ABSTRACT OBJECTIVE To estimate age and sex-specific suicide rates, compare suicide rates between indigenous communities, and quantify the frequency of intrafamilial suicide clustering. METHODS We performed a retrospective cohort study involving 14,666 indigenous individuals in reservations in Dourados, state of Mato Grosso do Sul, Brazil, from 2003 through 2013 using national and local census. RESULTS The overall suicide rate was 73.4 per 100,000 person-years. Adolescent males aged 15-19 and girls aged 10-14 had the highest rates for each sex at 289.3 (95%CI 187.5-391.2) and 85.3 (95%CI 34.9-135.7), respectively. Comparing the largest reservations, Bororo had a higher suicide rate than Jaguapiru (RR = 4.83, 95%CI 2.85-8.16) and had significantly lower socioeconomic indicators including income and access to electricity. Nine of 19 suicides among children under 15 occurred in household clusters. Compared with adult suicides, a greater proportion of child (OR = 5.12, 95%CI 1.89-13.86, p = 0.001) and adolescent (OR = 3.48, 95%CI 1.29-9.44, p = 0.017) suicides occurred within household clusters. CONCLUSIONS High rates of suicide occur among children and adolescents in these indigenous reservations, particularly in poor communities. Nearly half of child suicides occur within household clusters. These findings underscore the need for broad public health interventions and focused mental health interventions in households following a suicide.

ABSTRACT OBJECTIVE To estimate age and sex-specific suicide rates, compare suicide rates between indigenous communities, and quantify the frequency of intrafamilial suicide clustering. METHODS We performed a retrospective cohort study involving 14,666 indigenous individuals in reservations in Dourados, state of Mato Grosso do Sul, Brazil, from 2003 through 2013 using national and local census. RESULTS The overall suicide rate was 73.4 per 100,000 person-years. Adolescent males aged 15-19 and girls aged 10-14 had the highest rates for each sex at 289.3 (95%CI 187.5-391.2) and 85.3 (95%CI 34.9-135.7), respectively. Comparing the largest reservations, Bororo had a higher suicide rate than Jaguapiru (RR = 4.83, 95%CI 2.85-8.16) and had significantly lower socioeconomic indicators including income and access to electricity. Nine of 19 suicides among children under 15 occurred in household clusters. Compared with adult suicides, a greater proportion of child (OR = 5.12, 95%CI 1.89-13.86, p = 0.001) and adolescent (OR = 3.48, 95%CI 1.29-9.44, p = 0.017) suicides occurred within household clusters. CONCLUSIONS High rates of suicide occur among children and adolescents in these indigenous reservations, particularly in poor communities. Nearly half of child suicides occur within household clusters. These findings underscore the need for broad public health interventions and focused mental health interventions in households following a suicide.

Cryptococcus spp. cerebral abscesses are uncommon in immunocompetent subjects. The recommended induction treatment is the administration of amphotericin B plus flucytosine combined with resection for lesions ≥3cm. In this paper, we describe an HIV-negative woman diagnosed with a large cryptococcoma in the immediate postpartum period. The lesion was not resected, and due to amphotericin B intolerance, she received an extended course of fluconazole monotherapy. There was no disease recurrence during the 4 years of follow-up. The abrupt onset of her symptoms following delivery suggests that she developed a postpartum immune reconstitution syndrome. This case also demonstrates that in specific situations fluconazole monotherapy can be attempted in immunocompetent patients with cryptococcoma.

OBJECTIVE: To characterize current leptospirosis reporting practices in the Americas. METHODS: Information was collected from the official websites of national ministries of health from the Americas region and two international organizations; personal communications; and three international morbidity databases. For all sources other than the morbidity databases, the review was limited to official reports citing clinically suspected and laboratory confirmed leptospirosis cases or deaths during the period 1996-2005. RESULTS: A total of 73 out of 1 644 reports met the selection criteria and were included in the analysis. Published leptospirosis data were available from half of the countries/sovereign territories (24 out of 48), and 18 of them had mandatory notification policies for leptospirosis. The sum of the median number of leptospirosis cases notified annually by the 24 countries/territories was 4 713.5, but just three countries (Brazil, Costa Rica, and Cuba) accounted for 83.1% (3 9cas20 es) of the notifications. Eight (16.7%) countries reported deaths due to leptospirosis. The sum of the median number of deaths reported annually for the eight countries was 380, but 349 (91.8%) were reported by Brazil. CONCLUSIONS: Notification practices in the Americas for leptospirosis are limited. Therefore, the numbers of cases and deaths reported are not representative for the region. The lack of leptospirosis data for many countries/territories may reflect weaknesses in certain aspects of national surveillance systems, including mandatory reporting policies, clinical laboratory infrastructure for performing case confirmation, and capacity to collect reported cases. Improved surveillance of leptospirosis cases and deaths in the Americas is needed to allow monitoring of regional epidemiological patterns and to estimate the burden of this important disease.

