Andrea Straatmann

Epidemia de dengue em Ipupiara e Prado, Bahia. Inquérito soro-epidemiológico

Serologic studies in Brazil have indicated a 25% to 56% prevalence of dengue virus infections. However, these studies were carried out in populations of middle-sized and larger cities. The present study describes two epidemics of classic dengue fever in two small cities in the State of Bahia. The first occurred in 1987, in Ipupiara and was caused by dengue serotype-1 (DEN-1), the second occurred in 1995, in Prado and was caused by dengue serotype-2 (DEN-2). The laboratory diagnosis was made by the hemagglutination-inhibition test. 461 serum samples were collected in 1995 in Ipupiara (district of Chapada Diamantina) out of a population of 3,868 and 228 samples out of a total of 9,126 inhabitants of Prado (in the southernmost coastal region). The seropositivity of the samples was 11.9% (55/461) in Ipupiara and 17.5% (40/228) in Prado. These were no statistically significant differences as to age and sex between seropositive and seronegative individuals of the two cities studied. However, the seropositive cases in Ipupiara indicated a higher percentage (15.9% vs. 9.3%) of residency in or travel to other states of Brazil (p<0.03). Based on these data we estimate the occurrence of 460 and 1,597 cases of infection in Ipupiara and Prado, respectively. In conclusion, dengue virus infections in smaller cities probably have singular characteristics, since they exhibit a lesser prevalence of seropositivity caused by decreased breeding possibilities of Aedes aegypti.Serologic studies in Brazil have indicated a 25% to 56% prevalence of dengue virus infections. However, these studies were carried out in populations of middle-sized and larger cities. The present study describes two epidemics of classic dengue fever in two small cities in the State of Bahia. The first occurred in 1987, in Ipupiara and was caused by dengue serotype-1 (DEN-1), the second occurred in 1995, in Prado and was caused by dengue serotype-2 (DEN-2). The laboratory diagnosis was made by the hemagglutination-inhibitation test. 461 serum samples were collected in 1995 in Ipupiara (district of Chapada Diamantina) out of a population of 3,868 and 228 samples out of a total of 9,126 inhabitants of Prado (in the Southernmost coastal region). The seropositivity of the samples was 11.9% (55/461) in Ipupiara and 17.5% (40/228) in Prado. These were no statistically significant differences as to age and sex between seropositive and seronegative individuals of the two cities studied. However, the seropositive cases in Ipupiara indicated a higher percentage (15.9% vs. 9.3%) of residency in or travel to other states of Brazil (p<0.03). Based on these data we estimate the occurrence of 460 and 1,597 cases of infection in Ipupiara and Prado, respectively. In conclusion, dengue virus infections in smaller cities probably have singular characteristics, since they exhibit a lesser prevalence of seropositivity caused by decreased breeding possibilities of Aedes aegypti.

Infecção pelo HTLV-I/II no Estado da Bahia

The city of Salvador, capital of Bahia, presents a population with the highest prevalence of HTLV-I infection in Brazil. Until now, only one study has investigated this infection in other cities of this state, even though by using a small sample. With objective to evaluate the prevalence of HTLV-I/II antibodies in four cities of the state of Bahia. Serum samples from 1,539 individuals who lived in Catolândia, Ipupiara, Jacobina and Prado were screened by ELISA, and repeatedly reactive samples confirmed by Western Blot. Forty-seven (3.1%) samples were positive by ELISA, and 44 of them were tested by Western blot: 5 (0.3%) were positive, 8 (0.5%) were indeterminate (all of them from Jacobina) and 31 were negative. The overall prevalence of HTLV-I antibodies was 0.3%. This prevalence varied from 0.0% (Prado) to 0.7% (Jacobina), but differences were not statistically significant (p > 0.21). None of these individuals presented HTLV-II antibodies. Jacobina showed the highest prevalence of HTLV-I infection among the cities studied, although the overall prevalence was low. In conclusion, further epidemiological, clinical and virological studies will be of paramount importance to obtain a better understanding of the natural history of this infection in Jacobina.The city of Salvador, capital of Bahia, presents a population with the highest prevalence of HTLV-I infection in Brazil. Untill now, only one study has investigated this infection in other cities of this state, even though by using a small sample. With objective to evaluate the prevalence of HTLV-I/II antibodies in four cities of the state of Bahia. Serum samples from 1,539 individuals who lived in Catolândia, Ipupiara, Jacobina and Prado were screened by ELISA, and repeatedly reactive samples confirmed by Western Blot. Forty-seven (3.1%) samples were positive by ELISA, and 44 of them were tested by Western blot: 5 (0.3%) were positive, 8 (0.5%) were indeterminate (all of them from Jacobina) and 31 were negative. The overall prevalence of HTLV-I antibodies was 0.3%. This prevalence varied from 0.0% (Prado) to 0.7% (Jacobina), but differences were not statistically sgnificant (p > 0.21). None of these individuals presented HTLV-II antibodies. Jacobina showed the highest prevalence of HTLV-I infection among the cities studied, although the overall prevalence was low. In conclusion, further epidemiological, clinical and virological studies will be of paramount importance to obtain a better understanding of the natural history of this infection in Jacobina.

