Current status of Paragonimus and paragonimiasis in Ecuador

A review of national and international publications on paragonimiasis in Ecuador, epidemiological records from the Ministry of Public Health and unpublished research data was conducted to summarise the current status of the parasite/disease. The purpose of the review is to educate physicians, policy-makers and health providers on the status of the disease and to stimulate scientific investigators to conduct further research. Paragonimiasis was first diagnosed in Ecuador 94 years ago and it is endemic to both tropical and subtropical regions in 19 of 24 provinces in the Pacific Coast and Amazon regions. Paragonimus mexicanus is the only known species in the country, with the mollusc Aroapyrgus colombiensis and the crabs Moreirocarcinus emarginatus, Hypolobocera chilensis and Hypolobocera aequatorialis being the primary and secondary intermediate hosts, respectively. Recent studies found P. mexicanus metacercariae in Trichodactylus faxoni crabs of the northern Amazon. Chronic pulmonary paragonimiasis is commonly misdiagnosed and treated as tuberculosis and although studies have demonstrated the efficacy of praziquantel and triclabendazole for the treatment of human infections, neither drug is available in Ecuador. Official data recorded from 1978-2007 indicate an annual incidence of 85.5 cases throughout the 19 provinces, with an estimated 17.2% of the population at risk of infection. There are no current data on the incidence/prevalence of infection, nor is there a national control programme.

Sensitivity and specificity of parallel or serial serological testing for detection of canine Leishmania infection

In Brazil, human and canine visceral leishmaniasis (CVL) caused byLeishmania infantum has undergone urbanisation since 1980, constituting a public health problem, and serological tests are tools of choice for identifying infected dogs. Until recently, the Brazilian zoonoses control program recommended enzyme-linked immunosorbent assays (ELISA) and indirect immunofluorescence assays (IFA) as the screening and confirmatory methods, respectively, for the detection of canine infection. The purpose of this study was to estimate the accuracy of ELISA and IFA in parallel or serial combinations. The reference standard comprised the results of direct visualisation of parasites in histological sections, immunohistochemical test, or isolation of the parasite in culture. Samples from 98 cases and 1,327 noncases were included. Individually, both tests presented sensitivity of 91.8% and 90.8%, and specificity of 83.4 and 53.4%, for the ELISA and IFA, respectively. When tests were used in parallel combination, sensitivity attained 99.2%, while specificity dropped to 44.8%. When used in serial combination (ELISA followed by IFA), decreased sensitivity (83.3%) and increased specificity (92.5%) were observed. Serial testing approach improved specificity with moderate loss in sensitivity. This strategy could partially fulfill the needs of public health and dog owners for a more accurate diagnosis of CVL.

Control programme for cystic echinococcosis in Uruguay

Cystic echinococcosis is a highly endemic parasitic zoonosis that is present in the Southern Cone countries of America. For several decades, various prevention and control programmes have been implemented in different countries and regions, with varying results. In Uruguay, a new control programme was implemented in 2006 that employed new strategies for canine diagnosis and treatment, dog population control, diagnosis in humans, epidemiological surveillance, and health education, including community participation. The control programme in Uruguay addresses the control and surveillance of the disease from a holistic perspective based on Primary Health Care, which has strengthened the community’s participation in developing and coordinating activities in an interdisciplinary manner. Similarly, the control programme that is currently implemented is based on a risk-focused approach. The surveillance and control measures were focused on small villages and extremely poor urban areas. In this study, the strategies used and the results obtained from 2008-2013 are analysed and discussed.

