Amaury Coutinho

Factors involved in Schistosoma mansoni infection, in rural areas of northeast Brazil

Two contiguous villages in Tracunhaém county (State of Pernambuco), endemic for schistosomiasis, were studied: Itapinassu (138 inhabitants) and São Joaquim (91 inhabitants). Agriculture predominates in the former region while ceramics is the main activity in the latter. Although no statistical difference was found regarding prevalence, severe infection (> 400 epg) predominated in Itapinassu, probably related to the kind of occupation. No association was found between parasite burden and severity of disease, in spite of the high infection rates for Schistosoma mansoni in both communities (approx. 60%). Typical epidemiological features of schistosomiasis such as age-related prevalences and intensities of infection (high in children, low in adults) were also mutual characteristics. Nutritional status determined through anthropometric evaluation was carried out by measuring specific anthropometric indicators. A deficit of energy intake, as well as vitamin A and riboflavin deficiencies were detected. The prevalence of moderate or severe undernutrition in patients under 18 years old was 21.9% in Itapinassu and 24.1% in São Joaquim. In this group an association was found between prevalence of schistosomiasis and chronic undernutrition. Similarly, for patients over 18 year old the prevalence of undernutrition was higher than 20%. However, in this case no association between nutritional status and either prevalence of schistosomiasis or parasite burden could be detected. The two communities had not been treated for eight years.

Tratamento da esquistossomose mansônica hepatesplênica com praziquantel

Ninety-four patients, 22 males and 72 females, from 11 to 71 years old, with an average of 25 years, presenting the hepatosplenic form of Schistosomiasis mansoni were treated with a new anthelmintic drug — praziquantel — to investigate its efficacy and tolerance. In addition to the hepatosplenic form of the disease, 14 patients had the cardio-pulmonary hypertensive or cyanotic form and 16 had already been submitted to splenectomy. Two oral doses — 1 x 30 and 2 x 25 mg/kg body weight — were compared. Side-effects were noticed during the first two days following the drug administration but usually of mild intensity and short duration. The most frequent and, at times, more severe were abdominal pain or discomfort, diarrhea, headache, dizziness and nausea. Fever was present in 19.2% of the cases and urticaria and pruritus in two patients. The laboratorial investigation of liver function showed, in some cases, slight enzymatic alterations (AST, ALT, y GT) 24 hours after medication, but without any major significance. No urinary, blood glucose or hematological changes have been detected, except, for the commonly seen increase of eosinophyls on the 7th and 30th day, related to the death of parasites inside the organism. Likewise, no abnormality was noticed in the electroencephalografic study. In the electrocardiogram it was observed in two patients a slight and transitory modification on the ventricular repolarization. With regard to the parasitological cure, it was observed in 62 patients Who have finished the 6 months control period, a total cure rate of 80.6%. With 30 mg/kg single dose this cure rate was 76.7% and with 25 mg/kg b.i.d. 84.4%. The non-cured patients, on the other hand, have shown a marked reduction in the number of S. mansoni eggs eliminated in the feces. Furthermore, five of these patients Were retreated six or more months afterwards with the same initial dose, achieving 100% negative stool examinations. The Authors believe that administering a higher dose, like 60 mg/kg, it would be possible to accomplish, in addition to good tolerance, a greater percentage of parasitological cure. The long-term clinical and laboratory improvement, observed 6 and 12 months after treatment, is worthy of note.

Reduction of morbidity in hepatosplenic Schistosomiasis mansoni after treatment with praziquantel: a long term study

Forty-two with hepatosplenic patients treated with praziquantel and followed up for 5 years. One half of the patients received a single 30 mg/kg dose and the other half, two doses of 25 mg/kg given 4 hrs apart. According to Hoffman and Kato-Katz stool exams, an 83.3% cure rate, was observed after twelve months. Stool egg counts in cases of incomplete cure were greatly reduced. Liver function, as assessed by serum levels of aspartate aminotransferase, alanine aminotransferase, gamma glutamyltransferase and alkaline phosphatase activities as well as albumin and gamma globulin showed marked improvement after one year. Hepatomegaly was reduced in 81.0% of patients and splenomegaly in 78.8%. Spleen regression was complete in 15.1% of the total, and in 18.5% of those with compensated hepatosplenic disease. As a result of these observations, the authors recommend early treatment with anti-schistosomal medication, either oxamniquine or praziquantel, to halt progression of disease and reduce splenomegaly.