OBJETIVO: Determinar los procedimientos actuales de notificación de la leptospirosis en la Región de las Américas. MÉTODOS: Se recopiló información de los sitios web oficiales de los ministerios de salud de los países de la Región de las Américas y dos organizaciones internacionales, de comunicaciones personales y de tres bases de datos internacionales de morbilidad. Con la excepción de las bases de datos de morbilidad, el análisis se limitó a los informes oficiales que citaban casos de leptospirosis, clínicamente presuntos o confirmados por el laboratorio o defunciones por esta infección, ocurridos durante el período de 1996 al 2005. RESULTADOS: Un total de 73 informes de los 1 644 considerados reunían los criterios de selección y se incluyeron en el análisis. Se dispuso de datos publicados sobre leptospirosis de la mitad de los países o territorios soberanos (24 de 48), 18 de los cuales contaban con políticas de notificación obligatoria de la leptospirosis. La suma de las medianas del número de casos de leptospirosis notificados anualmente por los 24 países o territorios fue de 4 713,5, pero tres países en particular (Brasil, Costa Rica y Cuba) representaban 83,1% (3 920 casos) de las notificaciones. Ocho países (16,7%) notificaron defunciones debidas a leptospirosis. La suma de las medianas del número de defunciones notificadas anualmente por los ocho países fue de 380, pero 349 (91,8%) fueron notificadas por Brasil. CONCLUSIONES: Los procedimientos de notificación de la leptospirosis en la Región de las Américas son limitados. Por consiguiente, los números de casos y muertes notificados no son representativos de la Región. La carencia de datos de leptospirosis de muchos países o territorios puede reflejar los puntos débiles de ciertos aspectos de los sistemas nacionales de vigilancia, incluidas las políticas de notificación obligatoria, la infraestructura de laboratorios clínicos para confirmar los casos y la capacidad para recopilar los casos notificados. Es necesario mejorar la vigilancia de los casos y las defunciones por leptospirosis en la Región de las Américas con objeto de permitir el seguimiento de los perfiles epidemiológicos regionales y calcular la carga de esta importante enfermedad.

Este estudo foi realizado no Pantanal brasileiro: região que apresenta importante biodiversidade. As condições de clima, hidrologia e geomorfologia dessa região, bem como a existência de grande variedade de espécies animais silvestres, favorecem a manutenção da Leptospira no meio ambiente. O objetivo desse estudo foi avaliar o ELISA IgG com proteína recombinante LipL32 em comparação com a soroaglutinação microscópica (SAM) para o diagnóstico sorológico de Leptospira. Adicionalmente, contribuir para o conhecimento da distribuição da leptospirose bovina, uma das mais importantes zoonoses mundialmente distribuída. Foi avaliada a soropositividade para essa bactéria em rebanhos bovinos de corte da região do Pantanal, uma área onde o bovino constitui não apenas o recurso econômico mais importante, como também a principal atividade econômica compatível com a conservação dos recursos naturais da região. Das 282 amostras de soro bovino analisadas, 143 (50,71%) foram positivas na SAM. O sorovar Hardjo (genótipos Hardjoprajitno e Hardjobovis), Wolffi e Ballum apresentaram freqüências altas de amostras reativas. No IgG ELISA rLipL32, 161 amostras (57,09%) foram positivas, apresentando esse teste uma maior soropositividade em relação à SAM (p<0,001). A Sensibilidade do ELISA em comparação com a SAM foi de 99,30% e a especificidade de 86,33%. O IgG ELISA rLipL32 mostrou ser um teste sensível, específico e de alta acurácia para o diagnóstico de leptospirose bovina.

This investigation was carried out in Brazilian Pantanal: region with important biodiversity. This region's climatic conditions, hydrology and geomorphology as well as the existence of great variety of wild species favor the maintenance of the Leptospira in the environment. The aim of this study was to evaluate IgG ELISA with recombinant protein LipL32 in comparison with microscopic agglutination test (MAT) and additionally contribute to the knowledge of the distribution of the one of most important worldwide zoonotic infection, assessing the seropositivity of bovine leptospirosis in beef cattle herds of Brazilian Pantanal, an important ecological preserved area, where cattle constitute not only the most important economic resource but also the major activity compatible of the conservation of natural resource of the region. Out of 282 samples of cattle serum analyzed, 143 (50.71%) were positive in MAT. The serovar Hardjo (genotypic Hardjoprajitno and Hardjobovis), Wolffi and Ballum showed the largest frequency of reactive samples. In the IgG ELISA rLipL32, 161 samples (57.09%) were positive. This result was higher than obtained by MAT (p<0.001). The sensitivity of the ELISA test was 99.30% and the specificity was 86.33%, based on the MAT. This test was shown to be a more sensitive, specific and accurate test for the diagnosis of bovine leptospirosis compared to the MAT.

