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PubMed1998

Characteristics of Isolates Streptococcus pneumoniae from Middle-Aged and Elderly Adults in Brazil: Capsular Serotypes and Antimicrobial Sensitivity to Invasive Infections.

Pneumococcal infection cause frequent, serious problems among middle aged and elderly populations worldwide. Efforts to prevent mortality caused by pneumococci are based mainly on rapid diagnosis of the infection and appropriate antimicrobial therapy. Vaccination is considered to be the best approach to prevent the disease in at risk populations and the current 23-valent pneumococcal polysaccharide vaccine is recommended for people &gte;65 years of age. To evaluate the present antibiotic sensitivity patterns and the potential for vaccine use to prevent this disease in Brazil, 94 isolates of pneumococci from normally sterile body sites from patients &gte;50 years of age were analyzed for capsular serotypes and antimicrobial resistance. Among the total isolates, 7.4% (n = 7) of the isolates showed intermediate level resistance to penicillin (IR). Among the IR isolates, 6 were also resistant to trimethoprim-sulfamethoxazole. All isolates were susceptible to cefotaxime, chloramphenicol, erythromycin, and vancomycin. Twenty-eight serotypes were identified and the serotypes included in the 23-valent vaccine accounted for 81.7%. By adding the cross-reacting serotypes, the percentage of vaccine preventable infections was 90.3%. Each of intermediate level resistant strains were among the 23 serotypes included in pneumococcal vaccine. This preliminary data on the distribution of serotype of S.pneumoniae among those &gte;50 years of age in Brazil, and the potential for increased antimicrobial resistance to penicillin and trimethoprim-sulfamethoxazole, support the use of pneumococcal vaccine in this population.

Journal Article↗
PubMed1998

The Dynamics of the AIDS Epidemic in Brazil: A Space-Time Analysis in the Period 1987-1995.

The dynamics of the spread of the AIDS epidemic in Brazil have been studied by an analysis of cases reported between 1987 and 1995. The analysis evaluates characteristics of the epidemic as it changed over time, geographic region and special sub-populations affected. Data collected by the National Coordination of sexually transmitted diseases (STD's) and AIDS of the Health Ministry were reviewed and incidence rates calculated. Three periods of time were identified (1987-89, 1990-92, and 1993-95) and the distribution of cases by age group, sex, risk factor sub-population, and major geographic region recorded. Several observations can be made from this information: 1)The disease began among homosexual / bisexual males in large metropolitan areas of the southeast of Brazil. 2) It spread to other risk groups such as intravenous drug users (IDU) and recipients of blood products. 3) The diseases increased rapidly between 1987-89 and 1990-92, but then showed a plateau, particularly in the homosexual / bisexual group. 4) Increase in cases persisted in the IDU group. 5) The incidence among heterosexuals and in smaller municipalities has continued to increase indicative of a shift in the dynamics of the epidemic. The shift in the characteristics of the epidemic away from special groups and towards the socially vulnerable, poorly educated, heterosexual, smaller municipalities require new preventive strategies adaptable to regional patterns of each social structure, economy and culture.

Journal Article↗
PubMed1999

Neurologic Manifestations of AIDS in Children and Adolescents: A Review of Cases in Santos, Brazil.

OBJECTIVE: To review the neurologic manifestations of AIDS in all children and adolescents who were seen by specialist doctors at 2 centers in Santos, Brazil, over the past 7 years. MATERIALS AND METHODS: Files of all patients aged 17 and under who were infected by HIV and admitted to 2 specialized AIDS centers between 1990 and 1997 were reviewed. RESULTS: Of the 239 children and adolescents admitted to AIDS centers, 20 presented with a variety of neurologic complications, including focal motor signs, altered tonus, retarded neurodevelopment, cognitive disturbances, intractable headache, seizures, and coma. Opportunistic infections were the exception, an important difference from the adult population of the same area. CONCLUSION: Neurologic complications of AIDS in children and adolescents in the city of Santos, Brazil, were relatively unusual, found in less than 10% of this population. The neurologic involvement did not increase the mortality of these children and adolescents. These finding may be attributable to the quality of diagnoses, treatment, and follow-up of children infected with HIV by specialized professionals in adequate institutions.

Journal Article↗
PubMed2001

Valsartan alone and as part of combination therapy in general practice in Brazil.

