A total of 250 dentists (53.6% men and 46.4% women), with a mean age of 35.1 ± 9.8 years, were submitted to serological tests for the diagnosis of hepatitis B (HB) - HBsAg, anti-HBs, anti-HBc, HBeAg, and anti-HBe - using a radioimmunoassay. One or more of these markers were detected in 78 individuals (31.2%) who were excluded from the group to be vaccinated. Of the 172 HB-susceptible individuals, 135 (78.5%) responded to the call and were intradermally injected with three 2 µg doses of the Belgian HB recombinant vaccine, applied at an interval of one month between the 1st and 2nd dose and of five months between the 2nd and 3rd dose. A new determination of HB markers carried out 50 days after the 3rd dose showed that 110 (81.5%) individuals had become anti-HBs positive (65.5% good responders and 34.5% poor responders). Mean serum anti-HBs titer of these 110 dentists was 42.4 U S/N, similar in both sexes. The adverse effects analyzed in 106 dentists were: (a) local: pain (12.3%), burning sensation (14.1%), pruritus (25.5%), erythema (28.3%), local heat (18.9%), and a hypochromic spot (32.1%); (b) systemic (4.7%): discomfort in two patients, and fever, anorexia, and asthenia in one patient each. Intradermal administration of a fourth 2 µg vaccine dose to 39 dentists (poor or non-responders) increased the total number of anti-HBs-positive individuals from 110 (81.5%) to 114 (84.4%), with the number of good responders increasing from 72 (65.5%) to 85 (74.6%). We conclude that the Belgian recombinant vaccine applied in the scheme used here induces a high rate of seroconversion and causes only mild and transitory adverse effects.

Of the 110 dentists who had presented seroconversion 50 days after the intradermal application of three 2 µg doses of the Belgian recombinant vaccine against hepatitis B (HB), administered eight years before at an interval of one month between the 1st and 2nd doses and of five months between the 2nd and 3rd doses, 51 were included for the assessment of the persistence of immunity. None of the dentists had hepatitis or had received HB vaccine during this period. All subjects were submitted to serological tests for the detection of the following markers of hepatitis B virus (HBV) infection: HBsAg, anti-HBc, HBeAg, anti-HBe, and anti-HBs, with no HBsAg, anti-HBc, HBeAg or anti-HBe being detected. A microparticle enzyme immunoassay (MEIA) revealed the presence of anti-HBs at protective titers (> 10 mIU/ml) in 42 dentists (82.4%), with the anti-HBs titer being higher than 100 mIU/ml in 36 of them (70.6%) (good responders), between 10 and 100 mIU/ml in 6 (11.8%) (poor responders), and lower than 10 mIU/ml in 9 (17.6%) (non-responders). According to clinical data and serological tests, none of the dentists had presented disease or latent HBV infection during the eight years following the first vaccination. A 2 µg booster dose was administered intradermally to eight dentists with anti-HBs titers lower than 10 mIU/ml (non-responders) and to six dentists with titers ranging from 10 to 100 mIU/ml (poor responders); the determination of anti-HBs one month later demonstrated the occurrence of seroconversion in the eight non-responders and an increase in anti-HBs titer in the six poor responders. In summary, the present results demonstrated the prolonged persistence of protection against HBV infection and the development of immunologic memory provided by vaccination against HB - with intra-dermal application of three 2 µg doses of the Belgian recombinant vaccine at 0, 1, and 6 months - carried out eight years before in 51 dentists.

Foram estudadas as alterações clínicas e radiológicas pulmonares da fase inicial da esquistossomose mansoni em 30 indivíduos previamente sadios, que se infectaram simultaneamente. Os achados foram comparados aos de um grupo - controle e relacionados a possíveis fatores patogenéticos como carga parasitária, eosinofilia sangüínea e área de reação intradérmica imediata, esta como estimativa de IgE ligada a mastócito. As manifestações pulmonares foram de intensidade leve ou moderada, sendo a tosse seca o sintoma mais comum. As alterações radiológicas significativas constaram de espessamento de paredes brônquicas, micronodulação em rosário e micronodulação esparsa, localizadas predominantemente nas porções inferiores dos campos pulmonares. Verificou-se associação significativa de sibilos e área da reação intradérmica imediata, bem como entre o número de eosinófilos sangüíneos e a ocorrência de alterações radiológicas tomadas em conjunto. Houve correlação entre a carga parasitária, expressa pelo número de ovos eliminados nas fezes, e a presença de sibilos, dor torácica e micronodulação em rosário.