Specific treatment of advanced Schistosomiasis liver disease in man: favourable results

One hundred eighty-four patients with hepatosplenic schistosomiasis mansoni from the northeast of Brazil were studied. All were treated with a single dose of Oxamniquine or Praziquantel, and were observed over 6 to 12 months. Special attention was given to the evolution of severe hepatopathy. Favourable results were obtained, particularly with the compensated hepatosplenic form. Hepatic function showed great improvement. Hepatomegaly and splenomegaly were significantly reduced in size, to a greater or lesser extent, in the great majority of patients. The implications of the results obtained are considered below.

Estudo epidemiológico da esquistossomose mansônica em áreas de irrigação do Nordeste brasileiro

E mundialmente reconhecida a importância das areas de irrigacao na disseminacao da esquistossomose. O presente estudo foi desenvolvido no periodo de outubro de 1986 a dezembro de 1987 em 23 perimetros de irrigacao do Nordeste semi-arido. A analise socio-economica-sanitaria mostrou varios aspectos de interesse epidemiologico, salientando-se a presenca de trabalhadores flutuantes originarios de areas endemicas da parasitose e vivendo em mas condicoes sanitarias nos lotes de irrigacao. O estudo coprologico indicou os seguintes resultados: de 10.279 individuos examinados (82% da populacao) somente 3 (tres) casos apresentaram-se positivos para S. mansoni. O estudo malacologico mostrou a presenca exclusiva da Biomphalaria straminea em 17.188 amostras coletadas. Somente em um dos perimetros (Sao Goncalo, Souza, PB) foi constatada a infeccao esquistossomotica ativa em 17 caramujos. Esses resultados indicam que as areas de irrigacao estudadas nao constituem, no momento, problema relevante de transmissao da esquistossomose. Os autores consideram, porem, necessaria uma permanente vigilância epidemiologica em todas as areas de irrigacao do Nordeste.

História da felariose linfática em Pernambuco: I. Aspectos epidemiológicos e de controle

Este trabalho faz uma revisao sobre a filariose linfatica bancroftiana, doenca endemica no Estado de Pernambuco, mostrando que seus estudos datam desde a decada de dez. Para se ter uma ideia da evolucao eprogresso sobre o conhecimento da doenca na regiao, julgamos de interesse fazer uma analise retrospectiva da historia da filariose em Pernambuco e, em particular, no Recife, nos ultimos anos, abordando os aspectos epidemiologicos e de controle da doenca.

Tratamento da esquistossomose mansônica na criança com oxamniquine sob forma de xarope

The authors present the results of the treatment of 40 children (5 to 14 years) with oxamniquine syrup; 25 of them were given a single dose of 20 mg/kg b.w. and 15 received the same total dose divided at 12 hours intervals. Tolerance was good; 22,5% had dizziness and 20%, drowsiness; 5 patients of the first group presented psychological disturbances. 70% of the patients presented parasitological cure 4 to 6 months after treatment; (90% em Group A and 5% in Group B) a marked egg count reduction was observed.

Implicações hemodinâmicas na esquistossomose mansônica - Estudo do gradiente pressórico portal

The author presents a comparative study on the portal gradient in hepato-splenic schistosomiasis and the haemodynamic findings in normal people, in patients presenting extrahepatic obstruction and in patients with cirrhosis of liver. A study is given on the wedged and free hepatic vein pressures in the same entities; the gradients of splenic and wedged hepatic vein pressures are shown in 16 cases and the transparietal hepatic and splenic pressures gradient are shown in 35 cases. The results of these findings are summarized as follows: