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

Foram analisados os dados clínicos de 182 pacientes com leishmaniose cutânea, provavelmente causada por Leishmania braziliensis braziliensis. Sessenta e oito por cento apresentavam uma única lesão, usualmente uma úlcera, na terça parte inferior anterior da tíbia. Todos os grupos etários estavam representados e muitos apresentaram histórico de um a dois meses. Treze por cento apresentavam lesões fechadas de natureza verrucosa ou em placa. Após tratamento, a evolução destas lesões foi relacionada à regularidade da terapia por antimônio. Embora a cura usualmente ocorresse em três meses, o tempo de cicatrização, após o início de tratamento, foi variável e relativo ao tamanho da lesão (p < 0.01). Em geral a lesão fechava quando era dado suficiente antimônio como tratamento. Sete entre dez pacientes que apresentavam teste cutâneo negativo para leishmania tomavam positivos após o tratamento. Observou-se por fluorescência indireta, um declínio significante nos títulos de anticorpos em pacientes acompanhados durante e após a terapia. _________________________________________________________________________________ ABSTRACTThe 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

Características epidemiológicas da leishmaniose tegumentar americana em uma região endêmica do Estado da Bahia : II leishmaniose canina

Um inquérito em cães realizado na região de Três Braços, Bahia, mostrou que 3,0% de 98 animais tinham amastigotas em lesões de pele. Parasitos não foram encontrados em pele normal da orelha. De uma amostra selecionada de 13 cães, portadores de lesão cutânea ativa, nove (69,2%) deles estavam comprovadamente infectados. Sete amostras de lesão produziram infecção em hamsters. O estudo biológico (crescimento em meio de cultura, evolução da lesão em hamster e desenvolvimento no tubo digestivo de Lutzomyia longipalpis) identificou o parasito como pertencente ao complexo L. braziliensis. A caracterização bioquímica (mobilidade eletroforética de enzimas em placas de acetato de celulose) e o estudo imunotaxonômico (anticorpos monoclonais) definiram as amostras como L. braziliensis braziliensis. O papel do cão como um possível reservatório de L. b. braziliensis na região de Três Braços é discutido. _______________________________________________________________________________ ABSTRACTDuring a survey of domestic and hunting dogs conducted in the Três Braços region, State of Bahia, 3,0% of 98 dogs had amastigotes in skin lesions. Parasites were not found in normal ear skin. In a nonrandomly selected sample of 13 dogs with active cutaneous lesions, infection was confirmed in nine (69,2%). Tissue biopsies from seven dog lesions produced infection in hamsters. The biological behaviour of the parasite (rate of growth in culture media, evolution of lesions in hamsters and development in the gut of Lutzomyia longipalpis,) identified it to the Leishmania braziliensis complex. Characterization by biochemical means (eletrophoretic mobility of enzymes in cellulose acetate plates) and immunotaxonomic studies (monoclonal antibodies) defined the strains as L. braziliensis braziliensis. The role of dogs as a possible reservoir host of L. b. braziliensis in Três Braços region is discussed

MORPHOMETRIC DISTINCTION OF DOMESTIC AND SYLVATIC POPULATIONS OF Rhodnius ecuadoriensis FROM DIFFERENT GEOGRAPHICAL ORIGINS

ABSTRACTRhodnius ecuadoriensis (Hemiptera, Reduviidae) is an important vector of both Trypanosoma hemoflagellates, Trypanosoma cruzi and Trypanosoma rangeli, in Ecuador and Peru. Ecotopes of sylvatic and domestic/peridomestic habitats have been reported in Ecuador. Meanwhile in Peru, to the best of our knowledge, findings of sylvatic populations in their different ecosystem regions have not yet been documented. Could this be the product of a lack of appropriate studies on wild populations of triatominae in Peruvian environments? In order to elucidate this topic, we take advantage of new insights in geometric morphometry as a tool to help differentiate between wild populations and the corresponding domestic/peridomestic ones, collected in their respective environments. When analyzing our results, we confirmed the efficacy of this technique in our study, and furthermore, we believe that it could be a proper tool for rangeliosis and Chagas disease vector control surveillance in Ecuador and Peru.Keywords: Morphometric geometry, sylvatic, domestic/peridomiestic populations distinction, Rhodnius ecuadoriensis. RESUMENRhodnius ecuadoriensis (Hemiptera, Reduviidae) es un importante vector de los tripanosomas Trypanosoma cruzi y Trypanosoma rangeli en el Ecuador y Perú. Se han reportado ecotopos de hábitats silvestres y domésticos/peridomésticos en Ecuador. Sin embargo, en Perú, hasta donde sabemos, no se ha documentado hallazgos de dichas poblaciones silvestres. ¿Podría este ser el caso de una falta de estudios focalizados en la búsqueda de poblaciones silvestres de triatominos dentro de los diferentes ecosistemas del Perú? Para elucidar este tema, aplicamos nuevas perspectivas en morfometría geométrica, como una herramienta que podría auxiliar en la diferenciación de poblaciones silvestres de aquellas domésticas/peridomésticas, colectadas en sus respectivos ambientes naturales. Al analizar nuestros resultados, se confirmó la utilidad de esta técnica dentro de nuestro estudio, y esto nos llevó a creer asimismo que serviría como un elemento apropiado en el control vectorial de la enfermedad de Chagas y de la rangeliosis, en Ecuador y Perú.Palabras claves: Geometría morfométrica, silvestre, diferenciación de poblaciones domesticas/peridomesticas, Rhodnius ecuadoriensis

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

Foram analisados os dados clínicos de 182 pacientes com leishmaniose cutânea, provavelmente causada por Leishmania braziliensis braziliensis. Sessenta e oito por cento apresentavam uma única lesão, usualmente uma úlcera, na terça parte inferior anterior da tíbia. Todos os grupos etários estavam representados e muitos apresentaram histórico de um a dois meses. Treze por cento apresentavam lesões fechadas de natureza verrucosa ou em placa. Após tratamento, a evolução destas lesões foi relacionada à regularidade da terapia por antimônio. Embora a cura usualmente ocorresse em três meses, o tempo de cicatrização, após o início de tratamento, foi variável e relativo ao tamanho da lesão (p < 0.01). Em geral a lesão fechava quando era dado suficiente antimônio como tratamento. Sete entre dez pacientes que apresentavam teste cutâneo negativo para leishmania tomavam positivos após o tratamento. Observou-se por fluorescência indireta, um declínio significante nos títulos de anticorpos em pacientes acompanhados durante e após a terapia. _______________________________________________________________________________ ABSTRACTThe 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

Household food insecurity positively associated with increased hospital charges for infants

Objective: To test whether household food insecurity (HFI) was associated with total annual hospitalization charges, annual days hospitalized, and charges per day, among low-income infants (months) with any non-neonatal hospital stays. Methods: Administrative inpatient hospital charge data were matched to survey data from infants\u27 caregivers interviewed 1998-2005 in emergency departments in Boston and Little Rock. All study infants had been hospitalized at least once since birth; infants whose diagnoses were not plausibly related to nutrition were excluded from both groups. Log-transformed hospitalization charges were analyzed, controlling for site fixed effects. Results: 24% of infants from food-insecure households and 16% from food-secure households were hospitalized \u3e2 times (P=0.02). Mean annual inpatient hospital charges ($6,707 vs$5,735; P Conclusion: HFI was positively associated with annual inpatient charges among hospitalized low income infants. Average annual inpatient charges were almost $2,000 higher (inflation adjusted) for infants living in food-insecure households. Reducing or eliminating food insecurity could reduce health services utilization and expenditures for infants in low-income families, most of whom are covered by public health insurance