Active and latent tuberculosis in prisoners in the Central-West Region of Brazil

Introduction Jailed populations exhibit high rates of tuberculosis (TB) infection and active disease. Methods A cross-sectional study was performed to estimate the prevalence of latent and active TB and to identify factors associated with latent infection in inmates. Results The prevalence of latent TB was 49%, and the prevalence of active TB was 0.4%. The presence of a Bacille Calmette-Guérin (BCG) scar (prevalence ratio (PR)=1.65; 95% confidence interval (CI): 1.09-2.50; p=0.0162) and the World Health Organization (WHO) score for active TB in prisons (PR=1.07; 95% CI: 1.01-1.14; p=0.0181) were correlated with infection. Conclusions The identification of associated factors and the prevalence of latent and active TB allows the development of plans to control this disease in jails.

Active surveillance to determine the impact of methicillin resistance on mortality in patients with bacteremia and influences of the use of antibiotics on the development of MRSA infection

Introduction Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important pathogens of nosocomial infections, mainly in intensive care units (ICUs), and accounts for 40-60% of all healthcare-associated S. aureus infections. We evaluated the incidence of nosocomial infection by S. aureus, identified the risk factors for MRSA infection, and evaluated the effect of resistance to methicillin on mortality in patients. Methods We conducted MRSA surveillance at a university hospital in Brazil from January 1, 2010, to December 31, 2010, and performed a retrospective case-control matched study to evaluate the frequency of subsequent MRSA bacteremia and death among patients. We evaluated and compared the risk factors between patients with MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) infection. Results Sepsis was the most common cause of infection (17.7/1,000 patient-days), followed by surgical site (11.4/1,000 patient-days), pneumonia (4.1/1,000 patient-days), and urinary tract infection (2.4/1,000 patient-days). The significant risk factors were time of hospitalization, use of central vascular catheter (CVC), urinary catheter, nasogastric tube, parenteral nutrition, tracheostomy, mechanical ventilation, and previous antibiotic administration, the latter of which was the only independent risk factor for MRSA infection. Mortality was significantly higher in patients with MRSA. The number of antibiotics tested was not related to increases in the frequency of MRSA/1,000 patient-days. The incidence of mortality attributable to MRSA (bloodstream infection) BSI was 50%. Conclusions Surveillance results showed that the use of high levels of antibiotics was directly related to the development of MRSA infection, and the mortality attributable to MRSA in patients with bacteremia was significant.

Twenty-eight years of Aedes albopictus in Brazil: a rationale to maintain active entomological and epidemiological surveillance

INTRODUCTION: Aedes albopictus was first detected in Brazil in 1986. This mosquito species presents a major threat to public health because Brazilian populations have shown substantial vector competence for arboviruses such as dengue and chikungunya. METHODS: We updated the records of Ae. albopictus in several States of Brazil, focusing on areas in which its presence had been reported after 2002. RESULTS: Twenty-eight years after its arrival in Brazil, Ae. albopictus has been detected in 24 of 27 States. CONCLUSIONS: The rapid spread of this species and its high vector competence demonstrate the danger of Ae. albopictus in Brazil.

Opportunistic infections among individuals with HIV-1/AIDS in the highly active antiretroviral therapy era at a Quaternary Level Care Teaching Hospital

INTRODUCTION : In this study, clinical-laboratory and epidemiological characteristics are described for a group of 700 individuals with HIV (human immunodeficiency virus)/AIDS (acquired immunodeficiency syndrome) in the ART (antiretroviral therapy) era at a teaching hospital that provides a quaternary level of care, with an emphasis on opportunistic infections (OIs), co-infections and immune profile. METHODS : A retrospective cross-sectional study of AIDS cases was conducted from 1998 to 2008 by reviewing medical records from the Base Hospital/FUNFARME (Fundação Faculdade Regional de Medicina), São José do Rio Preto, São Paulo, Brazil. RESULTS: The individuals were 14 to 75 years of age, and 458 were males. Heterosexuals accounted for 31.1% of all patients. Eighty-three percent were on ART, and 33.8% of those presented difficulties with treatment adherence. OIs were analyzed from medical records, and Pneumocystis jiroveci pneumonia was the most prevalent, regardless of the LTCD4+ (TCD4+ Lymphocytes) levels. Individuals whose viral loads were ≥10,000 showed a 90% greater chance of neurotoxoplasmosis. For P. jiroveci pneumonia, neurotoxoplasmosis, esophageal candidiasis, pulmonary tuberculosis and neurocryptococcosis, the chances of infection were higher among patients with LTCD4+ levels below 200 cells/mm3. HIV/hepatitis C virus (HCV) and HIV/hepatitis B virus (HBV) co-infections were significantly associated with death. CONCLUSIONS : OIs remain frequent in the ART era even in populations where the access to medical care is considered satisfactory.

