FIRST REPORT OF ACUTE CHAGAS DISEASE BY VECTOR TRANSMISSION IN RIO DE JANEIRO STATE, BRAZIL

SUMMARY Chagas disease (CD) is an endemic anthropozoonosis from Latin America of which the main means of transmission is the contact of skin lesions or mucosa with the feces of triatomine bugs infected by Trypanosoma cruzi. In this article, we describe the first acute CD case acquired by vector transmission in the Rio de Janeiro State and confirmed by parasitological, serological and PCR tests. The patient presented acute cardiomyopathy and pericardial effusion without cardiac tamponade. Together with fever and malaise, a 3 cm wide erythematous, non-pruritic, papule compatible with a "chagoma" was found on his left wrist. This case report draws attention to the possible transmission of CD by non-domiciled native vectors in non-endemic areas. Therefore, acute CD should be included in the diagnostic workout of febrile diseases and acute myopericarditis in Rio de Janeiro.

ACUTE TOXOPLASMOSIS IN A BREASTFED INFANT WITH POSSIBLE TRANSMISSION BY WATER

Toxoplasma gondii transmission via breastfeeding has been discussed; however, no cases have been confirmed to date. This article describes a case of acute toxoplasmosis diagnosed in a mother and her six-month-old breastfed infant. The study accounts for the possibility of breast milk transmission and directs both clinicians and pediatricians to the hypothesis that both patients acquired toxoplasmosis via water ingestion.

The control of Chagas' disease transmission in Mambaí, Goiás-Brazil (1980-1981)

BHC application in Mambai in 1980 resulted in a significant decline but not elimination of domiciliated T. infestans. T. sordida peridomestic populations persist and could pose a threat to interupting human transmission of T. cruzi The results of one massive attack spray application alone was compared with this application plus one selective application as regards the presence of T. infestans in houses oneyear later. No significance difference could be detected. It is likely that for interruption of T. infestans transmission cheaper procedures can be devised than those currently in use. A further pilot study of a virgin community afflicted by T. infestans transmission is indicated since Mambai cannot be regarded as a representative areafor those still awaiting insecticide application.

Human mucocutaneous leishmaniasis in Três Braços, Bahia - Brazil: an area of Leishmania braziliensis braziliensis transmission. I. Laboratory diagnosis

Leishmanial parasites were detected in 71.2% of patients with cutaneous disease and 48% of patients with mucosal disease, using principally scanning of imprints mears and histological sections and hamster inoculation. Parasites were more frequent in early cutaneous lesions (p < 0.005) o fless than two month duration. Also they were more common in multiple than single mucosal lesions (p < 0.02) in spite of considerable prior glucan time therapy in the former group. 93% of cutaneous lesions had a positive leishmanin skin test and most of the negatives occurred in patients with lesions of less than one month duration. 97% of patients with single mucosal lesion and 79% with multiple mucosal lesions had a positive skin test. 86% of cutaneous disease and 90% of mucosal disease was associated with a positive indirect immunofluorescent antibody test at a ≥ 1/20 dilution. In both groups multiple lesions were associated with higher titres and titres were significantly higher in patients with mucosal disease compared with cutaneous disease (p < 0.01).

Human mucocutaneous leishmaniasis in Três Braços, Bahia - Brazil: an area of Leishmania braziliensis braziliensis transmission. II. Cutaneous disease. Presentation and evolution

The clinical records of 182 patients with cutaneous leishmaniasis probably due to Leishmania braziliensis braziliensis are analysed. 68% had a single lesion which was usually an ulceron the lower anterior tibial third. Many had short histories of one to two months and all age groups were represented 13% had closed lesions of a verrucose or plaque like nature. Evolution of these skin lesions after treatment was related to the regularity of antimony therapy. Although healing usually occurred in three months, the time to scarring after commencing treatment was variable and related to the size ofthe lesion (p < 0.01). Usually if sufficient antimony treatment was given the lesion closed. Seven of the ten patients with initially negative leishmanin skin tests converted to positive after treatment. A significant decline of indirect fluorescent antibody titres occurred in patients followed, during and after therapy.

Usefulness of serology for the evaluation of Trypanosoma cruzi transmission in endemic areas of Chagas' disease

Thirteen communities from 7 Argentinian provinces were selected for the evaluation of serology as an indicator of transmission of Chagas disease. Of the communities appraised, 6 did not have a history of previous treatment with insecticides and 7 had received sporadic or continuous insecticide treatment. The inhabitants of 20% of the houses of each locality were studied by serology. The samples were obtained byfinger pricking and 50 fil of blood were mixed with 150μl of 50% glycerine solution in tissue culture media to be assayed by Indirect Hemagglutination and Indirect Immunofluorescence tests. In untreated areas, the prevalence of infection in infants 0-4 years old was 17.5%, reaching to over 22% for the 5-9 year old group, and to 33.3% in 10-14 year old individuals. The prevalence in treated and surveyed areas was 2.6% in 0-4 year old children, 5.4% in 5-9 year old and 6,2% in 10-14 year old youngsters. The differences between both areas were statistically significant (p < 0.005). This study favors serology as a valid indicator for the evaluation of transmission of Chagas disease in rural areas.

Fatores individuais de risco de infeção hospitalar : conhecer para prevenir

RESUMO - Medidas efetivas de prevenção e controlo de infeção, assim como a sua aplicação diária e consistente, devem fazer parte da cultura de segurança dos profissionais de saúde para promover a excelência da prestação de cuidados. Também a identificação dos fatores de riscos individuais de infeção é crucial e indispensável para a adoção de medidas para a gestão desses mesmos riscos. A avaliação do risco pretende determinar a probabilidade que um doente tem de adquirir ou disseminar uma infeção hospitalar (IH) (WIRRAL, 2008) nas unidades de saúde. A avaliação deve ser efetuada na admissão do doente e, de forma periódica durante o internamento, usando uma grelha de avaliação, integrada no processo global de cuidados do doente. Efetuada a avaliação de risco individual, que pressupõe a identificação dos fatores de risco do doente (fatores de risco intrínsecos e extrínsecos) pode ser implementado um plano de cuidados individualizado para os gerir. Pretendeu-se com este estudo identificar os fatores de risco de infeção hospitalar do doente que estão presentes na admissão e/ou que podem surgir durante o seu internamento, para que posteriormente seja possível determinar as medidas de prevenção (gestão do risco) a aplicar individualmente. Foi realizado um estudo de caso-controlo com os doentes internados no Hospital dos Lusíadas em 2011 com o objetivo de, por um lado, determinar os fatores de risco individuais que contribuem para a aquisição da IH e, por outro, caraterizar os fatores de risco para uma futura identificação de possíveis medidas de prevenção e controlo da aquisição e transmissão cruzada da infeção hospitalar. A população em estudo foi constituída pelos doentes que foram internados, entre 1 de Janeiro e 31 de Dezembro de 2011 sendo os casos os doentes em que foi identificada a presença de infeção hospitalar através do programa institucional de vigilância epidemiológica das infeções, tendo os controlos sido selecionados numa razão de 3:1 caso. Foi utilizado um suporte estruturado para a colheita de dados, com a listagem de fatores de risco identificados na revisão bibliográfica e de todos os fatores de risco apresentados pelos doentes em estudo. Os fatores de risco identificados que apresentaram um maior significado estatístico foram: a idade acima dos 50 anos, o género masculino, a administração de antimicrobianos nas três semanas anteriores ao internamento, a colocação de cateter venoso central, a algaliação e, no caso dos doentes cirúrgicos, a cirurgia de urgência e a classificação ASA 3. Após a identificação dos fatores de risco da população estudada neste hospital, é agora possível utilizar a informação obtida e delinear investigações adicionais, objetivando a construção de instrumentos para a identificação de doentes com risco aumentado de infeção.

Report on ticks collected in the Southeast and Mid-West regions of Brazil: analyzing the potential transmission of tick-borne pathogens to man

Specimens of ticks were collected in 1993, 1996, 1997, and 1998, mostly from wild and domestic animals in the Southeast and Mid-West regions of Brazil. Nine species of Amblyommidae were identified: Anocentor nitens, Amblyomma cajennense, Amblyomma ovale, Amblyomma fulvum, Amblyomma striatum, Amblyomma rotundatum, Boophilus microplus, Boophilus annulatus, and Rhipicephalus sanguineus. The potential of these tick species as transmitters of pathogens to man was analyzed. A Flaviviridade Flavivirus was isolated from Amblyomma cajennense specimens collected from a sick capybara (Hydrochaeris hydrochaeris). Amblyomma cajennense is the main transmitter of Rickettsia rickettsii (=R. rickettsi), the causative agent of spotted fever in Brazil. Wild mammals, mainly capybaras and deer, infested by ticks and living in close contact with cattle, horses and dogs, offer the risk of transmission of wild zoonosis to these domestic animals and to man.

Molecular evidence of mother-to-child transmission of HTLV-IIc in the Kararao Village (Kayapo) in the Amazon Region of Brazil

Blood samples from native Indians in the Kararao village (Kayapo), were analysed using serological and molecular methods to characterize infection and analyse transmission of HTLV-II. Specific reactivity was observed in 3/26 individuals, of which two samples were from a mother and child. RFLP analysis of the pX and env regions confirmed HTLV-II infection. Nucleotide sequence of the 5' LTR segment and phylogenetic analysis showed a high similarity (98%) between the three samples and prototype HTLV-IIa (Mot), and confirmed the occurrence of the HTLV-IIc subtype. There was a high genetic similarity (99.9%) between the mother and child samples and the only difference was a deletion of two nucleotides (TC) in the mother sequence. Previous epidemiological studies among native Indians from Brazil have provided evidence of intrafamilial and vertical transmission of HTLV-IIc. The present study now provides molecular evidence of mother-to-child transmission of HTLV-IIc, a mechanism that is in large part responsible for the endemicity of HTLV in these relatively closed populations. Although the actual route of transmission is unknown, breast feeding would appear to be most likely.

Outbreak of aggressions and transmission of rabies in human beings by vampire bats in northeastern Brazil

Outbreaks of attacks upon human beings by vampire bats seems to be a common phenomenon in several regions of Latin America, but the occurrence of rabies infection among humans bled by vampires, is relatively low. In the present study, two outbreaks of human rabies transmitted by common vampire bats (Desmodus rotundus) are described from Bahia State, Northeasthern Brazil, in 1991 and 1992. The first was recorded in Aporá where 308 people were bled by vampire bats and three of these die from this zoonosis. The 2nd outbreak occurred in Conde where only five people were bled by vampires, and two deaths by rabies were registered. Our data suggest that rabies transmitted by bats basically depends on the presence of virus in the vampire bat population and not on the number of humans bled by them.