. tympanica Bezzi, 1909 (espécie-tipo) da Bolívia, Mapiri. Cinco espécies neotropicais são redescritas e uma nova sinonímia é proposta: Porphyrochroa argyrina (Bezzi, 1909), lectótipo (aqui designado); P. galactodes (Bezzi, 1909); P. micrargyra (Bezzi, 1909), lectótipo (aqui designado), sinônimo sênior de P. monstrosa (Bezzi, 1909) syn. nov.; P. penicillata (Bezzi, 1909) e P. perpulchra (Bezzi, 1909), lectótipo (aqui designado).

Mecoptera (Insecta) do estado do Maranhão: chave para identificação das espécies e descrição da fêmea de Bittacus latreillei(Collucci & Amorim)

Coletas recentes no estado do Maranhão indicaram que os mecópteros parecem ser abundantes neste estado. Foram estudadas 55 espécimes de quatro espécies: Bittacus diversinervis Souza Lopes & Mangabeira, 1942, B. femoralis Klug, 1836, B. latreillei (Collucci & Amorim, 2000) e Issikiella araguaiensis Penny & Arias, 1983. A maioria dos indivíduos foi coletada entre os meses de outubro e fevereiro, período chuvoso no Maranhão. Uma chave de identificação para essas espécies e a descrição da fêmea de B. latreillei são apresentadas.

Navicordulia aemulatrix sp. nov. (Odonata, Corduliidae) from northeastern Santa Catarina State, Brazil

Navicordulia aemulatrix sp. nov. (holotype male deposited in MZSP: Brazil, Santa Catarina State, [São Bento do Sul municipality, 26°14'58"S, 49°22'59"W], [railroad station] Rio Vermelho, II.1952) is described and illustrated based on three males. The long cercus (2.9-3.2 mm) places this species in the longistyla-group together with N. kiautai, N. longistyla and N. nitens but it differs from them mainly by the shape of cercus, with carinated part occupying 0.33 of cercus total length, and also by dorsal, ventro-medial and ventro-lateral tubercles developed. An unusual process on tergal portion of prothorax is reported for the first time in Navicordulia. The rate of description of new species of South American 'Corduliidae' is discussed. A map with records of Atlantic Forest Navicordulia species and a list of Brazilian corduliids by state are also presented.

Número mínimo de tensões para determinação da curva característica de retenção de água de um latossolo vermelho eutrófico sob sistema de semeadura direta

Para o conhecimento do comportamento físico-hídrico do solo, é fundamental a determinação da curva de retenção de água (CRA). A aquisição de dados para obtenção da CRA envolve processos demorados e custos elevados. A hipótese deste estudo foi a de que é possível determinar a CRA com menor número de tensões, reduzindo seu tempo de obtenção, sem, contudo, comprometer a acurácia dos resultados. Assim, o objetivo deste trabalho foi determinar quais tensões podem ser utilizadas para determinação da CRA de Latossolo Vermelho eutrófico de maneira acurada e em menor tempo. Foram determinados os conteúdos de água retidos em amostras de um Latossolo Vermelho eutrófico sob sistema de semeadura direta (SSD). As tensões utilizadas na determinação dos conteúdos de água foram: 0, 10, 20, 40, 60, 80, 100, 200, 300, 500, 700, 1.000, 3.000, 5.000 e 15.000 hPa. Os dados foram combinados e determinaram-se 450 CRAs ajustadas pelo modelo de van Genuchten. Os parâmetros α, m, n e Ug res, gerados pelo modelo, foram submetidos à análise de variância (teste F) e as médias comparadas pelo teste de Scott-Knott (p = 0,05). A hipótese deste estudo foi confirmada, ou seja, é possível determinar a CRA com menor número de tensões, reduzindo seu tempo de obtenção em até cinco vezes, sem, contudo, comprometer a acurácia dos resultados. A tensão de 15.000 hPa deve estar contida na combinação de tensões a serem utilizadas para determinação da curva característica de retenção de água, quando se emprega o modelo matemático de van Genuchten para ajuste dos dados. As curvas características de retenção de água do solo, definidas com as combinações de tensões (0, 60, 700 e 15.000 hPa), (0, 80, 700 e 15.000 hPa), (0, 100, 1.000 e 15.000 hPa), (0, 20, 60, 100, 700 e 15.000 hPa), (0, 80, 300, 700 e 15.000 hPa) e (0, 100, 300, 1.000 e 15.000 hPa), sendo os dados ajustados ao modelo de van Genuchten, proporcionaram estimativas dos conteúdos de água, retidos no Latossolo Vermelho eutrófico sob sistema de semeadura direta, com a mesma acurácia, quando comparada à curva de referência partindo-se de um conjunto de 15 valores de tensões.

Tillage systems and nutrient sources affecting soil cover, temperature and moisture in a clayey oxisol under corn

Tillage affects soil physical properties, e.g., porosity, and leads to different amounts of mulch on the soil surface. Consequently, tillage is related to the soil temperature and moisture regime. Soil cover, temperature and moisture were measured under corn (Zea mays) in the tenth year of five tillage systems (NT = no-tillage; CP = chisel plow and single secondary disking; CT = primary and double secondary disking; CTb = CT with crop residues burned; and CTr = CT with crop residues removed). The tillage systems were combined with five nutrient sources (C = control; MF = mineral fertilizer; PL = poultry litter; CS = cattle slurry; and SS = swine slurry). Soil cover after sowing was greatest in NT (88 %), medium in CP (38 %) and lowest in CT treatments (< 10 %), but differences decreased after corn emergence. Soil temperature was related with soil cover, and significant differences among tillage were observed at the beginning of the growing season and at corn maturity. Differences in soil temperature and moisture in the surface layer of the tilled treatments were greater during the corn cycle than in untilled treatments, due to differences in intensity of soil mobilization and mulch remaining after soil management. Nutrient sources affected soil temperature and moisture in the most intense part of the corn growth period, and were related to the variation of the corn leaf area index among treatments