Epidemiological aspects of Toxoplasma gondii infection in riverside communities in the Southern Brazilian Amazon

INTRODUCTION: Toxoplasma gondii infection is widely prevalent in humans and other animals worldwide. Information on the prevalence of T. gondii infection is scarce in some regions of Brazil, including riverside communities along the Amazon River basin. M METHODS: The prevalence of T. gondii in 231 people, aged 1-85 years, who were living in four riverside communities along the Purus River, Lábrea, State of Amazonas, Brazil, was determined. Antibodies against T. gondii were assayed using a commercial enzyme-linked immunosorbent assay (ELISA) kit. The hearts and brains of 50 chickens, which were raised free-range in the communities, were pooled according to the community of origin and bioassayed in mice. The isolates were genotyped using polymorphisms at 12 nuclear markers (SAG1, 5' and 3'-SAG2, alt.SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, Apico and CS3). RESULTS: The overall seroprevalence of T. gondii was 56.7% (131/231). IgG antibodies were presented by 117 (89.3%) and IgM by 14 (10.7%) of the 131 positive individuals. No association between age group and gender with prevalence was observed (chi-square test, p > 0.05); however, the comparison between localities showed that the seroprevalence of T. gondii was significantly lower among the individuals living in the Boca do Ituxi (p < 0.05) community. Five isolates of T. gondii were obtained in the mouse bioassay, and genotyping revealed two complete genotypes that had not been described previously and three mixed isolates. CONCLUSIONS: These results support previous findings that T. gondii population genetics are highly diverse in Brazil and that T. gondii infection is active in these riverside communities.

New strategies for active finding of leprosy cases in the Amazonian region

AbstractINTRODUCTION: The use of the Self-Image Form (SIF) expands the identification of active leprosy cases to neighbors of index cases.METHODS: The SIF was used to screen two groups: case (neighbors of index cases of leprosy) and control (individuals residing next to houses without leprosy) group. A specialist investigated suspected leprosy cases for disease confirmation.RESULTS: New cases of leprosy were diagnosed in the case group (n = 7, 8.6%), but not the control group.CONCLUSIONS: The new surveillance strategy is inexpensive, efficient, and feasible within a primary health strategy. Future studies can help improve the use of the SIF.

Physicochemical properties and antioxidant capacity of propolis of stingless bees (Meliponinae) and Apisfrom two regions of Tocantins, Brazil

ABSTRACTThe composition of propolis depends on time, vegetation and the location of the collection area. The objective of this study was to determine the physicochemical characteristics, the concentration of phenol compounds and the antioxidant capacity of propolis of native stingless bees (Meliponinae)and Apis from the State of Tocantins. Extraction with 80% ethanol (v/v) was performed in order to obtain the extracts. Parameters examined were: propolis mass loss by desiccation at 105 ºC, ashes, wax concentration and pH. Furthermore, the propolis antioxidant activity was measured, as well as the total concentration of phenol compounds. The extracts were also analyzed by high performance liquid chromatography. The total concentration of phenol compounds varied between 121.78 and 631.29 (mg GAE g-1). The antioxidant activity expressed by the value of CE50 varied between 29.81 and 845.38 µg mL-1. High performance liquid chromatography analysis allowed us to infer the existence of phenol compounds. The results indicated that the studied propolis samples constitute good sources of natural antioxidants. The variety of phenol compounds identified in this study, and the diverse biological functions reported in literature for these compounds indicated that this stingless bee propolis (Meliponinae) and Apis has a high pharmacological potential.

