ABSTRACT The municipality of Paracambi (Rio de Janeiro, Brazil) reports sporadic cases of American cutaneous leishmaniasis (ACL). Previous studies detected Nyssomyia intermedia (Diptera: Psychodidae) as the main vector in the region, but its spatial distribution and the presence of other vector species have not been evaluated. This study aims at filling this knowledge gap, by studying the ecology of sand flies, their spatiotemporal distribution, and correlation with land use/cover. Two campaigns of monthly sand fly collections using light traps and manual captures were conducted in 1992–1994 and 2001–2003. Females were dissected to detect natural Leishmania infections. The spatial distribution of sand flies was assessed using kernel density maps. Correlations with land use/cover were evaluated by extracting satellite imagery data around the capture points. A total of 17,232 sand flies from 13 species were captured. Medically important species included Ny. intermedia, Migonemyia migonei, Pintomyia fischeri and Ny. whitmani. No Leishmania-infected females were detected. Highest densities were detected in the peri-urban areas Cascata and Sabugo, and in rural areas São José and Mutirão. Ny. intermedia had statistically significant correlations with pasture and agricultural areas. Present results strengthened that Ny. intermedia and Mg. migonei are the main local ACL vectors. Correlations with land use evidence the association between ACL and anthropic environmental change.

Abstract INTRODUCTION: Favorable responses in American tegumentary leishmaniasis (ATL) patients to treatment with 5 mg Sbv/kg/day meglumine antimoniate (MA) has been reported in Rio de Janeiro, but little is known regarding the therapeutic response to low doses in patients from other locations. METHODS: A retrospective review of medical records was conducted to compare the therapeutic response to 5 mg Sbv/kg/day MA treatment among 36 patients who acquired ATL in Brazilian states other than Rio de Janeiro (OS group) and 72 patients from Rio de Janeiro (RJ group). RESULTS: One course of 5 mg Sbv/kg/day MA cured 72.8% of 81 cutaneous (CL) and 66.6% of 27 mucosal (ML) leishmaniasis-infected patients: 70% in the CL/RJ group, 81% in the CL/OS group, 50% in the ML/RJ group, and 80% in the ML/OS group. After up to two additional treatment courses at the same dose, 88.9% and 85.2% of the CL and ML patients were cured, respectively. Adverse events were observed in 40% of patients in the CL/RJ group, 57% of the CL/OS group, 58% of the ML/RJ group, and 80% of the ML/OS group. No significant differences were observed in the cure rates or adverse effects between the RJ and OS groups. No patients required permanent discontinuation of treatment due to adverse events. CONCLUSIONS: Patients with ATL acquired in both RJ and OS may respond to low-dose MA. While high-dose MA should remain the standard treatment for ATL, low-dose MA might be preferred when toxicity is a primary concern.

Descrição de uma série retrospectiva de 151 casos de leishmaniose cutânea atendidos entre 1967 e 1982. Destes, 139 (92%) pacientes apresentavam lesões ativas e foram tratados com antimoniato de meglumina diariamente: 81 adultos receberam uma ampola de 5ml e 58 crianças receberam 1 a 5ml. Quarenta e cinco (32,4%) pacientes receberam tratamento antimonial contínuo durante 25 a 116 dias e 94 (67,6%) receberam tratamento intermitente com 2 a 5 séries de antimoniato de meglumina, cada uma delas com duração de 10 a 25 dias e cujos intervalos de descanso entre as séries variaram de 10 a 60 dias. A dose de antimônio, calculada retrospectivamente em 66 (47,5%) casos, variou entre 3,9 e 28,7mg Sb5+/kg/dia. Desses pacientes, 35 receberam >10mg e 31 receberam <10mg Sb5+/kg/dia. Não houve diferença significativa no tempo de cicatrização entre adultos e crianças, entre esquemas intermitentes e ininterrupto, nem entre doses altas e baixas. Entretanto, o tempo de cicatrização nas pernas e pés (67,5 dias) foi superior ao encontrado em outras localizações (48,7 dias) (p < 0,001). Cinqüenta e um pacientes foram reavaliados entre cinco e 14 anos após o tratamento e mantinham-se clinicamente curados. Essa série originou ensaios clínicos prospectivos utilizando doses baixas de antimônio no Rio de Janeiro.

