Geusa Felipa de Barros Bezerra

Prevalência de infecção por Leishmania chagasi utilizando os métodos de ELISA (rK39 e CRUDE) e intradermorreação de Montenegro em área endêmica do Maranhão, Brasil

A prospective study was undertaken in 1,520 children less than 15 years of age in São José de Ribamar, Maranhão, Brazil, from June 1994 to January 1995, to evaluate the prevalence and characteristics (socioeconomic, environmental, and behavioral) associated with infection by Leishmania chagasi. Montenegro skin test (MST) and enzyme-linked immunosorbent assay (ELISA-rK39 and CRUDE) test were used to detect infection. The statistical analysis used the chi2 test with Yates correction and a p value less than 0.05 was considered statistically significant. Prevalence of infection was 61.7% as measured by MST, 19.4% according to ELISA (rK39), and 19.7% by ELISA (CRUDE). Association was detected between leishmaniasis in the family, water supply, application of insecticide, and infection by L. chagasi using MST. No association with infection by L. chagasi was detected using ELISA rK39 or CRUDE. More effective control measures are needed to reduce prevalence and to detect asymptomatic cases in this high percentage of infected children.

Spatial dynamics of urban populations of Lutzomyia longipalpis (Diptera: Psychodidae) in Caxias, State of Maranhão, Brazil

INTRODUCTION In this paper, we report the ecology of Lutzomyia longipalpis in Caxias City, located in the eastern part of State of Maranhão, Brazil and highlight its seasonal and geographical distribution by environment. In addition, we discuss natural Leishmania infection and its relationship with visceral leishmaniasis. METHODS Between September 2007 and August 2009, the collection of sandflies was performed using Center for Disease Control (CDC) light traps from 15 houses in 5 selected neighborhoods. RESULTS Lutzomyia longipalpis was present in all zones of the city. We also found that Lu. longipalpis was regularly detected both inside and around the house, predominantly in outdoor areas. In urban areas, Lu. longipalpis was present in both the dry and rainy seasons, with a higher density present in the latter. One female specimen of Lu. longipalpis was observed to have natural Leishmania infection. CONCLUSIONS The presence of Lu. longipalpis was observed throughout the year during 2 seasonal periods, with a predominance in the rainy season. A low rate of natural Leishmania infection was observed in urban areas during the rainy season.

Diversity and dynamics of airborne fungi in São Luis, State of Maranhão, Brazil

INTRODUCTION This study aimed to identify airborne fungi in São Luis, Maranhão, Brazil, to determine the prevalent genera and to correlate these genera with the area and season. METHODS In total, 1,510 colony-forming units (CFUs) of airborne fungi were isolated from the north, south, east and west sides and from the center of the city from January to December 2007. The samples were collected on Petri dishes that were exposed to the fungi by the gravitational method. RESULTS Twenty genera of fungi were isolated; the most common were Aspergillus (33.5%), Penicillium (18.8%), Cladosporium (14.2%), Curvularia (10.6%) and Fusarium (7.6%). The CFUs of the fungi were statistically significant (p < 0.0001). Fungal biological diversity was present all year, without any large seasonal variations but with slight increases in May, August and September. CONCLUSIONS The fungal genera identified in this study were correlated with natural systems and could be useful when evaluating the impact of environmental changes on the region.

Osteoporosis in primary care: an opportunity to approach risk factors

INTRODUCTION Climacteric women are susceptible to a number of changes, among them osteoporosis. Osteoporosis is a disease characterized by low bone mass and susceptibility to fracture. Currently, this disease is a public health issue, being necessary to recognize its risk factors. OBJECTIVES Identify risk factors related to osteoporosis in women attending PROPIS/PROEX/UFMA, tracing a socio-demographic characterization and considering community lifestyles. MATERIAL AND METHODS This is a transversal retrospective clinical with a quantitative approach study conducted between March and June 2013 in São Luís-MA with 107 women treated at the Programa de Práticas de Integralidade em Saúde (PROPIS - Integrality Health Practice Program). The study was approved by the University Hospital Ethics Committee of UFMA under opinion no. 362/07. Data were tabulated and analyzed in the epidemiological Epi-Info(®) software, version 3.4.1. RESULTS The brown color was predominant, consensual relationships proved to be a protective factor and low education was a risk factor. The average age of the group with menopause was 54.1 years and without menopause was 31.3 years (p<0.0001). The average age of menopause was 43.7 years. The irregular menstrual cycle was a protective factor. The average number of pregnancies was 4.56 for the group with menopause and 2.45 for the group without menopause, with most births occurring normally (p<0.0001). Smoking, physical inactivity and caffeine intake were risk factors, while the absence of alcoholism and of soda intake were protective factors for the disease. CONCLUSION The patients followed the socioeconomic and demographic profile of Maranhão. Most had menarche and menopause in appropriate periods, showed no positive family history of osteoporosis, did not usually drink alcohol, were sedentary and the caffeine intake was high.

