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PubMed2006

Changing antimicrobial susceptibility patterns among Streptococcus pneumoniae and Haemophilus influenzae from Brazil: Report from the SENTRY Antimicrobial Surveillance Program (1998-2004).

Although antimicrobial resistance rates among Streptococcus pneumoniae and Haemophilus influenzae have increased significantly in most countries in the last years, most studies from Brazil report relatively low resistance rates among these pathogens. In this study, we analyzed the susceptibility patterns of S. pneumoniae and H. influenzae from Brazil during a 7-year period. A total of 829 S. pneumoniae and 718 H. influenzae consecutively collected from 1998 to 2004, mainly from respiratory tract and bloodstream infections, were susceptibility tested by broth microdilution methods against >30 drugs and the results were analyzed by year. Overall, 77.8% of S. pneumoniae strains were considered susceptible (MIC, < or =0.06 microg/ml) to penicillin. Resistance to penicillin (MIC, > or =2 microg/ml) and ceftriaxone (MIC, > or =4 microg/ml) were detected in 7.5 and 0.5% of strains, respectively. The fluoroquinolones, levofloxacin (MIC90) 1 microg/ml) and gatifloxacin (MIC90, 0.5 microg/ml), were active against 99.8% of the isolates tested. Among the other non-beta-lactam drugs tested, the rank order of susceptibility rates was chloramphenicol (98.9%) > clindamycin (96.4%) > erythromycin (90.6%) > tetracycline (69.8%) > trimethoprim/sulfamethoxazole (36.7%). Resistance to penicillin has increased markedly among S. pneumoniae isolates over 7 years (from 2.9 to 11.0%). Additionally, resistance rates against erythromycin, clindamycin, and tetracycline decreased among pneumococcal strains during the same period. S. pneumoniae recovered from pediatric patients (< or =5 years) showed increased penicillin and trimethoprim/sulfametroxazole resistance rates compared to older populations. The rate of ampicillin resistance among H. influenzae was 14.0%, which also corresponds with the beta -lactamase production rate. All H. influenzae isolates were susceptible to amoxicillin/clavulanate (MIC90, 1 microg/ml), ceftriaxone (MIC90, < or =0.008 microg/ml), cefepime (MIC90, 0.12 microg/ml), ciprofloxacin (MIC90, < or = 0.12microg/ml), levofloxacin (MIC90, < or =0.5 microg/ml), and gatifloxacin (MIC90, < or =0.03 microg/ml). Resistance to the antimicrobials tested remained very stable among H. influenzae isolates during the 7-year study period. The continued emerging antimicrobial resistances found in these pathogens (mainly S. pneumoniae) highlight the need for alternative agents for the treatment of infections caused by these species.

Anti-Bacterial Agents↗
PubMed2005

Newly recognized hantaviruses associated with hantavirus pulmonary syndrome in northern Brazil: partial genetic characterization of viruses and serologic implication of likely reservoirs.

Following the occurrence of the first laboratory-confirmed cases of hantavirus pulmonary syndrome (HPS) in Maranhao State, Brazil, rodents were trapped and rodent materials screened by ELISA for antibodies to Sin Nombre and Andes hantaviruses. Antibody-positive samples were tested by RT-PCR, amplified products were sequenced, and phylogenetic trees were constructed for comparison with known hantaviruses. From 104 rodent blood samples collected (40 Bolomys lasiurus, 52 Holochilus sciureus, 12 Oligoryzomys fornesi, and one Proechimys guyannensis), 21 (20.2%) were antibody-positive (one B. lasiurus, five O. fornesi, and 15 H. sciureus). Hantavirus RNA was amplified by PCR from two O. fornesi and four H. sciureus. Viral sequencing identified two hantavirus genotypes. The genotype recovered from O. fornesi, is designated herein as Anajatuba (ANAJ) and the genotype recovered from H. sciureus is designated Rio Mearim (RIME). Phylogenetic analysis of a 643-nucleotide region of the N segment showed both viruses to be most closely related (94-96% nucleotide homology) to Río Mamoré virus, a virus associated with Oligoryzomys microtis in Bolivia and Peru, but not found in northern Brazil. O. fornesi was frequently captured in and around human dwellings. H. sciureus, is a semi-aquatic rodent captured only in remote areas rarely frequented by humans.

