Combination Therapy for the Cardiovascular Effects of Perinatal Lead Exposure in Young and Adult Rats

Background: Combination therapy can play a significant role in the amelioration of several toxic effects of lead (Pb) and recovery from associated cardiovascular changes. Objective: To investigate the effects of combination therapy on the cardiovascular effects of perinatal lead exposure in young and adult rats Methods: Female Wistar rats received drinking water with or without 500 ppm of Pb during pregnancy and lactation. Twenty-two- and 70-day-old rat offspring who were or were not exposed to Pb in the perinatal period received meso-dimercaptosuccinic acid (DMSA), L-arginine, or enalapril and a combination of these compounds for 30 additional days. Noradrenaline response curves were plotted for intact and denuded aortas from 23-, 52-, 70-, and 100-day-old rats stratified by perinatal Pb exposure (exposed/unexposed) and treatment received (treated/untreated). Results: Systolic blood pressure was evaluated and shown to be higher in the 23-, 52-, 70-, and 100-day age groups with Pb exposure than in the corresponding control age groups: 117.8 ± 3.9*, 135.2 ± 1.3*, 139.6 ± 1.6*, and 131.7 ± 2.8*, respectively and 107.1 ± 1.8, 118.8 ± 2.1, 126.1 ± 1.1, and 120.5 ± 2.2, respectively (p < 0.05). Increased reactivity to noradrenaline was observed in intact, but not denuded, aortas from 52-, 70-, and 100-day-old exposed rats, and the maximum responses (g of tension) in the respective Pb-exposed and control age groups were as follows: 3.43 ± 0.16*, 4.32 ± 0.18*, and 4.21 ± 0.23*, respectively and 2.38 ± 0.33, 3.37 ± 0.13, and 3.22 ± 0.21, respectively (p < 0.05). Conclusions: All treatments reversed the changes in vascular reactivity to noradrenaline in rats perinatally exposed to Pb. The combination therapy resulted in an earlier restoration of blood pressure in Pb-exposed rats compared with the monotherapies, except for enalapril therapy in young rats. These findings represent a new approach to the development of therapeutic protocols for the treatment of Pb-induced hypertension.

Healthcare-Associated Infective Endocarditis: a Case Series in a Referral Hospital from 2006 to 2011

Background: Healthcare-associated infective endocarditis (HCA-IE), a severe complication of medical care, shows a growing incidence in literature. Objective: To evaluate epidemiology, etiology, risk factors for acquisition, complications, surgical treatment, and outcome of HCA-IE. Methods: Observational prospective case series study (2006-2011) in a public hospital in Rio de Janeiro. Results: Fifty-three patients with HCA-IE from a total of 151 cases of infective endocarditis (IE) were included. There were 26 (49%) males (mean age of 47 ± 18.7 years), 27 (51%) females (mean age of 42 ± 20.1 years). IE was acute in 37 (70%) cases and subacute in 16 (30%) cases. The mitral valve was affected in 19 (36%) patients and the aortic valve in 12 (36%); prosthetic valves were affected in 23 (43%) patients and native valves in 30 (57%). Deep intravenous access was used in 43 (81%) cases. Negative blood cultures were observed in 11 (21%) patients, Enterococcus faecalis in 10 (19%), Staphylococcus aureus in 9 (17%), and Candida sp. in 7 (13%). Fever was present in 49 (92%) patients, splenomegaly in 12 (23%), new regurgitation murmur in 31 (58%), and elevated C-reactive protein in 44/53 (83%). Echocardiograms showed major criteria in 46 (87%) patients, and 34 (64%) patients were submitted to cardiac surgery. Overall mortality was 17/53 (32%). Conclusion: In Brazil HCA-IE affected young subjects. Patients with prosthetic and native valves were affected in a similar proportion, and non-cardiac surgery was an infrequent predisposing factor, whereas intravenous access was a common one. S. aureus was significantly frequent in native valve HCA-IE, and overall mortality was high.

