The effect of Schistosoma mansoni infection on child morbidity in the State in Bahia, Brazil: II — Analysis at the individual level

The present investigation was carried out on a sample of 840 children (5 to 16 years old) from ten small towns of the State of Bahia in northeastern Brazil. The objetive was to study, by using a cross sectional methodology, the evolution of schistosomiasis morbidity (hepatic and splenic enlargement) in children, and the role of the intensity of S. mansoni infection in this process. The children were analised in three age groups (5 to 8, to 12 and 13 to 16 years old) and classified as uninfected, mildly infected, moderately infected and heavily infected according to the number of eggs in the stool. In children aged 5 to 8 years, increasing egg counts were not associated with increasing frequencies of hepatic or splenic enlargement. In the 9 to 12 years old group and association was observed with the prevalence of hepatic enlargement, but not with the prevalence of spleen enlargement. In the oldest group, 13 to 16 years old, an association was observed with the prevalence of enlargement of both organs. It was evident that in this population schistosomiasis morbidity develops in the early period of life as a gradual process starting with liver enlargement and followed by spleen enlargement some years later. It was found that the intensity of infection has a fundamental role in this process, although there is a latent period of some years before clinical splenomegaly appears in moderate-heavily infected children. The Authors suggest that the prevalence of splenomegaly in the 13 to 16 years old group is a good measure of the community level of schistosomiasis morbidity and could be used to measure the impact of control programs.

Subcutaneous mucormycosis caused by Rhizopus oryzae: probable nosocomial acquired infection

The Authors present a case of subcutaneous mucormycosis occurring in a patient with clinical and biochemical evidence of diabetic ketoacidosis. The clinical, mycological and histopathological features are described, emphasizing the relevance of a rapid diagnosis in order to stablish early treatment. The clinical forms of mucormycosis and the main associated conditions are briefly reviewed as well as the most probable conditions which may lead to the enhanced susceptibility to infection in the diabetic patient in ketoacidosis. The recovery of Rhizopus oryzae from the air of the room of the patient suggests a nosocomial infection acquired through contamination of venous puncture site by air borne spores.

Malaria at Humaita county, Amazonas state, Brazil: XVII — immune response in patients with Plasmodium falciparum according to gametocytes

In August 1983 the Authors studied 36 patients with Plasmodium falciparum malaria and 14 normal individuals born in Humaita region who had never had malaria, had no spleen enlargement and had negative parasitemia as well as passive hemagglutination. Medical histories were obtained and complete physical examination were performed in all of them just as blood tests, parasite density and lymphocyte typing. The lymphocytes were separated and then frozen in liquid nitrogen for later typing by rosette formation. The patients were divided in two groups according to the presence (13 patients) or abscence (23 patients) of gametocytes before treatment. Severe malaria was predominant in the group without gametocytes. The results showed a decrease in the T-cell numbers in Plasmodium falciparum acute malaria patients both with or without gametocytes before the treatment, while B-cell numbers were normal only in the patients with gametocytes. These observations as like as those previously reported by the Authors, permit to associate the presence of gametocytes in peripheral blood and normal number of B-cells in patients with mild Plasmodium falciparum malaria.

Protection of athymic (Nu/Nu) BALB/c mice against Plasmodium berghei by splenocytes from normal (Nu/ +) BALB/c mice

Athymic BALB/c (Nu/Nu) mice died at 7-13 days after inoculation (DAI) of Plasmodium berghei NK65, whereas their heterozygous (Nu/+) littermates died at 7-8 DAI. Nude (Nu/Nu) mice, reconstituted with 2 x 10(7) splenocytes from uninfected heterozygous (Nu/+) littermates at 20 days before parasite inoculation (DBI), died about 2 days earlier than control nude mice; nude mice reconstituted at 10 or 2 DBI lived 2 to 4 days longer than control nudes; and nude mice reconstituted 2 DAI lived even longer and some survived. These findings indicate that P. berghei NK65 induces at least two T-cell dependent immune phenomena, one suppressive and the other stimulatory. Reconstitution of nude mice with T-cells from BALB/c (Nu/+) mice appeared to reduce or bypass suppressive T-cell activities which allowed the formation of a protective immune response by some of the nude mice.

