Celeste A.N. Silveira

Parasite persistence in treated chagasic patients revealed by xenodiagnosis and polymerase chain reaction

Polymerase chain reaction (PCR) was compared with xenodiagnosis performed 20 years after trypanocidal chemotherapy to investigate parasite clearance. Eighty-five seropositive individuals for Chagas disease presenting a positive xenodiagnosis were treated with specific drugs; 37 in the acute phase and 48 in the chronic phase. Fifteen chronic asymptomatic patients received a placebo. Treatment in the acute phase led to PCR negative results in 73% of the cases, while xenodiagnosis was negative in 86%. In the chronic phase, PCR was negative in 65% of the patients and 83% led to xenodiagnosis negative results. Regarding the untreated group (placebo), 73% gave negative results by xenodiagnosis, of which 36% were positive by PCR. Individuals that were considered seronegative (n=10), presented unequivocally negative results in the PCR demonstrating the elimination of parasite DNA. Seventeen individuals had their antibodies titers decreased to such a level that the final results were considered as doubtful and 16 of them presented negative PCR. The molecular method represents a clear advantage over conventional techniques to demonstrate persistent infections in Chagas disease patients that underwent chemotherapy.

Avaliação do tratamento específico para o Trypanosoma cruzi em crianças, na evolução da fase indeterminada

Twelve chagasic patients between the ages of seven and twelve, in the indeterminate phase with serology and xenodiagnosis positive, received the specific treatment. Eight of these were evaluated after an eight-year treatment period and four were followed-up during 20 years. Two patients took 7 mg/kg of nifurtimox during sixty and ninety days and ten of these used 5-7 mg/kg of benznidazole during 60 days. The clinical outcome was verified through clinical examination, electrocardiogram and contrasted X-ray of the esophagus. After the treatment, only one patient presented negativity in all the examinations. Seven (58.4%) remained in the indeterminate form and despite the precocious treatment four chagasic patients (33.3%) progressed clinically to second degree cardiopathy and/or megaesophagus.

Prevalência e suscetibilidades bacterianas das infecções comunitárias do trato urinário, em Hospital Universitário de Brasília, no período de 2001 a 2005

Urinary tract infection is among the most common infectious diseases in clinical medicine, and knowledge of its epidemiology and the sensitivity profile of the etiological agents is mandatory. The aim of this study was to identify the most frequent etiological agents and the profile of sensitivity to antimicrobial agents of the bacteria isolated from urine cultures from outpatients at the University Hospital of Brasília between 2001 and 2005. From analyses at the hospitals microbiology laboratory, there were 2,433 positive urine cultures. Escherichia coli was the most commonly isolated bacteria (62.4%), followed by Klebsiella pneumoniae (6.8%) and Proteus mirabilis (4.7%). Escherichia coli showed the highest sensitivity to amikacin (98.6%), gentamicin (96.2%), nitrofurantoin (96.3%) and the quinolones ciprofloxacin (90.9%) and norfloxacin (89.8%), with low sensitivity to sulfamethoxazole-trimethoprim (50.6%). The others bacteria presented similar sensitivity profiles. In conclusion, Escherichia coli was the most commonly isolated bacteria, and it was highly sensitive to aminoglycosides, nitrofurantoin and quinolones.

Estudo comparativo entre o xenodiagnóstico artificial realizado imediatamente e quatro horas após a coleta de sangue

Artificial xenodiagnosis was performed immediately after blood venous punch and then four hours later on 63 patients; 29 (46%) were male and 34 (54%) female, mean age 39 years (range 18 to 68 years). Eleven (17.5%) patients presented positive exams, of which eight (12.7%) were from immediate xenodiagnosis and 7 (11.1%) xenodiagnosis four hours after. Eight patients showed 17 positive pools from immediate xenodiagnosis and 7 patients with xenodiagnosis four hours later showed 11 positive pools (p = 0.34). Four patients were positive only on immediate xenodiagnosis, three only on xenodiagnosis 4 hours after and four were positive in both. The data demonstrate that xenodiagnosis can be performed up to four hours after blood collection without impairing the test results.

