Response to chemotherapy with benznidazole of clones isolated from the 21SF strain of Trypanosoma cruzi (biodeme Type II, Trypanosoma cruzi II)

Susceptibility to chemotherapy with benznidazole was investigated of 5 clones isolated from the 21 SF strain (biodeme Type II, Trypanosoma cruzi II). Swiss mice were infected with the parental strain for each clone and submitted to chemotherapy with benznidazole (100mg/kg/day during 90 days). Treatment determined negativity of the parasitemia. Cure rates were evaluated by parasitological cure tests. Serology was evaluated for treated animals (titers from negative to 1:640) and untreated controls (1:160 to 1:640). Cure rates varied from 30 to 100% for the 5 clones, and were 25% for the parental strain. Results suggested that the variability of response to treatment of the clonal populations of Trypanosoma cruzi II strains is responsible for the high variation in the response to chemotherapy with benznidazole and nifurtimox by strains of this biodeme.

High prevalence of methicillin-resistant Staphylococcus aureus with SCCmec type III in cystic fibrosis patients in southern, Brazil

INTRODUCTION: Bacterial colonization of the lungs is the main cause of morbidity in cystic fibrosis (CF). Pathogens such as Staphylococcus aureus are very well adapted to the pulmonary environment and may persist for years in the same patient. Genetic determinants of these bacteria, such as the presence of SCCmec have recently emerged as a problem in this population of patients. METHODS: Staphylococcus aureus isolates obtained from different clinical materials coming from CF and non-CF patients attended at a cystic fibrosis reference hospital were compared according to SCCmec type and antibiotic susceptibility profile. RESULTS: Three hundred and sixty-four single-patient Staphylococcus aureus isolates were collected, of which 164 (45%) were from CF patients. Among the latter, 57/164 (44.5%) were MRSA, and among the non-CF patients, 89/200 (35%) were MRSA. Associated pathogens were found in 38 CF patients. All 57 MRSA from CF patients harbored the multiresistant cassette type III. In contrast, 31/89 MRSA from non-CF patients harbored SCCmec type I (35%) and 44/89 harbored type III (49%). The antibiotic susceptibility pattern was similar between CF and non-CF patients. CONCLUSIONS: The high prevalence of multiresistant SCCmec type III among CF patients compared with non-CF patients in our institution may make it difficult to control disease progression through antibiotic therapy for promoting the survival of this kind of patient.

Cryptococcus gattii molecular type VGII as agent of meningitis in a healthy child in Rio de Janeiro, Brazil: report of an autochthonous case

Cryptococcus gattii causes meningoencephalitis in immunocompetent hosts, occurring endemically in some tropical and subtropical regions. Recently, this fungus was involved in an outbreak in Vancouver Island and British Columbia (Canada). In this temperate region, the VGII type is predominant. The paper describes an autochthonous case of meningoencephalitis by C. gattii VGII in a previously health child in Rio de Janeiro, considered nonendemic region of Brazil. The fungus was identified by biochemical tests and the molecular type was determined by URA5-RFLP. The present report highlights the need for clinical vigilance for primary cryptococcal meningitis in nonendemic areas.

Community-acquired methicillin-resistant Staphylococcus aureus carrying SCCmec type IV in southern Brazil

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen commonly associated with nosocomial infections. However, it has also been associated with community-acquired skin and soft tissue infections (CA-MRSA). There are few data on the identification and prevalence of CA-MRSA infections in Brazil. METHODS: This is a cross-sectional study of 104 patients with community-acquired skin infections attending two health care centers in Porto Alegre, southern Brazil. MRSA isolates were characterized by molecular methods, including detection of the mecA gene by PCR, gene SCCmec typing, Panton-Valentine leukocidin (PVL) detection, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). RESULTS: From the 104 samples, 58 Staphylococcus aureus isolates were obtained, of which five (8.6%) had a CA-MRSA-resistant profile. All five isolates had the mecA gene and amplified to SCCmec type IV. Analysis of chromosomal DNA by PFGE revealed the presence of two clusters related to international clones (OSPC and USA 300), with a Dice similarity coefficient >80%. The study was complemented by MLST, which detected three different strains: ST30, ST8, and ST45, the latter not presenting any relation with the clones compared in PFGE. CONCLUSIONS: The presence of CA-MRSA reveals an important change in the epidemiology of this pathogen and adds new elements to the knowledge of the molecular biology of infections by MRSA with SCCmec type IV in southern Brazil.