Evidências sorológicas da circulação do arbovírus Rocio (Flaviviridae) na Bahia

Eight antibody anti-Rocio cases, from four distinct cities in the state of Bahia, are described; six of them being carriers of the antibody IgG (HI and NT) and two IgM (ELISA and NT). The authors comment on the circulation of these arboviruses in the state of Bahia and on the possibility of cross reactions with other antigenically related viruses.

A randomized, pilot trial comparing full versus escalating dose regimens for the desensitization of AIDS patients allergic to sulfonamides

UNLABELLED Sulfonamides are drugs extensively used in the management of AIDS patients. However, the use of sulfonamides is often associated with the development of allergic reactions, provoking the substitution of the drug (by another that may be less effective); alternatively attempts are made to desensitize the patient. OBJECTIVE Compare two drug regimens (full vs. escalating doses) for the oral desensitization of AIDS patients allergic to sulfonamides. MATERIAL AND METHODS AIDS patients with previous allergic reactions to sulfonamides and requiring prophylaxis against Pneumocistis carinii, central nervous system toxoplasmosis and diarrhea caused by Isospora belli were randomly assigned to a group receiving a routine dose of cothrimoxazole, or another that received escalating doses of an oral suspension of the same drug, initiating with 75 mg/day of sulfamethoxazole that was doubled every 48 hours till the full dose was reached, if no allergic reaction occurred. Patients were monitored for at least 6 months after enrollment in the trial. The major end-point was the ability to maintain prophylactic treatment after that period of time. Plasma viral load (PVL) and CD(4)/CD(8) counts were measured at baseline. Liver enzymes and hematological parameters were measured at baseline and after 1, 3 and 6 months. RESULTS Eighteen patients were enrolled in the study (15 men and 3 women), with ages ranging from 30 to 57 years (mean 39.9). The mean CD(4) counts were slightly higher for patients receiving a full dose; there was also a trend towards higher baseline CD(8) counts among patients developing new reactions. The mean PVL was similar among the patients in both desensitization groups. The incidence of new allergic reactions was identical (40%) in the two groups. All adverse reactions were mild and no significant increase in liver enzymes were observed. CONCLUSION Dose regimen is not a predictor of the development of new allergic reactions amongst patients challenged with sulfonamides after an initial allergic reaction.

Estado imune contra o vírus vacinal (17D) da febre amarela em duas populações do Estado da Bahia

The occurrence of cases of yellow fever (YF) and also the extensive distribution of A. aegypti in Brazil, inspired a study about the estimate of immunity against vacinal virus (17D) among the residents at two cities of the Bahia state, Ipupiara (n = 461) and Prado (n = 228). At this non-endemic area of YF, the search for serology antibody against 17D (Ab17D) and 18 another arbovirus was made thereby hemagglutination inhibition (HI). Only 1.2% (8/689) showed Ab17D, six of those with monotypic sort. The heterotypic sort for flavivirus (FLV) was interpretted as associated to immunity against 17D too, being much frequent in Prado (30.3%) than in Ipupiara (23.2%). The age ³ 50 years and residence in another states were related to seropositive for FLV, the same way that vaccinations history (17D). Howener, the history of vaccination presented low percentages of sensibility (£ 45.4%) and predictive-positive value (£38.4%), but high specificity (³70.8%) and predictive-negative value (³ 78.8%). Therefore, the frequency of residents with Ab17D was low (1.2%), althoug the higher frequency (25.5%) of antibody FLV carriers , what signifies that 26.7% of the studied population should present protection against the YF virus.The occurrence of cases of yellow fever (YF) and also the extensive distribution of A. aegypti in Brazil, inspired a study about the estimate of immunity against vaccinal virus (17D) among the residents at two cities of the Bahia State, Ipupiara (n = 461) and Prado (n = 228). At this non-endemic area of YF, the search for serology antibody against 17D (Ab17D) and 18 another arbovirus was made thereby hemagglutination inhibition (HI). Only 1.2% (8/689) showed Ab17D, six of those with monotypic sort. The heterotypic sort for flavivirus (FLV) was interpreted as associated to immunity against 17D too, being much frequent in Prado (30.3%) than in Ipupiara (23.2%). The age > or = 50 years and residence in another states were related to seropositive for FLV, the same way that vaccinations history (17D). However, the history of vaccination presented low percentages of sensibility ( or = 70.8%) and predictive-negative value (> or = 78.8%). Therefore, the frequency of residents with Ab17D was low (1.2%), although the higher frequency (25.5%) of antibody FLV carriers, what signifies that 26.7% of the studied population should present protection against the YF virus.

