ABSTRACT INTRODUCTION Despite their high toxicity, antimonials and amphotericin B deoxycholate are commonly used for treating visceral leishmaniasis (VL). Few studies showing conflictive data about their efficacy and adverse events in pediatric population are available. This study aimed to evaluate efficacy and safety of amphotericin B deoxycholate vs. that of N-methylglucamine antimoniate in treating pediatric VL in Brazil. METHODS This was a randomized, open-label, 2-arm and controlled pilot clinical trial. Treatment naïve children and adolescents with VL without signs of severe illness were treated with N-methylglucamine antimoniate (20mg/kg/day for 20 days) or amphotericin B deoxycholate (1 mg/kg/day for 14 days). All patients were diagnosed with positive direct examination and/or positive PCR for Leishmania spp. performed in bone marrow samples. The primary efficacy end-point was VL cure determined after 180 days of completion of treatment. The analysis was performed using intention-to-treat (ITT) and per protocol (PP) analyses. RESULTS In total, 101 volunteers were assessed. Efficacy was similar for both groups. The antimonial (n=51) and amphotericin B groups (n=50) had a cure rate of 94.1% and 100%, and 94% and 97.9% according to ITT and PP analyses, respectively. All patients reported adverse events (AE). Serious AE incidence was similar in both groups. Five individuals were excluded from the study because of severe adverse events. CONCLUSIONS N-methylglucamine antimoniate and amphotericin B deoxycholate have similar efficacy and adverse events rate in pediatric patients with VL.

ABSTRACTINTRODUCTION: This study aimed to determine the frequencies of bacterial isolates cultured from diabetic foot infections and assess their resistance and susceptibility to commonly used antibiotics.METHODS: This prospective study included 41 patients with diabetic foot lesions. Bacteria were isolated from foot lesions, and their antibiotic susceptibility pattern was determined using the Kirby-Bauer disk diffusion method and/or broth method [minimum inhibitory concentration (MIC)].RESULTS: The most common location of ulceration was the toe (54%), followed by the plantar surface (27%) and dorsal portion (19%). A total of 89 bacterial isolates were obtained from 30 patients. The infections were predominantly due to Gram-positive bacteria and polymicrobial bacteremia. The most commonly isolated Gram-positive bacteria were Staphylococcus aureus, followed by Staphylococcus saprophyticus, Staphylococcus epidermidis, Streptococcus agalactiae, and Streptococcus pneumoniae. The most commonly isolated Gram-negative bacteria were Proteus spp. and Enterobacterspp., followed by Escherichia coli, Pseudomonasspp., and Citrobacterspp. Nine cases of methicillin-resistant Staphylococcus aureus (MRSA) had cefoxitin resistance, and among these MRSA isolates, 3 were resistant to vancomycin with the MIC technique. The antibiotic imipenem was the most effective against both Gram-positive and Gram-negative bacteria, and gentamicin was effective against Gram-negative bacteria.CONCLUSIONS: The present study confirmed the high prevalence of multidrug-resistant pathogens in diabetic foot ulcers. It is necessary to evaluate the different microorganisms infecting the wound and to know the antibiotic susceptibility patterns of the isolates from the infected wound. This knowledge is crucial for planning treatment with the appropriate antibiotics, reducing resistance patterns, and minimizing healthcare costs.

Introduction: This study aimed to describe the main features of visceral leishmaniasis (VL), both related to and independent of human immunodeficiency virus (HIV) infection, in patients who were registered in Tocantins, Brazil. Methods: Data from 1,779 new patients with VL, 33 of whom were also infected with HIV, were reviewed. Results: The incidence of VL/HIV coinfection increased from 0.32/100,000 inhabitants in 2007 to 1.08/100,000 inhabitants in 2010. VL occurred predominantly in children aged 10 years or younger, while VL/HIV was more common in patients aged between 18 and 50 years. There were more male patients in the VL/HIV group than in the VL group. Relapse rates were also considerably higher in the VL/HIV (9.1%) group than in the VL group (1.5%). Despite a similar clinical presentation, VL/HIV patients exhibited a higher proportion (24.2%) of concomitant infectious diseases and jaundice. Pentavalent antimonials were used for the initial treatment of VL and VL/HIV infections. However, amphotericin B deoxycholate and liposomal amphotericin B were also widely used in the treatment of VL/HIV coinfection. The mortality rate was higher in the VL/HIV coinfection group (19.4%) than in the VL group (5.4%). Furthermore, the mortality rate due to other causes was significantly higher in the VL/HIV group (12.9%) than in the VL group (0.7%). Conclusions: The study showed that the incidence, clinical characteristics and outcomes among the VL and VL/HIV patients in this state are similar to those from other endemic regions, indicating that both infections are emerging with increasing frequency in Brazil.