Atrial Fibrillation Ablation in Systolic Dysfunction: Clinical and Echocardiographic Outcomes

Background:Heart failure and atrial fibrillation (AF) often coexist in a deleterious cycle.Objective:To evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF) ablation.Methods:Patients with ventricular systolic dysfunction [ejection fraction (EF) <50%] and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class) and echocardiographic (EF, left atrial diameter) data were compared (McNemar test and t test) before and after ablation.Results:31 patients (6 women, 25 men), aged 37 to 77 years (mean, 59.8±10.6), underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%). During a mean follow-up of 20.3±17 months, 24 patients (77%) were in sinus rhythm, 11 (35%) being on amiodarone. Eight patients (26%) underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures). Significant NYHA functional class improvement was observed (pre-ablation: 2.23±0.56; postablation: 1.13±0.35; p<0.0001). The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68%±6.02%, post: 59%±13.2%, p=0.0005) and a significant left atrial diameter reduction (pre: 46.61±7.3 mm; post: 43.59±6.6 mm; p=0.026). No major complications occurred.Conclusion:Our findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement.

Contribuição para o controle biológico da broca da cana de açúcar

Em 5 meses e 20 dias, obtivemos 4 gerações de Metagonis lylum minense Towns, correspondentes a um total de 662 adultos. O ciclo evolutivo completo, varia de 31 a 51 dias com evolução média de 38 dias a 18,9°C. As porcentagens de parasitismo natural em culturas de cana e de milho foram respectivamente de 23,1 e 37,3%. Libertaram-se 526 moscas, obtendo-se um parasitismo de 48,3% para cana de açúcar e 61,1% no milho. Em 12 meses foram criados em laboratório 10 gerações de Lixophaga diatraeae Towns, num total de 915 adultos. O ciclo evolutivo completo, de emergência a emergência do adulto, varia de 30 a 39 dias nos meses de Setembro a Abril, sendo a evolução média de 32,5 dias a 21,4°C e de 33 a 43 dias nos meses de Maio a Agosto com evolução média de 36 dias a 16.9°C. No campo foram libertados 262 adultos de Lixophaga. Do total, 139 distribuídos em cultura de milho (Lote A) e os restantes, em cultura de cana (Lotes B e C). Recuperamos 76 pupários vivos e 38 vazios. A porcentagem total de parasitismo verificado foi de 28,7%. Temos recuperado diversos pupários após um ano das primeiras libertações (1951), o que vem demonstrar que a Lixophaga já se estabeleceu nesta região. Nos meses de Maio a Agosto, a capacidade larval torna-se mais reduzida devido a baixa temperatura. Nesse período, deve- se conservar os adultos em ambiente cuja temperatura seja de 22 a 25°C, a fim de que os mesmos não paralisem sua reprodução.No período da gestação, a Lixophaga demonstrou ser mais resistente do que as outras duas espécies nativas. O potencial de reprodução da Metagonistylum e da Parathersia é maior do que a da Lixophaga. Na técnica de criação e conservação da broca parasitada, utilizamos pontas de cana introduzidas em recipientes contendoágua, uma vez que os roletes são de efêmera duração e precisam ser substituídos constantemente O ciclo médio de Metagonistylum sendo de 38 dias, conforme determinamos e o de Paratheresia de 47 dias de acordo com o trabalho de SOUZA (7), concluímos que o ciclo médio de Lixophaga é menor comparando àquelas espécies. Embora, os parasitos da broca, sejam na natureza, hiper parasitados, em nada vem alterar esse método, um vez que quando o parasito destruir completamente a broca e passar ao estado de prê-pupa, observamos pelas experimentações, que somente nessa fase poderá vir a ser hiperparasitado e assim mesmo em porcentagem insignificante, não indo além de 5%. Pela criação sistemática desses parasitos em larga escala e sua distribuição periódica na cultura de cana, não dependendo, portanto, de sua multiplicação total na natureza, anula-se o efeito do hiperparasitismo e consegue-se reduzir grandemente a infestação ocasionada pela broca.

