RCAAP Repository

During the year of 2001, a retrospective, descriptive study in order to determine the influence of the antiretroviral therapy received by 111 HIV-HCV coinfected patients who had undergone at least one liver biopsy was conduced, 74 of them were treated with a protease inhibitor regimen (WPI), and 37 with a non-protease inhibitor regimen (NPI). The main characteristics found were: a young patient population (mean age 41 years old in both groups), composed in most part of male individuals (74.3% WPI and 51.4% NPI) with previous risk factors for both infections (WPI 93.2% and NPI 89.2%). The most significant findings included AIDS-defining disease (WPI 18.9% and NPI 13.5% of the cases), elevated hepatic enzyme levels (WPI: SGOT 52.1 and NPI 53.2), absence of liver disease-related symptoms (16.2% for both groups), average CD4 count >; 350 for both groups (WPI 362.2 and NPI 378.1), predominantly low-grade fibrosis in both populations (0-2 in 63.6% of WPI patients and in 80% of NPI patients), with necro-inflammatory activity ranging from 5-7 in 51.3% and 42.9% of WPI patients and NPI patients, respectively. It is suggested a sequential biopsy to better evaluate the evolution of the hepatic disease, according to the HAART regimen received.

The aim of this research was to evaluate the prevalence of Sthaphylococcus spp. and S. aureus in the odontological clinic environment (air), their production of beta-lactamase and antibacterial susceptibility to the major antibiotics utilized in medical particle. During 12 months of samples collect were isolated 9775 CFU by MSA medium suggesting a high amount of Staphylococcus spp. in the clinic environment which can appear through aerosols. A total of 3149 colonies (32.2%) were suggestive of pathogenic staphylococci. Gram coloration, catalase test, colony-mallow growing on chromogenic medium, and coagulase test confirmed the identity of 44 (0.45%) S. aureus isolates. Of these, 35 isolates (79.5%) showed production of beta-lactamase by CefinaseTM discs and resistance to ampicillin, erythromycin (7 isolates) and tetracycline (1 isolate) suggesting the existence of multiresistant isolates. The evaluation of the oxacillin MIC by Etest® assays showed susceptibility patterns suggesting the inexistence of the mecA gene in chromosomal DNA. These results point out to the need of a larger knowledge on the contamination means and propagation of this microorganism into the odontological clinic.

Anthrax is a zoonosis produced by Bacillus anthracis, and as an human infection is endemic in several areas in the world, including Peru. More than 95% of the reported naturally acquired infections are cutaneous, and approximately 5% of them can progress to meningoencephalitis. In this study we review the clinical and epidemiological characteristics of the patients with diagnosis of cutaneous anthrax evaluated between 1969 and 2002 at the Hospital Nacional Cayetano Heredia (HNCH) and the Instituto de Medicina Tropical Alexander von Humboldt in Lima, Peru. Seventy one patients were included [49/71 (69%) of them men], with a mean age of 37 years. The diagnoses were classified as definitive (44%) or probable (56%). The most common occupation of the patients was agriculture (39%). The source of infection was found in 63 (88.7%) patients. All the patients had ulcerative lesions, with a central necrosis. Most of the patients (65%) had several lesions, mainly located in the upper limbs (80%). Four patients (5.6%) developed meningoencephalitis, and three of them eventually died. In conclusion, considering its clinical and epidemiological characteristics, cutaneous anthrax must be included in the differential diagnosis of skin ulcers. A patient with clinical suspicion of the disease should receive effective treatment soon, in order to avoid neurological complications which carry a high fatality rate.

This study involved a total of 116 samples, 79 taken from pigeon droppings and 37 of atmospheric air taken close to accumulations of excrement. Cryptococcus neoformans var. grubii was isolated from 11 (13.9%) of these samples. Other species of Cryptococcus were also isolated from these samples, such as C. albidus (12.6%) and C. laurentii (8.9%). C. neoformans was not isolated from the air samples, though C. albidus (5.4%) was. All the strains of C. neoformans were found to belong to the A serotype (C. neoformans var. grubii). In regard to the studies with the antifungal agents 5-fluorocytosine, fluconazole, itraconazole, amphotericin B and voriconazole, by means of the microdilution method (EUCAST), we point out that one sample demonstrated resistance to fluconazole, this being especially significant because this is an environmental strain.

