ABSTRACT This study was conducted to characterize the transmission cycle of the tegumentary leishmaniasis (TL) in an old colonization area at Pernambuco State, Brazil. The aims were to identify autochthonous cases, sandflies fauna, domestic animals as possible reservoir hosts and the Leishmania species involved in this endemic area. A total of 168 suspected human cases of TL and 272 domestic animals (canine, feline, equine, goat, and sheep) were included. The sandflies were captured and identified by species. Patients were predominantly male and the average age was 37+18.1 years old. Of 85 patients who had skin lesions, 25.6% of them had direct positive smears for TL and 34 isolates were identified as Leishmania (Viannia) braziliensis. The confirmation for TL diagnosed by molecular detection (PCR) was almost three times more sensitive than the direct test [p < 0.001; PR = 2.72] associated with clinical examination. The Kappa test on PCR between two different specimens, biopsy, and skin lesion swab was 60.8% (p < 0.001). More than 200 specimens of sandflies (80 males and 159 females) were captured and identified as Lutzomyia whitmani (99.6%) and Lu. evandroi (0.4%). The detection of L. (V.) braziliensis by Real-Time PCR in the blood of a captured fed female was positive in 59.3% of Lu. whitmani. Of the 272 domestic animals included, 61.76% were male (n = 168). Thirty-six animals (13.2%) had lesions compatible with TL (34 dogs, 1 cat and 1 sheep) and 3 of them, all dogs, had lesions on the snout, showing destruction of cartilage and mucosa. The study suggests the participation of domestic animals as possible reservoirs. However, further studies are necessary to better understand the transmission cycle and take recommended measures in order to control the disease.

Several studies have described the use of non-invasive collection methods, mostly based on the detection of parasite DNA, for diagnosis. However, no Leishmania specimens have been isolated from saliva. Here, we report the first isolation of Leishmania braziliensis from the saliva of humans with cutaneous leishmaniasis but without lesions on their mucosa. The isolates were obtained from salivary fluid inoculated in hamsters and were tested by multilocus enzyme electrophoresis. Seven samples from 43 patients suspected of having the disease were identified for in vivo culture. These findings suggest that saliva is a clinical sample that allows the isolation of Leishmania sp.

Abstract In Brazil, visceral Leishmaniasis is caused by Leishmania chagasi. The development of cutaneous lesions in visceral leishmaniasis patients has been described in two different clinical contexts. Patients with compromised immunity can develop skin lesions as a direct consequence of a current visceral disease. Equally, patients with a history of kala-azar and progressive, immune improvement occasionally develop skin lesions as a consequence of immune reconstitution infl ammatory syndrome. These cases manifest in similar fashion to the classic form of post-kala-azar dermal Leishmaniasis. We describe different cases that exemplify these two clinical presentations.

Os poromas são neoplasias benignas incomuns oriundas das porções ductais terminais das glândulas sudoríparas. Caracterizam-se principalmente por pápula ou nódulo cor da pele ou róseo, em geral nas extremidades. Devido à raridade, a hipótese clínica da forma pigmentada dificilmente é aventada, sendo fundamental a histopatologia. Relata-se caso de poroma écrino pigmentado na região palmar direita, localização considerada atípica. Ressalta-se a importância da dermoscopia como método auxiliar no diagnóstico do poroma e, principalmente, no diagnóstico diferencial com outras lesões pápulo-nodulares pigmentadas.

Poromas are uncommon benign neoplasms originating from the terminal ductal portion of the sweat glands, mainly characterized by skin-colored or pink pa pules or nodules, usually on the extremities. Due to their rarity, the pigmented form clinical hypothesis is hardly ever suggested and psychopathology is fundamental. We report a case of pigmented eccrine poroma in the right palmer area, a location considered atypical. We stress the importance of dermoscopy as a method for diagnosis of poromas, especially in the differential diagnosis with other pigmented nodular-popular lesions.