Sexual transmission of human T-cell lymphotropic virus type 1

Human T-cell lymphotropic virus type 1 (HTLV-1) is endemic in many parts of the world and is primarily transmitted through sexual intercourse or from mother to child. Sexual transmission occurs more efficiently from men to women than women to men and might be enhanced by sexually transmitted diseases that cause ulcers and result in mucosal ruptures, such as syphilis, herpes simplex type 2 (HSV-2), and chancroid. Other sexually transmitted diseases might result in the recruitment of inflammatory cells and could increase the risk of HTLV-1 acquisition and transmission. Additionally, factors that are associated with higher transmission risks include the presence of antibodies against the viral oncoprotein Tax (anti-Tax), a higher proviral load in peripheral blood lymphocytes, and increased cervicovaginal or seminal secretions. Seminal fluid has been reported to increase HTLV replication and transmission, whereas male circumcision and neutralizing antibodies might have a protective effect. Recently, free virions were discovered in plasma, which reveals a possible new mode of HTLV replication. It is unclear how this discovery might affect the routes of HTLV transmission, particularly sexual transmission, because HTLV transmission rates are significantly higher from men to women than women to men.

The use of botulinum toxin type A in the treatment of HTLV-1-associated overactive bladder refractory to conventional therapy

Urinary symptoms occur in 19% of human T-cell lymphotropic virus type 1 (HTLV-1)-infected patients who do not fulfill criteria for HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and in almost 100% of HAM/TSP patients. Few studies have evaluated therapies for overactive bladder (OAB) caused by HTLV-1 infection. This case report describes the effect of onabotulinum toxin A on the urinary manifestations of three patients with HAM/TSP and OAB symptoms. The patients were intravesically administered 200 units of Botox®. Their incontinence episodes improved, and their OAB symptoms scores (OABSS) reduced significantly. These data indicate that Botox® should be a treatment option for OAB associated with HTLV-1 infection.

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.

Oropharyngeal colonization by Haemophilus influenzae in healthy children from Taubaté (São Paulo), prior to the Haemophilus influenzae type b vaccination program in Brazil

Haemophilus influenzae is one of the most important bacterial agents of otitis and sinusitis. H. influenzae type b (Hib) is one of the main causes of meningitis, pneumonia, and septicemia in nonvaccinated children under 6 years of age. The aims of this study were to determine the prevalence of H. influenzae and Hib oropharyngeal colonization prior to the onset of the Hib vaccination program in Brazil in previously healthy children and to assess the susceptibility profile of this microorganism to a selected group of antimicrobials that are used to treat acute respiratory infections. METHOD: Cultures of Haemophilus influenzae were made from oropharynx swabs from 987 children under 6 years of age who were enrolled in 29 day-care centers in Taubaté (a city of São Paulo state, Brazil) between July and December 1998. RESULTS: The prevalence of H. influenzae carriers was 17.4%, and only 5.5% of the strains were beta-lactamase producers. The prevalence of Hib carriers was high, 7.3% on average (range, 0.0 - 33.3%). CONCLUSIONS: The low prevalence of colonization by penicillin-resistant strains indicates that it is not necessary to substitute ampicilin or amoxicilin to effectively treat otitis and sinusitis caused by H. influenzae in Taubaté.

List of type-specimens of Isoptera (Insecta) in the collection of the Museu Paraense Emílio Goeldi, State of Pará, Brazil

The collection of the Museu Paraense Emílio Goeldi (MPEG), in the city of Belém, State of Pará, Brazil, has 65 samples of type-specimens of Isoptera, representing 26 species (21 holotypes and 5 paratypes) of 18 genera. This paper lists the number of specimens of each caste in each type series, type localities with geographical coordinates, collectors, and dates of collection.

Eficácia da memantina na doença de Alzheimer em seus estágios moderado a grave

INTRODUÇÃO: O objetivo desta revisão de literatura é avaliar a eficácia, a segurança e a tolerabilidade da memantina, um antagonista não-competitivo do receptor N-metil-D-aspartato (NMDA), no tratamento da doença de Alzheimer em seus estágios moderado a grave. MÉTODOS: Realizou-se uma busca no banco de dados MEDLINE com as palavras-chave memantine e Alzheimer's disease, sendo inseridos apenas ensaios clínicos randomizados, duplo-cegos e controlados com placebo. RESULTADOS: Foram incluídos quatro estudos que preenchiam os critérios de inclusão supracitados, realizados com pacientes portadores de doença de Alzheimer com grau moderado a grave. Todos os estudos indicaram um efeito benéfico da memantina com relação ao placebo para os seguintes parâmetros: melhora da capacidade funcional e maior participação nas atividades diárias. Dois estudos evidenciaram melhora cognitiva. A duração média dos estudos foi de 28 semanas e as doses mais eficazes variaram de 10 a 20mg/dia. Os efeitos adversos, em todos os estudos, foram maiores no grupo placebo. DISCUSSÃO: Apesar de ser uma droga nova e ainda de custo elevado, a memantina parece reduzir os custos totais e o tempo gasto do cuidador, além de produzir melhora global do paciente, gerando melhor qualidade de vida tanto para o paciente quanto para o cuidador. Estudos ainda não publicados, contudo, sugerem que o impacto dessa droga nos estágios mais avançados da demência de Alzheimer seja marginal.