Ação de substâncias de crescimento nos teores de carboidratos e fenóis em soja (Glycine max cv. Davis)

Em condições de casa de vegetação, estudou-se o efeito de fitoreguladores nos teores de carboidratos solúveis totais, sacarose, glucose, frutose e fenóis totais nas folhas da planta de soja 'Davis'. Pulverização com cloreto (2-cloroetil) trimetilamonio (CCC) 2.000 ppm, ácido succínico-2,2-dimetilhidrazida (SADH) 4.000 ppm, ácido giberelico (GA) 100 ppm e ácido indolilacético (IAA) 100 ppm foi efetuada 25 dias após a semeadura. Coletando-se as folhas 43 dias após a semeadura, realizou-se a extração dos carboidratos e determinação usando-se glucose como padrão. A separação dos açúcares foi efetuada por cromatografia de papel e a quantificação pelo método de Dubois. Após a extração dos fenóis procedeu-se à determinação adotando-se catecol como padrão. Utilizou-se delineamento inteiramente casualizado com 6 repetições e comparação de médias pelo teste Tukey (5%). Verificou-se que o CCC reduziu o teor de carboidratos solúveis e de sacarose nas folhas de soja. Os fitoreguladores não alteraram os níveis de glucose e frutose, nem os teores de fenóis totais nas folhas de soja 'Davis'.

Nutrição mineral de hortaliças: XXXVIII. deficiências de macronutrientes em alface (Juactuoa sativa L.), cv. Brasil e Clause's Aurélia

Com os objetivos de: a) obter o quadro síntomatológico das deficiências de macronutrientes; b) relacionar o quadro sintomatológico a composição química das plantas, foi conduzido um ensaio em casa de vegetação, cultivando o cv. Brasil 48 e Clause's Aurélia em solução nutritiva, tendo como substrato silica finamente moida. Os tratamentos foram: completo, omissão de nitrogênio, omissão de fósforo, omissão de potássio, omissão de cálcio, omissão de magnésio e omissão de enxofre. Os autores observaram e identificaram as deficiências de nutrientes que se traduziram por sintomas típicos e facilmente identificáveis, com exceção do enxofre. As concentrações de macronutrientes nas folhas para plantas sem sintomas e com sintomas para o cultivar Brasil 48 foram: N% 3,37 a 1,86; P% 0,44 a 0,16; K% 5,54 a 1,32; Ca% 0,97 a 0,20; Mg% 0,35 a 0,05. As concentrações de S% foram iguais a 0,16. Para o cv. Clause's Aurélia, as concentrações nas folhas correspondentes a plantas sem e com deficiências foram: N% 3,02 a 2,68; P% 0,71 a 0,19; K% 7,7 a 1,54; Ca% 1 ,47 a 0,31; Mg% 0,43 a 0,10 e S% 0,25 a 0,24.

Proteína total Sérica em bezerros da raça holandesa submetidos a diferentes regimes de aleitamento