A leishmaniose tegumentar americana incide em todas as regiões do Estado de Pernambuco, Brasil, onde se apresenta em expansão, com o surgimento de focos em novas áreas, como o Município de Moreno, na região metropolitana do Recife. O objetivo deste estudo foi avaliar a prevalência da infecção e identificar os casos autóctones de leishmaniose tegumentar americana. Em abril de 2006, realizou-se um inquérito populacional por meio da aplicação de um questionário e do teste de intradermoreação de Montenegro a 481 indivíduos do Engenho Pinto, dos quais 47% eram do sexo masculino e 74% menores de 30 anos. Cento e quarenta e quatro (30%) indivíduos apresentaram reação positiva ao teste. Dentre estes, cinco apresentaram lesões ativas, 41 foram curados após quimioterapia e um curado espontaneamente. A RIFI realizada nos soros de 89 indivíduos apresentou 36% de positividade. A alta prevalência aponta para a expansão epidemiológica da doença nessa área da região metropolitana, fato preocupante, pois não há medidas eficazes para o controle da leishmaniose tegumentar americana, a não ser uma conscientização ecológica para minimizar o risco de infecção.

American tegumentary leishmaniasis (ATL) is present in all regions of Pernambuco State, Brazil, where it is spreading, with the emergence of foci in new areas like the Municipality (County) of Moreno in Greater Metropolitan Recife. The objective of the current study was to assess the prevalence of infection and identify autochthonous cases of ATL. In April 2006 a population survey was performed using a questionnaire and the Montenegro skin test (MST) in 481 individuals from the Pinto Sugar Mill, of whom 47% were males and 74% were younger than 30 years. One hundred forty-four individuals (30%) showed a positive MST. Of these, five presented active lesions, 41 were cured after meglumine antimoniate treatment, and one showed a spontaneous cure. Indirect immunofluorescence (IIF) was performed on sera from 89 individuals and showed a 36% positive rate. The high ATL prevalence demonstrates the epidemiological spread of the disease in Greater Metropolitan Recife, a worrisome development since there are no effective measures for ATL control except ecological awareness raising to minimize the risk of infection.

A leishmaniose tegumentar americana incide em todas as regiões do Estado de Pernambuco, Brasil, onde se apresenta em expansão, com o surgimento de focos em novas áreas, como o Município de Moreno, na região metropolitana do Recife. O objetivo deste estudo foi avaliar a prevalência da infecção e identificar os casos autóctones de leishmaniose tegumentar americana. Em abril de 2006, realizou-se um inquérito populacional por meio da aplicação de um questionário e do teste de intradermoreação de Montenegro a 481 indivíduos do Engenho Pinto, dos quais 47% eram do sexo masculino e 74% menores de 30 anos. Cento e quarenta e quatro (30%) indivíduos apresentaram reação positiva ao teste. Dentre estes, cinco apresentaram lesões ativas, 41 foram curados após quimioterapia e um curado espontaneamente. A RIFI realizada nos soros de 89 indivíduos apresentou 36% de positividade. A alta prevalência aponta para a expansão epidemiológica da doença nessa área da região metropolitana, fato preocupante, pois não há medidas eficazes para o controle da leishmaniose tegumentar americana, a não ser uma conscientização ecológica para minimizar o risco de infecção.

American tegumentary leishmaniasis (ATL) is present in all regions of Pernambuco State, Brazil, where it is spreading, with the emergence of foci in new areas like the Municipality (County) of Moreno in Greater Metropolitan Recife. The objective of the current study was to assess the prevalence of infection and identify autochthonous cases of ATL. In April 2006 a population survey was performed using a questionnaire and the Montenegro skin test (MST) in 481 individuals from the Pinto Sugar Mill, of whom 47% were males and 74% were younger than 30 years. One hundred forty-four individuals (30%) showed a positive MST. Of these, five presented active lesions, 41 were cured after meglumine antimoniate treatment, and one showed a spontaneous cure. Indirect immunofluorescence (IIF) was performed on sera from 89 individuals and showed a 36% positive rate. The high ATL prevalence demonstrates the epidemiological spread of the disease in Greater Metropolitan Recife, a worrisome development since there are no effective measures for ATL control except ecological awareness raising to minimize the risk of infection.

