Abstract Background: Leptospirosis is an infectious and acute disease caused by Leptospira spp. that have high epidemic potential. This study verified the main Leptospira spp. serovars detected by MAT from serum of patients with suspicion of leptospirosis from 2008 to 2012 in Minas Gerais State. Methods: The laboratory received sera from 4654 patients. All serum were screened by IgM-ELISA according to the manufacturer's instructions. Each sample reactive or indeterminate were tested against twenty-four serovars of Leptospira by MAT. Results: In this study, 597 patients were classified as reactive on MAT. Only 301 patients were confirmed by laboratory test. It was not possible confirmation by laboratory diagnosis of 296 patients. Among the samples classified as reactive on MAT, 273 patients exhibited titers bigger than 800 for one or more serovars; seroconversion was detected in 28 cases. Percentage of 85.1% of the samples reactive on MAT corresponded to males, 39.4% corresponded to patients aged between 20 and 39 years old. The most common serovars found were Icterohaemorrhagiae, Andamana, Patoc, Tarassovi, Copenhageni, Hardjo and Australis. Concerning the samples that exhibited titers bigger than 800, serovar Icterohaemorrhagiae was also the most common, followed by Copenhageni, Andamana, Patoc, Tarassovi, Grippotyphosa and Canicola. In this study, 40% of the cases occurred to the metropolitan area, state capital and 34 neighboring towns. Conclusion: Our results show the possibly spreading serovars in Minas Gerais State and contribute to knowledge of human leptospirosis, aiming at improving the prevention, control of the disease, as well as the treatment of infected patients.

This study performed a bacteriological analysis of the liquid soap in dispensers that health professionals use for hand washing. This exploratory, cross-sectional study was developed at the hospitalization units of a medium-sized hospital in Fortaleza, Ceará, Brazil. Data were collected between May and July 2007. Fifty-nine liquid soap dispensers were analyzed, of which 33 contained the following microorganisms: Burkholderia cepacia (14), Pseudomonas putidas (9), Pseudomonas aeruginosa (3), Klebsiella pneumoniae (3), Enterobacter clocae (2), and Pseudomonas luteola (2). The units with the largest number of contaminated samples were the surgical (n=7) and the dermatological clinics (n=4). Contamination was also found in an original flask of the same lot of liquid soap used to fill up the dispensers. In conclusion, there is a need to regulate and control the quality of these products in the production lines as well as during use in hospital services, mainly because they are used to prevent hospital infection.

El estudio realizó el análisis bacteriológico de jabones líquidos utilizados para lavado de manos de los profesionales de salud. Se trata de un estudio exploratorio transversal, desarrollado en las unidades de internación de hospital mediano en Fortaleza, Ceará, Brasil. Los datos fueron recolectados en el período de mayo a julio de 2007. Del total de 59 frascos con jabón líquido, 33 contenían los siguientes microorganismos: Burkholderia cepacia (n=14), Pseudomonas putidas (9), Pseudomonas aeruginosa (3), Klebsiella pneumoniae (3), Enterobacter cloacae (2), Pseudomonas luteola (2). Las unidades con mayor número de muestras contaminadas fueron la de clínica quirúrgica (n=7) y la clínica dermatológica (n=4). Se verificó también contaminación en frasco original del mismo lote de jabón líquido usado para abastecer las jaboneras. Podemos concluir en que es necesario disciplinar y controlar la calidad de estos productos en las líneas de producción, tanto como en las fases de uso en los servicios de salud, sobre todo porque su utilidad apunta a la prevención de infecciones hospitalarias.

O estudo realizou a análise bacteriológica de sabões líquidos utilizados para lavagem das mãos dos profissionais de saúde. Trata-se de estudo exploratório transversal, desenvolvido nas unidades de internação de hospital de médio porte em Fortaleza/CE. Os dados foram colhidos no período de maio a julho de 2007. Do total de 59 frascos com sabão líquido, 33 continham os seguintes microorganismos: Burkholderia cepacia (n=14), Pseudomonas putidas (9), Pseudomonas aeruginosa (3), Klebsiella pneumoniae (3), Enterobacter cloacae (2), Pseudomonas luteola (2). As unidades com maior número de amostras contaminadas foram a clínica cirúrgica (n=7) e a clínica dermatológica (n=4). A contaminação também foi verificada em frasco original do mesmo lote de sabão líquido usado para abastecer as saboneteiras. Podemos concluir ser necessário disciplinar e controlar a qualidade desses produtos nas linhas de produção tanto quanto nas fases de uso nos serviços de saúde, sobretudo porque sua utilidade se presta à prevenção de infecção hospitalar.