A flutuação de proteína total sérica foi avaliada em 37 bezerros, machos e fêmeas, da raça Holandesa Preta e Branca, apresentando grupos genéticos 15/16 Holandês: Guzerá, puro por cruza e puro de origem. O período experimental abrangeu os primeiros 70 dias de vida do bezerro. Os tratamentos foram os seguintes: A1 - leite integral, colostro e sucedâneo (1 :1 :2) , com desmama aos 30 dias de idade; A2 leite integral, colostro e sucedâneo (1:1:2), com desmama aos 45 dias de idade; A3 - leite integral, colostro e sucedâneo (1:1:2), com desmama aos 60 dias de idade; B - leite integral, com desmama aos 45 dias de idade; C -sucedâneo, com desmama aos 45 dias de idade. Em todos os tratamentos os bezerros receberam colostro até 72 horas após o nascimento. O sucedâneo empregado foi leite em pó comercial, cuja fonte protéica é subproduto do leite. O concentrado utilizado foi uma ração comercial para desmama precoce. A coleta de sangue dos bezerros obedeceu ao seguinte esquema: imediatamente pós-natal (antes de qualquer ingestão de colostro) e 1, 2, 5, 10, 15, 20, 30, 40, 50, 60 e 70 dias de vida. Para análise da proteína foi utilizado o método de biureto. Para interpretação dos resultados, os dados foram submetidos às seguintes análises estatísticas: análise da variância, teste Tukey, correlação e regressão linear e análise da variância sob modelo fatorial, envolvendo os efeitos de tratamentos, coletas e interações. A concentração média de proteína total sérica apresentou o valor mais baixo por ocasião do nascimento (5,02 ± 0,51 g/100 ml) e o mais elevado (8,09 ± 0,51 g/100 ml) 24 horas pós-parto. No período de 1 a 30 dias, o tratamento A (A1 + A2 + A3) apresentou uma concentração de proteína total sérica significativamente mais elevada do que o tratamento C, não diferindo do tratamento B. Foi verificada uma redução linear e quadrática do teor de proteína total sérica nos primeiros 30 dias, seguida de elevação linear no período de 50 a 70 dias.

Alguns dados sobre a leishmaniose visceral americana e doença de Chagas no Nordeste Brasileiro (Relatório de uma excursão realizada nos Estados do Ceará, Pernambuco e Baía)

Antes de nossas pesquisas, nas zonas emque trabalhamos, haviam sido asinalados cinco casos vivos de Leishmaniose Visceral Americana, três no Ceará e dois em Pernambuco. Alem desses, oito tinham sido evidenciados por viscerotomia na Baía, município de Jacobina. Já se tinha conhecimento tambem, de um caso de Doença de Chagas no Ceará. Na confecção do presente trabalho visitamos regiões dos Estados do Ceará, Pernambuco e Baía, onde realizamos rápidos inquéritos epidemiológicos sobre as duas protozooses. No Ceará, região do Cariri, encontramos dois novos casos de Leishmaniose Visceral Americana, cujo diagnóstico foi confirmado pelo exame de esfregaços de polpa esplênica, e cinco de Doença de Chagas, evidenciandos pelos xenodiagnóstico. Foram capturados Flebotomus longipalpis Lutz & Neiva, F. villelai Mangabeira., F. limai Fonseca e F. nordestinus Mangabeira, assim com Panstrongylus megistus (Burm.), 13.5% dos quais infectados. Examinamos animais domésticos (cães e gatos) e silvestres com resultado negativo. Em Pernambuco, município de Exú, fizemos um inquérito sobre os dois casos de Leishmaniose Visceral Americana anteriormente assinalados, não encontrando outros. foram capturados F. longipalpis Lutz & Neiva, alem de Panstrongylus magistus (Burm.) e Triatoma brasiliensis Neiva; nenhum deles estava infectado. Dos animais domésticos foram autopsiados três cães sendo encontrado um com leishmanias no fígado e no baço. O exame de 43 animais silvestres nada revelou. Na Baía, município de Jacobina, encontramos, na zona periférica da cidade, um caso de Leishmaniose visceral Americana e, em outras localidades do município, três outros casos, cujos diagnósticos foram confirmados pelo exame de esfregaços de polpa esplênica; encontramos, também dois casos de Doença de Chagas, evidenciados pelo xenodiagnóstico. Foram capturados F. evandroi Costa Lima, F. lenti Mangabeira e F. longipalpis Lutz & Neiva; Panstrongylus megistus (Burm.) (65.5% infectados) e um exemplar de Eutriatoma maculata (Erich.). Encontramos, tambem, em oco de pau, longe das habitações, um exemplar de P. megistus (Burm.) infectado. Examinamos quatro animais domésticos (cães e gatos), tendo sido encontrado um cão portador de S. cruzi.

