Avaliação da Imunidade para Infecções de Transmissão Vertical na População de Mulheres da Maternidade

Introdução: O rastreio sistemático para infecções de transmissão vertical durante a gravidez permite melhorar o prognóstico e o seguimento dos doentes eventualmente afectados e facilita o raciocínio do pediatra ou neonatologista. Objectivo: Avaliar a imunidade materna e a evolução nos últimos anos e a estudar a influência da idade e da nacionalidade no estado imunológico para estas doenças. Métodos e doentes: Estudo não probabilístico de prevalência de imunidade e infecção durante a gravidez. Dados obtidos dos processos clínicos dos recém-nascidos da Maternidade do Hospital (Abril, 2004-Diciembro, 2009). Resultados: Em 3162 mulheres recolheram-se 9508 resultados de serología 2639 resultados de rastreio para Streptococcus do grupo B (SGB). A taxa de imunidade para rubéola foi 93,3%, significativamente mais elevada em mães portuguesas e também mais elevada que no período 1988-95; para a toxoplasmosis foi 25,7%, superior nos grupos de mães com mais idade e entre estrangeiras e mais baixa que no período 1988-95; foi encontrada IgG positiva para virus citomegálico humano (CMV) em 62,4% das mulheres. No período 1988-95 era de 85%. As provas não treponémicas foram positivas em 0,5%. O AgHBs foi identificado em 2,3%, com taxa mais elevada entre as estrangeiras. Os anticorpos para o vírus da hepatite C e para o vírus da imunodeficiência humana foram encontrados respectivamente em 1,4% e 2,8% das mulheres rastreadas. Não forma diagnosticados casos de infecção congénita. A taxa de seroconversão para a Toxoplasmose diminuiu de 1988 para o período em estudo. O rastreio para o SGB revelou que 13,9% das mulheres eram portadoras. Conclusão: Em vinte e cinco anos foi possível identificar uma mudança importante na seroprevalência e taxa de seroconversão de algumas doenças infecciosas de transmissão vertical durante a gravidez.

Immunoactivation and immunopathogeny during active visceral leishmaniasis

Visceral leishmaniasis is caused by protozoan parasites of the Leishmania donovani complex. During active disease in humans, high levels of IFN-γ and TNF-α detected in blood serum, and high expression of IFN-γ mRNA in samples of the lymphoid organs suggest that the immune system is highly activated. However, studies using peripheral blood mononuclear cells have found immunosuppression specific to Leishmania antigens; this poor immune response probably results from Leishmania antigen-engaged lymphocytes being trapped in the lymphoid organs. To allow the parasites to multiply, deactivating cytokines IL-10 and TGF-β may be acting on macrophages as well as anti-Leishmania antibodies that opsonize amastigotes and induce IL-10 production in macrophages. These high activation and deactivation processes are likely to occur mainly in the spleen and liver and can be confirmed through the examination of organ samples. However, an analysis of sequential data from studies of visceral leishmaniasis in hamsters suggests that factors outside of the immune system are responsible for the early inactivation of inducible nitric oxide synthase, which occurs before the expression of deactivating cytokines. In active visceral leishmaniasis, the immune system actively participates in non-lymphoid organ lesioning. While current views only consider immunocomplex deposition, macrophages, T cells, cytokines, and immunoglobulins by diverse mechanism also play important roles in the pathogenesis.

Compressão Extrínseca ou Intrínseca Congénita da Via Aérea e Infecções Respiratórias - A Propósito de Três Casos Clínicos

A imaturidade das vias aéreas e a susceptibilidade às infecções, no lactente, são factores que condicionam a expressividade clínica de malformações do aparelho respiratório, muitas vezes "rotuladas" como bronquiolites ou outras infecções respiratórias comuns. No entanto, a evolução atípica ou a recorrência são sinais que alertam para a possibilidade de existirem situações clínicas menos frequentes subjacentes. Assim, e curiosa verificar que, nos casos clínicos apresentados, 0 diagnóstico inicial de infecção respiratória com componente obstrutivo baixo conduziu a identificação de malformações congénitas da via aérea.