Amino Acid Sequence↗
PubMed1977

Effect of income and geographic region on the nutritional value of diets in Brazil.

The nutritional quality of dietary patterns in Brazil was examined as influenced by income level, region, and urbanization by calculating nutrient to calorie ratios and amino acid scores. In general, income level had only a minor influence on diet quality. Riboflavin and calcium were generally low in the low income groups in all regions, especially in urban areas. Thiamin intake was marginal in urban areas at all income levels. Protein quality appeared to be relatively independent of income, with two exceptions. These were the dietary patterns of the lowest income groups in the rural Northeast and the City of Sao Paulo which were somewhat limiting in methionine and lysine, respectively. In contrast, the total availability of calories and protein was greatly dependent on income and the lowest income families were seriously short of food. Income, therefore, appeared to be more important in determining the total amount of food available to a family in Brazil than in affecting the nutritional quality of the diet.

Amino Acids↗
PubMed1980

Food habits and nutritional status of agricultural migrant workers in Southern Brazil.

A new class of migrant workers, commonly known as "Boia-Frias", is rapidly growing in the periurban slumbs (favelas) of Brazil. In 1978 a collaborative study was undertaken to assess the food habits and nutritional status of 100 migrant worker families of Vila Recreio, a typical Boia-Fria settlement near Ribeirao Preto in the state of Sao Paulo. The findings of this survey revealed that the traditional diet of Boia-Frias is nutritionally inadequate both in quality and quantity. Their rice and bean-based diet lacks sufficient variety because of the infrequent use of fresh fruits and vegetables, which are available locally, and of supplemental amounts of protein-rich foods of animal origin. Empty-calorie foods such as carbonated drinks and alcoholic beverages are consumed freely; and starchy foods, traditionally used in the North and Northeast of Brazil, are used commonly as weaning foods. Although dietary practices of pregnant and lactating women are poor, breast-feeding is still practiced by most mothers. The biochemical analysis of blood samples did not indicate major subclinical deficiencies except low hematological values and low plasma vitamin A concentrations in about 25% of the population examined. Plasma cholesterol and plasma vitamin E values were found to be normal. However, anthropometric examinations revealed clear signs of malnutrition and/or undernourishment, which likely impairs their capacity for physical work and adversely affects their overall health.

Adult↗
PubMed1981

Anthropometric and cycloergometric assessment of the nutritional status of the children of agricultural migrant workers in Southern Brazil.

In our survey of the food habits and nutritional status of "Boia-Fria" agricultural migrant workers in Southern Brazil, a special project was undertaken to assess the influence of socioeconomic and dietary deprivation on the physical growth and development and physical performance of their children. Four hundred fifty-five children in Boia-Fria families from Vila Recreio, a periurban slum of Ribeirao Preto located in the interior of the state of Sao Paulo, were examined for body weight, standing height, mid-upper arm muscle circumference, and head circumference. For comparison, 475 children from "Vita et Pax", a private school attended primarily by children of well-to-do families from the city of Ribeirao Preto, were also examined using similar anthropometric procedures. A small group of selected Boia-Fria children and their well-to-do counterparts were subjected to ergometric-cum-electrocardiographic testing for submaximal physical work performance. The overall results of this comparative study indicate that the physical growth and development and the physical performance of the Boia-Fria children are significantly lower than their well-to-do counterparts. It is suggested that the poor anthropometric and ergometric status of the Boia-Fria children is a reflection of poor dietary habits and socioeconomic deprivation prevalent among the agricultural migrant workers and poor periurban populations of Brazil.

Adolescent↗
PubMed1986

Vitamin A status of young children in Southern Brazil.