Foram obtidos dois hibridomas secretores de anticorpos monoclonais (MAbs) que reagem com uma lipoproteína (LipL32) da membrana externa de leptospiras patogênicas. Para a produção dos hibridomas, células do baço de camundongos BALB/c, imunizados com LipL32 recombinante (rLipL32), foram fusionadas com células SP2/O-Ag14, selecionadas em meio HAT e testadas em ELISA indireto. Um dos MAbs secretados pelos hibridomas é do isotipo IgG2b e o outro do isotipo IgM. A especificidade dos MAbs foi confirmada em ELISA indireto e immunoblotting usando rLipL32 purificada, Escherichia coli (E. coli) expressando LipL32 e sorovares patogênicos e saprófitas. Os dois MAbs reagiram com a maioria dos sorovares patogênicos e não reagiram com sorovares saprófitas. Os MAbs possuem potencial para uso em testes de diagnóstico de leptospirose.

Two hybridomas secreting monoclonal antibodies (MAbs) that react with a lipoprotein (LipL32) of the outer membrane of pathogenic Leptospira were obtained. For hybridoma production, spleen cells from BALB/c mice imunized with recombinant LipL32 (rLipL32) were fused to SP2/O-Ag14 cells, selected in HAT medium and screened in an indirect ELISA. One MAb produced was of the IgG2b isotype and the other was an IgM. MAbs specificity was confirmed by indirect ELISA and immunoblotting using purified rLipL32 and whole-cell antigen preparations from Escherichia coli (E. coli) expressing LipL32 and from pathogenic and non-pathogenic serovars. Both Mabs reacted with most of the pathogenic serovars tested and none reacted with non-pathogenic Leptospira. The MAbs described have potential for use in diagnostic tests for leptospirosis.

Objetivando verificar a freqüência de enterovírus (EV), leptospiras e arbovírus como agentes causais da síndrome da meningite asséptica (SMA), em períodos não-epidêmicos, e comparar os pacientes com e sem diagnóstico etiológico determinado, foram selecionados 112 pacientes de idade entre 3 meses e 15 anos, com suspeita clínica de SMA, referenciados para Hospital Couto Maia, especializado em Doenças Infecciosas e Parasitárias (Salvador, Bahia), Em 44,6% (n=50) a etiologia foi determinada: enterovírus em 37,7% (n=42) dos casos, pelo teste de PCR Amplicor, por cultura do líquor e/ou de fezes; a Leptospira sp. em 7,1% (n=8), pelo método da micro-aglutinação, e nenhum caso de arbovírus foi detectado (inibição da hemaglutinação passiva). Entre os 14 enterovírus dos 22 isolados, foram identificados seis diferentes sorotipos, sendo o Echovirus-4 predominante (27,2%; 6/22) entre outros (Coxsackie B2, B3, B6 e B9; EV 71). Conclui-se que, os enterovírus foram os agentes mais freqüentes, e que a leptospirose deve ser lembrada no diagnóstico diferencial da SMA. Uma vez que as características clínicas e liquóricas dos pacientes dos grupos com e sem determinação do agente etiológico foram semelhantes, pode-se supor que o diagnóstico presuntivo de SMA é de provável etiologia viral ou pela leptospira.

For the purpose of identifying the frequency that enterovirus, leptospires, arbovirus cause aseptic meningitis syndrome (AMS) during non-epidemic periods and comparing patients with and without laboratory evidence for an etiologic agent, 112 patients were selected aged between 3 months and 15 years and a clinical suspicion of AMS and were referred to Couto Maia Hospital, the Infectious and Parasitic Disease Reference Center for Salvador, Bahia. In 44.6% (n=50), the etiologic agent for the diagnosis was laboratory-confirmed: enterovirus was identified in 37.7% (n=42) of the cases by the PCR Amplicor diagnostic kit, cerebrospinal fluid or fecal culture isolation; Leptospira sp. in 7.12% (n=8) by the microagglutination test; and arbovirus in non of the cases by inhibition of passive hemagglutination. In 14 of the 22 enteroviral isolates that were evaluated, 6 different serotypes were identified with Echovirus-4 being the major serotype (27.2%; 6/22) among all found (Coxsackie B2, B3, B6 and B9; Enterovirus 71). In conclusion, enteroviruses were the most frequent etiologic agent of AMS and that leptospirosis should be included in the differential diagnosis. In addition, patients with and without laboratory-confirmed identification of the etiologic agent had similar demographic and clinical characteristics and cerebrospinal fluid findings (p >0.05), therefore suggesting that patients without a confirmed diagnosis had enteroviral or leptospiral etiologies.