Risk factors for cutaneous leishmaniasis transmission in children aged 0 to 5 years in an endemic area of Leishmania (Viannia) braziliensis

With the purpose of identifying risk factors for cutaneous leishmaniasis transmission in children from 0 to 5 years, a matched case-control study was carried out in Corte de Pedra, Bahia, Brazil, an endemic area of Leishmania (Viannia) braziliensis. Children with a positive leishmanin skin test and one or more active lesions or scars consistent with cutaneous leishmaniasis were defined as cases. Forty cases and 71 controls were selected and matched by age and place of residence. The presence of a family member with a history of cutaneous leishmaniasis in the year prior to the appearance of the disease in the child was found to be an important risk factor (MÔRMH = 17.75; 95%CI: 4.08-77.25). No evidence of association between the disease and other risk factors was found, such as child’s habits inside or outside the house, domiciliary or peridomiciliary characteristics, or presence of vectors or probable reservoir animals. These findings support the hypothesis that humans serve as both the reservoir and source of infection for this age group.Fue realizado un estudio caso-control pareado en Corte de Pedra, Bahía, Brasil, área endémica de Leishmania (Viannia) braziliensis para evaluar los diferentes factores de riesgo asociados a la presencia de leishmaniasis cutánea en niños de 0 a 5 años. Fueron considerados como casos, los niños con prueba de leishmanina positiva y que presentaban en el examen físico, una o más lesiones clínicas, activas o cicatrizales, compatibles con leishmaniasis cutánea. Fueron seleccionados 40 casos y 71 controles que fueron pareados por edad y área de residencia. La presencia de algún otro miembro de la familia con antecedente de leishmaniasis cutánea durante el año anterior a la aparición de la enfermedad en el niño demostró ser un importante factor de riesgo (MÔRMH = 17,75; IC95%: 4,08-77,25). No se encontraron evidencias de asociación con otros factores, como hábitos del niño dentro y fuera de casa, características de la vivienda y del peridomicilio, presencia de vectores y animales como probables reservorios. Estos hallazgos apoyan la hipótesis que el ser humano podría comportarse como un posible reservorio y servir de fuente de contagio para este grupo de edad

Clinical findings of tegumentary leishmaniasis in children under five years of age in an endemic area of Leishmania (Viannia) braziliensis

Para caracterizar a clínica da leishmaniose tegumentar em crianças de 0 a 5 anos de idade, foram avaliadas, retrospectivamente, 4.464 fichas clínicas do Centro de Saúde de Corte de Pedra, Presidente Tancredo Neves, Bahia, Brasil, área endêmica de leishmaniose tegumentar americana, entre maio de 1987 e dezembro de 1995. Foram registrados neste período 4.275 casos novos de leishmaniose, dos quais, 491 (11,5%) correspondiam a crianças de 0 a 5 anos. A razão entre gênero masculino e feminino nas crianças foi 1,1:1. A forma clínica predominante foi a cutânea (98%) e as lesões ulceradas foram as mais freqüentes (99%). A localização das lesões ocorreu, principalmente, acima da cintura (p<0,05), e 35,5% apresentaram lesões múltiplas. A magnitude da doença em crianças, a freqüência semelhante observada em ambos os gêneros e a localização das lesões sugere a possibilidade de transmissão vetorial no domicílio ou peridomicílio.A retrospective study was performed in a field clinic to characterize the clinical findings of tegumentary leishmaniasis in children from 0 to 5 years old. The clinical records of 4,464 patients were analyzed at the Primary Health Center of Corte de Pedra, Presidente Tancredo Neves, Bahia, Brazil, from May 1987 to December 1995. Four hundred and ninety one (11.8%) children were identified among 4,275 new cases of tegumentary leishmaniasis registered at this Unit. The gender ratio (M:F) for children under six years was 1.1:1. Cutaneous lesions predominated (98%), mainly skin ulcers (99%) located above the waist (p<0.05). Thirty five percent had multiple lesions. The observed magnitude of the disease in children, the similar proportion of cases in both genders and the location of the lesions suggest the possibility of peri or intradomiciliary transmission

Genus-specific kinetoplast-DNA PCR and parasite culture for the diagnosis of localised cutaneous leishmaniasis: applications for clinical trials under field conditions in Brazil