O estudo realizou a análise bacteriológica de sabões líquidos utilizados para lavagem das mãos dos profissionais de saúde. Trata-se de estudo exploratório transversal, desenvolvido nas unidades de internação de hospital de médio porte em Fortaleza/CE. Os dados foram colhidos no período de maio a julho de 2007. Do total de 59 frascos com sabão líquido, 33 continham os seguintes microorganismos: Burkholderia cepacia (n=14), Pseudomonas putidas (9), Pseudomonas aeruginosa (3), Klebsiella pneumoniae (3), Enterobacter cloacae (2), Pseudomonas luteola (2). As unidades com maior número de amostras contaminadas foram a clínica cirúrgica (n=7) e a clínica dermatológica (n=4). A contaminação também foi verificada em frasco original do mesmo lote de sabão líquido usado para abastecer as saboneteiras. Podemos concluir ser necessário disciplinar e controlar a qualidade desses produtos nas linhas de produção tanto quanto nas fases de uso nos serviços de saúde, sobretudo porque sua utilidade se presta à prevenção de infecção hospitalar.

This study performed a bacteriological analysis of the liquid soap in dispensers that health professionals use for hand washing. This exploratory, cross-sectional study was developed at the hospitalization units of a medium-sized hospital in Fortaleza, Ceará, Brazil. Data were collected between May and July 2007. Fifty-nine liquid soap dispensers were analyzed, of which 33 contained the following microorganisms: Burkholderia cepacia (14), Pseudomonas putidas (9), Pseudomonas aeruginosa (3), Klebsiella pneumoniae (3), Enterobacter clocae (2), and Pseudomonas luteola (2). The units with the largest number of contaminated samples were the surgical (n=7) and the dermatological clinics (n=4). Contamination was also found in an original flask of the same lot of liquid soap used to fill up the dispensers. In conclusion, there is a need to regulate and control the quality of these products in the production lines as well as during use in hospital services, mainly because they are used to prevent hospital infection.

El estudio realizó el análisis bacteriológico de jabones líquidos utilizados para lavado de manos de los profesionales de salud. Se trata de un estudio exploratorio transversal, desarrollado en las unidades de internación de hospital mediano en Fortaleza, Ceará, Brasil. Los datos fueron recolectados en el período de mayo a julio de 2007. Del total de 59 frascos con jabón líquido, 33 contenían los siguientes microorganismos: Burkholderia cepacia (n=14), Pseudomonas putidas (9), Pseudomonas aeruginosa (3), Klebsiella pneumoniae (3), Enterobacter cloacae (2), Pseudomonas luteola (2). Las unidades con mayor número de muestras contaminadas fueron la de clínica quirúrgica (n=7) y la clínica dermatológica (n=4). Se verificó también contaminación en frasco original del mismo lote de jabón líquido usado para abastecer las jaboneras. Podemos concluir en que es necesario disciplinar y controlar la calidad de estos productos en las líneas de producción, tanto como en las fases de uso en los servicios de salud, sobre todo porque su utilidad apunta a la prevención de infecciones hospitalarias.