Protocolo do Programa de Assistência Auxiliada por Animais no Hospital Universitário

A Assistência Auxiliada por Animais (AAA) consiste na visitação e recreação por meio do contato com animais, propondo o entretenimento e a melhora no relacionamento interpessoal entre pacientes e equipe. Para evitar acidentes e zoonoses, a permissão para os animais visitarem uma instituição exige um protocolo com normas e rotinas de segurança. Este artigo objetivou descrever pontos importantes do protocolo de implementação do programa de AAA. O protocolo contempla: introdução, objetivos, critérios de inclusão e exclusão dos animais, dos condutores e dos pacientes; recomendações aos condutores e à equipe de saúde, responsabilidades da Comissão Controle de Infecção Hospitalar, quadro de zoonoses, calendário vacinal de cães e gatos, termo de responsabilidade para participação do programa e ficha de análise comportamental dos animais. Consideramos que a divulgação do protocolo, fundamentado em estudos científicos, favorece a implantação de novos programas em instituições, visto a escassez de publicações nacionais.

Les maladies infectieuses ont encore un bel avenir [Infectious diseases have again a good future!].

Invasive fungal diseases (IFDs) have become major causes of morbidity and mortality among highly immunocompromised patients. Authoritative consensus criteria to diagnose IFD have been useful in establishing eligibility criteria for antifungal trials. There is an important need for generation of consensus definitions of outcomes of IFD that will form a standard for evaluating treatment success and failure in clinical trials. Therefore, an expert international panel consisting of the Mycoses Study Group and the European Organization for Research and Treatment of Cancer was convened to propose guidelines for assessing treatment responses in clinical trials of IFDs and for defining study outcomes. Major fungal diseases that are discussed include invasive disease due to Candida species, Aspergillus species and other molds, Cryptococcus neoformans, Histoplasma capsulatum, and Coccidioides immitis. We also discuss potential pitfalls in assessing outcome, such as conflicting clinical, radiological, and/or mycological data and gaps in knowledge.

Culex nigripalpus Theobald (Diptera, Culicidae) feeding habit at the Parque Ecológico do Tietê, São Paulo, Brazil

The blood feeding of a population of Cx. nigripalpus from Parque Ecológico do Tietê (PET) was investigated using an indirect ELISA protocol. Mosquitoes were captured outside houses. Five hundred sixteen engorged females collected in a reforested area and 25 in an open area were tested. Rodents and dogs were the most common blood sources, accounting for approximately 65.3% of blood meals. Human blood was detected in 10.9%, dog blood in 26.1%, chicken blood in 2.4%, and rodent blood in 39.2% of the 541 insects tested. ELISA failed in identifying the blood sources of 233 engorged females, indicating that the mosquitoes may have fed on a host which was not tested. One hundred six individuals were positive for more than one host. The unweighted human blood index was 0.14 and the rodent/human, human/chicken, and dog/rodent feeding index values were 2.70, 1.51, and 1.33, respectively. Furthermore, rodents are defensive hosts for this haematophagous insect which looks for another host to complete blood-feeding. Considering that rodents are potential reservoirs for Mucambo virus and Saint Louis encephalitis virus and that Cx. nigripalpus feed on the blood of those mammals, we hypothesize that mosquito population in PET could participate in the transmission cycle of those arboviruses. Additionally, this species might be involved in the transmission of Dirofilaria immitis to dogs at this area.

Hepatitis E virus: a zoonosis adapting to humans.

Hepatitis E virus (HEV) infection is gaining global attention, not only because of the increasing burden of the disease in low endemicity countries, in terms of morbidity and mortality rates, but also due to recent advances in the molecular virology and epidemiology of this emerging pathogen. HEV infection spread can be described as the evolution of a zoonosis towards an established human infection. As known from other viruses, such as the human immunodeficiency virus or the influenza viruses, crossing the species barriers from animals to humans is a recurrent phenomenon. Albeit slow at the beginning, once the virus has adapted to humans, the person-to-person spread can proceed very quickly. Although an optimal cell culture system for HEV is not yet available, outstanding progress has been made with the in vitro expression of HEV-like particles. These new tools have fostered new research to understand the molecular, structural and immunological aspects of human HEV infection. Although some promising data from Phase II vaccine trials are available, recent discoveries will certainly open new avenues for HEV-specific prophylaxis and therapy.

