Limiar anaeróbio detectado pela "análise da curva-V" na cardiopatia chagásica crônica

O limiar anaeróbio (LA) medido pela análise da curva-V é a melhor medida da reserva funcional na insuficiência cardíaca e conseqüentemente a medida que melhor retrata o grau de comprometimento cardíaco. No presente trabalho foram estudados 28 pacientes (18 homens; idade média de 47 ± 6,7 anos) com sorologia positiva para a doença de Chagas, com graus variáveis de comprometimento cardíaco segundo a classificação de Los Andes e sem outras doenças associadas. A análise de variância mostrou que o LA dos pacientes do grupo IA (ECG e ventriculograma no ECO normal) é significativamente mais altos do que o valor observado nos demais grupos (p = 0,001). Enquanto o teste de comparações múltiplas de Tukey revelou que as médias do LA nos pacientes dos grupos IB, II e III (IB:ECG normal; ventriculograma no ECO anormal; II: ECG e venticulograma no ECO anormal sem ICC e III com ICC) não diferem significativamente entre si. O presente estudo demonstra que a ocorrência de alterações ventriculográficas iniciais já se associa a significativa redução da reserva cardiopulmonar e este comprometimento é progressivo e paralelo ao grau de comprometimento hemodinâmico cardíaco. A causa mais provável da redução do LA no grupo IB é a disfunção diastólica constatada ao ecocardiograma.

Avaliação da tolerância e nefrotoxicidade do antimonial pentavalente administrado na dose de 40mg Sb v/kg/dia, de 12/12h, por 30 dias na forma cutaneo-mucosa de leishmaniose

Foi avaliada a função renal de 11 pacientes com leishmaniose cutâneo-mucosa tratados com antimonial pentavalente na dose de 40mg SbV/kg/dia aplicada de 12/12 horas, em esquema contínuo, durante trinta dias. No estudo, um paciente apresentou insuficiência renal reversível e dois desenvolveram alterações enzimáticas hepáticas e eletrocardiográficas sendo o esquema terapêutico interrompido. Nos demais pacientes observou-se efeitos nefrotóxicos tais como diminuição da taxa de filtração glomerular, diminuição da capacidade de concentração urinária, avaliada por um jejum hídrico de 16 horas e aumento na fração de excreção de sódio. No exame do sedimento urinário observou-se um aumento no número de leucócitos e cilindros. Os resultados encontrados neste estudo sugerem que o tratamento com antimonial pentavalente na dose de 40mg SbV/kg/dia foi menos tolerado em virtude de seus efeitos tóxicos, não parecendo apresentar índice de cura superior ao esquema atualmente preconizado de 20mg SbV/kg/dia.

Aspectos laboratoriais evolutivos de crianças em tratamento da paracoccidioidomicose

Estudo de 38 crianças com paracoccidioidomicose, até 14 anos de idade, tratados por 24-30 meses, com um derivado sulfamídico ou cetoconazol, desde o início do tratamento ou em seguida ao uso da anfotericina B. Dados laboratoriais à admissão foram analisados e comparados com exames seqüenciais até 30 meses de acompanhamento. Anemia, eosinofilia e bilirrubinas e aminotransferases elevadas normalizaram-se, na maioria, até os três meses de tratamento e, hipoalbuminemia, até os seis meses, sugerindo que esses achados sejam bons parâmetros para o monitoramento da resposta terapêutica inicial. Leucócitos periféricos, velocidade de hemossedimentação, IgG e títulos sorológicos para o Paracoccidioides brasiliensis estavam elevados e normalizaram-se, freqüentemente, após nove a 12 meses de tratamento, o que sugere utilidade desses exames no monitoramento de todo o tratamento e enfatiza a necessidade de curso terapêutico prolongado da paracoccidioidomicose na infância.