Doenças intestinais em cidades brasileiras: associação com elementos climáticos

Enteric fevers and dysenteries showed, during the period 1940-44, a summer prevalence in brazilian cities of the temperate zone. The distribu¬tion of the diseases by four-months periods, selected in acordance with the highest of lowest values of rainfall, mean temperature and absolute humidity induced to suppose that, in those cities, and also in tropical ones, both enteric fevers and dysenteries were closely associated with such climatic factors: enteric fevers mainly with absolute humidity and temperature, and dysenteries with humidity and rainfall. Correlation coefficients, statistically significant, have been obtained comparing monthly waves of climatic factors and corresponding waves of prevalence of the diseases. For enteric fevers, clear associations have been disclosed: with temperature variations in all temperate cities (coefficients ranging from + 0.42 to + 0.75, higher with mean temperature in the previous month) and in two of the four tropical cities (from + 0.26 to ± 0.30); with absolute humidity variations in cities of the first group (from + 0.51 to 0.71) and in the tropical city of Rio ( + 0.26 ± 0.12 and + 0.28 ± 0.12); and also with rainfall variations but only in two temperate cities (from + 0.28 to + 0.64). For dysenteric diseases, in cities of temperate zone similar associations have been found with absolute humidity (values of r, ranging from + 0.32 to + 0.45), with temperature (from + 0.26 to + 0.44); and with rainfall only in Curitiba ( + 0.25 ± 0.12). Recife (tropical city) yielded two significant values : r = — 0.27 ± 0.12 (correlation with mean temperature in the same month) and r = + 0.40 ± 0.11 and -h 0.37 ± 0.11 (between monthly morbidity rates and rainfall, respectively in the same month and in the previous one). Deaths by diarrhea and enteritis, in the cities of the temperate zone, prevailed in spring-summer seasons, also in four-months periods of highest temperature and humidity, for those cities and for the tropical ones, with the exception of Belem in which percentages were identical to those of opposite periods. Still with the exception of Belem, in all cities studied positive correla¬tion coefficients, statistically significant, have been obtained with temperature variations (ranging from + 0.25 to + 0.65 in tropical cities, and from + 0.47 to + 0.76 in temperate zone) and with humidity variations (from + 0.34 to + 0.44 in the first group, and from + 0.43 and + 0.74 in the second) . With rainfall, only Rio (in the tropical region) showed a significant value for r ( + 0.26 ±0:12); similarly in S. Paulo and Curitiba, the values ranged from + 0.46 to + 0.56, while in Porto Alegre there were found — 0.26 ± 0.12 and — 0.32 ± 012, for rainfall variations in the same and previous months.

The conduction system of the heart in mice chronically infected with Trypanosoma cruzi: histopathological lesions and electrocardiographic correlations

Chronic focal and diffuse myiocarditis with interstitial fibrosis developed in Swiss outbred mice and in the inbred AKR and A/J strains of mice which were chronically infected with several Trypanosoma cruzi strains belonging to three biological types (Type I, II and III). High incidence of electrocardiographic changes with predominance of intraventricular conduction disturbances, 1st. and 2nd. degree AV block, arrhythmias, comparable with those found in human Chagas' disease, were also present. Morphological study of the conduction tissue of the heart revealed inflammatory and fibrotic changes. The presence of inflammation in the inter-atrial septum almost always coincided with the inflammatory involvement of the ventricular conduction system. Focal inflammation was associated with vacuolization and focal necrosis of the specific fibers. Most of the lesions were seen affecting the His bundel (76.3% of the cases), the right bundle branch (73.3%), AV node (43.9%) and left bundle branch (37.5%). Correlation between morphological changes in the conduction tissue and electrocardiographic alteration occured in 53.0 to 62.5% of the cases, according to the experimental groups.