The clinical and radiological pulmonary manifestations in the initial phase of schistosomiasis mansoni were studied in thirty previously healthy individuals who were simultaneously infected. The findings were compared with those concerning a control group and related to possible pathogenetic factors. The respiratory manifestations were of light or of moderate intensity, the dry cough being the most common symptom. The significant radiological alterations were: thickening of bronchial walls and beaded micronodulation, predominantly localized in the lower pulmonary fields. It was observed significant association between wheezing and IgE levels, estimated by the area of immediate intradermal reaction, as well as between the number of blood eosinophils and the occurrence of radiological changes. Moreover, there was correlation between the worm burden and the presence of wheezing, thoracic pain and beaded micronodulation. Thus, the clinical and radiological pulmonary manifestations described are significant part of the initial phase of schistosomiasis mansoni and present the worm burden, eosinophilia and levels of IgE as probable pathogenetic factors.

Foram estudados 115 recrutas que tiveram contato simultaneamente com águas infectadas pelo Schistosoma mansoni. Trinta e quatro pacientes apresentaram a fase inicial da infecção, diagnosticada através de parâmetros laboratoriais, clínicos e epidemiológicos, sendo que três deles não evidenciaram quadro clínico, sendo considerados como portadores da forma inaparente da doença. Não se verificou, entretanto, diferença estatística entre a intensidade da eosinofilia sanguínea, as áreas da reação intradérmica de leitura imediata e as médias das contagens do número de ovos de 5. mansoni eliminados nas fezes, quando se compararam os resultados obtidos em pacientes com as formas aguda e inaparente. Os casos ora descritos constituem evidenciação objetiva da forma inaparente, antes apenas presumida na literatura.

In this paper the history of 115 recruits that had bathed simultaneously in streams contaminated with Schistosoma mansoni, during military maneuvers, is reported. Thirty four of the infected patients presented the initial phase of the infection diagnosed through epidemiologic, clinical and laboratorial parameters. Three out of the 34 patients did not reveal the clinical picture of the infection, thus being considered representatives of the non-apparent form of the disease. Differences between the intensity of blood eosinophilia, the area of immediate cutaneous reaction and the number of Schistosoma eggs eliminated in the stools proved not to be statistically significant (p>0.05) when the non-apparent and acute cases of schistosomiasis were compared. These cases actually may be considered evidences of the non-apparent form hitherto merely taken for granted in the literature.

The acute toxemic form of schistosomiasis mansoni is studied under anatomic and clinical point of view, according to classification made by Neves, Raso and Bagliolo in 1975. The first phase is characterized by the following facts: cutaneous (immediate and late) manifestations; high fever or in progressive elevation; intense diaphoresis abdominal disconfort; intense acquous diarrhea; dehidratation; loss of weight, dry cough; painful hepatosplenomegaly; discreet lymphademegaly, progressive increase of blood leucocytes and eosinophisles; radiological pulmonary alterations; absence of alterations in serum protein and hepatic functional tests; the hepatic function byopsy shows focus of acute hepatitis. The second stage or properly named toxemic period was clinically characterized by the neat aggravation of the previously observed phenomena. At last, the evolutive course of the disease has implication derived not only of the worm's presence, but from the intense dissemination of eggs in the tissue. In the pre-laying phase one studied the forms of cercarian dermatitis, prodromic and innapparent. In the post laying phase, the properly named acute toxemic form, with its types: pseudocholeraic, pseudotyphous, pseudodysenteric-bacillary, pseudonophritic, pseudoenterovirotic, the reactivated, the ischemic enterocolitis and others; whenever possible clinical and anatomic correlation will be made.

Vinte pacientes com a associação Salmonella-S. mansoni (Grupo 1) e 20 com esquistossomose mansoni hepatesplênica (Grupo 2) foram selecionados para o estudo. Submeteram-se os pacientes dos Grupos le 2 a exame clínico minucioso e a uma série de exames complementares, com destaque para as provas de função renal. Em 10 pacientes do Grupo 1 e 20 do Grupo 2, realizou-se, ainda, estudo histológico do rim à microscopia óptica, de fluorescência e eletrônica. As alterações renais foram mais freqüentes nos pacientes do Grupo 1. Após o tratamento dos pacientes do Grupo 1, com antibióticos e/ou esquistossomicidas, observou-se regressão das alterações renais sob o ponto de vista clínico, laboratorial e imunopatológico. Os autores concluem pela existência de duas nefropatias distintas: a nefropatia esquistossomótica e a encontrada em pacientes com a associação Salmonella-S. mansoni.

