Luciana de Almeida Silva

Azithromycin in the treatment of mucosal leishmaniasis

This report describes three elderly patients with mucosal form of American tegumentary leishmaniasis associated with chronic cardiopathy. Due to the known toxicity of classical drugs with activity against Leishmania sp., the patients received three oral courses of azithromycin therapy in single 500 mg daily dose during ten days, every other month. All lesions healed after the third series. One of the patients relapsed and a new series of azithromycin was prescribed. Azithromycin may be an alternative drug for the treatment of leishmaniasis in special situations due to its optimal mucosal and intraphagocyte concentration, single daily posology, high tolerance and oral administration. The mechanism of this drug on Leishmania sp. is unknown at present.

Antileishmania Immunological Tests for Asymptomatic Subjects Living in a Visceral Leishmaniasis-Endemic Area in Brazil

The objective of this study was to evaluate the behavior of different tests used for the diagnosis of visceral leishmaniasis (VL) in asymptomatic subjects living in an endemic area. No gold standard is available for the diagnosis of asymptomatic infection with Leishmania. In continuation of a previous study, 1,017 subjects living in a VL-endemic area were clinically reevaluated. Of these, 576 had at least one positive serological test in a first assessment. About 3 years after the first evaluation, none of the subjects had progressed to clinical VL. Among this group, 246 subjects were selected, and five serological tests (enzyme-linked immunosorbent assay p [ELISAp], ELISArK39, ELISArK26, indirect immunofluorescence test [IIFT] using L. amazonensis promastigote antigen, and an immunochromatographic test using rK39 antigen [TRALd]) and the Montenegro skin test (MST) were repeated. There was a significant increase in the number of subjects who tested positive in the MST, IIFT, ELISAp, and ELISArK39 in the second evaluation. For all tests, there were subjects who tested positive in the first evaluation and negative in the second evaluation. A positive result in the serological tests and MST in subjects from the endemic area studied did not indicate a risk of progression to VL and may only be temporary.

USE OF THE POLYMERASE CHAIN REACTION FOR THE DIAGNOSIS OF ASYMPTOMATIC Leishmania INFECTION IN A VISCERAL LEISHMANIASIS-ENDEMIC AREA

The diagnosis of asymptomatic infection with Leishmania (Leishmania) chagasi has become more important over recent years. Expansion of visceral leishmaniasis might be associated with other routes of transmission such as transfusion, congenital or even vector transmission, and subjects with asymptomatic infection are potential reservoirs. Moreover, the identification of infection may contribute to the management of patients with immunosuppressive conditions (HIV, transplants, use of immunomodulators) and to the assessment of the effectiveness of control measures. In this study, 149 subjects living in a visceral leishmaniasis endemic area were evaluated clinically and submitted to genus-specific polymerase chain reaction (PCR), serological testing, and the Montenegro skin test. Forty-nine (32.9%) of the subjects had a positive PCR result and none of them developed the disease within a follow-up period of three years. No association was observed between the results of PCR, serological and skin tests. A positive PCR result in subjects from the endemic area did not indicate a risk of progression to visceral leishmaniasis and was not associated with a positive result in the serological tests.

Toxoplasmose do sistema nervoso central em paciente sem evidência de imunossupressão: relato de caso

O quadro clinico da toxoplasmose adquirida em pacientes imunocompetentes habitualmente nao inclui manifestacoes neurologicas focais, o que e frequente em pacientes imunodeprimidos, como aqueles com sindrome da imunodeficiencia adquirida. Este trabalho tem como objetivo relatar o caso de uma paciente adulta que apresentou abscessos cerebrais por Toxoplasma gondii, sem evidencia de qualquer fator causador de imunossupressao.The clinical manifestations of acquired toxoplasmosis in the immunocompetent patient rarely include localized neurological signs, which are frequent in the immunosuppressed patient (Aids). The objective of this paper is to report the case of a woman with Toxoplasma gondii brain abscess, without an identified cause of immunosuppression.

Intradermorreação de Montenegro após sucessivas repetições do teste em Porteirinha, MG

With the purpose of evaluating the response of sequential applications of Montenegro intradermoreaction (IDRM), we have repeated four times the test in the inhabitants of an endemic area for kala-azar, that resulted negative 3-4 years ago. Firstly, we have repeated three IDRM in those who remained negative, with a 60-day interval among them. In the second stage, we have performed a last reaction in all participants of the study. From the total of 49 individuals with prior negative IDRM, 19 (38.8%) have positivated the test in some of the times, 17 (34.7%) have given up the study and 13 (26.5%) remained with a negative result in all the applications. In the second stage, the repetition of IDRM has shown that from the 14 positive in some of the tests, 8 remained like this and 6 have become negative. Our results confirm the possibility of late hypersensitivity induction in some individuals as a consequence of IDRM application.

Infection with Leishmania (Leishmania) infantum of 0 to 18-Month-Old Children Living in a Visceral Leishmaniasis-Endemic Area in Brazil

The diagnosis of Leishmania (Leishmania) infantum infection in children from birth may serve as a reference for the early identification of cases that would progress to classical visceral leishmaniasis (VL) in endemic areas. This study prospectively evaluated newborns of mothers living in the municipality of Paracatu, Minas Gerais, Brazil. The infants were followed up at 6-month intervals by clinical examination, serological tests (immunofluorescence [IIF] and enzyme-linked immunosorbent assay with rK39 [ELISA-rK39]) and polymerase chain reaction (PCR) until they had completed 18 months of age. A total of 166 pregnant women were included to evaluate the possible transfer of antibodies or even congenital transmission. Twenty-two of the women tested positive by IIF, four by ELISA-rK39, and one by PCR. Three infants of the 25 women with some positive test results were also positive in the first test (one by IIF, one by ELISA-rK39, and the third by ELISA-rK39 and PCR). One hundred and sixty infants were included in the study; of these, 43 had at least one positive sample over time. However, agreement between tests was low. Follow-up of children with a positive result in the tests studied revealed no progression to classical disease within a period of 18 months. In contrast, two children with negative IIF, PCR, and ELISA-rK39 results developed classical VL at 9 and 12 months of age. In conclusion, a positive test result was variable and sometimes temporary and agreement between tests was low. Therefore, the early diagnosis of Leishmania infection was not associated with the early identification of cases that would progress to classical VL in the endemic area studied.

Comparação de dois antígenos para intradermorreação de Montenegro

Intradermal reactions were performed in 399 individuals by using, simultaneously, the antigen produced by both the Universidade Federal de Minas Gerais and Fundacao Instituto Oswaldo Cruz. Each of these antigens was manufactured with promastigotes of Leishmania (L) amazonensis (IFLA/BR/67/PH8). The Fundacao Oswaldo Cruz antigen caused a larger number of positive reactions. Discordant reactions occurred in 22% of the individuals.