A tomografia computadorizada na avaliação do comprometimento abdominal na paracoccidioidomicose

A tomografia computadorizada foi utilizada para avaliar o comprometimento abdominal em 25 doentes deparacoccidioidomicose. Existiam lesões intra-abdominais em, respectivamente, 75%e23% dos doentes com asformas aguda ("juvenil") e crônica ( do adulto '). A alteração mais freqüente foi o aumento dos gânglios linfáticos abdominais (12/25 casos); outras lesões foram: calcificação de gânglios linfáticos em 4 casos; obstrução das vias biliares em 5 doentes ictéricos; abscessos ou calcificação esplénica em 3 casos; 2 doentes mostraram lesões incomuns: aumento e irrgularidade do pâncreas em um e múltiplos abscessos nos músculos psoas em outro. Conclui-se que a tomografia computadorizada é procedimento útil na avaliação da disseminação da paracoccidioidomicose ao abdome e no diagnóstico de suas complicações abdominais.

The hemorrhagic syndrome of leptospirosis: an experimental study in guinea pigs

The hemorrhagic syndrome of leptospirosis was studied in guinea pigs. The study correlates hematological, histopathological and immunohistochemical alterations in sixty animals inoculated by the intraperitoneal route with lml of the culture of virulent strain of Leptospira interrogans serovar copenhageni. Leptospirae antigens were detected by immunoperoxidase, chiefly in liver, kidney and heart muscle capillaries. Possible pathogenic mechanisms responsible for hemorrhagic syndrome are discussed with emphasis on toxic and anoxic attacks causing damage to endothelia, platelet depletion and alterations to hemostasia rates: prothrombin time [FT], partial thromboplastin time [PIT] and fibrinogen concentrations. Tide clinical-laboratoiy picture is compatible with the histopathological observation of disseminated intravascular coagulation [D1C] in most of the guinea pigs from day 4 of infection.

Angiostrongilose abdominal: profilaxia pela destruição das larvas infectantes em alimentos tratados com sal, vinagre ou hipoclorito de sódio

A infecção acidental humana pelo Angiostrongylus costaricensis ocorre com elevada prevalência em certas áreas do Brasil meridional, eventualmente se manifestando como doença abdominal severa. Profilaxia é importante, pois não hã tratamento medicamentoso. Um dos modos de transmissão é a ingestão de frutas e vegetais contaminados com a mucosidade de moluscos infectados, os hospedeiros intermediários deste parasita. Larvas de terceiro estágio obtidas do ciclo mantido em laboratório foram incubadas a 5°C por 12 horas, em vinagre, solução saturada de cloreto de sódio e hipocloríto de sódio a 1,5%. A viabilidade das lamas tratadas foi testada através da inoculação em camundongos albinos. Os percentuais de larvas que estabeleceram infecção foram: 0% com hipocloríto de sódio, 1,8% com salmora e 2,4% com vinagre. Em conclusão, todas as substâncias - de baixo custo e disponíveis nas áreas endêmicas - reduziram à população de lamas viáveis e podem ser úteis na descontaminação de alimentos para profilaxia da angiostrongilose abdominal.

Prevalence of IgG and IgM anti-Toxoplasma antibodies in patients with HIV and acquired immunodeficiency syndrome (AIDS)

With the emergence of the human immunodeficiency virus (HIV), in patients with acquired immunodeficiency syndrome (AIDS), Toxoplasma gondii has arisen as an important opportunist pathogenic agent, especcially in the central nervous system, being the most common cause of intracerebral lesions. The incidence of Toxoplasma gondii in HIV-infected patients depends principally on the existence of latent Toxoplasma parasitosis in the population affected. Through the enzyme-linked immunosorbent assay (ELISA), IgG and IgM anti-Toxoplasma antibodies were found in 92 patients of which 46 (50.0%) were IgG seropositive, and only one case (1.0%) had IgM antibodies.Of the 92 patients: 53 were HIV seropositives and 39 had AIDS. The detection and monitoring of anti-Toxoplasma antibodies in HIV patients is essential, since in this group there is a high percentage risk of developing cerebral toxoplasmosis, which is the second cause of death in this type of patients.