A comprehensive survey was carried out to assess the vitamin A status of preschool children of poor migrant families in the periurban population of Ribeirao Preto, a typical agricultural town in the sugarcane and coffee region of the State of Sao Paulo in Southern Brazil. The intake of vitamin A and carotenoids from the rice and bean based diet of these children is considered low and appears to influence blood concentrations and liver reserves of this vitamin. With respect to plasma vitamin A, 1.8% of the children had a deficient level (less than 10 micrograms%), whereas 48.8% of the children had a low level (less than 20 micrograms%). Most children with inadequate plasma vitamin A (less than 20 micrograms%) responded positively to a massive dose of 200,000 IU vitamin A, suggesting that these children may be at risk of having low liver stores of vitamin A. Rose Bengal staining test and rapid dark adaptation time did not indicate definite signs of conjunctival xerosis and night blindness among these children. No ocular evidence of hypovitaminosis A was found in the children studied, but marginal or inadequate vitamin A status appears to be a common public health problem among young children in this region of Brazil.

Anthropometry↗
PubMed1995

Human T lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis in São Paulo, Brazil.

We conducted a prospective clinical and epidemiologic evaluation of 45 cases of human T lymphotropic virus type I (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in São Paulo, Brazil. All enrolled patients had progressive chronic myelopathy and high titers of HTLV-I and HTLV-II antibodies, as determined by enzyme immunoassay and western blot. In 24 cases, the polymerase chain reaction (PCR) was performed so that HTLV-I could be distinguished from HLTV-II. The clinical and epidemiologic features of the patients from our study were similar to those of patients with HAM/TSP from other areas of endemicity for HTLV-I except that more patients in our study had received a blood transfusion prior to their illness. Despite the presence of HTLV-II virus in Brazil, all patients whose serum was tested by PCR were found to be infected with the HTLV-I virus.

Adult↗
PubMedDate not supplied

Control of measles in Brazil.

Measles is regarded as a major public health problem in Brazil, accounting for much of the morbidity and mortality among children younger than five years of age. Rates of immunization have risen steadily since the National Immunization Program (NIP) was set up in 1973, reaching a maximum of 72.1% in 1981. However, the impact of the program cannot yet be demonstrated because of variations in reporting and of operational problems involved in the maintenance of efficient routine vaccination in most states. Changes in NIP field strategies after 1980 included the organization of campaigns in areas where the rates of vaccination are lowest, particularly in northern and northeastern Brazil.

Adolescent↗
PubMed2002

Past and present habitual physical activity and its relationship with bone mineral density in men aged 50 years and older in Brazil.

BACKGROUND: The aim of this study was to determine the relationship between habitual physical activity (HPA) during life and bone mineral density (BMD) in men aged 50 years and older. METHODS: A total of 326 men aged 50 years and older, volunteers living in São Paulo city, Brazil, were studied. BMD was measured in the whole body, femoral neck, Ward's triangle, trochanter, and lumbar spine (L2-L4) with a dual-energy x-ray absorptiometer. The HPA data were collected with questionnaires inquiring about physical exercise and occupational physical activity in the past and during the past 12 months and leisure and locomotor physical activity in the preceding 12 months. The relationship between BMD and HPA was analyzed using multiple linear regression models adjusted for age and body mass index (BMI). RESULTS: Practice of physical exercise in the past 10-20 years and leisure and locomotor physical activity in the preceding 12 months showed a significant positive correlation with BMD of whole body, femoral neck, trochanter, and lumbar spine, and this association was independent of age and BMI. CONCLUSIONS: HPA can contribute to preserving BMD in men aged 50 years and older in Brazil, when it is practiced in the past 10-20 years and even in the present.

Age Factors↗
PubMed1986

Why so many caesarean sections? The need for a further policy change in Brazil.

Caesarean sections in Brazil rose from 15 per cent of all births in 1970 to over 30 per cent in 1980. A new policy was introduced by the largest medical care provider (INAMPS) which made the reimbursement fee payable to doctors the same for both vaginal and caesarean section deliveries. However, the caesarean rate has continued to rise. This study analysed the antenatal care and deliveries of over 7000 births which occurred during 1982 in the city of Pelotas in southern Brazil. The organization of health care is discussed in relation to the findings on the utilization of the different antenatal and delivery services available. Utilization is then related to the gestational risk and socio-economic status of the mothers. There were marked differentials between the low and high risk mothers and between those from high and low income families. Doctors clearly concentrated their efforts on the low risk and high income mothers, with 50 per cent of private patients having an operative delivery compared to 13 per cent of uninsured mothers. There was a large demand for tubal ligations to be carried out at the same time as the caesareans. The non-medical and financial reasons for these high rates are discussed and the high extra cost that is being incurred by patients and the insurance schemes is emphasized.