O diagnóstico da leishmaniose cutânea americana é baseado na associação dos aspectos clínicos, epidemiológicos e laboratoriais. O presente estudo identificou a espécie de Leishmania circulante no Estado de Pernambuco, descreveu os aspectos clínico-epidemiológicos e diagnosticou a doença. Foram selecionados 19 pacientes apresentando lesão ativa e diagnosticados através de avaliação clínica e pelos exames laboratoriais que incluíram a pesquisa direta, cultivo in vitro, intradermorreação de Montenegro, imunofluorescência indireta e reação em cadeia de polymerase. A intradermorreação de Montenegro apresentou resultado positivo em 89% dos pacientes. A imunofluorescência indireta apresentou 79% de positividade, a pesquisa direta apresentou 58% e a reação em cadeia de polymerase 75% de positividade. Sete amostras de Leishmania (Viannia) braziliensis foram isoladas desses pacientes e caracterizadas através de anticorpos monoclonais específicos. Esses dados confirmam que é necessário a combinação de diferentes técnicas diagnósticas para se obter resultados eficientes e que, até o momento, a Leishmania (Viannia) braziliensis é a única espécie responsável pela infecção da leishmaniose cutânea americana em Pernambuco. Portanto, a identificação da espécie do parasito envolvido nos casos da doença no homem em uma área endêmica é essencial para o conhecimento dos aspectos clínicos e epidemiológicos, sobretudo para o diagnóstico e para o desenvolvimento da terapia e prognóstico da doença.

The diagnosis for American cutaneous leishmaniasis is based on an association of clinical, epidemiological and laboratory characteristics. The present study identified the circulating species of Leishmania in the State of Pernambuco, described its clinical-epidemiological characteristics and diagnosed the disease. Nineteen patients presenting active lesions who had been diagnosed through clinical evaluation and laboratory tests were selected. The tests included direct investigation, in vitro culturing, Montenegro skin test, indirect immunofluorescence and polymerase chain reaction. The Montenegro Skin Test showed positive results in 89% of the patients; indirect immunofluorescence, in 79%; direct investigation, in 58%; and polymerase chain reaction in 75%. Seven Leishmania (Viannia) braziliensis samples were isolated from these patients and were characterized by means of specific monoclonal antibodies. These data confirm that a combination of different diagnosis techniques is needed in order to obtain efficient results and that, so far, Leishmania (Viannia) braziliensis is the only species responsible for American cutaneous leishmaniasis infection in Pernambuco. Thus, it is essential to identify the parasite species involved in cases of human disease in an endemic area in order to determine the clinical and epidemiological characteristics, especially with regard to diagnosis, therapy development and disease prognosis.

O Staphylococcus aureus é um dos principais patógenos que coloniza indivíduos saudáveis na comunidade e responde por infecções em pacientes hospitalizados. Um estudo transversal foi realizado para determinar a prevalência de S. aureus meticilina-resistente e sensível entre 231 pacientes, internados entre janeiro e abril de 2003, nas unidades de terapia intensiva (UTIs) do Hospital Universitário Oswaldo Cruz, assim como os possíveis fatores associados à colonização. Foram coletadas secreções de narinas, axilas, região perineal e dermatoses com soluções de continuidade, de todos os pacientes, nas primeiras 48 horas de internamento nas UTIs. O material foi semeado em meios de cultura adequados. A prevalência de S. aureus igualou-se a 37,7% (87/231), sendo 13% (30/231) meticilina-resistente e 24,8% (57/231) meticilina-sensível. Idade, sexo, uso de antibioticoterapia, corticoterapia, motivo e local do internamento não se associaram à presença do S. aureus ou do meticilina-resistente. Houve associação significante entre procedência hospitalar e colonização por S. aureus, independente da cepa, e entre internamento anterior e presença do S. aureus meticilina-resistente. As narinas foram o sítio de colonização mais significante, por S. aureus meticilina-resistente (47/57=82,4%) e sensível (23/30=76,7%). Foi alta a prevalência do S. aureus (meticilina resistente ou sensível), assim como do meticilina-resistente entre os pacientes das UTIs deste hospital. Estudos futuros poderão comprovar se os resultados aqui descritos e medidas de rastreamento para S. aureus poderiam ser adotadas, de forma prospectiva, para se avaliar o risco, assim como a magnitude do efeito, no controle de infecções hospitalares provocadas por estes patógenos.