We retrospectively analyzed a series of 151 cases of cutaneous leishmaniasis treated between 1967 and 1982. One-hundred-and-thirty-nine (92%) patients presented with active lesions and were treated with daily doses of meglumine antimoniate: 81 adults received a 5-ml vial IM and 58 children received 1 to 5ml. Forty-five (32.4%) patients underwent continuous treatment with meglumine antimoniate for 25 to 116 days without rest intervals, and 94 (67.6%) intermittent treatment with 2 to 5 series of meglumine antimoniate. Intermittent series could include schedules of daily IM applications for 10 to 25 days each and intervals varying from 10 to 60 days. Antimony dose was calculated for 66 (47.5%) patients and ranged from 3.9 to 28.7 Sb5+/kg/day. Of these, 35 patients received >10mg and 31 patients <10mg Sb5+/kg/day. Median time of healing was longer for lesions on the legs and feet - 67.5 days versus 48.7 days (p < 0.001) for other sites. However, there were no significant differences in the median time of healing between adults and children, intermittent and continuous regimens or high and low antimony doses. Fifty-one patients were reassessed 5 to 14 years after treatment and showed no evidence of disease. These results support further investigation (clinical trials) on treatment using low doses of antimony.

No município de Paracambi, Estado do Rio de Janeiro, foi realizado um inquérito epidemiológico sobre a leishmaniose tegumentar americana na população canina residente em áreas endêmicas rural e semiurbana. Foram cadastrados 179 cães e 138 (77,1%) foram examinados, segundo seus aspectos clínicos e desenvolvimento de hipersensibilidade tardia ao antígeno Imunoleish® e respostas sorológicas à reação de imunofluorescência indireta e ao ensaio imunoenzimático. Dos 9 (6,5.%) animais portadores de lesões/cicatrizes suspeitas, 66,7% foram causadas por Leishmania sp; 44,4% produziram infecção em hamsters e apresentaram crescimento em meio de cultura, compatíveis com o comportamento de Leishmania do complexo braziliensis. A caracterização molecular (análises isoenzimáticas e do perfil de restrição do KDNA) identificou 2 amostras como similares à Leishmania (Viannia) braziliensis. A prevalência da infecção canina observada através do teste cutâneo, RIFI e ELISA foi, respectivamente, 10,1%, 16,7% e 27,8%. A presença das formas clínica/subclínica da LTA na população canina associada à infecção humana sugere que o cão pode atuar como possível fonte de infecção, assim como na disseminação da doença.

In the district of Paracambi, State of Rio de Janeiro an epidemiological survey for American tegumentary leishmaniasis in canine population was carried out in endemic localities. A total of 179 dogs was registered and 138 (77.1%) examined for their clinical aspects, development of delayed hypersensitivity (DHS) with Imunoleish® antigen and serological responses by indirect immunofluorescent reaction and enzyme-linked immunosorbent assay. In 9 (6.5%) dogs with active cutaneous lesions or suspect scars, 66.7% were caused by Leishmania sp; 44.4% produced infection in hamsters and showed growth in culture media, which was considered to be compatible with the species of Leishmania braziliensis complex. The molecular characterization (isoenzyme and KDNA restriction profiles) defined two strains with similar profiles for L. (Viannia) braziliensis. The prevalence of canine infection estimated by the cutaneous test, IFR and ELISA was 10.1%, 16.7% and 27.8%, respectively. The presence of clinical / sub-clinical form of ATL in canine population associated with human infections suggested that the dog can act as source of infection as well as for dissemination of the disease.

Euthanasia of seropositive dogs has been one of the principal measures adopted by the Program for the Control of Leishmaniasis in Brazil for many years. However, its efficacy is currently being questioned. We obtained intact skin samples from 20 Leishmania-reactive dogs from the municipality of Rio de Janeiro that had been referred for euthanasia. The promastigote forms of Leishmania were isolated in culture from 18 of these animals. Fourteen of these isolates were identified as Leishmania (Leishmania) chagasi by isoenzyme electrophoresis; seven of these were from asymptomatic dogs and seven were from symptomatic animals with visceral leishmaniasis. In conclusion, cutaneous parasitism is found in the intact skin of dogs naturally infected with L. (L.) chagasi, irrespective of the presence or absence of clinical signs suggestive of visceral leishmaniasis.