The responses of Plasmodium falciparum to antimalarial drugs were evaluated through the in vitro test using blood sample collected from patients of 7 municipalities of the south of Pará State. Sixty nine microtests for chloroquine and mefloquine, 62 for amodiaquine and 61 for quinine were pet formed. The results showed a high resistancefor chloroquine (71%), a relatively low resistance level for amodiaquine (25.8%) and little resistance to quinine (8.2%). For mefloquine 100% of sensitivity wasfound.

Com o objetivo de testar a viabilidade do ciclo biológico, 15 pacientes (masculinos, de quatro a 14 anos) com Ascaris lumbricoides, foram selecionados ao acaso. Após tratamento clássico com sais básicos de levamisole (7 pacientes) e de pamoato de pirantel (8), os ovos retirados das fêmeas expelidas ficaram incubados por 18 dias em de H2SO4 N/10. A seguir foram administrados per os a grupos de 5 camundongos por pacientes. Decorridos 8 dias da infecção, os animais foram sacrificados para pesquisas microscópica de larvas nos fragmentos pulmonares. Dos 75 animais, somente 1, pertencente ao grupo de tratados com levamisole, não apresentou larvas nos fragmentos pulmonares. Concluiu-se que as drogas, nas doses utilizadas, não possuem ação deletéria sobre os ovos de A. lumbricoides, mas promovem a eliminação de material infectivo, com possibilidade de incrementar a poluição onde vivem comunidades sem adequadas condições de saneamento básico.

A total of 15 patients from 4 to 14 years of age were submitted to specific treatment for Ascaris lumbricoides infection. Seven out of these 15 patients received Levamisole (150 mg/ kg of body weight), and eight received Pyrantel Pamoate (10 mg/kg of body weight). Eggs collected directly from the uteri of the female were incubated for 18 days in H2SO4 N/10 solution. These eggs were administered per os to groups of five white mice per patient. Eight days after the infection, the mice were sacrificed to permit microscopic searching of larvae in lung specimens. Only in one out of the 75 examined mice, in the group of patients treated with Levamisole, larvae were not recovered from the lungs. Thus, it is to conclude that the drugs used in the treatment did not demonstrate deleterious effect on the A. lumbricoides eggs. However, the drugs really promote the elimination of infectious eggs. In these circumstances it is possible to believe in the in- creasing of the pollution level in communities without adequate basic sanitation facilities.

Vinte pacientes com SSP (Grupo 1) e 20 com esquistossomose mansoni (Grupo 2) foram selecionados para o estudo. Realizou-se a reação de Widal, com antígenos preparados da amostra Ty 901 (S. typhi), nos pacientes dos Grupos 1 e 2. Em seis pacientes do Grupo 1, a reação de Widal foi feita com antígenos preparados a partir de salmonelas isoladas destes pacientes (autoantígenos). Foram considerados significativos os títulos superiores a 1:200. Dez pacientes do Grupo 1 (50%) tiveram a reação positiva para o antígeno "H" e cinco (25%) para o "O". Em quatro casos em que se isolou a S. typhi, a reação de Widal foi positiva. Em três pacientes com reação negativa para "H" e "O", houve viragem da reação com títulos elevados quando se utilizou autoantígenos; outros dois casos positivos mantiveram os mesmos títulos e em um caso houve elevação de quatro vezes nos títulos quando a reação foi feita com antígenos da Salimonella isolada. A reação de Widal foi positiva na maioria dos casos quando as salmonelas isoladas eram do Grupo D. Para o grupo 2, caso se aceitem os títulos superiores a 1:200 todos os exames foram negativos. Os Autores concluem que a reação de Widal apresenta baixa positividade na SSP. Com o uso de antígenos de S. paratyphi A e B e de uma mistura de antígenos de salmonelas de grupos distintos, a reação provavelmente será de valor no diagnóstico da SSP.

