HIV/AIDS-associated visceral leishmaniasis in patients from an endemic area in Central-west Brazil

An increase in morbidity associated with visceral leishmaniasis (VL) in human immunodeficiency virus (HIV)/AIDS patients has been described in Africa and the Mediterranean. Despite the high endemicity of VL and HIV-1/AIDS in Brazil, this association has not been thoroughly investigated. Our aim was to evaluate the epidemiologic and clinical characteristics of VL-HIV-1/AIDS cases from Central-west [Mato Grosso do Sul (MS)] Brazil. Medical records of 23 VL-HIV-1/AIDS patients were reviewed. Patients were predominantly adult males (87%) and 34.8% of the patients were intravenous drug users (IVDU). Leishmaniasis was the first opportunistic infection in 60% of the HIV-1 patients. Fever occurred in all patients, although splenomegaly and hepatomegaly were absent in 21.7% of the cases. CD4+ T-cell counts were below 200 cells/mm³ in 80% of the cases and the counts did not increase after clinical remission despite antiretroviral therapy. The first drug chosen to treat the cases was antimonial, but the therapeutic regimen was altered to amphotericin B in 12 of 17 cases due to side effects. Relapses were reported in 56.5% of the patients. IVDU may constitute an important risk factor for the transmission of both diseases in MS. VL-HIV-1/AIDS patients in MS share similar clinical characteristics as those from other endemic regions worldwide. Thus, these findings are critical for improving the surveillance of VL-HIV/AIDS patients

Infecção secundária por dengue em escolares numa região endêmica para o dengue no Estado do Rio de Janeiro, Brasil

A seroepidemiologic survey was carried out in schoolchildren from public schools of the Niterói municipality, state of Rio de Janeiro, Brazil, after a period of sequential epidemics by dengue virus type 1 and 2 (DEN-1 and DEN-2). 450 blood samples were obtained by fingertip puncture and collected on filter paper discs. The hemagglutination inhibition (HAI) test was carried out using DEN-1 and DEN-2 antigens. HAI titres were demonstrated in 66% (297/450) of the sera and the geometric means of the titres were 1/182 and 1/71 for DEN-1 and DEN-2, respectively. Secondary infections were observed in 61% (181/297) of positive cases. Among these, 75% (135/181) were under fifteen years old. No dengue haemorrhagic fever (DHF) was reported in these children. Asymptomatic or oligosymptomatic infections were detected in 56% of the studied population. The absolute and relative frequencies of positive tests by age group and sex did not evidence statistically significant difference. The number of individuals infected probably produced a immunologic barrier responsible for the non occurrence of dengue epidemic in the latter years.Após um período de epidemias sequenciais pelos vírus dengue tipo 1 e 2 (DEN-1 e DEN-2), foi realizado um estudo soroepidemiológico em uma amostra de escolares da rede pública de ensino do município de Niterói; 450 amostras de sangue foram obtidas através de punção da polpa digital, coletadas sobre discos de papel de filtro e testadas para a detecção de anticorpos inibidores da hemaglutinação (1HA) para DEN-1 e DEN-2. Das amostras testadas, 66,0% (297/450) apresentaram títulos de anticorpos IHA e as médias geométricas dos títulos de anticorpos foram de 1/182 e 1/71, para DEN-1 e DEN-2, respectivamente. Cerca de 61,0% (181/297) daqueles com anticorpos IHA tiveram infecção secundária. Destes, 75% (135/181) tinham idade igual a ou menor do que 15 anos. Nenhum caso de dengue hemorrágico foi relato entre os participantes do estudo. Cerca de 56,0% dos casos com anticorpos IHA tiveram infecção assintomática ou oligossintomática. As freqüências absoluta e relativa das sorologias positivas por idade e sexo não evidenciaram diferenças estatisticamente significativas. Acredita-se que a barreira imumtária formada pelos individuos infectados pelo DEN-2 seja a responsável pela não ocorrência do dengue de forma epidêmica nos anos imediatamente posteriores ao presente estudo

Retrospective study on dengue in Fortaleza, State of Ceara, Brazil

A retrospective serologic study was carried out in Fortaleza, State of Ceara, Brazil, in order to detect the dengue virus activity before recognizing the epidemic of 1994. Mac-Elisa was performed by using a mixture of specific DEN-1 and DEN-2 antigens on serum samples from the Emilio Ribas Laboratory collection. Samples were obtained from 1,224 patients with exanthematic febrile disease and negative serological results for rubella. All specimens were taken during November 1993 to May 1994. The results confirmed dengue infections in Fortaleza by November 1993, approximately six months before the beginning of the epidemic, proving how misleading diagnosis of dengue infection are still troublesome, in spite of the strong dengue activity in Ceara. The authors stress the urgent necessity to implement the active surveillance system in order to prevent another extensive dengue fever epidemics in the state. Epidemiological background of the dengue activity in the State of Ceara is also described

Effects of reprocessing on chemical and morphological properties of guide wires used in angioplasty

OBJECTIVE: To investigate the influence of the reprocessing technique of enzymatic bath with ultrasonic cleaning and ethylene oxide sterilization on the chemical properties and morphological structure of polymeric coatings of guide wire for regular guiding catheter. METHODS: These techniques simulated the routine of guide wire reprocessing in many hemodynamic services in Brazil and other countries. Samples from three different manufacturers were verified by scanning electron microscopy and X-ray photoelectron spectroscopy. RESULTS: A single or double sterilization of the catheters with ethylene oxide was not associated with morphological or chemical changes. However, scanning electron microscopy images showed that the washing method was associated with rough morphological changes, including superficial holes and bubbles, in addition to chemical changes of external atomic layers of polymeric coating surfaces, as detected by the X-ray photoelectron spectroscopy method, which is compatible with extended chemical changes on catheter surfaces. CONCLUSION: The reprocessing of the catheters with ethylene oxide was not associated with morphological or chemical changes, and it seemed appropriate to maintain guide wire coating integrity. However, the method combining chemical cleaning with mechanical vibration resulted in rough anatomical and chemical surface deterioration, suggesting that this reprocessing method should be discouraged