Efeito do Mycobacterium bovis BCG, lipopolissacarideo bacteriano e hidrocortisona no desenvolvimento de imunidade ao Plasmodium berghei em camundongos

Mycobacterium bovis (BCG) aumenta significantemente o desenvolvimento da imunidade nos camundongos CFW, C57BL/6, C57BL/l0ScN e BALB/c (Nu/+) para os estágios eritrocitos do Plasmodium berghei. Camundongos tratados com BCG requerem menos ciclos de infecção com P. berghei e cura pelo Fansidar (pirimetamina + sulfadoxina) para desenvolverem imunidade sólida a este parasita do que os controles. Contudo, os animais que receberam BCG 30 dias antes do início da imunização evidenciaram uma perda precoce da imunidade adquirida para o P. berghei, quando comparado com os animais que receberam BCG 14 dias antes ou que não receberam BCG. Assim, sendo, o BCG aumentada a indução na resposta imune do hospedeiro ao P. berghei no curso de infecções subseqüentes. O tratamento de camundongos CFW, BALB/c e C57BL/6 com lipopolissacarídeo bacteriano ou hidrocortisona faz com que os animais requeiram um número maior de ciclos de infecção e cura para tornarem-se imunes ao P. berghei que os controles. O tratamento dos camundongos C57BL/10ScN com hidrocortisona aboliu completamente a sua habilidade de sobrevida subseqüentes a ciclos de infecção com P. berghei e cura pelo Fansidar.

Experimental infection with Schistosoma mansoni of Biomphalaria straminea from different parts of the Northeast of Brazil

In the western part of the State of Bahia Biomphalaria straminea and B. glabrata both occur, but in the majority of cases they do not share the same habitat. In the State of Ceará, however, B. straminea is the sole snail host of Schistosoma mansoni. In this survey, no naturally infected B. straminea was found among snails collected from Bahia and Ceará, evidently because of the very low infection rates. The susceptibility of laboratory-reared specimens to infection with a Puerto Rican strain of S. mansoni was then tested experimentally. In general, the snails showed very low susceptibility. The infection rates were 1.1% among snails from Redenção (Ceará); 2.3% in those from Pentecoste (Ceará); 2.9% in snails from São Desidério (Bahia), while they were very high among an albino strain (NIH) of B. glabrata used as control. Another group of B. straminea from São Desidério was exposed to a Bahian strain of S. mansoni and the infection rate was still very low (3.6%) Apparently, the very low susceptibility of B. straminea, despite high snail density, is correlated with moderate infection rates with S. mansoni among humans, as shown by the results of stool examinations conducted by SUCAM in the municipalities of Redenção and Pentecoste, in Ceará.

Water-contact patterns and schistosoma mansoni infection in a rural community in northeast Brazil

We evaluated the influence of water-related human activities, contaminative behaviour, house location, education and socio-economic status on endemic Schistosoma mansoni infection. The study was conducted in a hilry non-irrigated area of rural northeast Brazil amongst a defined population of subsistence farmers, of whom 93% were infected by age 20. The area was mapped, water bodies were surveyed, and a detailed questionnaire was performed on each household. Infection was assessed by duplicate stool examinations using the sensitive Bell technique to quantify egg excretion. For each household, and index of intensity of infection was computed by grouping individual log-transformed egg counts as an age-sex adjusted Z score. Few households had a sanitary installation or a domestic water supply. However, neither water-contact nor contaminative behavior were indiscriminate. The people made considerable effort to defaecate far from a water source, to obtain household drinking water from the cleanest source, and to bathe only at certain sites where privacy is assured. Land ownership and literacy correlated poorly with the household index of intensity of infection. The key influence on infection status was the relative location of the house and snail-free or snail colonized water sources. In this area, a safe domestic water supply is the critical input needed to achieve definitive control of endemic Schistosomiasis.