Avaliação dos testes rápidos Optimal-IT® e ICT P.f./P.v.® para o diagnóstico da malária, na Atenção Básica de Saúde, no município de Manaus, Amazonas

O diagnóstico da malária é realizado rotineiramente pelo exame da gota espessa, entretanto, esta técnica requer o treinamento de microscopistas e pode consumir muito tempo. Foi realizado um estudo de concordância de dois testes rápidos (Optimal-IT® e ICT P.f./P.v.®) com a gota espessa, na atenção básica de saúde, em Manaus.

Morbidity due to Schistosoma mansoni - Entamoeba histolytica coinfection in hamsters (Mesocricetus auratus)

Data on Schistosoma mansoni-Entamoeba histolytica coinfection are scarce in the literature. In the present study, hamsters that had been infected for 70 days with Schistosoma mansoni (LE strain) were inoculated via the portal vein with two strains of trophozoites of Entamoeba histolytica: ICB-EGG (highly virulent) and ICB-RPS (non-virulent). The most evident result of coinfection was increased morbidity and mortality, in comparison with either of the infections alone. Histologically, there were no evident signs of interaction between these two infections. The morphological findings of schistosomal granuloma and amoebic abscesses in the liver were similar to those seen in the respective single-infection controls. However, there was severe wasting of the animals with both infections and greater numbers of amoebic lesions in their livers. The results obtained indicated that schistosomiasis aggravates the course of amoebiasis in hamsters.

Aedes aegypti and Aedes albopictus (Diptera: Culicidae): coexistence and susceptibility to temephos, in municipalities with occurrence of dengue and differentiated characteristics of urbanization

INTRODUCTION: The aim of the present study was to verify the coexistence between Aedes aegypti and Aedes albopictus populations in municipalities of the States of Paraná and Santa Catarina with different urbanization profiles where dengue occurs and evaluate their susceptibility to the organophosphate temephos. METHODS: The number of eggs per ovitrap were counted and incubated for hatching to identify the species. Data analysis of the populations was conducted to determine randomness and aggregation, using the variance-to-mean ratio (index of dispersion). Susceptibility to temephos was evaluated by estimation of the resistance ratios RR50 and RR95. Aedes aegypti samples were compared with the population Rockefeller and Aedes albopictus samples were compared with a population from the State of Santa Catarina and with the Rockefeller population. RESULTS: Coexistence between Aedes aegypti and Aedes albopictus and the aggregation of their eggs were observed at all the sites analyzed in the State of Paraná. CONCLUSIONS: All the Aedes aegypti populations from the State of Parana showed alteration in susceptibility status to the organophosphate temephos, revealing incipient resistance. Similarly, all the Aedes albopictus populations (States of Paraná and Santa Catarina) presented survival when exposed to the organophosphate temephos.

Giardia duodenalis: genotypic comparison between a human and a canine isolates

INTRODUCTION: Evidence suggests that giardiasis is a zoonotic disease. The present work aimed to evaluate the genetic identity of Giardia duodenalis isolated from human and dog fecal samples from Belo Horizonte. METHODS: Human and dog fecal samples were cultured for isolation of G. duodenalis. To determine the genotype of the isolates, primers that amplify a specific region in rRNA of the protozoan were used. RESULTS: Two G. duodenalis isolates were obtained, which belong to the subgroup A genotype. CONCLUSIONS: These findings suggest that the transmission of giardiasis follows a zoonotic pattern.

Antigens of worms and eggs showed a differentiated detection of specific IgG according to the time of Schistosoma mansoni infection in mice

INTRODUCTION: The correlation between the immunological assay and the antibody titer can offer a tool for the experimental analysis of different phases of the disease. METHODS: Two simple immunological assays for Schistosoma mansoni in mice sera samples based on specific IgG detection for worms soluble antigens and eggs soluble antigens were standardized and evaluated in our laboratory. Fifty mice were used in negative and positive groups and the results obtained by enzyme-linked immunosorbent assays (ELISA) assays were compared with the number of worms counted and the IgG titers at different times of infection. RESULTS: Data showed that ELISA using adult worm antigens (ELISA-SWAP) presented a satisfactory correlation between the absorbance value of IgG titers and the individual number of worms counted after perfusion technique (R²=0.62). In addition, ELISA-SWAP differentially detected positive samples with 30 and 60 days post infection (p=0.011 and 0.003, respectively), whereas ELISA using egg antigens (ELISA-SEA) detected samples after 140 days (p=0.03). CONCLUSIONS: These data show that the use of different antigens in immunological methods can be used as potential tools for the analysis of the chronological evolution of S. mansoni infection in murine schistosomiasis. Correlations with human schistosomiasis are discussed.