Perfil neuropsiquiátrico na doença de Alzheimer e na demência mista

Alguns estudos sugerem que infartos cerebrais possam agravar a demência em pacientes com doença de Alzheimer (DA) e que sintomas neuropsiquiátricos sejam comuns tanto na DA quanto na demência vascular (DV). Doença cerebrovascular concomitante à DA incorre na chamada demência mista (DM). OBJETIVOS: Comparar a freqüência e o perfil dos sintomas neuropsiquiátricos em uma amostra de pacientes com DA e DM. MÉTODOS: Análise retrospectiva dos prontuários de 70 pacientes com diagnóstico de DA provável e 14 com DM. Informações sobre sintomatologia neuropsiquiátrica foram obtidas por meio dos relatos de familiares e cuidadores. RESULTADOS: A média etária foi de 74,5 anos na DA e 75,1 na DM. O sintoma mais comum na DA foi agitação (61,4%), enquanto na DM foi apatia (71,7%). Na DM, nove (64,3%) pacientes apresentavam > 5 sintomas, enquanto na DA, 40 (57,1%) apresentavam < 4. Quarenta e cinco (64,3%) pacientes com DA tinham > 4 anos de doença; na DM, 10 (71,4%) tinham < 3 anos. Pacientes com DM mostraram menor duração de sintomas (p < 0,05), sugerindo que tenham procurado atendimento médico mais precocemente. CONCLUSÕES: Os pacientes com DM exibiram maior gravidade de sintomas neuropsiquiátricos, fato que pode ter sido responsável pela busca mais precoce de assistência especializada.

Qualidade de vida em cuidadores de idosos portadores de demência de Alzheimer

OBJETIVO: Realizar revisão sistemática da literatura acerca da QV dos cuidadores de idosos com DA. MÉTODOS: Revisão sistemática de literatura por meio do PubMed e da MedLine entre os anos de 1997 e 2008, utilizando os termos quality of life, caregivers, Alzheimer disease. RESULTADOS: Dezesseis estudos entre 274 publicações iniciais e 39 artigos posteriormente incluídos pelas referências bibliográficas foram avaliados. A QV dos cuidadores dos idosos demenciados, na maioria dos estudos, estava comprometida negativamente. Diversos fatores interferem na QV do cuidador, desde a gravidade da doença até alterações comportamentais que esses idosos possam vir a apresentar. CONCLUSÃO: É necessária a realização de mais estudos direcionados a esse tema, a fim de buscar estratégias para melhora da QV desse cuidador.

Atividade física sistematizada e sintomas de depressão na demência de Alzheimer: uma revisão sistemática

OBJETIVO: Realizar uma revisão sistemática de artigos científicos que analisaram os efeitos da atividade física sistematizada nos sintomas de depressão de pacientes com demência de Alzheimer. MÉTODOS: Foi realizada uma busca nas seguintes bases de dados: Web of Science, PubMed, PsycINFO, MedLine e Biological Abstracts, utilizando-se as seguintes palavras-chave: "Alzheimer dementia" , "Alzheimer disease" , "Alzheimer, physical activity", "physical exercise", "motor intervention" , "physical therapy" , "exercise" , "aerobic" , "strength" , "fitness" , "depression" , "dysphoria" , "depressive symptoms" e "depressive episodes". Além da busca nas bases de dados, foi realizada também uma busca manual nas listas de referências dos artigos selecionados. RESULTADOS: Foram encontrados quatro estudos que preencheram todos os critérios de inclusão adotados para o presente trabalho. Dois estudos apresentaram reduções dos sintomas depressivos, e outros dois não encontraram redução desses sintomas. CONCLUSÃO: Com a realização desta revisão sistemática, observou-se que não há consenso em relação aos benefícios da atividade física aos sintomas depressivos em pacientes com demência de Alzheimer.