Lutzomyia longipalpis behavior and control at an urban visceral leishmaniasis focus in Argentina

During the earlier stages of visceral leishmaniasis transmission in Posadas City, Misiones, both the night activity and attraction to humans of Lutzomyia longipalpis were assessed, in order to provide preliminary recommendations. The impact of peridomestic deltamethrin spraying performed by local officials was also evaluated. Although Lu. longipalpis were found in traps located over a dog the entire night, 90% of the females were captured from 20.30h to 1.30h, and only landed on a human when he was at a distance of 1.5 m from the dog. Peridomestic spraying of deltamethrin (25 mg/m²) reduced the sand fly capture up to seven days post-intervention without dispersion in the border of the sprayed areas. These results support the recommendations about time-space focus of the protection measures: first half of the night, in the backyard, with pets and domestic animals kept at least 5 m from humans. The deltamethrin as it was used did not seem very effective in this scenario; neither did the eventual use of bed nets, at least in adults, due to the place/hour of sand fly higher activity. This study strengthens the need for a multidisciplinary approach to develop prevention strategies based both on biological and anthropological studies.

Canine visceral leishmaniasis: study of methods for the detection of IgG in serum and eluate samples

The Brazilian Ministry of Health recommends the culling and euthanasia of dogs with a positive serological test for canine visceral leishmaniasis (CVL). In the Municipality of Rio de Janeiro, the technique used for the diagnosis of CVL is the indirect fluorescent antibody test (IFAT), using blood samples eluted on filter paper (eluate). A dog survey was conducted over a period of one year in the region of Carapiá, in order to evaluate the diagnosis of CVL in this region. All animals underwent clinical examination, and blood samples (serum and eluate) were collected for analysis by enzyme immunoassay (ELISA) and IFAT. A skin biopsy was obtained for parasitological examination (culture). A total of 305 animals were studied and Leishmania chagasi was isolated from nine animals. Sensitivity and specificity were 100% and 96.6% for ELISA, respectively, 100% and 65.5% for IFAT (cut-off at a 1:40 dilution), 100% and 83.4% for IFAT (cut-off at a 1:80 dilution), and 22.2% and 97.0% for eluate IFAT. In conclusion, ELISA was the best tool for the diagnosis of CVL among the serological techniques tested. The present results suggest the need for a better evaluation of filter paper IFAT as the only diagnostic method for CVL in the Municipality of Rio de Janeiro.

Hyponatremia in visceral leishmaniasis

There are few reports linking hyponatremia and visceral leishmaniasis (kala-azar). This is a study of 55 consecutive kala-azar patients and 20 normal individuals as a control group. Hyponatremia and serum hypo-osmolality were detected in 100% of kala-azar patients. High first morning urine osmolality (750.0 ± 52.0 vs. 894.5 ± 30.0mOsm/kg H2O, p < 0.05), and high 24-hour urine osmolality (426.0 ± 167.0 vs. 514.6 ± 132.0 mOsm/kg H2O, p < 0.05) demonstrated persistent antidiuretic hormone secretion. Urinary sodium was high (82.3 ± 44.2 vs.110.3 ± 34.7 mEq/L, p < 0.05). Low seric uric acid occurred in 61.8% of patients and increased fractional urinary uric acid excretion was detected in 74.5% of them. Increased glomerular filtration rate was present in 25.4% of patients. There was no evidence of extracellular volume depletion. Normal plasma ADH levels were observed in kala-azar patients. No endocrine or renal dysfunction was detected. It is possible that most hyponatremic kala-azar patients present the syndrome of inappropriate antidiuretic hormone secretion.