Staphylococcus aureus host range and human-bovine host shift.

Staphylococcus aureus is a major agent of bovine mastitis. The concomitant emergence of pig-associated methicillin-resistant S. aureus (MRSA) in human carriage and infection requires a reexamination of the host range and specificity of human- and cow-associated S. aureus strains, something which has not been systematically studied previously. The genetic relatedness of 500 S. aureus isolates from bovine mastitis cases, 57 isolates from nasal carriage of farmers, and 133 isolates from nonfarmers was determined by amplified fragment length polymorphism (AFLP) analysis and spa typing. Multilocus sequence typing (MLST) was conducted on a subset of isolates to match AFLP clusters with MLST clonal complexes (CCs). This data set allowed us to study host range and host specificity and to estimate the extent of bovine-to-human transmission. The genotype compositions of S. aureus isolates from farmers and nonfarmers were very similar, while the mastitis isolates were quite distinct. Overall, transmission was low, but specific genotypes did show increased cow-to-human transmission. Unexpectedly, more than one-third of mastitis isolates belonged to CC8, a lineage which has not been considered to be bovine mastitis associated, but it is well known from human carriage and infection (i.e., USA300). Despite the fact that we did detect some transmission of other genotypes from cows to farmers, no transmission of CC8 isolates to farmers was detected, except for one tentative case. This was despite the close genetic relatedness of mastitis CC8 strains to nonfarmer carriage strains. These results suggest that the emergence of the new bovine-adapted genotype was due to a recent host shift from humans to cows concurrent with a loss of the ability to colonize humans. More broadly, our results indicate that host specificity is a lineage-specific trait that can rapidly evolve.

Fievre Q: une zoonose souvent méconnue [Q fever, a zoonosis often overlooked].

Q fever is a zoonosis caused by an intracellular Gram-negative bacteria, Coxiella burnetii. Animals are the main reservoir and transmission to men generally is occurring by inhalation of contaminated aerosols. Acute Q fever generally is benign and usually resolves spontaneously. When symptomatic, the clinical presentation typically includes one of the following three syndromes: a flu-like illness, a granulomatous hepatitis or an atypical pneumonia. Individuals presenting risk factors such as patients with valvular heart diseases and vascular prostheses, as well as pregnant women and immuno-suppressed patients represent a population at risk of chronic infection, with endocarditis as the most common clinical form.

Intracerebral alveolar echinococcosis.

There are two species of the genus Echinococcus, Echinococcus multilocularis (also called alveolar hydatid) and Echinococcus granulosus, characterized by distinct growth features in humans. The main endemic regions for human alveolar echinococcosis (AE) caused by E. multilocularis are Central Europe, Russia, Turkey, Japan, China, eastern France and North America. Human echinococcosis is usually caused by an intrahepatic growth of parasitic larvae. Cerebral occurrence of E. multilocularis disease is rare, accounting for only 1% of cases, and is generally considered to be fatal. This report presents two cases of intracerebral E. multilocularis disease which occurred in two infected patients with AE pulmonary metastases. The anatomical and clinical features are discussed. Our retrospective survey would indicate that surgical treatment should be envisaged whenever possible.