Os objetivos do estudo foram determinar a incidência de infecção por vírus respiratórios em crianças pré-termo externas submetidas à ventilação mecânica e avaliar os padrões clínico, laboratorial e radiológico das infecções virais entre crianças pré-termo internadas em unidade de cuidados intensivos neonatal (NICU) com insuficiência respiratória aguda de qualquer tipo. Setenta e oito crianças pré-termo externas foram estudadas de Novembro de 2000 a Setembro de 2002. Os recém-nascidos foram classificados em dois grupos: com infecção viral (Grupo I) e sem infecção viral (Grupo II). Vírus respiratórios foram diagnosticados em 23 crianças pré-termo (29,5%); o vírus mais importante foi o sincicial respiratório (VSR) (14,1%), seguido pelo vírus influenza A (10,2%). Rinorréia, sibilância, vômitos e diarréia, pneumonia, atelectasia e infiltrado intersticial foram significativamente mais freqüentes nos recém-nascidos com infecção viral hospitalar. Houve correlação entre infecção viral hospitalar e valores baixos de proteína C-reativa. Dois pacientes com infecção mista do Grupo I faleceram durante a internação. Em conclusão, o VSR foi vírus mais incidente nestes pacientes com infecção nosocomial do trato respiratório inferior. Foi observado que, embora a maioria das infecções respiratórias virais tenham tido uma evolução favorável, alguns pacientes apresentaram quadro clínico grave e prolongado, principalmente quando houve infecção bacteriana ou fúngica concomitante.

Chagas disease has been almost entirely eradicated from the arid zones in Central and Northeastern Brazil where rare or no autochthonous cases have been reported. However, in the last 10 years the disease has increasingly been registered in the Amazon Region. Aiming to investigate the possibility of the occurrence of autochthonous cycle of Chagas disease in Roraima, triatomine collections, vectorial susceptibility studies (this one to be shown elsewhere), parasitological and serological analyses were conducted in three agricultural settlement areas (Rorainópolis, Passarão Project and Ilha Community). Blood-donor candidates were also investigated. This is the first epidemiological survey on Chagas disease conducted in agricultural settlements in Roraima. Triatomine species found were Triatoma maculata, Rhodnius pictipes, Rhodnius robustus and Panstrongylus geniculatus. Trypanosoma cruzi detection analyses included xenodiagnosis, indirect immunofluorescence, indirect hemaglutination, ELISA and kinetoplast PCR amplification. Natural triatomine infection was not found in intestinal contents. Twenty-five adult settlers (1.4% out of 1821, all >; 15 year-old, 20 migrants) presented anti-T. cruzi antibodies. Two migrant settlers (from Minas Gerais and Maranhão) tested positive for more than two serological tests, besides either being positive for xenodiagnosis or PCR. Results show that Chagas disease is not endemic in the areas studied. However, all elements of the transmission cycle are present, demanding for an adequate and continuous vigilance.

Este trabalho relata um caso de feohifomicose subcutânea causado por Exophiala jeanselmei em um paciente que havia recebido transplante de coração e mantinha terapia com micofenolato mofetil, tracolimus e prednisone. As lesões tiveram início após trauma na perna inferior direita que evoluíram produzindo múltiplos nódulos e úlceras. Diagnóstico foi realizado através de avaliação histológica e de características macroscópicas e microscópicas da cultura das lesões da pele. O paciente fez uso de itraconazol em concentração de 200 mg/dia durante três meses, não se observando no entanto, melhora das lesões. Após este período, o paciente foi tratado com anfotericina B a uma concentração de 0,5 mg/Kg/dia totalizando 3,8 g. Após quatro meses de tratamento as lesões mostraram melhora evidente, verificando-se fechamento das fístulas e cicatrização das lesões.

No summary/description provided

No summary/description provided

O virus da hepatite C e o HIV compartilham os mesmos mecanismos de transmissão. A prevalência da infecção pelo vírus da hepatite C em pacientes co-infectados pelo HIV varia em diferentes regiões do mundo, a depender dos diferentes fatores de exposição para ambos os vírus. A co-infecção com o HIV acelera a progressão da doença causada pelo vírus da hepatite C, agrava a progressão da infecção causada pelo HIV e aumenta o risco de transmissão do vírus da hepatite C. Portanto, a atenção clínica e o tratamento da infecção pelo vírus da hepatite C deveriam ser prioridade nas unidades de atendimento a pacientes infectados pelo HIV. O manejo clínico desses pacientes envolve procedimentos diagnósticos específicos e equipe médica treinada para esse fim. O tratamento dessa condição deve seguir critérios clínicos e laboratoriais específicos. Atualmente já são disponíveis medicamentos para o tratamento da hepatite C em pacientes co-infectados pelo HIV.