Twenty patients with prolonged septicemic salmonellosis (Group 1) and 20 with schistosomiasis mansoni (Group 2) were selected for this study. In both groups, the Widal test was done using antigens of the sample Ty 901 (S. typhi). The test was also applied in 6 group 1 patients with antigens prepared from salmonellae isolated from these patients (autoantigens). Titres over 1:200 were considered significant. Ten group 1 patients (50%) were positive for antigen "H" and 5 (25%) were positive for antigen "O". Three patients with negative "H" and "O" reactions became positive with high titres when using autoantigens. Two other cases maintained the same positive titres and one case showed a fourfold increase in titres when the test was done 'with antigens of the Salmonella isolated. The Widal test was positive in most patients infected with group D Salmonellae. Considering titres above 1:200, all cases were negative in Group 2. The authors conclude that the Widal test has low positivity in prolonged septicemic salmonellosis. The test may be valuable in the diagnosis of this disease when using S. paratyphi "A" and "B" antigens and a mixture of Salmonella antigens taken from other groups.

Trinta e cinco pacientes com salmonelose septicêmica prolongada (SSP) foram selecionados para o estudo. Vinte (Grupo 1), foram tratados com a oxamniquine oral (15-20mg/kg de peso, dose única) e 15 (Grupo 2) com o cloranfenicol (50mg/kg de peso/15-20 dias). Realizaram-se exames clínico, laboratorial e radiológico antes e após o tratamento. Oito pacientes do Grupo 1 (40%) exibiram uma ou mais queixas após o tratamento. Exceção feita a um paciente que apresentou crise convulsiva, uma hora após a ingestão do medicamento, os demais efeitos colaterais foram de pouca importância. Não se observou efeito tóxico da oxamniquine à luz dos exames complementares realizados após o tratamento. Os pacientes do Grupo 2, não apresentaram qualquer manifestação que pudesse ser imputada ao cloranfenicol. No Grupo 1, 90% dos pacientes foram considerados curados e no Grupo 2, 93% também o foram. Os Autores concluem pela boa eficácia e baixa toxicidade da oxamniquine no tratamento da SSP.

Thirty-five patients with Prolonged Septicemic Salmonellosis were selected for this trial. Twenty patients (Group 1) were treated with a single oral dose of oxamniquine (15-20mg/kg body weight) and 15 (Group 2) were treated with cloramphenicol (50mg/kg body weight, for 15-20 days). Clinical, laboratory and radiological examinations were performed before and after treatment. Eight Group 1 patients (40%) presented one or more complaints after treatment. With the exception of one patient With seizures, one hour after taking oxamniquine, the others symptoms were unimportant. No toxic effects of oxamniquine were observed on laboratorial tests done after treatment. Group 2 patients did not present complaints related to cloramphenicol. In Group 1, 90% of the patients were cured, and in Group 2, 93% also were considered as cured. The Authors conclude that oral oxamniquine in the prescribed dosage has low toxicity and good therapeutic efficacy in patients with Prolonged Septicemic Salmonellosis.

Analisa-se a incidência de infecções hospitalares no Brasil e nos Estados Unidos, destacando-se a alta letalidade das mesmas em relação a algumas doenças transmissíveis clássicas. Explica-se a incidência elevada em países industrializados, não obstante toda sofisticação de instalação e de equipamentos, distingüindo-se dois tipos básicos de doenças infecciosas. Admitindo-se que o desenvolvimento sócio-econômico promove uma redução substancial nas doenças de origem exôgena sem contudo impedir o aumento das doenças de origem endógena. Cita-se uma série de evidências que demonstram não ter a equipe de saúde substituído ainda os seus rituais mágicos de profilaxia por medidas administrativas coerentes, derivadas do conhecimento científico produzido ao longo do tempo. Conclui-se que esse processo histórico de racionalização será, inevitavelmente, relutante e lento.

The paper analises the incidence of nosocomial infections in Brazil and in the United States of America, emphasizing its letality rate when compaired with some classic communicable diseases. The paper also expiains the high incidence of nosocomial infections in industrialized countries, in spite of ali the sophistication of installations and equipments. It is pointed out that social and economic developments are able to produce a substantial decrease in the origin of exogenous diseases without impeding the increasing of the endogenous ones. Some evidences are shown to demonstrate the difficulty with the health personal substitute the magic rituais of prophylaxis by coherent administrative proceedings derived from the scientific knowledge. It is concluded that this historie process of rationalization will inevitably be reluetant and slow.