Caracterização de cepas de plasmodium falciparum do Estado de Rondônia, Brasil, utilizando microtestes de sensibilidade aos antimaláricos, tipificação enzimática e anticorpos monoclonais

Nove amostras de Plasmodium falciparum foram coletadas de migrantes infectados no Estado de Rondônia. Estas amostras foram mantidas em cultivo para caracterização por tipificação enzimática em acetato de celulose, sensibilidade á cloroquina, amodiaquina, mefloquina e quinino e análise da diversidade antigê-nica através de anticorpos monoclonais específicos. Os resultados obtidos mostraram variação entre todas as amostras estudadas: encontrou-se resistência crescente à cloroquina, resistência intermediária à amodiaquina e quinino e sensibilidade a baixos níveis de mefloquina; apenas dois isolados mostraram sensibilidade a todas as drogas. A tipificação enzimática mostrou presença de parasitas GPI 1 e 2 e ADA 1 e 2, enquanto que para PEP e LDH todas as amostras foram do tipo 1. Sorotipagem com anticorpos monoclonais PSA mostrou presença de três sorotipos diferentes (II, III e IV). Estes resultados mostraram: a) variação entre as amostras para os marcadores analisados; b) nesta região, para o pequeno número de amostras analisadas, não foram observadas diferenças significativas ou novos tipos de parasitas.

Manifestações respiratórias na malária por Plasmodium falciparum e Vivax: vivax

Foram selecionados 110 pacientes que procuraram a SUCAM/CUIABÁ para diagnóstico e tratamento de malária, com queixa de febre e procedente de área malarígena. Nestes pacientes foram realizados: gota espessa para a pesquisa de Plasmodium; aplicação de questionário padronizado para detectar sintomas respiratórios presentes no momento da entrevista; gasometria arterial e espirometria para avaliar a função pulmonar. Desta amostra, 62 pacientes foram positivos para malária sendo 41 P. vivax, 20 P. falciparum e 01 forma mista (grupo Malárico); 48 mostraram-se negativos à pesquisa de hematozoários através da gota espessa (grupo Não Malárico). As manifestações respiratórias encontradas nesta população quando comparadas os grupos Malárico e Não Malárico, foram respectivamente: 1º) Sintomáticos Respiratórios de 46,8% para 22 9% (p < 0,05); 2°) Alterações Espirométricas de 53,2% para 20,8% (p < 0,05); 3°) Alterações Gasométricas de 62,9% para 25,0% (p < 0,05). Com estes resultados concluímos que há nítida associação entre a Malária produzida pelo P. vivax e P. falciparum e as manifestações respiratórias apresentadas, nesta população de estudo.

Estudos "in vitro" dos níveis de resistência do Plasmodium falciparum a drogas, de 1983 a 1986

Foram realizados 171 testes de sensibilidade (microtécnica) com cepas de Plasmodium falciparum da Região Amazônica brasileira para cloroquina, mefloquina, amodiaquina e quinino. Os testes tiveram duração de 24 horas com as drogas preparadas na hora da realização de cada teste. Os resultados mostraram elevada resistência a cloroquina (83%) e sensibilidade em quase a totalidade das amostras testadas para mefloquina (97,7%). Para amodiaquina e quinino observou-se sensibilidade em 51,0% e 56,5% das cepas, respectivamente. Este estudo demonstra a emergência de um possível foco de resistência do Plasmodium falciparum a mefloquina, em Tucuruí.

Malária no município de Humaitá, estado do Amazonas: XXI. Prevalência da deficiência de glicose-6-fosfato desidrogenase (G6PD) Em amostra da população e em doentes com malaria causada pelo Plasmodium falciparum

