O tifo murino tem sido reconhecido com freqüência crescente em todo o mundo e vem se tornando um relevante diagnóstico diferencial de quadros febris. No Brasill, o tifo murino nunca mereceu grande atenção. Descrevemos um caso clínico e fazemos revisão da literatura que sugere que a doença poderia ser mais prevalente no sudeste brasileiro do que reconhecido até então.

Murine typhus has been increasingly recognized worldwide and is becoming a relevant differential diagnosis in febrile conditions. In Brazil, murine typhus has never received much attention. We present a recently diagnosed case and a literature review that suggests that the disease could be more prevalent in Southeastern Brazil than acknowledged until now.

INTRODUÇÃO: O número de casos notificados de tétano acidental no Estado de São Paulo sofreu redução. O declínio do número de casos de qualquer doença sempre traz transformações no seu perfil epidemiológico, que devem sempre ser analisadas para aprimorar as medidas preventivas. Assim, foi analisado o perfil clínico e epidemiológico dos casos de tétano internados em hospital universitário de Campinas de 1989 a 1996. MATERIAL E MÉTODO: Estudo descritivo e retrospectivo (série de casos). Todos os pacientes com diagnóstico de tétano de janeiro de 1989 a março de 1996, internados no hospital universitário, foram analisados. RESULTADOS: Catorze (28%) eram da zona rural e 36 (72%) da zona urbana. A idade média foi de 47,6 anos e a mediana de 49,5. Dos pacientes da zona rural, 42,8% tinham até 30 anos e 21,42% tinham mais de 50 anos, sendo a média 36,21 e a mediana 34,5; dos pacientes da zona urbana, 13,9% tinham até 30 anos e 58,3% mais de 50 anos, sendo a média de 52,2 e a mediana de 54,5. A letalidade foi de 20%, mais elevada nos pacientes curarizados (60%). CONCLUSÃO: Na região estudada existem dois padrões epidemiológicos: o rural, com maior número de jovens, refletindo uma vacinação inadequada, e o urbano, semelhante ao dos países desenvolvidos, com predomínio das faixas etárias mais altas.

INTRODUCTION: Notwithstanding its substantial decline over the last two decades, acquired tetanus is still a serious health problem in most developing countries. Epidemiological transition is often cited as an explanation for this decline, the increase in vaccination coverage of children being the most obvious cause. Few studies have looked carefully at the current epidemiological patterns of acquired tetanus in developing countries. METHODOLOGY: A descriptive, retrospective (series of cases). An acute care 400 - bed university referral hospital situated in a densely populated and highly urbanized area in Southeastern Brazil (Campinas, SP). Patient records the data-base analysed were from the Epidemiological Surveillance Unit of the hospital. RESULTS: In the 57 month period from January 1989 to March 1996 fifty-three patients were admitted with a diagnosis of acquired tetanus. Fifty patients had clinical confirmation, 3 were otherwise diagnosed. Thirty-two (64%) were male and 18 (36%) female. Fourteen (28%) were from rural areas and 36 (72%) from urban. Mean age was 47.6 years, with a median of 49.5. Of the rural patients, 42.85% were under 30 years and 21.42% were over 50, mean age was 36.21 with a median of 34.5. Fewer urban patients were under 30 (13.88%) than over 50 (58.33%), mean age was 52.19 with a median of 54.5. Trismus was the most frequent (92.0%) clinical sign on admittance, followed by abdominal muscular rigidity (84.0%). Treatment measures were uniform and included tetanus immune globulin, antibiotics, surgical debridement of the wound when feasible, diazepan or curare depending on the intensity of spasms. In the second half of the study period, penicillin was replaced by metronidazol. Overall case fatality rate was 20%, in patients that had to receive curare, it was 60%. Hospitalization exceeded 21 days in 56% (28) of the cases, only 10% (5) had a hospital stay of less than 7 days. CONCLUSION: A high proportion of patients were from rural areas, despite an urbanization rate of more than 90%. In the Campinas region there are two different epidemiological patterns of acquired tetanus: a rural pattern, with a higher proportion of younger patients, determined by an inadequate immunization rate and an urban pattern, similar to that found in industrialized countries, with a higher proportion of older patients. RECOMMENDATIONS: There is an obvious need to immunize older individuals in urban areas and young adults in rural areas. The elimination of acquired tetanus will only be achieved with a wider and more intensive adult vaccination program.