Ovos e órgãos reprodutores de fêmeas de Angiostrongylus costaricensis são reconhecidos mais intensamente por soros humanos de fase aguda na angiostrongilíase abdominal

O Angiostrongylus costaricensis é um nematódeo intra-arterial de roedores. O homem acidentalmente pode se infectar ao ingerir alimentos ou água contaminados. Nosso objetivo foi o de descrever as estruturas do parasita que são reconhecidas por soros humanos das fases aguda e convalescente da angiostrongilíase abdominal. O método de imunofluorescência indireta foi empregado para estudar a reatividade sobre ovos íntegros e cortes de vermes fêmeas e de larvas de primeiro estágio (L1). L1 também foram estudadas íntegras e depois de tratamento por sonicação. Fluorescência sempre mais intensa com soros de fase aguda foi detectada na superfície dos ovos inteiros e nos fragmentos de L1 e não estava presente nem nas L1 inteiras, nem em seus cortes. Uma reatividade inespecífica foi detectada na borda cuticular da cavidade geral e sobre os órgãos reprodutores. Os dados indicam que estes órgãos são fonte importante de antigenicidade.

Longitudinal clinical and serological survey of abdominal angiostrongyliasis in Guaporé, southern Brazil, from 1995 to 1999

Abdominal angiostrongyliasis is a zoonotic infection caused by Angiostrongylus costaricensis, a nematode with an intra-vascular location in the mesentery. Our objective was to address several aspects of the natural history of this parasitosis, in a longitudinal clinical and seroepidemiological study. A total of 179 individuals living in a rural area with active transmission in southern Brazil were followed for five years (1995-1999) resulting in yearly prevalence of 28.2%, 4.2%, 10%, 20.2% and 2.8% and incidences of 0%, 5.9%, 8% and 1.5%, respectively. Both men and woman were affected with higher frequencies at age 30-49 years. In 32 individuals serum samples were collected at all time points and IgG antibody reactivity detected by ELISA was variable and usually persisting not longer than one year. Some individual antibody patterns were suggestive of re-infection. There was no association with occurrence of abdominal pain or of other enteroparasites and there was no individual with a confirmed (histopathologic) diagnosis. Mollusks were found with infective third-stage larvae in some houses with an overall prevalence of 16% and a low parasitic burden. In conclusion, abdominal angiostrongyliasis in southern Brazil may be a frequent infection with low morbidity and a gradually decreasing serological reactivity.

Prolonged survival and immune reconstitution after chagasic meningoencephalitis in a patient with acquired immunodeficiency syndrome

We report a case of cerebral meningoencephalitis due to Trypanosoma cruzi in a patient with acquired immunodeficiency syndrome. The patient presented with seizures and focal neurological signs. Definitive diagnosis of chagasic meningoencephalitis was made by demonstration of free trypomastigote forms in the cerebrospinal fluid. Benznidazol was prescribed with clinical and neurological improvement. Antiretroviral drugs improved cellular immunity and three years later the patient presents a good clinical condition with immune reconstitution and undetectable viral load. Chagasic meningoencephalitis has a poor prognosis when specific treatment is not initiated or is delayed. A high index of diagnosis is necessary for early diagnosis and treatment, especially in endemic areas for Trypanosoma cruzi infection.

Clinical and laboratory findings related to a favorable evolution of hantavirus pulmonary syndrome

The medical records of 27 patients with hantavirus pulmonary syndrome were analyzed according to the need for invasive mechanical ventilation in relation to the following data up on hospital admission: age, gender, fever, cough, dyspnea, systolic arterial blood pressure, heart rate, levels of hemoglobin, hematocrit, leukocytes, lymphocytes, platelets, creatinine and arterial blood gases. The volume infused during the first 24 hours after admission, the use of inotropic agents, the use of corticosteroids and the patient outcomes were also evaluated. A favorable outcome was related to systolic blood pressure³ 100mmHg, heart rate lower than 100 beats per minute, creatinine below 1.6mg/dl, arterial blood pH³ 7.35, bicarbonate higher than 15mEq/dl, oxygen saturation higher than 84.1%, lower rehydration volume in the first 24 hours of hospitalization and no use of inotropic agents. Absence of clinical and laboratory signs of circulatory shock up on admission was associated with a favorable outcome of the patients.

Schistosomiasis mansoni and severe gastrointestinal cytomegalovirus disease in a patient with acquired immunodeficiency syndrome

The behavior of the Schistosoma mansoni infection in patients with AIDS has not been explored. The case of a young woman with schistosomiasis mansoni, AIDS, and cytomegalovirus disease is reported. The authors suggest that the helminth was not a bystander in this case, or rather, by interfering with the host's immune response, it set the stage for the development and/or aggravation of the viral infection.