Os Autores descrevem um caso grave de esquistossomose mansoni numa criança de 9 anos de idade (forma hepática com hipertensão portai associada a forma pulmonar com hipertensão pulmonar e cor pulmonale) clinicamente caracterizado por episódios de insuficiência respiratória desencadeados em face de esforços físicos moderados. Sucessivos exames radiológicos de tórax revelaram comprometimento predominantemente arteriolar ao iado de uma micronodulação delicada e difusamente distribuída e configuração de cor pulmonale. Ao contrário do caso anteriormente descrito, a evolução se deu sem que se verificassem manifestações febris. Embora tenham sido afastadas várias hipóteses de associação da esquistossomose a concausas infectuosas, optou-se pelo tratamento de prova da tuberculose pulmonar. O fundo de olho também apresentava vários nódulos esbranquiçados disseminados pelo coróide e retina, caracterizando provável coroidite e retinite esquistossomótica. O tratamento antituberculoso resultou praticamente nulo. Não se procedeu ao tratamento específico da esquistossomose, considerando-se o alto risco da cardiopatia face aos esquistossomicidas disponíveis. A alta foi fornecida após treze meses de observação hospitalar. Não compareceu a ulterior controle.

The Authors report a severe case of schistosomiasis mansoni in a 9-year-old child (heplus pulmonary form with pulmonary hypertension and cor pulmonalel The clinical features comprised episodes of respiratory insufficiency induced by moderate physical exercise. Serial chest X-raysshowed a predominantly arteriolar involvement associated with fine micronodules and the features of cor pulmonale. The fever episodes found in the case previously reported did not happen in th is patient. Even though various hypothesis of association of schistosomiasis and other infectious diseases were discarted, a trial of anti-tuberculous drugs was performed. Eye examination disclosed various whitish nodules disseminated throughout the retina and choroid, and this suggested schistosomiasis as the cause for the eye involvement. The antituberculous drugs did not change the clinical picture at all. Antischistosome drugs were. not used due to the risk of circulatory side-effects of the drugs available. The patient was discharged after 13' months and no follow-up has been done since.

Com o objetivo de demonstrar algumas modalidades distintas do comprometimento pulmonar na esquistossomose mansoni, ressaltando sempre a diversidade dé interação dos múltiplos fatores envolvidos, os Autores iniciam a publicação de uma seqüência de casos ilustrativos, embora considerados pouco comuns na clínica diária. No caso ora descrito, ao lado de sintomatologia definida dominantemente por surtos paroxísticos de asma, o estudo radiológico seriado, durante sete anos, revelou imagem pieuro-parenquimatosa caracterizada por irregularidades de radiopacidade com traves fibróticas extensas, notadamente à direita e desvio acentuado do mediastino para este lado; a área cardíaca encontrava-se aparentemente normal. À microtoracotomia, observou-se lesão pleural dominante com enclausuramento do LSD e condensação extensa subpleural do LSD, afetando amplamente o parênquima. Procedeu-se àdetorticação do LM e LID e reexpansão parcial de seus parénquimas, bem como à biopsia pulmonar. Apesar de o estudo histopatológico haver revelado uma arterite pulmonar grave, não foram registrados sinais e sintomas de cor pulmonale. Este comprometimento pulmonar verificou-se, entretanto, isoladamente de uma forma hepato-esplênica e, conseqüentemente, na ausência de síndrome de hipertensão portai a determinar a rota oreferencial de migração de ovos e, eventualmente, de vermes aos pulmões.

To demonstrate some different modalities of lung lesions in schistosomiasis mansoni, the authors relate a series of illustrative, though unusual cases, stressing the diversity of the multiple factors involved. In the present studied case, besides a definite symptomatology of paroxistic attacks of asthma, a series of radiological studies through seven years showed a pleuro-parenchymatous image characterized by irregularities of radioopacity, with extensive fibrous proliferation especially on the rightside, and marked deviation of the mediastinum also to the right; cardiac area was apparently normal. Microthoracotomy showed dominant pleural lesion enclosing the right superior lobe, affecting widely the parenchyma. Decortication of medium and right inferior lobes, partial reexpansion of their parenchyma, and pulmonary biopsy were performed. Histopathological study disclosed a predomiantly focal, but relatively extensive, and severe case of pulmonary arteritis without cor pulmonale. This pulmonary involvement occured isolated, not related to a hepato-splenic symptomatology, and consequently there was no syndrome of portal hypertension to indicate the preferentiai way of migration of the eggs, and eventually of the worms to the lungs.