The positivities of two methods for the diagnosis of localised cutaneous leishmaniasis (CL) were estimated in 280 patients enrolled in a clinical trial. The trial was conducted in an endemic area of Leishmania (Viannia) braziliensis and trial participants were patients with skin ulcers and positive leishmanin skin tests. Patients underwent aspirative skin punctures of the ulcerated lesions and lymph nodes for in vitro cultures, which were processed under field conditions at the local health centre. Skin lesion biopsies were tested at a reference laboratory using kinetoplastid DNA (kDNA)-PCR to detect DNA. The median time required to obtain a positive culture from the skin samples was seven days and the contamination rate of the samples was 1.8%. The positivities of the cultures from skin lesions, kDNA-PCR and the combination of the two methods were 78.2% (95% CI: 73-82.6%), 89.3% (95% CI: 85.1-92.4%) and 97.1% (95% CI: 94.5-98.5%). We conclude that parasite culture is a feasible method for the detection of Leishmania in field conditions and that the combination of culture and PCR has a potential role for the diagnosis of CL in candidates for clinical trials

Field evaluation of a rapid immunochromatographic dipstick test for the diagnosis of cholera in a high-risk population

BACKGROUND: Early detection of cholera outbreaks is crucial for the implementation of the most appropriate control strategies. METHODS: The performance of an immunochromatographic dipstick test (Institute Pasteur, Paris, France) specific for Vibrio cholerae O1 was evaluated in a prospective study in Beira, Mozambique, during the 2004 cholera season (January-May). Fecal specimens were collected from 391 patients with acute watery nonbloody diarrhea and tested by dipstick and conventional culture. RESULTS: The overall sensitivity and specificity of the rapid test compared to culture were 95% (95% confidence interval [CI]: 91%–99%) and 89% (95% CI: 86%–93%), respectively. After stratification by type of sample (rectal swab/bulk stool) and severity of diarrhea, the sensitivity ranged between 85% and 98% and specificity between 77% and 97%. CONCLUSION: This one-step dipstick test performed well in the diagnosis of V. cholerae O1 in a setting with seasonal outbreaks where rapid tests are most urgently needed

AEEH «Consensus about detection and referral of hidden prevalent liver diseases»

Las enfermedades hepáticas constituyen una carga de enfermedad muy importante para nuestro sistema sanitario, tanto por su alta prevalencia como por su morbimortalidad asociada. La hepatitis C se ha considerado la principal causa de enfermedad hepática en los últimos 30 años, pero gracias al efectivo tratamiento antiviral directo y a las estrategias de cribado, actualmente su peso ha disminuido notablemente. La infección por virus de la hepatitis B sigue afectando a casi el 0,7% de la población...Peer reviewe

Efficacy and safety of low-dose pentavalent antimonial for treatment of cutaneous leishmaniasis by Leishmania (Viannia) braziliensis in Bahia, Brazil: a randomized clinical trial