Immunity against yellow fever vaccinal virus (17D) in two populations of Bahia state, Brazil.

The occurrence of cases of yellow fever (YF) and also the extensive distribution of A. aegypti in Brazil, inspired a study about the estimate of immunity against vacinal virus (17D) among the residents at two cities of the Bahia state, Ipupiara (n = 461) and Prado (n = 228). At this non-endemic area of YF, the search for serology antibody against 17D (Ab17D) and 18 another arbovirus was made thereby hemagglutination inhibition (HI). Only 1.2% (8/689) showed Ab17D, six of those with monotypic sort. The heterotypic sort for flavivirus (FLV) was interpretted as associated to immunity against 17D too, being much frequent in Prado (30.3%) than in Ipupiara (23.2%). The age ³ 50 years and residence in another states were related to seropositive for FLV, the same way that vaccinations history (17D). Howener, the history of vaccination presented low percentages of sensibility (£ 45.4%) and predictive-positive value (£38.4%), but high specificity (³70.8%) and predictive-negative value (³ 78.8%). Therefore, the frequency of residents with Ab17D was low (1.2%), althoug the higher frequency (25.5%) of antibody FLV carriers , what signifies that 26.7% of the studied population should present protection against the YF virus.The occurrence of cases of yellow fever (YF) and also the extensive distribution of A. aegypti in Brazil, inspired a study about the estimate of immunity against vaccinal virus (17D) among the residents at two cities of the Bahia State, Ipupiara (n = 461) and Prado (n = 228). At this non-endemic area of YF, the search for serology antibody against 17D (Ab17D) and 18 another arbovirus was made thereby hemagglutination inhibition (HI). Only 1.2% (8/689) showed Ab17D, six of those with monotypic sort. The heterotypic sort for flavivirus (FLV) was interpreted as associated to immunity against 17D too, being much frequent in Prado (30.3%) than in Ipupiara (23.2%). The age > or = 50 years and residence in another states were related to seropositive for FLV, the same way that vaccinations history (17D). However, the history of vaccination presented low percentages of sensibility ( or = 70.8%) and predictive-negative value (> or = 78.8%). Therefore, the frequency of residents with Ab17D was low (1.2%), although the higher frequency (25.5%) of antibody FLV carriers, what signifies that 26.7% of the studied population should present protection against the YF virus.

Immunity against yellow fever vaccinal virus (17D) in two population of the Bahia State, Brazil

The occurrence of cases of yellow fever (YF) and also the extensive distribution of A. aegypti in Brazil, inspired a study about the estimate of immunity against vacinal virus (17D) among the residents at two cities of the Bahia state, Ipupiara (n = 461) and Prado (n = 228). At this non-endemic area of YF, the search for serology antibody against 17D (Ab17D) and 18 another arbovirus was made thereby hemagglutination inhibition (HI). Only 1.2% (8/689) showed Ab17D, six of those with monotypic sort. The heterotypic sort for flavivirus (FLV) was interpretted as associated to immunity against 17D too, being much frequent in Prado (30.3%) than in Ipupiara (23.2%). The age ³ 50 years and residence in another states were related to seropositive for FLV, the same way that vaccinations history (17D). Howener, the history of vaccination presented low percentages of sensibility (£ 45.4%) and predictive-positive value (£38.4%), but high specificity (³70.8%) and predictive-negative value (³ 78.8%). Therefore, the frequency of residents with Ab17D was low (1.2%), althoug the higher frequency (25.5%) of antibody FLV carriers , what signifies that 26.7% of the studied population should present protection against the YF virus.The occurrence of cases of yellow fever (YF) and also the extensive distribution of A. aegypti in Brazil, inspired a study about the estimate of immunity against vaccinal virus (17D) among the residents at two cities of the Bahia State, Ipupiara (n = 461) and Prado (n = 228). At this non-endemic area of YF, the search for serology antibody against 17D (Ab17D) and 18 another arbovirus was made thereby hemagglutination inhibition (HI). Only 1.2% (8/689) showed Ab17D, six of those with monotypic sort. The heterotypic sort for flavivirus (FLV) was interpreted as associated to immunity against 17D too, being much frequent in Prado (30.3%) than in Ipupiara (23.2%). The age > or = 50 years and residence in another states were related to seropositive for FLV, the same way that vaccinations history (17D). However, the history of vaccination presented low percentages of sensibility ( or = 70.8%) and predictive-negative value (> or = 78.8%). Therefore, the frequency of residents with Ab17D was low (1.2%), although the higher frequency (25.5%) of antibody FLV carriers, what signifies that 26.7% of the studied population should present protection against the YF virus.