Deteccion de amastigotas en Leishmaniasis cutanea y mucocutanea por el metodo de inmunoperoxidasa, usando anticuerpo policlonal: sensibilidad y especificidad comparadas con metodos convencionales de diagnostico

Con el objeto de aumentar la sensibilidad del diagnóstico histopatológico de lesiones cutáneas y mucocutáneas causada por subespecies del complejo Leismania braziliensis y para lograr una mejor visualización de los parásitos en las lesiones, se evaluó el método de la inmunoperoxidas indirecta para localizar en forma rápida y específica los amastigotas en biopsia de tejido afectado. Los cortes de tejido se fijaron en formol y se incluyeron en parafina; después se evaluaron por inmunohistoquímica usando un antisuero policlonal producido en conejo, como reactivo primario, Se examinaron 265 biopsias de pacientes con lesiones sospechosas de leishmaniasis de la costa Pacífica y región suroriental colombiana. a 1983 (72.8%) pacientes se les estableció el diagnóstico por métodos clínicos y/o poarasitológicos. Los resultados obtenidos por la inmunoperoxidasa en el grupo de pacientes a los cuales se les confirmó la leishmaniasis se compararn con la histopatología convencional, el examen directo de frotis y el aislamiento del parásito por cultivo del aspirado de la lesión. La localización inmunoenzimática de las amastigotas fue más efectivas (61.3%) que la histopatología com hematoxilina y eosina (34.6%), y que el frotis (43,9%). En cambio, el cultivo de aspirado fue más sensible (89.8%). La eficiencia del método de inmunoperoxidasa fue mayor en las lesiones recientes (72.5%) positivos en los casos con menos de tres meses de evolución) que en las lesiones más antiguas (55.6, 37.5 y 21.1% para 3-5.9, 6-11 meses y mayores o iguales a 12 mese, respectivamente). La combinación de frotis e inmunoperoxidasa incrementó el porcentaje de caso diagnosticados a 72.0%, lo que indica la importancia de combinar métodos para obtener una mayor eficiencia de diagnóstico. La especificidad fue de 100% en controles sanos y 92.9% en pacientes con lesiones causadas por agentes etiológicos distintos a leishmania.

The importance of the opossum (Didelphis albiventris) as a reservoir for Trypanosoma cruzi in Bambuí, Minas Gerais state

In a survey realized on the sylvatic and peridomestic environment at Bambuí county, Minas Gerais State, 44 (37.9%) out of 116 opossums (Didelphis albiventris) captured were found to be naturally infected with Trypanosoma cruzi. One handred and forty three parasite samples were obtanied from 43 infected opossums using simultaneously hemoculture, xenodiagnosis (Triatoma infestans, Panstrongylus megistus and Rhodnius neglectus) and examination of anal glands contents. The parasite samples were characterized according to six isoenzyme patterns. All samples, independently of the method of isolation, presented an isoenzyme pattern similar to the standard T. cruzi Z1, showing that either xenodiagnosis or hemoculture can used without selecting parasite subpopulation from naturally infected opossums. Preveous isoenzyme patterns reported for human T.cruzi isolates from same region were completely different. This isoenzyme dissimilarity between sylvatic and domiciliar environments suggests the existence of two independent T. cruzi transmission cycles in Bambuí. The epidemiological implicatinos of these results are discussed.

Gundlachia dutrae: n. sp. from northwest Brazil (Mollusca: Basommatophora: Ancylidae)