Tese (doutorado)-Universidade de Brasília, Faculdade de Medicina, Núcleo de Medicina Tropical, 2009.Foi desenvolvido, um ensaio clínico randomizado aberto para estimar a eficácia e segurança de uma dose de 5mg/kg/dia por 20 dias de antimoniato-N-metil-glucamina, no tratamento da leishmaniose cutânea (LC) por L. (V.) braziliensis, comparada com a dose padrão de 15mg/kg/dia por 20 dias (ClinicalTrials.gov número NCT00317980). Entre janeiro de 2006 e janeiro de 2007 foram incluídos 280 pacientes entre 7 e 50 anos de idade, de ambos os sexos com diagnóstico clínico e laboratorial de LC. Os pacientes foram alocados de maneira randômica, 140 pacientes em cada grupo de tratamento. Todos apresentavam até nove lesões cutâneas ulceradas com duração entre duas a 20 semanas. A cura clínica foi definida como a epitelização total de todas as lesões com ausência completa de eritema, edema, descamação e adenite ou linfangite regional, três meses após a finalização do tratamento. Segundo a análise por protocolo (180 pacientes), o coeficiente de incidência de cura foi 8,8% para o grupo que recebeu 5 mg/kg/d, e de 20,2% para o grupo que recebeu 15 mg/kg/d com uma diferença de risco de 11,4% (limite superior do IC95% unicaudal = 20,3). Na análise por intenção de tratar (280 pacientes), observou-se um coeficiente de incidência de cura de 9,3% para o grupo que recebeu dose baixa, e de 18,6% para o grupo que recebeu 15 mg/kg/d, com uma diferença de risco de 9,3% (limite superior do IC95% unicaudal = 16,2). A dose de 5 mg/kg/d mostrou ser inferior à dose de 15 mg/kg/d quando aplicado o teste de não inferioridade, comparando com a diferença proposta a priori de 15% para definir a dose baixa como não inferior. Os pacientes que receberam 15 mg/kg/d experimentaram maior quantidade de eventos adversos comparado com os pacientes que receberam dose baixa de antimonial. Não foi evidenciado desenvolvimento de lesões mucosas com dois anos de seguimento. Os pacientes que utilizaram dose baixa tiveram maior coeficiente de incidência de falhas entre os primeiros 20 a 40 dias de seguimento pós- tratamento, 28,6% (IC95% 20,0 a 38,5) versus 7,9% (IC95% 3,5 a 14,9) no grupo que recebeu 15 mg/kg/d (p < 0,001). Foram encontradas como variáveis preditoras de falha precoce a utilização da dose baixa, ser de sexo feminino, ter lesões localizadas na região de cabeça e pescoço e a presença de parasitos intestinais no momento do diagnóstico de leishmaniose. Em conclusão o coeficiente de incidência de cura da dose baixa foi consideravelmente inferior à dose de 15 mg/kg/dia, e a quantidade de eventos adversos foi maior no grupo que recebeu a dose padrão. _________________________________________________________________________________ ABSTRACTA randomized open-label clinical trial was conducted to assess the efficacy and safety of an intravenous dose of 5 mg/kg/day antimony-N-methyl-glucamine for 20 days compared with the conventional dose of 15mg/kg/day for 20 days for treatment of cutaneous leishmaniasis (CL) associated with L. (V.) braziliensis infection. This trial was registered with clinicaltrials.gov, number: NCT00317980. From January 2006 to January 2007 were enrollment 280 patients aged 7 to 50 years old, of both sexes with clinical and laboratory diagnosis of CL. The volunteers were randomly assigned to one of the two treatment groups. All patients presented with up to nine ulcerated cutaneous lesions with less than twenty weeks of disease evolution. Clinical cure was defined as complete healing of the lesions defined as complete epithelization plus absence of erythema, oedema, flaking, and regional adenitis or lymphangitis, three months after finishing the exposure to the drug. According to the per-protocol analysis (180 patients) the cure rate was 8.8% and 20.2% for the group receiving 5 mg/kg/d and 15mg/kg/d respectively, and the cure rate difference was 11.4% (upper limit of a 1-sided 95% IC = 20.3). The intention-to-treat analysis (280 patients) showed effectiveness rate of 9.3% and 18.6% for the group receiving 5 mg/ kg/d and 15mg/kg/d respectively, and the cure rate difference was 9.3% (upper limit of a 1-sided 95% IC = 16.2), confirming the findings of the per-protocol analysis. The dose of 5mg/kg/d was shown to be inferior than 15 mg/kg/d when the non-inferiority test was applied compared to the proposed a priori difference of 15%. Patients who received the 15 mg/kg/d dose experienced more adverse events compared with patients who received the low dose schedule. By the end of the second year of follow-up there were no patients diagnosed with mucosal disease. Patients who received low dose had a higher failure rate between the first 20 to 40 days of followup, 28.6% (95% CI 20.0 to 38.5) versus 7.9% (CI 95% 3.5 to 14.9) in the group receiving 15 mg/kg/d (p < 0.001). Risk factors for early treatment failure identified in the final multivariate model were: exposition to the low dose schedule, to be female, to have lesions in the head and neck and the presence of intestinal parasites at the time of diagnosis of leishmaniasis. In conclusion, the incidence rate of cure of low dose was significantly lower than 15 mg/kg/d, and the number of adverse events was higher in the group receiving the standard dose

Estudio de las imágenes y representaciones sobre género asociadas a los deportes que tienen los y las adolescentes de Temuco y Padre las Casas.