Staphylococcus aureus is the most important pathogen that colonizes healthy individuals in the community and is responsible for infections in hospitalized patients. A cross-sectional study was carried out to determine the prevalence of methicillin-resistant and sensitive S. aureus, in 231 patients, hospitalized from January to April 2003, in the Intensive Care Units (ICU) of Hospital Universitário Oswaldo Cruz, as well as possible factors associated with colonization. Secretions, from the anterior nostrils, armpits, perineum and dermatosis with continuity solutions, were collected from all patients, within the first 48 h of admission at the ICU. These samples were spread on appropriate media. The prevalence of S. aureus was 37.7% (87/231), of which 13% (30/231) methicillin-resistant and 24.8% (57/231) methicillin-sensitive. Age, gender, antibiotic therapy, corticoid therapy and cause and place of hospitalization were not associated to colonization by S. aureus or methicillin-resistance. There was a significant association between hospital of origin and S. aureus colonization, regardless of strain, as well as between previous hospitalization and the presence of methicillin-resistant S. aureus. Regardless of strain, nostrils were the most significant colonization site for methicillin-resistant (47/57=82.4%) and methicillin-sensitive S. aureus (23/30=76.7%). There was a high prevalence of S aureus, (methicillin resistant or sensitive), as well as of methicillin resistance among ICU patients in this hospital. Future studies may prove the results reported here and screening routines for S. aureus should be adopted, prospectively, to evaluate risk, as well as the magnitude of the effect, on the control of hospital infections caused by these pathogens.

O Staphylococcus aureus é um dos principais patógenos que coloniza indivíduos saudáveis na comunidade e responde por infecções em pacientes hospitalizados. Um estudo transversal foi realizado para determinar a prevalência de S. aureus meticilina-resistente e sensível entre 231 pacientes, internados entre janeiro e abril de 2003, nas unidades de terapia intensiva (UTIs) do Hospital Universitário Oswaldo Cruz, assim como os possíveis fatores associados à colonização. Foram coletadas secreções de narinas, axilas, região perineal e dermatoses com soluções de continuidade, de todos os pacientes, nas primeiras 48 horas de internamento nas UTIs. O material foi semeado em meios de cultura adequados. A prevalência de S. aureus igualou-se a 37,7% (87/231), sendo 13% (30/231) meticilina-resistente e 24,8% (57/231) meticilina-sensível. Idade, sexo, uso de antibioticoterapia, corticoterapia, motivo e local do internamento não se associaram à presença do S. aureus ou do meticilina-resistente. Houve associação significante entre procedência hospitalar e colonização por S. aureus, independente da cepa, e entre internamento anterior e presença do S. aureus meticilina-resistente. As narinas foram o sítio de colonização mais significante, por S. aureus meticilina-resistente (47/57=82,4%) e sensível (23/30=76,7%). Foi alta a prevalência do S. aureus (meticilina resistente ou sensível), assim como do meticilina-resistente entre os pacientes das UTIs deste hospital. Estudos futuros poderão comprovar se os resultados aqui descritos e medidas de rastreamento para S. aureus poderiam ser adotadas, de forma prospectiva, para se avaliar o risco, assim como a magnitude do efeito, no controle de infecções hospitalares provocadas por estes patógenos.

Staphylococcus aureus is the most important pathogen that colonizes healthy individuals in the community and is responsible for infections in hospitalized patients. A cross-sectional study was carried out to determine the prevalence of methicillin-resistant and sensitive S. aureus, in 231 patients, hospitalized from January to April 2003, in the Intensive Care Units (ICU) of Hospital Universitário Oswaldo Cruz, as well as possible factors associated with colonization. Secretions, from the anterior nostrils, armpits, perineum and dermatosis with continuity solutions, were collected from all patients, within the first 48 h of admission at the ICU. These samples were spread on appropriate media. The prevalence of S. aureus was 37.7% (87/231), of which 13% (30/231) methicillin-resistant and 24.8% (57/231) methicillin-sensitive. Age, gender, antibiotic therapy, corticoid therapy and cause and place of hospitalization were not associated to colonization by S. aureus or methicillin-resistance. There was a significant association between hospital of origin and S. aureus colonization, regardless of strain, as well as between previous hospitalization and the presence of methicillin-resistant S. aureus. Regardless of strain, nostrils were the most significant colonization site for methicillin-resistant (47/57=82.4%) and methicillin-sensitive S. aureus (23/30=76.7%). There was a high prevalence of S aureus, (methicillin resistant or sensitive), as well as of methicillin resistance among ICU patients in this hospital. Future studies may prove the results reported here and screening routines for S. aureus should be adopted, prospectively, to evaluate risk, as well as the magnitude of the effect, on the control of hospital infections caused by these pathogens.