Visceral leishmaniasis is a relevant public health problem worldwide. Most of the reported cases in Latin America are from Brazil. Herein we report two human cases of congenitally transmitted visceral leishmaniasis in two patients who developed symptoms during pregnancy. The diagnosis was made by visual examination of Leishmania parasites in bone marrow aspirates of the mothers and by detecting parasite kDNA in bone marrow samples of the newborn children using polymerase chain reaction.

Objetivou-se conhecer a atividade de Lafoensia pacari e a de Brossimum gaudichaudii, sobre leveduras do gênero Candida isoladas da mucosa vaginal. As leveduras foram isoladas a partir de esfregaço de mucosa vaginal de mulheres com ou sem sintomatologia. Realizou-se os testes de susceptibilidade em duplicata para 34 linhagens de Candida frente aos extratos brutos das espécies vegetais, nas concentrações de 50, 100 e 200 mg.mL-1. Consideraram-se como ativos os extratos que produziram halos de inibição com média a partir de 10 mm. Evidenciou-se atividade antifúngica de B. gaudichaudii na concentração de 200 mg.mL-1, enquanto que a de L. pacari mostrou-se ativo a 50 mg.mL-1. A atividade dos extratos vegetais estudados destacou-se em relação à Nistatina creme (100.000UI/4g) utilizada como controle.

This work aims to evaluate the activity of Lafoensia Pacari and Brossimum gaudichaudii on yeast of the Candida variety isolated from vaginal mucus. The yeasts were obtained from swabs of women with or without symptoms. Susceptibility testing in duplicate was carried out for 34 strains of Candida compared to crude extracts of plant species at concentrations of 50, 100 and 200 mg.mL-1. Extracts that produced inhibition zones with an average of over 10 mm were considered to be active. Antifungal activity of B. gaudichaudii at a concentration of 200-mg.mL-1 was proven, while that of L. pacari was found to be active at 50 mg.mL-1. The activity of plant extracts was revealed compared to Nystatin cream (100.000UI/4g) used for control purposes.

Objetivou-se conhecer a atividade de Lafoensia pacari e a de Brossimum gaudichaudii, sobre leveduras do gênero Candida isoladas da mucosa vaginal. As leveduras foram isoladas a partir de esfregaço de mucosa vaginal de mulheres com ou sem sintomatologia. Realizou-se os testes de susceptibilidade em duplicata para 34 linhagens de Candida frente aos extratos brutos das espécies vegetais, nas concentrações de 50, 100 e 200 mg.mL-1. Consideraram-se como ativos os extratos que produziram halos de inibição com média a partir de 10 mm. Evidenciou-se atividade antifúngica de B. gaudichaudii na concentração de 200 mg.mL-1, enquanto que a de L. pacari mostrou-se ativo a 50 mg.mL-1. A atividade dos extratos vegetais estudados destacou-se em relação à Nistatina creme (100.000UI/4g) utilizada como controle.

This work aims to evaluate the activity of Lafoensia Pacari and Brossimum gaudichaudii on yeast of the Candida variety isolated from vaginal mucus. The yeasts were obtained from swabs of women with or without symptoms. Susceptibility testing in duplicate was carried out for 34 strains of Candida compared to crude extracts of plant species at concentrations of 50, 100 and 200 mg.mL-1. Extracts that produced inhibition zones with an average of over 10 mm were considered to be active. Antifungal activity of B. gaudichaudii at a concentration of 200-mg.mL-1 was proven, while that of L. pacari was found to be active at 50 mg.mL-1. The activity of plant extracts was revealed compared to Nystatin cream (100.000UI/4g) used for control purposes.