Brazil↗
PubMed1998

Determinants of abortion among women admitted to hospitals in Fortaleza, North Eastern Brazil.

BACKGROUND: Maternal mortality from complications of unsafe abortion constitutes a serious problem in several developing countries. There is, however, a paucity of well-designed and implemented studies in this area, especially in Latin America. The aim of this paper is to present the findings on the determinants and medical characteristics of abortions among women admitted to hospitals. METHODS: A descriptive cross-sectional hospital-based study was carried out between October 1992 and September 1993 in Fortaleza, Brazil. A Cox's proportional hazard model was used to estimate prevalence rate ratios after adjustment for confounding. RESULTS: Among 2074 (48%) women who admitted to terminating the pregnancy, 66% reported using misoprostol to induce abortion. Women with an induced abortion as compared with those with an unlikely induced abortion are younger, more often not married, have fewer children alive and experienced one or more previous induced abortions. We have not found any important differences with regard to complication or duration of stay in hospital. CONCLUSIONS: This finding, at odds with most previous studies, could reflect the special situation in Brazil where misoprostol is used for illegally-induced abortion. The use of misoprostol by this population may have contributed to the reduction of severe complications related to induced abortion which were most prevalent with more invasive methods. Recommendations are made as to the need for confirmatory studies as well as on information regarding cultural perceptions and concepts of abortion, and reasons why poor women fail to adopt available family planning methods.

Abortifacient Agents, Nonsteroidal↗
PubMed1999

Variations in infant mortality rates among municipalities in the state of Ceará, Northeast Brazil: an ecological analysis.

BACKGROUND: Infant mortality rates vary substantially among municipalities in the State of Ceará, from 14 to 193 per 1000 live births. Identification of the determinants of these differences can be of particular importance to infant health policy and programmes in Brazil where local governments play a pivotal role in providing primary health care. METHODS: Ecological study across 140 municipalities in the State of Ceará, Brazil. RESULTS: To determine the interrelationships between potential predictors of infant mortality, we classified 11 variables into proximate determinants (adequate weight gain and exclusively breastfeeding), health services variables (prenatal care up-to-date, participation in growth monitoring, immunization up-to-date, and decentralization of health services), and socioeconomic factors (female literacy rate, household income, adequate water supply, adequate sanitation, and per capita gross municipality product), and included the variables in each group simultaneously in linear regression models. In these analyses, only one of the proximate determinants (exclusively breastfeeding (inversely), R2 = 9.3) and one of the health services variables (prenatal care up-to-date (inversely), R2 = 22.8) remained significantly associated with infant mortality. In contrast, female literacy rate (inversely), household income (directly) and per capita GMP (inversely) were independently associated with the infant mortality rate (for the model including the three variables R2 = 25.2). Finally, we considered simultaneously the variables from each group, and selected a model that explained 41% of the variation in infant mortality rates between municipalities. The paradoxical direct association between household income and infant mortality was present only in models including female illiteracy rate, and suggests that among these municipalities, increases in income unaccompanied by improvements in female education may not substantially reduce infant mortality. The lack of independent associations between inadequate sanitation and infant mortality rates may be due to the uniformly poor level of this indicator across municipalities and provides no evidence against its critical role in child survival. CONCLUSIONS: These results suggest that promotion of exclusive breastfeeding and increased prenatal care utilization, as well as investments in female education would have substantial positive effects in further reducing infant mortality rates in the State of Ceará.

Brazil↗
PubMed1999

Increased blood pressure in adolescents who were small for gestational age at birth: a cohort study in Brazil.