O diagnóstico de esporotricose disseminada costuma ser obtido através da necrópsia e o isolamento de Sporothrix schenckii do sangue é raro. Fungemia foi demonstrada in vivo através do isolamento do S. schenckii do sangue periférico de 13 (n=38; 34,2%) gatos com esporotricose naturalmente adquirida. A coinfecção com FIV e com FeLV encontradas, respectivamente, em 6 (n=34; 17,6%) casos e 1 (n=34; 2,9%), aparentemente não alterou a freqüência do isolamento de S. schenckii do sangue periférico. Comparando estes resultados aos dos hemocultivos realizados simultaneamente houve concordância de 84,2%. Assim, propomos o cultivo do coágulo como um método alternativo prático, eficiente e econômico para o diagnóstico de esporotricose disseminada em gatos in vivo.

The diagnosis of disseminated sporotrichosis is usually obtained by necropsy and the isolation of Sporothrix schenckii from blood is rare. Fungemia was shown in vivo through the isolation of S. schenckii from peripheral blood of 13 (n=38, 34.2%) cats with naturally acquired sporotrichosis. The coinfection with FIV and with FeLV found, respectively, in 6 (n=34, 17.6%) cases and 1 (n=34, 2.9%), apparently did not alter the frequency of the isolation of S. schenckii from peripheral blood. There was agreement of 84.2% comparing these results to the blood culture results simultaneously achieved. In this way, we propose the clot culture as a practical alternative method, efficient and cheap for the diagnosis of disseminated sporotrichosis in cats in vivo.

Em 1977 foi diagnosticado o primeiro caso autóctone de leishmaniose visceral (LV) humano no Município do Rio de Janeiro. A partir de 1980, foram diagnosticados 54 casos autóctones em diversas localidades, sendo que desde 1993 ocorreram 17 casos humanos autóctones notificados. Oito deles ocorreram no bairro de Barra de Guaratiba e o restante distribuído pelos bairros: Camorim, Colônia, Grota Funda, Grumari, Ilha de Guaratiba e Carapiá. Entre setembro de 1996 a dezembro de 1999, foram realizadas capturas de flebotomíneos em 18 localidades nas encostas do maciço da Pedra Branca, no município, e coletados 18.303 espécimes com predomínio de L. intermedia (87,33%), L. migonei (6,59%), L. longipalpis (3,10%) e L. firmatoi (1,90%). A espécie L. longipalpis predominou em Barra de Guaratiba (46,80%), permanecendo ausente nas outras seis localidades onde também ocorreram casos de LV, o que sugere a participação de outras espécies tais como L. migonei e L. firmatoi, pertencentes ao mesmo grupo parafilético da espécie vetora, na cadeia de transmissão da LV na região.

The first autochthonous case of human visceral leishmaniasis (VL) in the Municipality of Rio de Janeiro was diagnosed in 1977. Since 1980, 54 autochthonous cases have been diagnosed in various locations, and since 1993 some 17 autochthonous human cases have been reported. Eight of these occurred in the neighborhood of Barra de Guaratiba and the others were distributed in the following neighborhoods: Camorim, Colônia, Grota Funda, Grumari, Ilha de Guaratiba, and Carapiá. From September 1996 to December 1999, phebotomine sandfly captures were performed at 18 sites on the mountainsides of the Pedra Branca Massif, in the Municipality, and a total of 18,303 specimens were collected, with a predominance of L. intermedia (87.33%), L. migonei (6.59%), L. longipalpis (3.10%), and L. firmatoi (1.90%). The species L. longipalpis predominated in Barra de Guaratiba (46.80%) and was absent from the other six locations where VL cases also occurred, suggesting the participation of other species like L. migonei and L. firmatoi, belonging to the same paraphyletic group of the vector species, in the VL transmission chain in the region.

Em 1977 foi diagnosticado o primeiro caso autóctone de leishmaniose visceral (LV) humano no Município do Rio de Janeiro. A partir de 1980, foram diagnosticados 54 casos autóctones em diversas localidades, sendo que desde 1993 ocorreram 17 casos humanos autóctones notificados. Oito deles ocorreram no bairro de Barra de Guaratiba e o restante distribuído pelos bairros: Camorim, Colônia, Grota Funda, Grumari, Ilha de Guaratiba e Carapiá. Entre setembro de 1996 a dezembro de 1999, foram realizadas capturas de flebotomíneos em 18 localidades nas encostas do maciço da Pedra Branca, no município, e coletados 18.303 espécimes com predomínio de L. intermedia (87,33%), L. migonei (6,59%), L. longipalpis (3,10%) e L. firmatoi (1,90%). A espécie L. longipalpis predominou em Barra de Guaratiba (46,80%), permanecendo ausente nas outras seis localidades onde também ocorreram casos de LV, o que sugere a participação de outras espécies tais como L. migonei e L. firmatoi, pertencentes ao mesmo grupo parafilético da espécie vetora, na cadeia de transmissão da LV na região.