Acute schistosomiasis diagnosis: a new tool for the diagnosis of schistosomiasis in a group of travelers recently infected in a new focus of Schistosoma mansoni

IntroductionThe diagnosis of schistosomiasis mansoni on early stages of infection is important to prevent late morbidity. A simple, cheap, sensitive and specific assay for routine diagnosis of schistosome infection based on the detection of specific IgG for schistosomula tegument antigens (ELISA-SmTeg) was developed by our group.MethodsWe describe here an acute outbreak involving a travel group of 80 individuals from a non-endemic area of the State of Minas Gerais, Brazil. These individuals were in contact with a freshwater pool where Biomphalaria glabrata was found. Results obtained from our new methodology were compared to IgG antibody titers against soluble worm antigenic preparation (SWAP) by ELISA and, also to parasitological examination, nuclear magnetic resonance and clinical findings.ResultsELISA-SmTeg was capable of detecting 64 positive cases among the 80 individuals participating at the survey with a positivity ratio of 80% and a higher sensitivity than ELISA-SWAP that was only sensitive for 56% of positive cases. Besides, a significant correlation was found for the severity of the infection and the specific IgG titers against SmTeg.ConclusionsOur data showed that ELISA-SmTeg might serve as the initial diagnostic tool for acute stages of the infection in community-based helminth control programs or for the surveillance of individuals from non-endemic areas.

Puerperal brain cryptococcoma in an HIV-negative woman successfully treated with fluconazole: a case report

Cryptococcus spp. cerebral abscesses are uncommon in immunocompetent subjects. The recommended induction treatment is the administration of amphotericin B plus flucytosine combined with resection for lesions ≥3cm. In this paper, we describe an HIV-negative woman diagnosed with a large cryptococcoma in the immediate postpartum period. The lesion was not resected, and due to amphotericin B intolerance, she received an extended course of fluconazole monotherapy. There was no disease recurrence during the 4 years of follow-up. The abrupt onset of her symptoms following delivery suggests that she developed a postpartum immune reconstitution syndrome. This case also demonstrates that in specific situations fluconazole monotherapy can be attempted in immunocompetent patients with cryptococcoma.

Acceptance and potential barriers to effective use of diagnostic tests for visceral leishmaniasis in an urban area in Brazil

Abstract: INTRODUCTION: Acceptance of the IT LEISH(r) and direct agglutination test- made in the Laboratório de Pesquisas Clínicas (DAT-LPC) by healthcare professionals and patients suspected of visceral leishmaniasis (VL) in Ribeirão das Neves was evaluated. METHODS: Ninety-two patients and 47 professionals completed three questionnaires. RESULTS: Eighty-eight (96%) patients considered fingertip blood collection a positive test feature, and 86% (37) and 91% of professionals considered the IT LEISH(r) easy to perform and interpret, respectively. All professionals classified the DAT-LPC as simple and easy. CONCLUSIONS: Patients and healthcare professionals in Ribeirão das Neves demonstrated a high degree of acceptance of the IT LEISH(r) and DAT-LPC.

Manipulus Rubiacearum - V. A revision of the genus Capirona.

The taxonomic histort of the genus Capirona is presented. Complete synonymies, descriptions, common names, distributions and discussions are given for Capirona and its two species C. descorticans and C. leiophloea. The generic distribution is the Amazon valley and eastern Guianas and coincides with that of the genus Hevea. C. descorticans is know from the western and southeastern Amazon valley; C. leiophloea is reported from the eastern Guianas and the northeastern Amazon valley. The zone of contact between the two species is along the southern edge oh the Amazon River and the lower drainage of the Rio Tapajoz in Pará, Brazil.