The objective of this study was to assess the efficacy and tolerability of valsartan (Diovan) when given alone or as part of a combination regimen in normal clinical practice, in general practice patients in Brazil. In an open, multicentre post-marketing surveillance (PMS) study, 7256 hypertensive patients were evaluated. Therapy with valsartan either as monotherapy or in combination with 12.5 mg chlorthalidone was observed for up to six months. Assessments at baseline and study endpoints included analysis of adverse events and measurement of systolic and diastolic blood pressure (BP). A total of 3855 patients (53%) received valsartan as monotherapy (mostly as 80 mg once daily), 1162 (16%) received 80 mg valsartan + 12.5 mg chlorthalidone, and 347 (4.8%) received valsartan together with other antihypertensive agents; 858 patients were not evaluable because of inadequate records. A control group of 1034 patients received other antihypertensives. Overall tolerability was high, with 98.5% of patients receiving valsartan alone, 97.7% of those receiving valsartan + chlorthalidone and 92.4% of those receiving other antihypertensives giving tolerability ratings of 'excellent' or 'good'. In this large PMS study, valsartan alone and in combination with chlorthalidone was associated with excellent safety and tolerability in general practice patients in Brazil with primary hypertension, irrespective of age, sex or concomitant diseases.

Adolescent↗
PubMed2001

Diagnosis and treatment of osteoporosis in Brazil.

The definition of Osteoporosis as proposed by WHO is widely accepted amongst Brazilian physicians. The main diagnostic tool in Brazil is Bone Densitometry (DXA). Both public and private health insurance systems reimburse the densitometry test. DXA have been used also for monitoring changes in BMD. Biochemical markers and peripheral methods of bone assessment are not widely used in Brazil. Estrogens, Vitamin D and its metabolites, Salmon Calcitonin, Ipriflavone, Tibolone, Etidronate, Alendronate, Raloxifene and Risendronate are currently available for treating osteoporosis. Since 1995, Brazilian Society of Clinical Densitometry have been educating Bone Densitometry Professionals and all clinicians in order to improve their ability to turn DXA results into adequate clinical decisions.

Journal Article↗
PubMed2005

Anaphylaxis due to Brazil nut skin testing in a walnut-allergic subject.

The diagnosis and management of nut allergy can be difficult because of the possible severity of the clinical manifestations and the cross reactivity between different species. We report a case of anaphylaxis due to skin testing in a young adult with clinically ascertained walnut allergy. After an episode of anaphylaxis due to walnut ingestion, a routine diagnostic workup was carried out, involving skin prick test with commercial extracts, prick by prick with fresh food and CAP-RAST assay for different nuts. Immediately after pricking with fresh Brazil nut, a severe episode of anaphylaxis occurred, that required epinephrine and intravenous steroids. The subject had never eaten Brazil nut before. Therefore we hypothesize a cross reactivity effect, since this phenomenon is well known for tree nuts. Our case suggests that in vivo diagnosis, especially if fresh nuts are used, should be performed only if adequate equipment to treat anaphylaxis is available.

Adolescent↗
PubMed2006

Genetic and phylogenetic characterization of rabies virus isolates from wildlife and livestock in Paraiba, Brazil.

Thirty-four rabies virus (RV) isolates from foxes (8), insectivore bats (9), cattle (14), sheep (1), a goat (1) and a donkey (1) from Paraiba state, northeastern Brazil, were genetically characterized. Sequences of 890 nts of nucleoprotein (N) genes of these isolates were analyzed and compared with those of other Brazilian isolates characterized earlier. Phylogenetic analysis revealed three genetical lineages of RV co-existing in this region. Each lineage was found to be associated with particular host species and to circulate independently of each other. The first lineage was found in foxes (Dusicyon sp.) and could be discriminated from domestic carnivore isolates from Sao Paulo, Goias and Minas Gerais in the southern and central Brazil. The second lineage was associated with insectivorous bats (Molossus spp.) and differed from vampire bat-associated RV isolates. The third lineage was found in livestock and clustered with vampire bat-associated RV isolates from Sao Paulo, Tocantins, Goias and Matto Grosso. These results indicate that RV of these genetic lineages are cocirculating in the Paraiba state and that livestock in this region are infected with vampire bat-associated RV, suggesting that the vampire bat is the main reservoir of livestock rabies in this region.

Animals↗
PubMedDate not supplied

[Anti-BHc determination in blood donors in São Paulo: should this test be adopted in Brazil?].