Trends in the risk of mortality due to cardiovascular diseases in five Brazilian geographic regions from 1979 to 1996

OBJECTIVE - To analyze the trends in risk of death due to cardiovascular diseases in the northern, northeastern, southern, southeastern, and central western Brazilian geographic regions from 1979 to 1996. METHODS - Data on mortality due to cardiovascular, cardiac ischemic, and cerebrovascular diseases in 5 Brazilian geographic regions were obtained from the Ministry of Health. Population estimates for the time period from 1978 to 1996 in the 5 Brazilian geographic regions were calculated by interpolation with the Lagrange method, based on the census data from 1970, 1980, 1991, and the population count of 1996, for each age bracket and sex. Trends were analyzed with the multiple linear regression model. RESULTS - Cardiovascular diseases showed a declining trend in the southern, southeastern, and northern Brazilian geographic regions in all age brackets and for both sexes. In the northeastern and central western regions, an increasing trend in the risk of death due to cardiovascular diseases occurred, except for the age bracket from 30 to 39 years, which showed a slight reduction. This resulted from the trends of cardiac ischemic and cerebrovascular diseases. The analysis of the trend in the northeastern and northern regions was impaired by the great proportion of poorly defined causes of death. CONCLUSION - The risk of death due to cardiovascular, cerebrovascular, and cardiac ischemic diseases decreased in the southern and southeastern regions, which are the most developed regions in the country, and increased in the least developed regions, mainly in the central western region.

Biologia da Arsenura xanthopus (Walker, 1855) ( Lepidoptera - Adelocephalidae ), praga do «Açoita-Cavalo» (Luehea spp.) e notas sôbre seus inimigos naturais

Biology of Arsenura xanthopus (Walker, 1855) (Lep., Adelocephalidae), a pest of Luehea spp. (Tiliaceae), and notes on its natural enemies. In the beginning of 1950, one of the Authors made some observations about the biology of Arsenura xanthopus (Walker), in Piracicaba, State of S. Paulo, Brazil. From 1951 to 1953, both Authors continued the observations on such an important Adelocephalidae, the caterpillars of which represent a serious pest of Luehea spp. leaves. Actually, in some occasions, the caterpillars can destroy completely the leaves of the trees. The species is efficientely controlled by two natural enemies: an egg parasite (Tetrastichus sp., Hym., Eulophidae) and a fly attacking the last instar caterpillar (Winthemia tricolor (van der Wulp), Dip., Tachinidae). Tetrastichus sp. can destroy 100% of the eggs and the fly, 70 to 100% of the caterpillars. Indeed, facts as such are very interesting because we rarely know of a case of so complete a control of a pest by an insect. A. xanthopus had not yet been mentioned in our literature. Actually neither the systematic bibliography nor the economic one has treated of this species. However, a few other species of Arsenura are already known as living on Luehea spp. According to the Authors' observations, W. tricolor was also unknown by the Brazilian entomological literature. Arsenura xanthopus (Walker, 1855) After giving the sinonimy and a few historical data concerning the species, and its geographical distribution, the Authors discuss its placing in the genus Arsenura Duncan or Rhescyntis Huebner, finishing by considering Arsenura xanthopus as a valid name. The Authors put the species in the family Adelocephalidae, as it has been made by several entomologists. The host plant The species of Tiliaceae plants belonging to the genus Luehea are called "açoita-cavalo" and are well known for the usefulness of their largely utilized wood. The genus comprises exclusively American plants, including about 25 species distributed throughout the Latin America. Luehea divaricata Mart, is the best known species and the most commonly cultivated. Biology of Arsenura xanthopus Our observations show that the species passes by 6 larval stages. Eggs and egg-postures, all the 6 instars of the caterpillars as well as the chrysalid are described. The pupal period is the longest of the cycle, taking from 146 to 256 days. Data on the eclosion and habits of the caterpillars are also presented. A redescription of the adult is also given. Our specimens agreed with BOUVIER's description, except in the dimension between the extremities of the extended wings, which is a little shorter (107 mm according to BOUVlErVs paper against from 80 to 100mm in our individuals). Winthemia tricolor (van der Wulp, 1890) Historical data, geographical distribution and host are first related. W. tricolor had as yet a single known host-; Ar^-senura armida (Cramer). This chapter also contains some observations on the biolcn gy of the fly and on its behaviour when trying to lay eggs on the caterpillars' skin. The female of W. tricolor lays from 1 to 33 eggs on the skin of the last instar caterpillar. The mam region of the body where the eggs are laid are the membranous legs. Eggs are also very numerous oh the ventral surface of the thorax and abdomen. The. preference for such regions is easily cleared up considering the position assumed by the caterpillar when fixed motionless in a branch. In such an occasion, the fly approaches, the victim, puts the ovipositor out and lays the eggs on different parts of the body, mainly on the mentioned regions, which are much more easily reached. The eggs of the fly are firmly attached to the host's skin, being almost impossible to detach them, without having them broken. The minute larvae of the fly enter the body of, the host when it transforms into chrysalid. Chrysalids recentely formed and collected in nature f requentely show a few small larvae walking on its skin and looking for an adequate place to get into the body. A few larvae die by remaining in the skin of the caterpillar which is pushed away to some distance by the active movements of the chrysalid recentely formed. From 1 to 10 larvae completely grown may emerge from the attacked chrysalid about 8 days after their penetrating into the caterpillars' body and soon begin to look for an adequate substratum where they can transform themselves into pupae. In natural conditions, the metamorphosis occurs in the soil. The flies appear within 15 days. Tetrastichus sp. This microhymenoptera is economically the most interesting parasite, being commonly able to destroy the whole pos^ ture of the moth. Indeed, some days after the beginning of the infestation of the trees, it is almost impossible to obtain postures completely free of parasites. The active wasp introduces the ovipositor into the egg of the moth, laying its egg inside, from 80 to 120 seconds after having introduced it. A single adult wasp emerges from each egg. Sarcophaga lambens Wiedemann, 1830 During the observations carried out, the Authors obtained 10 flies from a chysalid that were recognized as belonging to the species above. S. lambens is a widely distributed Sarcophagidae, having a long list of hosts. It is commonly obtained from weak or died invertebrates, having no importance as one of their natural enemies. Sinonimy, list of hosts and distribution are presented in this paper. Control of Arsenura xanthopus A test has been carefully made in the laboratory just to find out the best insecticide for controlling A. xanthopus caterpillars. Four different products were experimented (DDT, Pa-rathion, BHC and Fenatox), the best results having been obtained with DDT at 0,25%. However, the Authors believe in spite of the initial damages of the trees, that the application of an insecticide may be harmful by destroying the natural agents of control. A biological desiquilibrium may in this way take place. The introduction of the parasites studied (Tetrastichus sp. and Winthemia tricolor) seems to be the most desirable measure to fight A. xanthopus.