In many countries, the Enterovirus 71 (EV-71) Picornaviridae family is associated to hand, foot and mouth disease in addition to acute neurological diseases while in Brazil these viruses are more closely associated to the latter group. The aim of this research was to use the first EV-71 isolate of the Northern region of Brazil in molecular and seroepidemiologic studies. Two (2.2%) out of 88 stool samples (44 cases of AFP), collected from January 1998 to December 2000 were positive for EV-71 isolation (73442/PA/99). Nucleotide sequence of the gen that codifies the VP1 protein showed that isolate 73442/PA/99 was similar to the EV-71 strains belonging to genotype B - more closely identified with EV-71 from North America. Neutralization test with 389 sera samples collected from January 1998 to November 2001, from individuals ranging from 0 to 15 years of age living in the city of Belém, State of Pará showed the following results in relation to isolate 73442/PA/99 and prototype BrCr: a total of 207 individuals (53.2%) had neutralization antibodies to both viruses, 167 (42.9%) had no antibodies and 15 showed the presence of neutralizing antibodies to one of the two viruses. Only 20.2% of the children aged 0 to 3 had neutralizing antibodies to EV-71, indicating that these children were more susceptible to the infection. Both the seroprevalence study and VP1 sequencing were important to demonstrate the spread and the molecular pattern of the EV-71 circulating in the Northern Region of Brazil.

Listeria monocytogenes, etiological agent of severe human foodborne infection, uses sophisticated mechanisms of entry into host cytoplasm and manipulation of the cellular cytoskeleton, resulting in cell death. The host cells and bacteria interaction may result in cytokine production as Tumor Necrosis Factor (TNF) alpha. Hepatocytes have potential to produce pro-inflammatory cytokines as TNF-alpha when invaded by bacteria. In the present work we showed the behavior of hepatocytes invaded by L. monocytogenes by microscopic analysis, determination of TNF-alpha production by bioassay and analysis of the apoptosis through TUNEL technique. The presence of bacterium, in ratios that ranged from 5 to 50,000 bacteria per cell, induced the rupture of cellular monolayers. We observed the presence of internalized bacteria in the first hour of incubation by electronic microscopy. The levels of TNF-alpha increased from first hour of incubation to sixth hour, ranging from 0 to 3749 pg/mL. After seven and eight hours of incubation non-significant TNF-alpha levels decrease occurred, indicating possible saturation of cellular receptors. Thus, the quantity of TNF-alpha produced by hepatocytes was dependent of the incubation time, as well as of the proportion between bacteria and cells. The apoptosis rate increased in direct form with the incubation time (1 h to 8 + 24 h), ranging from 0 to 43%, as well as with the bacteria : cells ratio. These results show the ability of hepatocyte invasion by non-hemolytic L. monocytogenes, and the main consequences of this phenomenon were the release of TNF-alpha by hepatocytes and the induction of apoptosis. We speculate that hepatocytes use apoptosis induced by TNF-alpha for release bacteria to extracellular medium. This phenomenon may facilitate the bacteria destruction by the immune system.

The importance of hydroelectric dams beside the human interchange in the maintenance of malarious foci and the occurrence of the Anopheles genus on the Binational Itaipu Reservoir were the main points of this retrospective study. Data were collected from existing registrations at National, State and Municipal Health Departments and literature systematic overview, from January 1984 to December 2003. The occurrence of some outbreak of malaria, mainly by Plasmodium vivax, and the prevalence of species of the Anopheles genus different from Anopheles darlingi in the region are discussed. The malaria in the left bank of Paraná River is a focal problem, which must be approached locally through health, educational and social actions to prevent the continuity of outbreaks in the area. Concomitantly, it is necessary to plan and apply effective surveillance measures in the influence area of the Itaipu Reservoir.

No final da década de 60, caramujos da espécie Melanoides tuberculatus, originários do nordeste africano e sudeste asiático, foram introduzidos no Brasil. Os primeiros registros de espécimes infectados com cercárias foram feitos no Estado do Rio de Janeiro em 2001. O presente estudo relata a ocorrência de M. tuberculatus infectados com larvas de trematódeos na cidade do Rio de Janeiro. O sedimento dos criadouros foi coletado e peneirado através de malhas de 0,25 polegadas. Os caramujos foram transportados em recipientes com água dos criadouros, sendo medidos e posteriormente individualizados. Eles foram expostos à luz e temperatura artificiais para induzir a emergência cercariana. As cercárias mais ativas foram processadas pelos métodos de coloração diferencial e de impregnação por nitrato de prata. Os caramujos negativos foram subsequentemente dissecados. Aproximadamente 700 caramujos foram coletados. Seu comprimento variou de 1,2 a 3,3 cm. A taxa de prevalência foi de 15,76% apesar de 53,76% dos caramujos estarem infectados em uma das áreas. Os caramujos estavam infectados com rédias e cercárias do tipo pleurolofocerca. A morfologia e a quetotaxia cercarianas foram compatíveis com as da família Heterophyidae principalmente devido à presença de nadadeiras medianas dorsais e ventrais e à ausência de receptores sensoriais CI dorsais.