PURPOSE: to study the incidence of anti-HBc (core) as a surrogate marker for post-transfusion Non-A, Non-B Hepatitis (HNANB-PT) among blood donors in São Paulo, Brazil. TYPE: prospective, screening all blood donors from September to December, 1989 (nr. 2,773 donors). PLACE: Sírio-Libanês Hospital and 9 de Julho Hospital (São Paulo). PATIENTS: a total of 2,773 donors, 84% male and 16% female. METHOD: the tests used were competitive ELISA for Anti-HBc. MEASUREMENTS AND RESULTS: the repeated rah reactivity (RR) was 10.2% among all donors, with a higher incidence in males than in females (10.9% x 6.8% p less than 0.05 6y X2). Only 4.5% were borderlines, and 94.5% showed an absorbance/cut-off ratio less than 0.9. CONCLUSIONS: despite the lack of prospective studies correlating HNANB-PT to surrogate markers (e.g. ALT and anti-HBc) in this country, the high incidence of anti-HBc in donors allows to conclude that it might be as high as reported in other countries. Although the costs related to the adoption of this test, its indication in other countries and its association with the newly-developed specific test (anti-HCV) supports the idea of anti-HBc as a screening test for HNANB-PT in Brazil, at least in the most developed blood centers in the country.

Adolescent↗
PubMed1990

Carotenoid composition and vitamin A value of a squash and a pumpkin from northeastern Brazil.

The carotenoid composition of a squash and a pumpkin from Northeastern Brazil was determined. Nineteen carotenoids were detected in Cucurbita moschata variety "Baianinha"; beta-carotene was the principal carotenoid, contributing about 74% of an average total carotenoid content of 317.8 micrograms/g. In C. maxima variety "Jerimum Caboclo", 11 carotenoids were found with lutein, and beta-carotene as the major pigments accounting for about 60% and 27%, respectively, of an average total carotenoid content of 78.4 micrograms/g. The abundance of beta-carotene in the C. moschata variety "Baianinha" makes this squash one of the richest sources of provitamin A. The average vitamin A value was 43,175 IU (International Units) per 100 g or 4,317 RE (retinol equivalents) per 100 g. Its vitamin A values is more than 11 times that of C. maxima variety "Jerimum Caboclo" and five times that of C. moschata cultivar "Menina Verde", the squash found previously to be highest in provitamin A among the Cucurbita vegetables most commercialized in São Paulo (Southeastern Brazil).

Carotenoids↗
PubMed1988

Relative resistance of Brazil strain trypomastigote forms of Trypanosoma cruzi to in vitro antibody-dependent complement-mediated lysis.

Various assay conditions were employed in experiments examining the susceptibility of trypomastigote forms of the Brazil strain of Trypanosoma cruzi to antibody-dependent complement-mediated lysis. To identify optimal assay conditions, both guinea pig serum and normal human serum were used as complement sources, and fibroblast-derived or blood-form trypomastigotes were either coincubated with immune sera and complement together, or the parasites were first precoated with antibodies and then were incubated in complement. Under conditions promoting maximal lysis by antibodies and complement, 60-90% of the trypomastigote forms were not lysed. These results indicate that trypomastigotes of certain isolates of T. cruzi, such as the Brazil strain, may possess an escape mechanism by which they evade complement-mediated lysis.

Animals↗
PubMed1998

Rotavirus G and P types in children from Belém, northern Brazil, as determined by RT-PCR: occurrence of mixed P type infections.

Fifty-four group A rotavirus-positive stool samples, obtained from children aged less than three years during a longitudinal (December 1982 to March 1986) study in Belém, Brazil, were re-examined. The samples were tested by reverse-transcription and polymerase chain reaction to determine their G-type and P-type specificity. Only 17 (32%) of these rotavirus strains could be successfully G- and P-genotyped. While 10 (59%) of the 17 strains showed single G- and P-type specificity, the remaining belonged to single G- and mixed P-genotypes. Rotavirus strains P[8], G1 and P[4], G1 predominated, accounting for 29% and 18% of the typed strains respectively. Mixed P-type infections caused by rotaviruses classified as P[8] + P[4], G1 were identified in 23% of cases. All but 3 of the 54 rotavirus strains displayed long genomic profiles, as demonstrated by the analysis of RNA by polyacrylamide gel electrophoresis. Most (70%) rotavirus strains with single G- and P-type specificity were detected during the first year of life, whereas 5 (71%) of the seven mixed P-type infections occurred throughout the second or third year of age. Reinfections were noted in two children, both of them being infected with P[8] + P[4], G1 rotavirus strains when aged 20 months. The high proportion of untypeable rotavirus strains suggests that unusual types may be circulating in Belém. In addition, the occurrence of mixed P-type infections in our region indicates the potential for reassortment between different rotavirus genogroups. Monitoring of these rotavirus strains may have important implication in the context of future strategies of rotavirus vaccination in Brazil.