Condições microclimáticas em um parreiral irrigado coberto com tela plástica

A região de Jales é uma das principais produtoras de uvas de mesa do Estado de São Paulo. As videiras da região são irrigadas e conduzidas, normalmente, no sistema latada, sendo comum, também, a utilização de coberturas com telas plásticas para a proteção contra granizo, pássaros e morcegos. Entretanto, a irrigação, o sistema de condução e a cobertura plástica podem modificar as condições microclimáticas no parreiral. O presente trabalho teve como objetivo comparar as condições meteorológicas no interior de um parreiral de uvas, na região de Jales, com as registradas a céu aberto. As avaliações foram realizadas na Estação Experimental de Viticultura Tropical da Embrapa Uva e Vinho, em Jales-SP, em uma área conduzida no sistema latada, coberta com tela plástica de polietileno e irrigada por microaspersão. Os dados meteorológicos foram registrados fora e no interior do parreiral, empregando-se dois sistemas automáticos de aquisição de dados, com registros efetuados a cada 15 minutos. Verificou-se que o uso da cobertura de tela plástica reduziu em 20%, em média, a radiação solar incidente (Rs) acima do dossel. Os valores de Rs abaixo do dossel, durante o período de maior expansão foliar, chegaram a ser inferiores a 20% dos registrados a céu aberto. A temperatura e a umidade relativa do ar no interior do parreiral não apresentaram, em geral, diferenças para os valores registrados na estação meteorológica. Durante a irrigação, a temperatura do ar foi reduzida em 3%, e a umidade relativa do ar aumentou em 4%, em média, no interior do parreiral.

Emerging bacterial pathogens: the past and beyond.

Since the 1950s, medical communities have been facing with emerging and reemerging infectious diseases, and emerging pathogens are now considered to be a major microbiologic public health threat. In this review, we focus on bacterial emerging diseases and explore factors involved in their emergence as well as future challenges. We identified 26 major emerging and reemerging infectious diseases of bacterial origin; most of them originated either from an animal and are considered to be zoonoses or from water sources. Major contributing factors in the emergence of these bacterial infections are: (1) development of new diagnostic tools, such as improvements in culture methods, development of molecular techniques and implementation of mass spectrometry in microbiology; (2) increase in human exposure to bacterial pathogens as a result of sociodemographic and environmental changes; and (3) emergence of more virulent bacterial strains and opportunistic infections, especially affecting immunocompromised populations. A precise definition of their implications in human disease is challenging and requires the comprehensive integration of microbiological, clinical and epidemiologic aspects as well as the use of experimental models. It is now urgent to allocate financial resources to gather international data to provide a better understanding of the clinical relevance of these waterborne and zoonotic emerging diseases.

Sinais clínicos, distribuição das lesões no sistema nervoso e epidemiologia da raiva em herbívoros na região Nordeste do Brasil

Descrevem-se 24 surtos de raiva em bovinos (25 casos), 4 em eqüinos (5 casos), 2 em caprinos (2 casos) e 2 em ovinos (4 casos). Todos os surtos ocorreram na Paraíba, exceto um em eqüinos que ocorreu no Rio Grande do Norte. Todos os surtos, com a exceção de um em ovinos, foram transmitidos provavelmente por morcegos hematófagos; no entanto, não se descarta a possibilidade de transmissão por raposas (Dusicyon vetulus). Os sinais clínicos foram representativos da localização das lesões no sistema nervoso central (SNC). Em bovinos os sinais eram, principalmente, da forma paralítica, causados por lesões da medula, tronco encefálico e cerebelo; mas alguns animais apresentaram depressão, excitação e outros sinais associados a lesões cerebrais. Três dos 5 eqüinos apresentaram sinais de lesões cerebrais e 2 apresentaram a forma paralítica. De 4 ovinos e 2 caprinos, 4 apresentaram a forma paralítica, mas em um caprino e um ovino os sinais foram predominantemente de lesões cerebrais. Todos os animais afetados, exceto um caprino, tiveram um curso clínico de 2-8 dias. As únicas lesões macros-cópicas observadas foram a dilatação da bexiga em 4 bovinos e a dilatação da ampola retal em 2. Dois cavalos apresentaram lesões da pele causadas por traumatismos. As lesões histológicas foram de encefalomielite e meningite difusa não supurativa. Nos eqüinos e em um caprino com evolução clínica de 35 dias as lesões foram mais severas, observando-se necrose neuronal, neuronofagia e presença de esferóides axonais. Corpúsculos de Negri foram observados em 87% (20/23) dos bovinos examinados e em 83% (5/6) dos ovinos e caprinos. Nessas 3 espécies os corpúsculos foram mais freqüentes no cerebelo, mas ocorreram também no tronco encefálico, medula e cérebro. Em cavalos, corpúsculos de Negri foram menos numerosos, sendo observados somente no córtex de um animal e no córtex e hipocampo em outro. No gânglio trigeminal, as lesões histológicas e os corpúsculos de Negri foram menos freqüentes que no SNC. Esses resultados mostram que na raiva dos herbívoros os sinais clínicos e a distribuição das lesões histológicas do SNC são variáveis, e que para o correto diagnóstico da enfermidade são necessários um bom exame clínico e o estudo histológico das diferentes regiões do SNC. Sugere-se, também, que perante resultados negativos nos testes de imunofluo-rescência e inoculação em camundongos, estes devam ser repetidos com amostras de diferentes regiões do SNC. Utilizando-se dados sobre a freqüência de doenças, de 4 laboratórios de diagnóstico, foi realizada uma estimativa das mortes de bovinos causadas pela raiva, anualmente, em 3 Estados. Na Paraíba, com uma população de 918.262 bovinos, o número de mortes é estimado em 8.609 cabeças por ano. No Mato Grosso do Sul, com uma população de 23 milhões de bovinos, as perdas por raiva são estimadas em 149.500 cabeças e, no Rio Grande do Sul, com uma população de 13 milhões de bovinos, as mortes são estimadas em 13.000 a 16.250 animais por ano. Se estas estimativas forem extrapoladas para todo o Brasil, com 195 milhões de bovinos, as mortes podem ser estimadas em 842.688 cabeças por ano.