Neutrophils, eosinophils and macrophages are cells that interact with invading parasites and naive hosts have been shown to have anti-parasitic activity. The initial reaction of these leukocytes is the generation of reactive oxygen species (ROS) to play in parasite expulsion. The present work was carried out to study the effect of total extract, scolex and membrane fractions from Cysticercus cellulosae on respiratory burst by pig neutrophils. Hydrogen peroxide (H2O2) production by neutrophils incubated with metacestode fractions from C. cellulosae showed an increase of: 190% (total extract), 120% (scolex) and 44% (membrane). High antioxidant catalatic activity (33%, 28%, 28% by total extract, scolex and membrane, respectively) was observed in neutrophils incubated with metacestode fractions, which could be an attempt at self-protection. Scolex and membrane fractions increased the phagocytic capacity of neutrophils (44% and 28%, respectively). On the other hand, total cysticerci did not alter the phagocytosis, possibly due to modifications in membrane function, caused by high ROS production from neutrophils in the presence of total cysticerci. Total fraction from C. cellulosae is toxic for neutrophils as shown by the decrease in phagocytic capacity, probably caused by high levels of ROS formation. The difference in toxicity of total extract, scolex and membrane fractions on neutrophils can be explained by the presence of an antigenic effect of the vesicular fluid in the total extract of C. cellulosae.

A cisticercose é uma doença que ocorre quando o indivíduo é infectado pela larva da Taenia solium, atuando como hospedeiro intermediário ao invés de definitivo. A cisticercose em cavidade oral é rara e seu diagnóstico clínico é difícil. Neste trabalho, é relatado um caso de cisticercose oral em paciente de 23 anos, sexo feminino que apresentou um crescimento indolor na região de dorso de língua. Foi realizada uma biópsia excisional e o exame histopatológico revelou uma cavidade cística apresentando em seu interior a larva.

Twenty-four whole blood and serum samples were drawn from an eight year-old heart transplant child during a 36 months follow-up. EBV serology was positive for VCA-IgM and IgG, and negative for EBNA-IgG at the age of five years old when the child presented with signs and symptoms suggestive of acute infectious mononucleosis. After 14 months, serological parameters were: positive VCA-IgG, EBNA-IgG and negative VCA-IgM. This serological pattern has been maintained since then even during episodes suggestive of EBV reactivation. PCR amplified a specific DNA fragment from the EBV gp220 (detection limit of 100 viral copies). All twenty-four whole blood samples yielded positive results by PCR, while 12 out of 24 serum samples were positive. We aimed at analyzing whether detection of EBV-DNA in serum samples by PCR was associated with overt disease as stated by the need of antiviral treatment and hospitalization. Statistical analysis showed agreement between the two parameters evidenced by the Kappa test (value 0.750; p < 0.001). We concluded that detection of EBV-DNA in serum samples of immunosuppressed patients might be used as a laboratory marker of active EBV disease when a Real-Time PCR or another quantitative method is not available.

This report documents the first two Brazilian cases of mediastinal granuloma due to histoplasmosis, presenting selected aspects on the diagnosis. Tissue samples revealing histoplasmosis were obtained from each of the patients by mediastinoscopy and thoracotomy. In the second patient, a subcarinal calcified mass eroded into the bronchial tree, leading to secondary bilateral aspiration pneumonitis one week after thoracotomy. Although rare, histoplasmosis should be included in the differential diagnosis of mediastinal granuloma, specially if there are calcifications greater than 10 mm in dimension.

O objetivo deste relato é descrever o primeiro registro de Desmodus rotundus na área urbana da cidade de Olinda, estado de Pernambuco, Nordeste do Brasil, e chamar atenção para o possível risco de transmissão da raiva nesta localidade. Após a queixa de um proprietário que observou três morcegos atacando um de seus cães, foram capturadas imagens com auxílio de uma câmara de vídeo que registram ataques de D. rotundus ao referido cão. No período das 21:00h do dia 13 de fevereiro de 2004 às 4:00h da manhã do dia seguinte, foram observados nove ataques de D. rotundus e também a presença de mordidas em várias partes do corpo do cão. Esse achado representa um sério risco para saúde pública. Conseqüentemente, faz-se necessária a realização de novos estudos a fim de conhecer melhor a biologia desta população de morcegos, com atenção especial para o comportamento alimentar, e adotar as medidas de controle pertinentes. Este é, para o nosso conhecimento, o primeiro relato da presença de D. rotundus em área urbana de Olinda.

The purpose of the present study was to evaluate the identification of 19 Brazilian C. dubliniensis based on the biochemical profile exhibited when tested by the commercial identification kit ID 32C (bioMerieux). Thirteen of the isolates were rigorously identified as C. dubliniensis and the remaining isolates (six) were considered as having a doubtful profile but the software also suggested that there was 83.6% of chances for them to be C. dubliniensis. As well as pointed by the literature the identification obtained by phenotypic tests should be considered presumptive for C. dubliniensis due to variability of this new species.