Os autores estudaram a prevalência da deficiência de glicose-6-fosfato desidrogenase (G6PD), pelo método de BREWER et alii, em 141 indivíduos da população do município de Humaitá, Estado do Amazonas. Destes, 128 eram amazônides, 67 dos quais nunca tiveram malária, enquanto que 61 tinham tido ou estavam tendo a doença; os 13 restantes que estavam com malária não eram arnazônides. Os resultados revelaram que 7 arnazônides (4,96%), eram deficientes. Destes, 5 eram do sexo feminino e 2 do masculino. Em todos os indivíduos do sexo feminino o teste foi positivo com comportamento do tipo heterozigoto. Dos indivíduos deficientes, 4 nunca tinham tido malária; dos outros 3, 2 apresentavam a reação de hemaglutinação positiva com título 1/16 e o terceiro estava tendo malária causada pelo Plasmodium falciparum pela primeira vez. Este doente apresentou forma benigna de malária evoluindo para cura clínica e parasitológica no 3.° dia de tratamento com a clindamicina. Nenhum dos 13 doentes não arnazônides apresentava deficiência de G6PD. Dessa forma, não houve diferença na prevalência da deficiência de G6PD em arnazônides que nunca tiveram malária e em arnazônides que tinham tido ou estavam tendo a doença. Portanto, os indivíduos com deficiência de G6PD estão sujeitos a infecções por Plasmodium falciparum na mesma proporção que os não deficientes. Por outro lado, o aumento da prevalência da deficiência de G6PD, na amostra estudada, poderia estar relacionado com a pressão seletiva exercida pela malária em população submetida à homozigose.

"In vitro" activity of gentian violet against asexual Plasmodium falciparum parasites

In order to investigate whether gentian violet exhibited "in vitro" inhibitory activity against Plasmodium falciparum, the Authors have carried out 20 sensitivity tests according to the microtechnique described by RIECK MANN et al.5. Results have shown inhibition of schizonts'maturation at the following concentration: 1/1000; 1/1500; 1/2000; 1/2500; 1/3000 and 1/4000, thus demonstrating inhibitory activity of the tested dye against asexual blood parasites. The present data suggest gentain violet may be possibly used in the prophylaxis of transfusion-acquired malaria.

Avaliação da resposta do Plasmodium falciparum à cloroquina, quinino e mefloquina

Nosso estudo envolveu a análise de cepas de Plasmodium falciparum provenientes da Região Amazônica Brasileira, coletadas no Laboratório de Malária da SUCEN. Os estudos "in vitro" foram efetuados com a cloroquina (46 ensaios), quinino (42 ensaios) e mefloquina (51 ensaios). Os resultados mostraram resistência de 100% em relação à cloroquina, 2,4% ao quinino e 31,4% à mefloquina, na análise "in vitro". Sete pacientes foram tratados com quinino isolado e nove com a associação mefloquina + pirimetamina-sulfadoxina, não mostrando correlação com os testes "in vitro".

Interrelation between parasitic infections and hypovitaminosis A: Schistosoma mansoni infection and the retinol blood levels in an endemic area of State of Minas Gerais (Brazil)

The interrelation between schistosomiasis and the retinol blood levels was studied in a double blind method, by comparing the serum vitamin A of the infected and non-infected group of an endemic area of Schistosoma mansoni infection. The infected group was characterized by 106 parasitized persons in the intestinal and hepatointestinal forms, who eliminated less than 500 eggs/gram of feces (Modified Kato's method); the non-infected group was characterized by 112 inhabitants of this endemic area without eggs in the stools and presenting negative intradermal reactions, and absence of previous specific treatment. The blood levels of retinol was determinated using trifluoracetic acid method, regarding the normal levels > 20,0mg/100ml. The results of this study point out the absence of correlation between S. mansoni infection and blood levels of vitamin A.

The efficiency of urine dipsticks for the diagnosis of urinary tract infection

Urinary tract infection (UTI) is one of the most prevalent pathologies in developed countries, particularly in women, characterized by the presence of bacterial growth in any part of the urinary system. Currently, urine culture is considered the gold standard method for the diagnosis of UTI. However, this method has several disadvantages including the time necessary for obtaining the results and the associated high costs. Therefore, it is important to evaluate new efficient and valuable methods for the diagnosis of these infections. Objectives: Presently, dipsticks are considered a possible valuable alternative to urine culture. This method has very low costs associated and the results can be obtained in few minutes. Here we aim to compare the sensibility, specificity, predictive value of a positive test and a negative test of both methods in order to determine the efficiency of the test strips method and also to characterize the microorganism more frequently isolated.