Child, Preschool↗
PubMed2005

Identification of naturally infected Lutzomyia intermedia and Lutzomyia migonei with Leishmania (Viannia) braziliensis in Rio de Janeiro (Brazil) revealed by a PCR multiplex non-isotopic hybridisation assay.

To identify naturally infected Lutzomyia spp. by Leishmania (Viannia) braziliensis, a PCR multiplex non-isotopic hybridisation assay was developed for the analysis of insect samples collected in distinct areas of the municipality of Rio de Janeiro (Brazil), from March to December 2003. Data from experimental infection indicate that the method can detect one individual infected insect out of ten. Wild sand flies were classified and grouped into pools of 10 specimens each, reaching a total of 40 female groups. Positive results were obtained with pools of Lu. intermedia (5/32) and Lu. migonei (3/5) collected in two areas from the district of Jacarepaguá presenting recent cases of human and canine leishmaniasis. Considering eight infected groups (8/40) with at least one positive insect in each, it was possible to infer an infection rate of 2%. This technique permits the synchronous processing of a large number of samples, in order to investigate infection rates in sand fly populations and to identify potential insect vectors. The results presented here represent the first molecular approach used to infer the natural infection index in both Lutzomyia spp. and constitute essential data to the understanding of leishmaniasis ecoepidemiology in endemic areas from Rio de Janeiro.

Animals↗
PubMed2005

PCR-based diagnosis for detection of Leishmania in skin and blood of rodents from an endemic area of cutaneous and visceral leishmaniasis in Brazil.

The technique of polymerase chain reaction (PCR) associated to hybridization was used to screen 123 samples collected from wild and synanthropic rodents captured in a cutaneous and visceral leishmaniasis endemic area in the State of Minas Gerais, Brazil. The detection of Leishmania spp in naturally infected rodents is of fundamental importance for incriminating them as possible reservoir hosts of the diseases in Minas Gerais. A total of 62 specimens belonging to wild (Thrichomys apereoides, Oryzomys subflavus, Galea spixii, Bolomys lasiurus and Wiedomys pyrrhorhinos) and synanthropic (R. rattus) rodent species were captured in different ecotopes. Blood and skin samples were submitted for PCR analyses followed by molecular hybridization with specific probes for the three Leishmania-species complexes. Fifteen samples were found positive after PCR-hybridization and identified as follows: nine belonging to the L. mexicana complex, three to the L. braziliensis complex and three to the L. donovani complex. Positive PCR results were found in 11 out of the 61 (18%) blood samples and in four out of the 62 (6.4%) skin fragments screened. R. rattus and T. apereoides were the most abundant species in the area also presenting high prevalence of natural infection. The presence of parasite DNA belonging to L. braziliensis, L. mexicana and L. donovani complexes was confirmed in several individuals of a rodent species, R. rattus. This work is the first report of the detection of L. (L.) chagasi in a naturally infected T. apereoides. The utility of filter paper as a substrate for PCR analyses and the efficacy of the procedure associated to the hybridization is emphasized.

Animals↗
PubMed2002

Epidemiological studies of an outbreak of cutaneous leishmaniasis in the Rio Jequitinhonha Valley, Minas Gerais, Brazil.

We detected an outbreak of American cutaneous leishmaniasis in the Jequitinhonha River Valley, Minas Gerais, Brazil. Clinical and epidemiological aspects were studied for a period of two years. Data include results of physical examinations, Montenegro skin test and serology. In total 72 of the 299 individuals evaluated presented active lesions. Only one case out of these 72 patients showed the mucosal form of the disease. The precarious sanitary conditions, low educational level and low income found in the population studied demonstrated that, as with the other parasitic diseases, cutaneous leishmaniasis occurs with greater frequency in needy populations. A canine serological survey detected 20.3% (30/148) of dogs reactive to the Leishmania antigen. Lutzomyia intermedia was the predominant phlebotomine species and the majority of the specimens (84.9%) were captured in the peridomicile. Four samples from human and three from canine cases were isolated and characterised by PCR and isoenzymes as being Leishmania (Viannia) braziliensis. The peridomiciliary nature of the disease is discussed.