OBJETIVO: Comparar quatro métodos laboratoriais no diagnóstico de tuberculose pulmonar. MÉTODOS: Foram realizadas pesquisa direta pelas colorações de Ziehl-Neelsen e auramina, cultura para micobactérias em meio Löwenstein-Jensen (LJ) e polymerase chain reaction (PCR, reação em cadeia da polimerase) para Mycobacterium tuberculosis em 160 amostras de secreção respiratória de pacientes com suspeita de tuberculose pulmonar. As cepas isoladas foram identificadas por método radiométrico utilizando-se p-nitro-alfa-acetilamino-beta-hidroxipropiofenona (NAP) e métodos clássicos. A sensibilidade dos métodos foi comparada com o padrão ouro para o diagnóstico da tuberculose pulmonar, definido por critérios clínicos, radiológicos e microbiológicos. RESULTADOS: Dos 160 pacientes, 142 foram diagnosticados com tuberculose pulmonar de acordo com o padrão ouro. As técnicas de Ziehl-Neelsen e auramina, cultura em meio LJ e PCR apresentaram sensibilidade de 54,2%, 58,4%, 67,6% e 77,5%, respectivamente, quando comparados ao critério diagnóstico adotado. A especificidade dos quatro métodos foi de 100%. A concordância na identificação da micobactéria entre PCR e o método radiométrico utilizando NAP foi alta (96,8%). A sensibilidade da PCR foi de 50,8% nas amostras com baciloscopia negativa e de 98,8% naquelas com baciloscopia positiva. Nas amostras com resultados negativos na baciloscopia e cultura, a sensibilidade da PCR foi menor que nas com resultados positivos (25,6% e 99,0%, respectivamente). CONCLUSÕES: A PCR é método promissor no diagnóstico da tuberculose pulmonar, mesmo em amostras paucibacilares. Além disso, apresenta a vantagem da identificação simultânea e rapidez do resultado.

OBJECTIVE: To compare four laboratory methods in the diagnosis of pulmonary tuberculosis. METHODS: Respiratory secretion specimens were collected from 160 patients suspected of having pulmonary tuberculosis. Direct testing for Mycobacterium tuberculosis was carried out using Ziehl-Neelsen and auramine staining. In addition, culture in Löwenstein-Jensen (LJ) medium and polymerase chain reaction (PCR) were used. The strains isolated were identified by means of a radiometric method using p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) and classical methods. The sensitivity of the methods was compared to the gold standard for the diagnosis of pulmonary tuberculosis, based on clinical, radiological and microbiological criteria. RESULTS: Of the 160 patients, 142 were diagnosed with pulmonary tuberculosis according to the gold standard. The sensitivity of Ziehl-Neelsen staining, auramine staining, culture in LJ medium and PCR was 54.2%, 58.4%, 67.6% and 77.5%, respectively, when compared with the diagnostic criterion adopted. All four methods presented 100% specificity. In the identification of mycobacteria, there was high (96.8%) concordance between PCR and the radiometric method using NAP. The sensitivity of PCR was 50.8% in samples with negative sputum smear microscopy results and 98.8% in those with positive results. The sensitivity of PCR was lower in specimens with negative results in sputum smear microscopy and culture than in those with positive results (25.6% and 99.0%, respectively). CONCLUSIONS: We found PCR to be a promising method for the diagnosis of pulmonary tuberculosis, even in paucibacillary specimens. Simultaneous identification and faster results are additional advantages of this method.

Um estudo seccional de base populacional foi desenvolvido no município de Sabará, região sudeste do Brasil, para identificar a leishmaniose visceral humana assintomática em uma área urbana de baixa prevalência da doença. Foi coletado sangue em papel filtro (n=1.604 moradores), sendo examinados pela reação de imunofluoresência indireta, ensaio imunoenzimático e teste imunocromatográfico (strip test). As taxas de prevalência da infecção variaram de 2,4 a 5,6%, dependendo do teste utilizado. Um ano depois foi coletado sangue venoso de um subgrupo de 226 participantes (102 soropositivos e 124 soronegativos). Os testes realizados foram IFAT, ELISA, rk39-ELISA, reação em cadeia da polimerase e hibridização com sonda específica para o complexo Leishmania donovani. Não foi observado nenhum sinal clínico ou sintoma de leishmaniose. Usando a hibridização como teste de referência, a sensibilidade e especificidade dos testes sorológicos foram, respectivamente: 24.8 e 71% (ELISA); 26,3 e 76,3% (rk39-ELISA); 30,1 e 63,4% (IFAT). Devido a discordâncias, diferentes critérios foram testados para definir a presença da infecção e a hibridização deveria ser considerada em estudos epidemiológicos.