A new species of Gundlachia, Gundlachia dutrae is described from northwest Brazil. It is distinguishable from other congenerie species by characteristics of the shell, radula and internal organs. Shell relatively high. Aperture near-circular; periostracum dark brown without periostracal hairs. Apex slightly inclined to the right, projected but not hooked, with an apical depression surrounted by a sculpture of well-marked irregular punctations. Shell surface with prominent radial sculpture. No septate specimens were observed. Ratios (n= 59): shell width/shell lenght = 0,66- 0,79 (mean 0,73); shell height/shell length = 0,32- 0,45 ( mean 0,37); shell height/shell width = 0,43- 0,63 (mean 0,51). Body of normal ancylid type; mantle pigmentation dark brown or black, concentrated along the mantle collar. The dorsal surface of the right anterior muscle is elongated and medially constricted. The left anterior and the posterior muscles are almost elliptical. Adhesive area is V-shaped. Pseudobranch unpigmented bearing a very small and thin dorsal lobe. Ovotestis with more than 25 unbranched diverticula. Ovispermiduct with seminal vesicle rather developed. Elongated nidamental gland continous with the glandular wall of the uterus. Nidamental gland appendix ending into a bulbous swelling Spermathecal body almost rounded. Well-developed prostate with five long diverticula. Ejaculatory complex with long glandular flagellum, without a penis or true ultra-penis. "Penis sheath" developed. "Ultra-penis" projected as a tube inside the lumem of prepuce, with a slit between "ultra-penis" and "penis sheath". Rachidian tooth tetracuspid, with two median cusps assymmetrical and aculeated. Lateral teeth tricuspid, with a reduced endocon and a prominent mesocon. A well marked gap occurs between meso and ectocon. Marginal teeth similar to lateral ones. Jaw T-shaped, with about 28 dorsal plates.

Integrate Study of a Bolivian Population Infected by Trypanosoma cruzi, the Agent of Chagas Disease

A cross section of a human population (501 individuals) selected at random, and living in a Bolivian community, highly endemic for Chagas disease, was investigated combining together clinical, parasitological and molecular approaches. Conventional serology and polymerase chain reaction (PCR) indicated an active transmission of the infection, a high seroprevalence (43.3%) ranging from around 12% in < 5 years to 94.7% in > 45 years, and a high sensitivity (83.8%) and specificity of PCR. Abnormal ECG tracing was predominant in chagasic patients and was already present among individuals younger than 13 years. SAPA (shed acute phase antigen) recombinant protein and the synthetic peptide R-13 were used as antigens in ELISA tests. The reactivity of SAPA was strongly associated to Trypanosoma cruzi infection and independent of the age of the patients but was not suitable neither for universal serodiagnosis nor for discrimination of specific phases of Chagas infection. Anti-R-13 response was observed in 27.5% only in chagasic patients. Moreover, anti-R13 reactivity was associated with early infection and not to cardiac pathology. This result questioned previous studies, which considered the anti-R-13 response as a marker of chronic Chagas heart disease. The major clonets 20 and 39 (belonging to Trypanosoma cruzi I and T. cruzi II respectively) which circulate in equal proportions in vectors of the studied area, were identified in patients' blood by PCR. Clonet 39 was selected over clonet 20 in the circulation whatever the age of the patient. The only factor related to strain detected in patients' blood, was the anti-R-13 reactivity: 37% of the patients infected by clonet 39 (94 cases) had anti-R13 antibodies contrasting with only 6% of the patients without clonet 39 (16 cases).

Mansonella ozzardi in Brazil: prevalence of infection in riverine communities in the Purus region, in the state of Amazonas

This study was undertaken to investigate the prevalence of Mansonella ozzardi infection and to estimate the parasitic infection rate (PIR) in simuliid black flies in the municipality of Pauini, Amazonas, Brazil. We used thick blood films to examine 921 individuals in 35 riverine communities along the Pauini and Purus Rivers. Simuliids were caught in several communities. Flies were identified, stained with haematoxylin and dissected. Overall, 44 (24.86%) of 177 riverines were infected in communities on the Pauini River and 183 (24.19%) of 744 on the Purus. The prevalence was higher in men (31.81% and 29.82%) than in women (17.98% and 19.18%) and occurred in most age groups. The prevalence increased sharply in the 28-37 (50% and 42.68%) age group and increased in the older age classes. The highest prevalence was in farmers (44% and 52.17%, respectively) in the Pauini and Purus Rivers. Only Cerqueirellum amazonicum (Simuliidae) transmits M. ozzardi in this municipality, and we found a PIR of 0-8.43% and infectivity rate of 0-3.61%. These results confirm that rates of M. ozzardi infection are high in Pauini and suggest that its prevalence may be far greater than has been previously reported due to the absence of a program for treating the population.