BACKGROUND: This paper studies the relationship between birthweight for gestational age and blood pressure in adolescents aged 14-15 years in southern Brazil. METHODS: A sample of 1076 adolescents belonging to a cohort of over 6000 children born in 1982 in Pelotas, southern Brazil, was studied in 1997. All households in a sample of 25% of the city's census tracts were visited and all adolescents born in 1982 were interviewed, weighed, and their blood pressures were measured twice. Data from the adolescents were linked to the database through their names and dates of births. RESULTS: High diastolic and systolic pressure (defined as >95th percentile) were significantly more frequent among adolescents who were born below the 10th percentile of birthweight for gestational age. No association was found between high blood pressure and low birthweight or preterm births. In a multiple linear regression analysis, the association between birthweight for gestational age and blood pressure was not statistically significant after adjusting for age, sex, skin colour and family income. However, when the current body mass index and height were added to the model both diastolic and systolic pressure were significantly associated with birthweight for gestational age, and adolescents who were small for gestational age at birth presented a mean elevation of 3.08 mmHg for diastolic pressure and 2.89 mmHg for systolic pressure. CONCLUSIONS: There is an inverse association between birthweight for gestational age and blood pressure during adolescence. This association, however, is only disclosed when the negative confounding effect of the body mass index is controlled for. The same association is not found when the effects of birthweight and gestational age on blood pressure are analysed separately. It appears therefore that the elevation of blood pressure during adolescence only occurs when there was intra-uterine growth retardation.

Adolescent↗
PubMed1999

American cutaneous leishmaniasis in Southeast Brazil: space-time clustering.

BACKGROUND: American cutaneous leishmaniasis (ACL) is endemic in many rural areas of Brazil where different transmission patterns of the disease have been described. This ecological study was carried out in a municipality located in Southeast Brazil and aimed to investigate the space-temporal patterns of the disease and environmental risk factors from 1966 to 1996. METHODS: Incident ACL cases were defined by clinical diagnosis, confirmed by a positive skin test and/or parasitological examination. Age-adjusted morbidity rate of ACL was calculated by year for this municipality and their different census enumeration districts. The homogeneity chi2 test, Moran and empirical Bayes index and Knox procedure were employed for testing the significance of clusters in time, space and in time-space, respectively. A Poisson regression model was used to identify environmental factors related to rate variability. RESULTS: A total of 1712 new ACL cases were reported with a yearly incidence rate of 48/100000 inhabitants. Higher incidence rates were detected in 1968, 1974, and 1988 (100, 160, and 190 cases/100000, respectively) with evidence of spatial clustering from 1986 to 1993. Significant space-time clustering with epidemic peaks followed by low incidence in subsequent periods was observed. The incidence rates of ACL were independently associated with rural areas; areas lacking sanitary installations and with higher proportion of exposed garbage (P < 0.01). CONCLUSIONS: This study suggests that ACL rates vary across space and time. Rural areas and some environmental factors could explain part of this variation. Environmental modifications in the vicinity of households over time and accumulation of susceptible individuals are discussed as possible factors responsible for variability.

Adult↗
PubMed2000

Vaccine-associated paralytic poliomyelitis: a retrospective cohort study of acute flaccid paralyses in Brazil.

BACKGROUND: At the present time, in Brazil and other countries in the Americas, the only cases of paralytic poliomyelitis due to poliovirus are caused by vaccine strains. The recognition of possible determinants of vaccine-associated paralytic poliomyelitis (VAPP) by public health surveillance and immunization programmes is relevant to inform the debate on criteria for case definition and vaccination strategies. METHODS: A retrospective cohort study based on the cases of acute flaccid paralysis (AFP) reported to the Ministry of Health (MoH) was designed, with the objective of studying cases of VAPP in Brazil between 1989 and 1995. Clinical, laboratory and epidemiological data from 3656 acute flaccid paralysis (AFP) cases, 30 of them diagnosed as VAPP, were analysed. RESULTS: An 8.88 risk ratio of VAPP (95% CI : 4.37-18.03) was found when comparing individuals who received oral poliovirus vaccine (OPV) between 4 and 40 days before the onset of paralysis and individuals who did not receive the vaccine within this period. A risk of 1 case/2.39 million first doses and 1 case/13.03 million OPV doses administered was estimated for the general population. CONCLUSIONS: Cases of AFP who received OPV between 4 and 40 days before the onset of paralysis and had fever, a prodrome of gastrointestinal symptoms, history of first dose of OPV, isolation of vaccine poliovirus type 2, and young age deserve careful investigation, since they are at increased risk for the condition studied.