A population-based cross-sectional study was set up in Sabará country, Southeastern Brazil, to identify asymptomatic human visceral leishmaniasis in an urban area of low disease prevalence. Blood was collected on filter paper (n=1,604 inhabitants) and examined by indirect immunofluorescent test, enzyme-linked immunosorbent assay and immunochromatographic strip test. The prevalence rates of infection ranged from 2.4 to 5.6% depending on the test used. One year later, venous blood was collected in a subset of 226 participants (102 seropositive and 124 seronegative). The tests performed were IFAT, ELISA, rk39-ELISA, polymerase chain reaction and hybridization with Leishmania donovani complex probe. No clinical signs or symptoms of leishmaniasis were observed. Using hybridization as a reference test, the sensitivity and specificity of serology were respectively: 24.8 and 71% (ELISA); 26.3 and 76.3% (rk-39); 30.1 and 63.4% (IFAT). Due to disagreements, different criteria were tested to define the infection and hybridization should be considered in epidemiological studies.

The best way to appraise the size of abdominal organs remains undefined. Herein we compare the size of liver and spleen in hepatosplenic schistosomiasis using clinical and ultrasound (US) examination, and the size of the organs measured by US with their visualization below the costal margin ("palpable by US"). For this study, 411 individuals from an endemic area for schistosomiasis mansoni in Brazil have been selected. We found that palpable spleens and left liver lobes are larger than non palpable ones. Also, 23% of normal spleens measured by US were palpable on clinical examination, and 22% of spleens increased in size on US were non palpable. A total of 21% of normal spleens were "palpable by US". We also found 54% of normal sized right liver lobes palpable on clinical examination, whilst 54% of the increased livers, measured by US, were non palpable. About 76% of normal right liver lobes were "palpable by US". We conclude that the association of clinical, ultrasound and magnetic resonance imaging (MRI) examinations, in the near future, should give the investigators the necessary tools to perform a more accurate clinical diagnosis of hepatosplenic schistosomiasis mansoni.

Com o objetivo de identificar os determinantes da infecção humana por Leishmania chagasi em uma área urbana, foi realizado um estudo seccional de base populacional utilizando-se métodos moleculares e sorológicos para identificar a infecção. Os participantes foram entrevistados utilizando-se questionário pré-codificado. Dois critérios foram testados para identificar os fatores de risco: Modelo 1- incluindo todos os participantes positivos na hibridização com sonda para o complexo Leishmania donovani; Modelo 2- incluindo todos os participantes positivos na hibridização e em pelo menos um teste sorológico. No Modelo 1, as variáveis associadas à infecção foram: criar pássaros, encontrar-se fora de casa entre 18:00-22:00h e não ter o lixo coletado. No Modelo 2, as variáveis associadas à infecção foram: família conhecer o vetor, não ter o lixo coletado, lixo não removido ou queimado, criar pássaros, proximidade de áreas erodidas. Os fatores de risco identificados foram associados às condições das moradias, presença de animais e probabilidade de contato com flebotomíneos.

In order to understand the determinants of human infection by Leishmania chagasi in an urban area, a cross-sectional population based study was conducted using molecular and serologic methods to identify infection. Participants were interviewed using a pre-coded questionnaire. Two criteria were tested to identify risk factors: Model 1- including all participants positive in hybridization by Leishmania donovani complex probe; Model 2- including all participants positive for hybridization and at least one serologic test. In Model 1, the variables associated with infection were: ownership of birds, time spent outside house between 6:00-10:00 PM and garbage not collected. In Model 2, the variables associated with infection were: family with knowledge of the vector, garbage not collected, garbage not removed or buried, ownership of birds and eroded areas in the neighborhood. The risk factors identified were associated with household conditions, presence of animals and the likelihood of contact with phlebotomine sandflies.