Adolescent↗
PubMed2004

Canine visceral leishmaniosis in Anastácio, Mato Grosso do Sul state, Brazil.

Canine visceral leishmaniosis (CVL) may be an important factor preceding human outbreaks of the disease. We report that the prevalence of canine visceral leishmaniosis infection has been increasing in recent years in Anastácio town, located in the central western region of Brazil. Serological investigations showed that 75.3% of dogs presented antibody titres ranging from 1/40 to 1/160 in the indirect immunofluorescence antibody test (IFAT). Bone marrow and lymph node aspirates provided positive cultures and furnished parasites for enzymological and serological typing in 42.5% and 41.1% of the cases, respectively. All the strains were typed as Leishmania (L.) chagasi. This is primarily a canine disease that spills over into the human population as a zoonosis. The study showed the epidemiological features of the infection in a region in which the problem of visceral leishmaniosis has been underestimated.

Animals↗
PubMedDate not supplied

Family socio-economic background modified secular trends in age at menarche: evidence from the Pró-Saúde Study (Rio de Janeiro, Brazil).

BACKGROUND: Since age at menarche has been associated with socio-economic status, its downward secular trend might vary according to the different socio-economic status levels of the family in which women lived during their childhood. AIM: This study seeks to describe secular trends in age at menarche for Brazilian women whose fathers had different levels of educational attainment. SUBJECTS AND METHODS: A self-administered questionnaire was applied to 2053 women born between 1931 and 1977. Multiple linear regression models were employed to estimate trends in age at menarche according to categories of educational level of the participants' father. RESULTS: The age at first menstruation varied from 7 to 19 years, with a mean age of 12.3 years (+/- 1.64 SD). The reduction in age at menarche was 2.4 months per decade for all women. Among daughters of fathers with less than 8 years of schooling this reduction was 3.6 months per decade, and among daughters of fathers with 8 years or more of study it was 1.2 months per decade. CONCLUSION: Improvements in living conditions in Brazil over the last decades seem to have had a stronger effect on the reduction of the age at menarche among women who lived their childhood in worse socio-economic standards.

Adolescent↗
PubMed1999

Morphometric and phenetic studies of five geographical populations of Lutzomyia whitmani (Diptera: Psychodidae) in Brazil.

A morphometric survey examined adult specimens of Lutzomyia whitmani (Antunes & Coutinho) captured at 5 municipalities in southeastern and northeastern Brazil to compare the populations. The localities were Ilhéus (Bahia), Martinho Campos (Minas Gerais), Corte de Pedra (Bahia), Baturité (Ceará), and Amaraji (Pernambuco): all are known foci of American cutaneous leishmaniasis. Fifteen males and 15 females from each population were analyzed morphometrically for 42 and 37 characters, respectively. Statistical data alone were insufficient to discriminate among the 5 populations. Further analysis generated phenograms that indicated there were 2 spatial clusters: the 1st was composed of specimens from Ilhéus (Bahia) and Baturité (Ceará) and the 2nd of specimens from Martinho Campos (Minas Gerais), Corte de Pedra (Bahia), and Amaraji (Pernambuco). Although insufficient to define the taxonomic status of the populations studied, the results delineated the existence of biogeographical structuring within L. whitmani. Complementary studies on the susceptibility to Leishmania braziliensis infection in the 5 populations are in progress to clarify the relationship between the 2 biogeographical clusters and American cutaneous leishmaniasis transmission in those Brazilian regions.

Animals↗
PubMedDate not supplied

[Poisonous sting by Tityus stigmurus (Scorpiones; Buthidae) in the state of Bahia, Brazil].

The present investigation is a descriptive study regarding the clinical aspects of accidents caused by the scorpion Tityus stigmurus in Bahia, Brazil. We analyzed 237 confirmed cases treated by the Antivenom Information Centre (CIAVE) from 1982 to 1995. Envenomation by T. stigmurus was mainly characterized by local symptoms: pain (94.4%), dormancy (30.0%), edema (17.8%), erythema (17.8), paresthesia (15.6%) and general manifestations such as headache (4.4%), vomiting (4.4%) and sudoresis (3.3%). Most of the envenomation cases were mild (94%) and all were successfully cured. Although T. stigmurus venom is not in the pool of anti-venom serum (SAE), the absence of lethality and benign nature of the cases suggest the efficiency of SAE. With the exception of deaths and systemic complications, envenoming gravity was similar to those of Tityus serrulatus.

Adolescent↗