Influência do sexo de indivíduos da mesma colônia no controle químico das populações do morcego hematófago Desmodus rotundus (Phyllostomidae) no estado de São Paulo

Os objetivos do presente trabalho foram estudar a fidelidade ao abrigo diurno por indivíduos de ambos os sexos da espécie Desmodus rotundus e verificar a eficácia da ação da pasta vampiricida 2% na redução do tamanho de suas colônias no estado de São Paulo, por meio de estudo experimental de campo. Durante os anos de 1999 e 2000, 626 morcegos distribuídos em 12 abrigos foram capturados com redes-de-espera (armadas durante a noite) e marcados. Em seguida, 10% da população previamente estimada recebeu a pasta vampiricida. No Experimento I foram tratados apenas machos, no Experimento II apenas fêmeas e no Experimento III, 5% dos machos e 5% das fêmeas foram tratados. Após 5 e 10 dias, foram feitas contagens dos morcegos que sobreviveram e morreram. As fêmeas mostraram-se mais fiéis aos abrigos (p<0,01) e melhores disseminadoras de pasta vampiricida (p<0,01).

Ocorrência de raiva em ovinos no Rio Grande do Sul

Descreve-se a ocorrência de raiva em ovinos na região Central do Rio Grande do Sul em novembro de 2003. Foram afetados dois ovinos de raça mista, um macho de três meses e uma fêmea de 2,5 anos de idade que apresentaram sinais clínicos com evolução de cinco dias e caracterizados por dificuldade de locomoção, tremores musculares, decúbito lateral, convulsões, opistótono e febre. Histologicamente havia mielomeningoencefalite não-supurativa, associada a inclusões eosinofílicas intracitoplasmáticas (corpúsculos de Negri) em neurônios nos dois ovinos afetados. Em um ovino em que o gânglio de Gasser foi examinado, havia ganglionite não-supurativa. As lesões concentravam-se predominantemente na substância cinzenta da medula espinhal, no tronco encefálico e no cerebelo. Antígeno viral foi detectado em seções selecionadas de ponte e bulbo submetidas ao teste de imuno-histoquímica utilizando anticorpo policlonal anti-ribonucleoproteína do vírus da raiva. Os casos ocorreram em meio a um surto de raiva bovina transmitida por morcegos e foram considerados, com bases epidemiológicas, como transmitidos da mesma forma, como ocorre na raiva endêmica de bovinos no Rio Grande do Sul.