The first autochthonous case of human visceral leishmaniasis (VL) in the Municipality of Rio de Janeiro was diagnosed in 1977. Since 1980, 54 autochthonous cases have been diagnosed in various locations, and since 1993 some 17 autochthonous human cases have been reported. Eight of these occurred in the neighborhood of Barra de Guaratiba and the others were distributed in the following neighborhoods: Camorim, Colônia, Grota Funda, Grumari, Ilha de Guaratiba, and Carapiá. From September 1996 to December 1999, phebotomine sandfly captures were performed at 18 sites on the mountainsides of the Pedra Branca Massif, in the Municipality, and a total of 18,303 specimens were collected, with a predominance of L. intermedia (87.33%), L. migonei (6.59%), L. longipalpis (3.10%), and L. firmatoi (1.90%). The species L. longipalpis predominated in Barra de Guaratiba (46.80%) and was absent from the other six locations where VL cases also occurred, suggesting the participation of other species like L. migonei and L. firmatoi, belonging to the same paraphyletic group of the vector species, in the VL transmission chain in the region.

Cutaneous biopsies (n = 94) obtained from 88 patients with American tegumentary leishmaniasis were studied by conventional and immunohistochemical techniques. Specimens were distributed as active lesions of cutaneous leishmaniasis (n = 53) (Group I), cicatricial lesions of cutaneous leishmaniasis (n = 35) (Group II) and suggestive scars of healed mucosal leishmaniasis patients (n = 6) (Group III). In addition, active cutaneous lesions of other etiology (n = 24) (Group C1) and cutaneous scars not related to leishmaniasis (n = 10) (Group C2) were also included in the protocol. Amastigotes in Group I biopsies were detected by routine histopathological exam (30.2%), imprint (28.2%), culture (43.4%), immunofluorescence (41.4%) and immunoperoxidase (58.5%) techniques; and by the five methods together (79.3%). In Group II, 5.7% of cultures were positive. Leishmanial antigen was also seen in the cytoplasm of macrophages and giant cells (cellular pattern), vessel walls (vascular pattern) and dermal nerves (neural pattern). Positive reaction was detected in 49 (92.5%), 20 (57%) and 4 (67%) biopsies of Groups I, II and III, respectively. Antigen persistency in cicatricial tissue may be related to immunoprotection or, on the contrary, to the development of late lesions. We suggest that the cellular, vascular and neural patterns could be applied in the immunodiagnosis of active and cicatricial lesions in which leishmaniasis is suspected.

A leishmaniose tegumentar americana (LTA) é de ocorrência endêmica no Estado do Rio de Janeiro, sendo a maior incidência observada nos municípios do litoral sul. No período de 1993 a 1995, foram registrados, no Município de Paraty, extremo sul do Estado, 169 casos humanos, o que corresponde a 15% das notificações no estado. Neste trabalho, realizou-se estudo em áreas endêmicas (Praia Grande, Taquari, Várzea do Machado e Graúna) de LTA, com cães residentes no Município de Paraty, entre março e dezembro de 1996. Foram visitadas 315 residências, compreendendo uma população de 1.282 habitantes, com 215 cães estudados. O trabalho inicial consistiu na coleta de sangue venoso, para realização das técnicas sorológicas: Reação de Imunofluorescência Indireta (RIFI) e Enzyme Linked Immunossorbent Assay (ELISA). O resultado da sorologia foi de 3,2% de positividade para a técnica de Rifi e 10,2% para a de Elisa. A prova intradérmica canina foi realizada na mesma ocasião da coleta de sangue e sua positividade foi de 8,8%. Dos 215 cães, cinco deles apresentaram lesões suspeitas, nos quais realizou-se biópsia e técnica de aspirado a vácuo.