This work is part of a research project sponsored by the Research Division of the Universidad de la Frontera and is set in the area of gender and sport. The focus of this research revolves around the study of the influence of sport as a socio-cultural phenomenon in adolescents and 1st and 2nd year of Secondary Education in the towns of Temuco and Padre Las Casas in the region of the Araucania, Chile, both in the formation of values and attitudes and the development of habits in the practice of sporting and physical activity. Reports on the findings and conclusions of the inquiry into the objectives of the research were, in brief: Determination of the image of sport (as a concept, as practice and performance); the influence of family, school and media in the formation of the image, and the influence of this same image, both in the formation of values and attitudes, and habits related to sports. From these objectives this study focuses on those aspects where results reveal the existence of differences depending on gender.El presente trabajo es parte de un proyecto de investigación auspiciado por la Dirección de Investigación de la Universidad de la Frontera y está enmarcada en la temática del género y el deporte. El tema central de esta investigación gira en torno al estudio de la influencia que ejerce el deporte como fenómeno socio-cultural en los y las adolescente de 1º y 2º año de Enseñanza Media de las comunas de Temuco y Padre las Casas en la región de la Araucanía de Chile, tanto en la formación de valores y actitudes como en el desarrollo de hábitos hacia la práctica de actividad física deportiva. Informa sobre los resultados y conclusiones del estudio en torno a los objetivos de la investigación que en síntesis fueron los siguientes: Determinación de la imagen del deporte (como concepto, como práctica y como espectáculo); influencia de la familia, el centro escolar y los medios de comunicación en la formación de dicha imagen; e influencia que ejerce esta misma imagen, tanto en la formación de valores y actitudes, como en los hábitos relativos a la práctica deportiva. A partir de estos objetivos, este estudio se centra en aquellos aspectos cuyos resultados busca poner de manifiesto la existencia de diferencias en función de la variable sexo

Risk factors for cutaneous leishmaniasis transmission in children aged 0 to 5 years in an endemic area of Leishmania (Viannia) braziliensis

With the purpose of identifying risk factors for cutaneous leishmaniasis transmission in children from 0 to 5 years, a matched case-control study was carried out in Corte de Pedra, Bahia, Brazil, an endemic area of Leishmania (Viannia) braziliensis. Children with a positive leishmanin skin test and one or more active lesions or scars consistent with cutaneous leishmaniasis were defined as cases. Forty cases and 71 controls were selected and matched by age and place of residence. The presence of a family member with a history of cutaneous leishmaniasis in the year prior to the appearance of the disease in the child was found to be an important risk factor (MÔRMH = 17.75; 95%CI: 4.08-77.25). No evidence of association between the disease and other risk factors was found, such as child’s habits inside or outside the house, domiciliary or peridomiciliary characteristics, or presence of vectors or probable reservoir animals. These findings support the hypothesis that humans serve as both the reservoir and source of infection for this age group.Fue realizado un estudio caso-control pareado en Corte de Pedra, Bahía, Brasil, área endémica de Leishmania (Viannia) braziliensis para evaluar los diferentes factores de riesgo asociados a la presencia de leishmaniasis cutánea en niños de 0 a 5 años. Fueron considerados como casos, los niños con prueba de leishmanina positiva y que presentaban en el examen físico, una o más lesiones clínicas, activas o cicatrizales, compatibles con leishmaniasis cutánea. Fueron seleccionados 40 casos y 71 controles que fueron pareados por edad y área de residencia. La presencia de algún otro miembro de la familia con antecedente de leishmaniasis cutánea durante el año anterior a la aparición de la enfermedad en el niño demostró ser un importante factor de riesgo (MÔRMH = 17,75; IC95%: 4,08-77,25). No se encontraron evidencias de asociación con otros factores, como hábitos del niño dentro y fuera de casa, características de la vivienda y del peridomicilio, presencia de vectores y animales como probables reservorios. Estos hallazgos apoyan la hipótesis que el ser humano podría comportarse como un posible reservorio y servir de fuente de contagio para este grupo de edad.Faculdade de Ciências da Saúde (FS)Departamento de Saúde Coletiva (FS DSC

Isolation of Complete Equine Encephalitis Virus Genome from Human Swab Specimen, Peru

While studying respiratory infections in Peru, we identified Venezuelan equine encephalitis virus (VEEV) in a nasopharyngeal swab, indicating that this alphavirus can be present in human respiratory secretions. Because VEEV may be infectious when aerosolized, our finding is relevant for the management of VEEV-infected patients and for VEEV transmission studies