O vírus linfotrópico humano de células T do tipo 1 (HTLV-1) é o primeiro retrovírus isolado do ser humano. Descreveu-se, em pouco tempo, o seu papel etiológico em algumas doenças, com destaque para a leucemia/linfoma de células T do adulto (ATLL), a mielopatia associada ao HTLV-1/paraparesia espástica tropical (HAM/TSP) e a uveíte associada ao HTLV-1 (HAU). Na década de 90, o HTLV-1 foi associado a eczema grave da infância, conhecido como dermatite infecciosa (DI). Desde então, diversos outros tipos de lesões cutâneas têm sido observados em pacientes infectados pelo HTLV-1, em especial, nos doentes de HAM/TSP ou de ATLL. Porém, mesmo portadores assintomáticos do vírus apresentam doenças dermatológicas. Excetuando-se a dermatite infecciosa, não há lesão da pele específica da infecção pelo HTLV-1. Aqui, os autores apresentam as principais lesões dermatológicas descritas em pacientes infectados pelo HTLV-1, destacando o valor epidemiológico e clínico desses achados.

Human T-cell Lymphotropic vírus type I (HTLV-1) was the first human retrovírus described. Some time after its discovery a group of diseases were related to this vírus, such as, adult T-cell leukemia lymphoma (ATLL), HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) and HTLV-1 associated uveitis (HAU). In the nineties, HTLV-1 was associated to a severe eczema of children, called infective dermatitis (ID). Since then, several other skin manifestations have been observed in HTLV-1-infected individuals, particularly in patients with ATLL or HAM/TSP. However, according to some reports, dermatologic lesions are also common in asymptomatic HTLV-1 carriers. Besides ID, all other skin lesions reported are nonspecific. The aim of this review is to outline the dermatologic manifestations reported in HTLV-1 infected patients, emphasizing the clinical and epidemiological value of these findings.

The association between worm infections and bacterial diseases has only recently been emphasized. This study examined the effect of experimental Angiostrongylus costaricensis infection on endogenous intestinal flora of Swiss Webster mice. Eight mice aging six weeks were selected for this experiment. Four were infected with A. costaricensis and the other four were used as controls. Twenty eight days after the worm infection, all mice in both groups were sacrificed and samples of the contents of the ileum and colon were obtained and cultured for aerobic and anaerobic bacteria. In the mice infected with A. costaricensis there was a significant increase in the number of bacteria of the endogenous intestinal flora, accompanied by a decrease in the number of Peptostreptococcus spp. This alteration in the intestinal flora of mice infected by the nematode may help to understand some bacterial infections described in humans.

A mielorradiculopatia esquistossomótica é a forma ectópica mais grave e incapacitante da infecção pelo Schistosoma mansoni. A sua prevalência em área endêmica tem sido subestimada. O diagnóstico baseia-se na presença de sintomas neurológicos decorrentes de lesões da medula espinhal em nível torácico baixo e/ou lombar alto, na demonstração da infecção esquistossomótica por técnicas microscópicas ou sorológicas e na exclusão de outras causas de mielite transversa. O tratamento precoce, com esquistossomicidas e corticoesteróides, mostra-se eficaz na maioria dos casos e os pacientes não tratados não se recuperam ou morrem. Não há consenso sobre doses e duração do tratamento, mas estudo recente sugere que os corticoesteróides devam ser usados por pelo menos seis meses. Como o diagnóstico é presuntivo e o tratamento essencialmente clínico, há que se manter alerta para a presença da doença, aperfeiçoar a propedêutica e, dessa forma, evitar-se a laminectomia rotineira. Com o advento da ressonância magnética da medula espinhal houve grande avanço no diagnóstico da esquistossomose medular. Como conseqüência, o número de casos de mielopatia esquistossomótica relatados tem aumentado rapidamente.

Schistosomal myeloradiculopathy is the most severe and disabling ectopic form of schistosomiasis mansoni. Its prevalence in endemic areas has been underestimated. The diagnosis relies on the presence of low thoracic/upper lumbar neurological symptoms, demonstration of the Schistosoma mansoni infection by microscopic or serologic techniques, and exclusion of other causes of transverse myelitis. When treatment with antischistosomal drugs and corticosteroids is started early, the clinical response is surprisingly good and those left untreated do not improve and frequently die. There is no consensus about doses and duration of treatment, but a recent study suggests that when steroids are given for at least 6 months clinical improvement is enhanced. As the diagnosis of SMR is presumptive and treatment is essentially clinical, physicians should be aware of the disease and more research is needed to increase the accuracy of the diagnostic methods and, hence, to avoid routine laminectomy. With the advent of magnetic resonance imaging of the spinal cord the diagnosis of this ectopic form of the disease was facilitated. In accordance, the number of cases of schistosomal myelopathy reported is increasing rapidly.