American tegumentary leishmaniasis (ATL) is endemic in the State of Rio de Janeiro, with the highest incidence observed in the municipalities along the Southern coast. A total of 169 human cases were reported from 1993 to 1995 in the municipality of Paraty, representing 15% of all case reports in the State of Rio de Janeiro during that period. From March to December, 1996, a survey was conducted in endemic american tegumentary leishmaniasis (ATL) areas (Praia Grande, Taquari, Várzea do Machado, and Graúna) in Paraty. 326 households with 215 pet dogs were surveyed. The initial study consisted of taking venous blood samples to perform Rifi and Elisa tests. The canine skin test was performed during the same visit and was positive in 8.8% of dogs. Of the 215 dogs, 5 presented lesions suspected of ATL; biopsies and the vacuum aspiration technique were performed on these cases. Correlating the study areas with the results obtained, some dogs presented sub-clinical infection, highly relevant to studies on canine ATL infection in the State of Rio de Janeiro.

A leishmaniose tegumentar americana (LTA) é de ocorrência endêmica no Estado do Rio de Janeiro, sendo a maior incidência observada nos municípios do litoral sul. No período de 1993 a 1995, foram registrados, no Município de Paraty, extremo sul do Estado, 169 casos humanos, o que corresponde a 15% das notificações no estado. Neste trabalho, realizou-se estudo em áreas endêmicas (Praia Grande, Taquari, Várzea do Machado e Graúna) de LTA, com cães residentes no Município de Paraty, entre março e dezembro de 1996. Foram visitadas 315 residências, compreendendo uma população de 1.282 habitantes, com 215 cães estudados. O trabalho inicial consistiu na coleta de sangue venoso, para realização das técnicas sorológicas: Reação de Imunofluorescência Indireta (RIFI) e Enzyme Linked Immunossorbent Assay (ELISA). O resultado da sorologia foi de 3,2% de positividade para a técnica de Rifi e 10,2% para a de Elisa. A prova intradérmica canina foi realizada na mesma ocasião da coleta de sangue e sua positividade foi de 8,8%. Dos 215 cães, cinco deles apresentaram lesões suspeitas, nos quais realizou-se biópsia e técnica de aspirado a vácuo.

American tegumentary leishmaniasis (ATL) is endemic in the State of Rio de Janeiro, with the highest incidence observed in the municipalities along the Southern coast. A total of 169 human cases were reported from 1993 to 1995 in the municipality of Paraty, representing 15% of all case reports in the State of Rio de Janeiro during that period. From March to December, 1996, a survey was conducted in endemic american tegumentary leishmaniasis (ATL) areas (Praia Grande, Taquari, Várzea do Machado, and Graúna) in Paraty. 326 households with 215 pet dogs were surveyed. The initial study consisted of taking venous blood samples to perform Rifi and Elisa tests. The canine skin test was performed during the same visit and was positive in 8.8% of dogs. Of the 215 dogs, 5 presented lesions suspected of ATL; biopsies and the vacuum aspiration technique were performed on these cases. Correlating the study areas with the results obtained, some dogs presented sub-clinical infection, highly relevant to studies on canine ATL infection in the State of Rio de Janeiro.

Através de métodos parasitológicos usuais avaliou-se a contaminação por cistos e ovos de enteroparasitas de 220 amostras de hortaliças que são consumidas cruas e comercializadas nas zonas norte (de menor poder aquisitivo) e sul (de maior poder aquisitivo) da Cidade do Rio de Janeiro. Apesar de não ter havido aparente diferença na procedência das hortaliças avaliadas, constatou-se maior grau de contaminação nas amostras procedentes da zotza norte e nas amostras de alface (Lactuca sativa). Discutiu-se a possibilidade de a diferença observada estar relacionada ao acondicionamento das hortaliças ou ser devido à manipulação das mesmas por vendedores e consumidores.

Parasitological examinations were performed in material derived from 220 vegetables to detect cysts and eggs of intestinal parasites. This material was collected from supermarkets in northern and southern areas and from CEASA (Central Supply Market - 40 vegetables) in Rio de Janeiro city. Vegetables proceeding from the northern areas presented a greater degree of contamination mostly of helminth eggs; lettuce was the most contaminated vegetable. The authors suggest that differences found between the northern and southern areas of the city may be due to either packing or manipulation by shop assistants and consumers.