Canine visceral leishmaniasis due to Leishmania (L.) infantum chagasi in Amazonian Brazil: comparison of the parasite density from the skin, lymph node and visceral tissues between symptomatic and asymptomatic, seropositive dogs

Canine visceral leishmaniasis (CVL) is recognizable by characteristic signs of disease and is highly lethal. The infection, however, may be quite inapparent in some seropositive dogs, and this has raised the polemic question as to whether or not such animals can be a source of infection for Lutzomyia longipalpis, the vector of American visceral leishmaniasis (AVL). In this study we have examined 51 dogs with acute CVL from an AVL area in Pará State, northern Brazil, and compared the parasite density, amastigotes of Leishmania (L.) infantum chagasi, in the skin, lymph node and viscera of symptomatic with that of nine asymptomatic but seropositive dogs (IFAT-IgG). Post-mortem biopsy fragments of these tissues were processed by immunohistochemistry, using a polyclonal antibody against Leishmania sp. The X² and Mann Whitney tests were used to evaluate the means of infected macrophage density (p < 0.05). There was no difference (p > 0.05) in the skin (10.7/mm² x 15.5/mm²) and lymph node (6.3/mm² x 8.3/mm²), between asymptomatic and symptomatic dogs, respectively. It was higher (p < 0.05), however, in the viscera of symptomatic (5.3/mm²) than it was in asymptomatic (1.4/mm²) dogs. These results strongly suggest that asymptomatic or symptomatic L. (L.) i. chagasi-infected dogs can serve as a source of infection, principally considering the highest (p < 0.05) parasite density from skin (10.7/mm² x 15.5/mm²), the place where the vetor L. longipalpis takes its blood meal, compared with those from lymph node (6.3/mm² x 8.3/mm²) and viscera (1.4/mm²x 5.3/mm²).

Um Caso de Sucesso no Tratamento Concomitante de Rotura de Aneurisma Intracraniano e Aneurisma Visceral

A associação entre aneurismas intracranianos e viscerais é extremamente rara, com mau prognóstico. A situação de rotura surge habitualmente no contexto de urgência e implica um tratamento imediato. Relata-se o caso de uma doente com rotura de aneurisma da artéria comunicante anterior e da artéria pancreaticoduodenal anterior. A actuação concertada das várias especialidades permitiu a abordagem cirúrgica dirigida ao aneurisma visceral, sem o agravamento da hemorragia cerebral que a eventual clampagem da Artéria Aorta poderia provocar. A manutenção da estabilidade hemodinâmica foi essencial para a posterior realização de embolização do aneurisma intracraniano.

Forty years of visceral leishmaniasis in the State of Piaui: a review

Visceral leishmaniasis (VL) has been known to occur in the state of Piauí since 1934. The typically rural disease began to appear in urban areas over time, being concentrated mainly in Teresina, the capital of Piauí. Teresina was also affected by the first urban epidemic of VL in Brazil. Over 1,000 cases of the disease were reported during urbanization (1981-1986). Human population growth and migration led to land occupation on the outskirts of Teresina. These factors have contributed to vector proliferation, increasing the incidence of VL. At present, the incidence of human and canine disease is quite high and uncontrolled in Piauí. It seems that some measures, such as the elimination of seropositive dogs, failed to significantly reduce the number of new VL cases in Teresina. Despite previously conducted studies, little is known about VL epidemiology in urban areas. The aim of this review is to reveal the situation of VL in Teresina during the last 40 years, focusing on the major factors that may contribute to the high incidence and persistence of VL infection.

Infecções da Mão e do Pé na Criança

As particularidades anatómicas e fisiopatológicas da Mao e do Pé levam a que as infecções localizadas adquiram aspectos especificos. Foram revistos 77 doentes internados e/ou seguidos em consulta externa do Hospital de Dona Estefânia com Infcções da Mão (25) e do Pé (52), no periodo de Janeiro de 1991 a Janeiro de 1994. Foram tratados em ambulatório os doentes com paroníquia (7 da mao e 42 do pe), um doente com polpite da mão e um com celulite do dorso da mao. Os restantes 16 com infecções da mão (64%) e 15 com infecções do pé (29%), foram internados tendo sido tratados com imobilização, elevação da zona afectada e antibioticoterapia endovenosa. Em todos os casos de abcesso foi efectuada drenagem cirurgica, 16 da mão e 22 do pé. Nas infecções da mão nao houve sequelas. Nas infecções do péhouve uma osteite do primeiro metatarso e umaa fistula cutânea.