Specific treatment evaluation for Trypanosoma cruzi in children, in the evolution of the indeterminate phase

Twelve chagasic patients between the ages of seven and twelve, in the indeterminate phase with serology and xenodiagnosis positive, received the specific treatment. Eight of these were evaluated after an eight-year treatment period and four were followed-up during 20 years. Two patients took 7 mg/kg of nifurtimox during sixty and ninety days and ten of these used 5-7 mg/kg of benznidazole during 60 days. The clinical outcome was verified through clinical examination, electrocardiogram and contrasted X-ray of the esophagus. After the treatment, only one patient presented negativity in all the examinations. Seven (58.4%) remained in the indeterminate form and despite the precocious treatment four chagasic patients (33.3%) progressed clinically to second degree cardiopathy and/or megaesophagus.

Eficácia do sulfato de aminosidine na leishmaniose visceral grave, resistente ao tratamento com antimonial pentavalente

A grave kala-azar infection in a 14 years old boy is described. The leishmanial infection failed to respond to ten interrupted courses of glucantime of variable duration (14-56 days) at a dose of 20mg Sb5/kg/day. However a favorable response ocurred to intramuscular aminosidine sulphate (20mg/kg/day) for 20 days. This same regimen was repeated 20 days later. After the first treatment splenic puncture parasite density fell from 50 amastigotes per oil immersion field to 3 amastigotes in 10 fields. A further splenic puncture 7 months after treatment was negative. The marked hepatoesplenomegaly gradually resolved over 26 months follow up and he gained 13 kilogramas in weight. After aminosidine sulphate therapy his Montenegro reaction become positive and his lymphocytes responded to leishmania antigens.

Course of serological tests in treated subjects with chronic Trypanosoma cruzi infection: A systematic review and meta-analysis of individual participant data

Highlights • This is the first meta-analysis of individual data in chronic Trypanosoma cruzi infection after treatment.• The probability of seroreversion is variable along the course of follow-up.• An interaction was found between age at treatment and country setting.• The course of parasitological/molecular tests after treatment needs to be assessed.

Pott's disease and tuberculous psoas abscesses in a patient with acquired immunodeficiency syndrome

. As she could notachieve relief of the back pain with analgesics, she was hospitalizedfor evaluation. At physical examination, she was thin and pale,with diffuse abdominal pain and tender enlargement of the liver. Tuberculin skin test was negative. Chest x-ray was normal,but roentgenography of the back revealed lytic lesions of the lastlumbar vertebrae, with collapse of the body of L5 (Figure A).Abdominal computed tomography (CT) showed abscesses in thepsoas major muscles bilaterally (12x15cm), extending to the rightto ileo-psoas and iliac muscles (Figure B), with paraaortic andmesenteric lymphadenopathy. The abscess on the right was drainedpercutaneously under CT guidance. A catheter was inserted afterthe drainage of 1,000ml of pus. Cultures of the left abscess drainagewere negative for pyogenic bacteria, but Ziehl-Neelsen stains werepositive on three different occasions. She was started on rifampin,isoniazid and pyrazinamide, and given tramadol for analgesia. This,with immobilization of the spine, led to clinical improvement.Abdominal CT scan performed two months after starting treatmentshowed incomplete involution of the abscesses (5x7cm). Atuberculous abscess of the psoas may develop secondary to spinaltuberculosis, but rarely presents as a primary manifestation.Paciente de 31 anos, do sexo feminino, com diagnostico deAIDS ha cerca de dois anos, tendo ja apresentado como complicacoesoportunistas coriorretinite por citomegalovirus (CMV) e candidiaseesofagica. Estava, ha um ano, em uso de estavudina, lamivudina eefavirenz, e profilaxia para CMV e

Evaluation of specific treatment for Trypanosoma cruzi in children, during the indeterminate phase.

Twelve chagasic patients between the ages of seven and twelve, in the indeterminate phase with serology and xenodiagnosis positive, received the specific treatment. Eight of these were evaluated after an eight-year treatment period and four were followed-up during 20 years. Two patients took 7 mg/kg of nifurtimox during sixty and ninety days and ten of these used 5-7 mg/kg of benznidazole during 60 days. The clinical outcome was verified through clinical examination, electrocardiogram and contrasted X-ray of the esophagus. After the treatment, only one patient presented negativity in all the examinations. Seven (58.4%) remained in the indeterminate form and despite the precocious treatment four chagasic patients (33.3%) progressed clinically to second degree cardiopathy and/or megaesophagus.