INTRODUÇÃO: O número de casos notificados de tétano acidental no Estado de São Paulo sofreu redução. O declínio do número de casos de qualquer doença sempre traz transformações no seu perfil epidemiológico, que devem sempre ser analisadas para aprimorar as medidas preventivas. Assim, foi analisado o perfil clínico e epidemiológico dos casos de tétano internados em hospital universitário de Campinas de 1989 a 1996. MATERIAL E MÉTODO: Estudo descritivo e retrospectivo (série de casos). Todos os pacientes com diagnóstico de tétano de janeiro de 1989 a março de 1996, internados no hospital universitário, foram analisados. RESULTADOS: Catorze (28%) eram da zona rural e 36 (72%) da zona urbana. A idade média foi de 47,6 anos e a mediana de 49,5. Dos pacientes da zona rural, 42,8% tinham até 30 anos e 21,42% tinham mais de 50 anos, sendo a média 36,21 e a mediana 34,5; dos pacientes da zona urbana, 13,9% tinham até 30 anos e 58,3% mais de 50 anos, sendo a média de 52,2 e a mediana de 54,5. A letalidade foi de 20%, mais elevada nos pacientes curarizados (60%). CONCLUSÃO: Na região estudada existem dois padrões epidemiológicos: o rural, com maior número de jovens, refletindo uma vacinação inadequada, e o urbano, semelhante ao dos países desenvolvidos, com predomínio das faixas etárias mais altas.

INTRODUCTION: Notwithstanding its substantial decline over the last two decades, acquired tetanus is still a serious health problem in most developing countries. Epidemiological transition is often cited as an explanation for this decline, the increase in vaccination coverage of children being the most obvious cause. Few studies have looked carefully at the current epidemiological patterns of acquired tetanus in developing countries. METHODOLOGY: A descriptive, retrospective (series of cases). An acute care 400 - bed university referral hospital situated in a densely populated and highly urbanized area in Southeastern Brazil (Campinas, SP). Patient records the data-base analysed were from the Epidemiological Surveillance Unit of the hospital. RESULTS: In the 57 month period from January 1989 to March 1996 fifty-three patients were admitted with a diagnosis of acquired tetanus. Fifty patients had clinical confirmation, 3 were otherwise diagnosed. Thirty-two (64%) were male and 18 (36%) female. Fourteen (28%) were from rural areas and 36 (72%) from urban. Mean age was 47.6 years, with a median of 49.5. Of the rural patients, 42.85% were under 30 years and 21.42% were over 50, mean age was 36.21 with a median of 34.5. Fewer urban patients were under 30 (13.88%) than over 50 (58.33%), mean age was 52.19 with a median of 54.5. Trismus was the most frequent (92.0%) clinical sign on admittance, followed by abdominal muscular rigidity (84.0%). Treatment measures were uniform and included tetanus immune globulin, antibiotics, surgical debridement of the wound when feasible, diazepan or curare depending on the intensity of spasms. In the second half of the study period, penicillin was replaced by metronidazol. Overall case fatality rate was 20%, in patients that had to receive curare, it was 60%. Hospitalization exceeded 21 days in 56% (28) of the cases, only 10% (5) had a hospital stay of less than 7 days. CONCLUSION: A high proportion of patients were from rural areas, despite an urbanization rate of more than 90%. In the Campinas region there are two different epidemiological patterns of acquired tetanus: a rural pattern, with a higher proportion of younger patients, determined by an inadequate immunization rate and an urban pattern, similar to that found in industrialized countries, with a higher proportion of older patients. RECOMMENDATIONS: There is an obvious need to immunize older individuals in urban areas and young adults in rural areas. The elimination of acquired tetanus will only be achieved with a wider and more intensive adult vaccination program.

Níveis de IgE sérica total e anticorpos específicos IgG e IgA anti - Strongyloides stercoralis foram pesquisados, através de técnicas imunoenzimáticas, em 27 pacientes com estrongiloidíase comprovada por métodos parasitológicos. Manifestações clínicas nesta série de casos foram investigadas pelo estudo retrospectivo dos prontuarios dos pacientes. Os níveis de IgE sérica foram elevados (maior do que 250 UI/ml) em 59% dos pacientes (concentração média = 1364 UI/ml). Anticorpos específicos IgG e IgA anti - S. stercoralis foram detectados, respectivamente, em 23 (85.2%) e 21 (77.8%) pacientes. No presente estudo, níveis elevados de IgE sérica e manifestações clínicas apresentadas pelos pacientes não contribuíram significativamente para o diagnóstico de estrongiloidíase. Por outro lado, os resultados deste trabalho corroboram o ponto de vista que as técnicas sorológicas para a detecção de anticorpos específicos anti-S. stercoralis, particularmente as técnicas imunoenzimáticas para a detecção de anticorpos específicos da classe IgG, podem ser de grande utilidade para o diagnóstico da estrongiloidíase.

Total serum IgE, and Strongyloides - specific IgG and IgA antibodies were studied in 27 patients with parasitologically proven strongyloidiasis. Clinical manifestations in this case series were investigated by a restrospective study of the patient's records. Total serum IgE levels were elevated (greater than 250 IU/ml) in 59% of the patients (mean concentration = 1364 IU/ml). Parasite - specific IgG and IgA antibodies were detected by ELISA in the serum of 23 (85.2%) and 21 (77.8%) patients, respectively. Elevated serum IgE and clinical manifestations were not useful indexes of the presence of strongyloidiasis. On the other hand, our results support the view that serologic tests, particularly ELISA for detecting Strongyloides - specific IgG antibodies, can be usefully exploited for diagnostic purposes in strongyloidiasis.