O espectro das doenças oportunistas em pacientes com aids vem se modificando desde a introdução da terapia antiretroviral altamente eficaz (HAART). O objetivo deste estudo é o de avaliar o perfil das afecções oportunistas em pacientes com aids internados em um hospital universitário do Brasil, comparando os períodos pré e pós-utilização da terapia HAART. Para tanto, revisaram-se os prontuários médicos de 342 pacientes infectados pelo HIV, dividindo-os em dois grupos: grupo 1, composto de 247 pacientes pré-HAART e grupo 2, composto de 95 pacientes pós-HAART. A relação homem-mulher caiu de 5:1 para 2:1. Houve aumento da prevalência da tuberculose e da toxoplasmose, com redução da prevalência do sarcoma de Kaposi, da histoplasmose e da criptococose. Observou-se ainda significativa redução da mortalidade intra-hospitalar (42% vs. 16,9%; p = 0,00002). A concordância entre o principal diagnóstico clínico e anatomopatológico foi observada em 10 de 20 pacientes necropsiados (50%). São relatados dois pacientes com esquistossomose disseminada e dois com paracoccidioidomicose. Em conclusão, excetuando-se a toxoplasmose, houve redução das doenças oportunistas relacionadas à imunossupressão grave nos pacientes pós-HAART. Observou-se significativa redução da mortalidade intra-hospitalar, possivelmente refletindo a melhora do tratamento dos pacientes HIV-positivos em nosso meio.

Opportunistic diseases in HIV-infected patients have changed since the introduction of highly active anti-retroviral therapy (HAART). This study aims at evaluating the frequency of associated diseases in patients with AIDS admitted to an university hospital of Brazil, before and after HAART. The medical records of 342 HIV-infected patients were reviewed and divided into two groups: group 1 comprised 247 patients before HAART and, group 2, 95 patients after HAART. The male-to-female rate dropped from 5:1 to 2:1for HIV infection. There was an increase in the prevalence of tuberculosis and toxoplasmosis, with a decrease in Kaposi's sarcoma, histoplasmosis and cryptococcosis. A reduction of in-hospital mortality (42.0% vs. 16.9%; p = 0.00002) has also occurred. An agreement between the main clinical diagnoses and autopsy findings was observed in 10 out of 20 cases (50%). Two patients with disseminated schistosomiasis and 2 with paracoccidioidomycosis are reported. Overall, except for cerebral toxoplasmosis, it has been noticed a smaller proportion of opportunistic conditions related to severe immunosuppression in the post HAART group. There was also a significant reduction in the in-hospital mortality, possibly reflecting improvement in the treatment of the HIV infection.

A combined clinical and sonographic classification of hepatosplenic schistosomiasis mansoni to be used in field-based studies is proposed herein. Seven hundred forty one individuals out of 892 (83%), living in an area endemic for schistosomiasis in Brazil, have been ubmitted to clinical and ultrasound examinations. Based on two stool examinations the overall prevalence for schistosomiasis in this area was 73%. Abdominal palpation was performed with patients in dorsal decubit, during deep breath, by two experienced physicians and a portable ultrasound was used for the evaluation of liver fibrosis, portal collaterals and spleen size. Four groups of individuals were identified using data obtained by abdominal palpation and ultrasound examination: (1) palpable spleen and intense periportal thickening in 9 individuals (1.2%); (2) spleen not palpable and intense periportal thickening in 15 (2%); (3) palpable spleen with light to moderate periportal thickening in 32 (4.3%), and (4) palpable spleen with a normal liver on ultrasound in 30 (4%). The definition of hepatosplenic schistosomiasis in field-based studies as the finding of Schistosoma mansoni eggs in the stools in an individual with splenomegaly is not acceptable anymore. Abdominal ultrasound should be combined with clinical examination to accurately identify hepatosplenics in endemic areas for schistosomiasis.