Eco-epidemiologic study of emerging fungi related to the work of babaçu coconut breakers in the State of Maranhão, Brazil

INTRODUCTION There are more than 300,000 extractors using the babaçu coconut as a source of income in the States of Maranhão, Pará, Tocantins and Piauí, and this activity is associated with fungal infections. The objective of this study was to examine the occurrence of emergent fungi in the conjunctiva, nails and surface and subcutaneous injuries of female coconut breakers in Esperantinópolis, Maranhão. Additionally, soil samples and palm structures were collected. METHODS The obtained samples were cultured in Petri dishes containing potato-dextrose-agar and chloramphenicol. The etiological agent was confirmed by a direct mycological exam and growth in culture. RESULTS In total, 150 domiciles were visited, and samples were collected from 80 patients. From the ground, the most frequently isolated fungus was Aspergillus niger (53. 8%). the most frequently detected fungus in babaçu coconut was Aspergillus niger (66.7%). Conjunctival fungal growth occurred in 76.3% of the women. The ocular fungal microbiota consisted of filamentous fungi (80.6%), and yeasts were present in 19.4% of cases. Onychomycosis was diagnosed in 44% (11/25) of the women. CONCLUSIONS The identification of the genera Neosartorya, Rhizopus and Curvularia in onychomycoses shows that emergent filamentous fungi can be isolated. Aspergillus sp., Penicillium sp. and Scedosporium sp. were the predominant genera found in the babaçu coconut. From ocular conjunctiva, Candida spp. were the most prevalent species isolated, and Fusarium sp. was present only in one woman. The nearly permanent exposure of coconut breakers to the external environment and to the soil is most likely the reason for the existence of a mycotic flora and fungal infections, varying according to the individuals practices and occupation.

Respiratory allergy to airborne fungi in São Luís – MA: clinical aspects and levels of IgE in a structured asthma program

Abstract Introduction: Respiratory allergies are becoming increasingly frequent, especially based on studies of asthma and rhinitis. It is estimated that 20–30% of the world’s population is affected. Allergic reactions are caused by the production of IgE antibodies specific to inhaled allergens, such as fungi in the air. This study aimed to analyze the level of specific IgE against airborne fungi in patients with a clinical diagnosis of asthma and rhinitis/sinusitis. Methods: In total, 158 patients enrolled in the Program of Support for Asthmatic Patient, and 20 controls were studied. Clinical data from the period of 2007–2008 were surveyed using a protocol form. ELISAs were performed to quantify the levels of total and specific IgE. Results: Of the 158 patients diagnosed with asthma, 71 had rhinitis and 32 had sinusitis. There was a predominance of females and residents of urban areas. The main symptoms reported were dyspnea, cough, wheezing and nasal obstruction. There was a statistically significant relationship between dyspnea and seropositivity for Fusarium (p = 0.01) and Penicillium (p = 0.005) and between cough and seropositivity for Aspergillus (p = 0.007). Conclusions: Anti-Penicillium (79.7%) and anti-Fusarium IgE (77.8%) were found to have the highest prevalence of seropositivity in individuals with asthma and rhinitis/sinusitis. Sensitivity to fungi was higher in symptomatic individuals. The identification of environmental fungi is essential for the diagnosis of respiratory allergy.

DIVERSITY AND INFECTIVITY POTENTIAL OF EMERGING FUNGI IN AN AREA OF BABAÇU TREES IN THE STATE OF MARANHÃO, BRAZIL

We studied human mycoses in conjunctiva, nails (onycholytic lesions) and skin lesions in 100 babaçu coconut breakers of Esperantinópolis, Maranhão (Fig. 1), and studied the ground near the babaçu palms, coconut shells and palm leaves (Fig. 2), for taxonomic classification of fungi by direct mycological and microscopic examination. We also performed direct examination with KOH for human mycoses. After the growth of colonies, these were analyzed by light microscopy using blue lactophenol dye. Colonies of interest were subcultured in tubes of 16 x 150, containing Sabouraud agar medium and subsequently was prepared microcultivation for taxonomic identification. The study was approved by the Ethics Committee in Research of the University Hospital of UFMA. Of the 20 samples taken from the soil, we obtained 13 isolates of fungi, whose macro and micromorphological characteristics of the colonies allowed the diagnosis of Aspergillus niger, Penicillium sp., and Scedosporium sp., besides others, Fusarium sp. not being found. In coconut shells Aspergillus niger and Penicillium sp. were found; in almond coconut, Aspergillus niger, A. versicolor, A. flavus, and Penicillium sp. were obtained. On palm leaves we identified Aspergillus niger and Penicillium sp. (Table 1). Twenty-five nail samples that showed suggestive alterations of onycholytic lesions (Fig. 3) were harvested; eleven positive cultures for yeast, Neosartorya spinosa, and Trichophyton sp. Rhizopus sp. and Curvularia sp. (Fig. 4) were isolated. Seventy-two fungal isolates were obtained from the conjunctiva, the most common were filamentous fungi from 58 (80.57%) breakers and 14 samples (19.43%) were found corresponding to Candida sp., and the Fusarium spp. occurred in only one sample (Fig. 5 and Table 2).

Estudo comparativo de anticorpos IgG e IgE antileishmania como marcadores de infecção e doença em indivíduos de área endêmica de leishmaniose visceral, em São Luis, MA

Comparative study regarding IgG and IgE anti-leishmania as markers of infection and illness among residents of a visceral leishmaniasis visceral leishmaniasis endemic area, São Luis, MA in the period from May 1999 to May 2000. All the 1,016 individuals younger than 16 years old were tested for the presence of IgG by ELISA. A total of 174 (17.1%) children revealed a positive IgG test and 4 children showed symptoms of classical visceral leishmaniasis during the time of the survey: 85 IgE anti-leishmania ELISA tests with positivity of 43.5% were realized. In this sample, all 7 children with past-visceral leishmaniasis in the sample were IgG positive and 4 (57.1%) were IgE positive, even after a 7 year post treatment period. Three children with current visceral leishmaniasis were evaluated, and all of them were positive for both tests. The detection of antileishman IgE antibodies presented as a good marker for infection by Leishmania chagasi in endemic areas but not as a disease marker.