A rapid method for testing in vivo the susceptibility of different strains of Trypanosoma cruzi to active chemotherapeutic agents

A method is described which permits to determine in vivo an in a short period of time (4-6 hours) the sensitivity of T. cruzo strains to known active chemotherapeutic agents. By using resistant- and sensitive T. cruzi stains a fairly good correlation was observed between the results obtained with this rapid method (which detects activity against the circulating blood forms) and those obtained with long-term schedules which involve drug adminstration for at least 20 consecutive days and a prolonged period of assessment. This method may be used to characterize susceptibility to active drugs used clinically, provide infomation on the specific action against circulating trypomastigotes and screen active compounds. Differences in the natural susceptibility of Trypanosoma cruzi strains to active drugs have been already reported using different criteria, mostly demanding long-term study of the animal (Hauschka, 1949; Bock, Gonnert & Haberkorn, 1969; Brener, Costa & Chiari, 1976; Andrade & Figueira, 1977; Schlemper, 1982). In this paper we report a method which detects in 4-6 hours the effect of drugs on bloodstream forms in mice with established T. cruzi infections. The results obtained with this method show a fairly good correlation with those obtained by prolonged treatment schedules used to assess the action of drugs in experimental Chagas' disease and may be used to study the sensitivity of T. cruzi strains to active drugs.

Active cutaneous leishmaniasis in Brazil, induced by Leishmania donovani chagasi

L.d. chagasi was isolated from active cutaneous leishmaniasis in both human and canine infections in an endemic area in Rio de Janeiro, Brazil. Both isolates were identified by molecular and immunological characterization of the parasite using three different methods: electrophoretic mobility of isoenzymes; restriction endonuclease fragment analysis of kDNA and serodeme analysis using monoclonal antibodies. This seems to be the first well documented case in the New World of a "viscerotropic" Leishmania inducing a case of cutaneous leishmaniasis. This observation emphasizes that the diagnosis of the etiologic agent of human or canine visceral leishmaniasis based solely upon clinical and epidemiological critwria may lead to erroneous conclusions.

Potential sources of biodynamically active natural products in Brazil

In contrast to China where vegatation is predominantly herbaceous, vegetation in Brazil is commonly arboreous. This fact may explain why Chinese drugs are usually acetate derived, while actual and potential natural therapeutic agents from Brazil are mostly shikimate derived. Only relatively few compounds isolated from Brazilian plants have been submitted to adequate pharmacological testing