Em 1974 foram diagnosticados vários casos de leishmaniose tegumentar americana, no Município do Rio de Janeiro, RJ (Brasil). Naquela ocasião, foram usadas como medidas profiláticas o tratamento dos doentes e a dedetização dos domicílios e anexos, resultando na interrupção da transmissão. Com o aparecimento de novos casos, a partir de 1979, foram reestudadas algumas características de uma das localidades (Camorim) do mesmo município. De junho de 1979 a agosto de 1981, foram comprovados nessa localidade 19 casos novos de leishmaniose tegumentar americana (18 humanos e um em cão). Coletaram-se 1.149 flebótomos (11,4% fêmeas e 88,6% machos) com predomínio de Lutzomyia intermedia (95%). De acordo com o estudo dos casos, pressupõe-se que a transmissão tenha ocorrido no domicílio ou peridomicílio. Acredita-se, pois, que na área estudada, as medidas de controle, adotadas em 1974, foram eficientes por um período de aproximadamente quatro anos.

In 1974 several cases of cutaneous leishmaniasis were diagnosed in Jacarepaguá, Rio de Janeiro, RJ (Brazil). At that time the patients were treated, the houses and surroundings were sprayed with DDT, and this resulted in the interruption of transmission. The emergence of new cases in 1979 led to a resumption to the study of some characteristics of one of the localities (Camorim) in this area. Eighteen new human cases of cutaneous leishmaniasis and one in a dog were confirmed between June 1979 and August 1981. One thousand hundred and forty nine sand flies were collected (11.4% females and 88.6% males) with predominance of Lutzomyia intermedia (95%). The study of the human cases led to the supposition that the transmission of the disease may take place in the domiciliary or peridomiciliary environment. It is believed that, at least for the studied area, the control measures taken in 1974 were efficient for four years.

Em 1974 foram diagnosticados vários casos de leishmaniose tegumentar americana, no Município do Rio de Janeiro, RJ (Brasil). Naquela ocasião, foram usadas como medidas profiláticas o tratamento dos doentes e a dedetização dos domicílios e anexos, resultando na interrupção da transmissão. Com o aparecimento de novos casos, a partir de 1979, foram reestudadas algumas características de uma das localidades (Camorim) do mesmo município. De junho de 1979 a agosto de 1981, foram comprovados nessa localidade 19 casos novos de leishmaniose tegumentar americana (18 humanos e um em cão). Coletaram-se 1.149 flebótomos (11,4% fêmeas e 88,6% machos) com predomínio de Lutzomyia intermedia (95%). De acordo com o estudo dos casos, pressupõe-se que a transmissão tenha ocorrido no domicílio ou peridomicílio. Acredita-se, pois, que na área estudada, as medidas de controle, adotadas em 1974, foram eficientes por um período de aproximadamente quatro anos.

In 1974 several cases of cutaneous leishmaniasis were diagnosed in Jacarepaguá, Rio de Janeiro, RJ (Brazil). At that time the patients were treated, the houses and surroundings were sprayed with DDT, and this resulted in the interruption of transmission. The emergence of new cases in 1979 led to a resumption to the study of some characteristics of one of the localities (Camorim) in this area. Eighteen new human cases of cutaneous leishmaniasis and one in a dog were confirmed between June 1979 and August 1981. One thousand hundred and forty nine sand flies were collected (11.4% females and 88.6% males) with predominance of Lutzomyia intermedia (95%). The study of the human cases led to the supposition that the transmission of the disease may take place in the domiciliary or peridomiciliary environment. It is believed that, at least for the studied area, the control measures taken in 1974 were efficient for four years.

Foi feito estudo visando a determinação das taxas de medida da doença meningocócica em japoneses e seus descendentes, do município de Londrina, Paraná, Brasil. A morbidade por doença meningocócica (DM) foi cerca de 7 meses mais baixa que no restante da população, tendo sido nula entre os mesmos a ocorrência de óbitos, tanto em fase endêmica, como epidêmica, A revisão dos prontuários médicos hospitalares correspondentes aos casos notificados exclui o diagnóstico de DM em 75% dos pacientes de origem japonesa e em 20% da amostra de pacientes não japoneses. É discutida a eventual relação de fatores sócio-econômicos e cultural (alimentar) às observações.

In the case of Japanese and their descendants living in the municipality of Londrina, State of Paraná, the morbidity of meningococcic disease was about seven times lower than for the rest of the population, the death rate having been nil during both endemic and epidemic phases. A review of medical and hospital records, covering registered cases, showed no diagnoses of meningococcic disease in 75% of patients of Japanese origin or in 20% of samplings of non-Japanese patients. The possible relationship of socioeconomic and cultural (nutritional) factors, as regards above observations is discussed.