Acute Disease↗
PubMed2000

High prevalence of congenital toxoplasmosis in Brazil estimated in a 3-year prospective neonatal screening study.

BACKGROUND: A pilot neonatal screening programme revealed a high (approximately 1 per 4800 live births) prevalence of congenital toxoplasmosis (CT) in the State of Rio Grande do Sul, Brazil. The purpose of this paper was to estimate in a larger prospective study the prevalence of CT in the country. METHODS: At the beginning of the study, an in-house indirect enzyme immunoassay (EIA) was used, to be later replaced with a commercial capture IgM fluorometric enzyme immunoassay (FEIA). Both methods detect specific anti-Toxoplasma gondii IgM-class antibodies eluted from dried blood spots. RESULTS: Of the total of 140,914 samples received from all over the country, 47 cases were identified and confirmed as CT. This finding suggests a prevalence of 1 per 3000 live births. Of the 47 patients, only eight (17%) had clinical manifestations: two had intracranial calcifications, four had retinal scars, one had an intracranial calcification and retinal scars, and one had hepatosplenomegaly with lymphoadenopathy. The testing was paid for by the patients' families who volunteered for the study and gave their informed consent. CONCLUSION: The 3-year prospective study using sensitive detection methods, reliable confirmation, and feedback from clinicians showed that CT has an extraordinarily high prevalence in Brazil, in fact the highest ever reported in the world. Although the long-term efficacy of treatment of CT has not been well documented, in view of the availability of reliable diagnostics, confirmation and monitoring, functional logistics, and networking for screening, the insidious nature of the sequelae and the very high prevalence of the disease, neonatal screening for CT should be considered an alternative to no screening at all.

Animals↗
PubMed1991

Acute respiratory viral infections in ambulatory children of urban northeast Brazil.

The morbidity of acute respiratory infections in young children and the role of respiratory viruses were evaluated in a 29-month household-based study in an impoverished urban population in Fortaleza, Brazil; subjects were 175 children less than 5 years of age in 63 families. Home visits were conducted three times weekly during which staff recorded the presence of respiratory and systemic symptoms and collected upper respiratory tract samples for viral isolation. A large and sustained burden of respiratory illness was observed, and respiratory viruses were isolated in 35% of the samples collected. Of the isolates, 45.6% were rhinoviruses, 16% parainfluenza viruses, 15.8% enteroviruses, 9.9% adenoviruses, 7.0% herpes simplex viruses, and 5.7% influenza viruses. The results indicate that poor children in northeast Brazil have a high prevalence of respiratory illness and that rhinovirus is the most frequent respiratory virus.

Acute Disease↗
PubMed1994

Cryptosporidial and microsporidial infections in human immunodeficiency virus-infected patients in northeastern Brazil.

To determine the frequency of the parasitic pathogens in human immunodeficiency virus (HIV)-infected patients in a developing world setting, 295 stool specimens were examined from 166 HIV-positive patients (49% with AIDS) at São José Hospital, Fortaleza, Brazil, from September 1990 to March 1992. Significantly more patients with diarrhea (85%) than without (66%) had AIDS or AIDS-related complex (ARC) (P < .005). Of the potential parasitic causes of diarrhea, only Cryptosporidium parvum and microsporidia were significantly associated with diarrheal disease. Infections with C. parvum, but not microsporidia, were associated with the rainy season (P < .005). Thus, C. parvum and microsporidia are the most common intestinal parasites associated with diarrhea in an HIV-infected population in Brazil and are associated with advanced HIV disease. The association of C. parvum infections with the rainy season suggests that contaminated water may be important in its transmission; however, the source of human microsporidia requires further investigation.

AIDS-Related Opportunistic Infections↗