Luciano Medeiros de Toledo

Canine Visceral Leishmaniasis in Rio de Janeiro, Brazil: clinical, parasitological, therapeutical and epidemiological findings (1977-1983)

Forty dogs from the periphery of the city of Rio de Janeiro were studied. All dogs where diagnosed as positive for leishmaniasis either parasitologically and/or serologically. Among them, 19 came from areas where only Visceral Leishmaniasis (VL) occurs (Realengo, Bangu, Senador Camará). Clinical signs of the disease were seen in 36.8% of the cases, including emaciation - 100%, lymphadenopathy and depilation - 85.7%. The other 21 dogs came from an area (Campo Grande) where both diseases (VL, and American Cutaneous Leishmaniasis - ACL) occur. Clinical signs of the disease, mainly cutaneous or mucocutaneous ulcers were seen in 76.2% of the cases. Leishmania parasites were found in 39 cases: 22% in viscera, 42.5% in viscera and normal skin and 35% in cutaneous or mucocutaneous ulcers. All the Leishmania stocks isolated from dogs which came from Realengo, Bangu, Senador Camará (VL area), and from Campo Grande (VL + ACL area) were characterized as L. donovani (except in one case) according to their schizodeme, zymodeme and serodeme. The only stock characterized as L. b. braziliensis, was isolated from the lymph node of a dog from Campo Grande with visceral disease and without skin lesions. Antimony therapy attempted in eight Leishmania donovani positive dogs was unsuccessful.

Distribution of dengue vectors in neighborhoods with different urbanization types of Manaus, state of Amazonas, Brazil

Aedes aegypti and Ae. albopictus are vectors of dengue viruses, which cause endemic disease in the city of Manaus, capital of the state of Amazonas, Brazil. More than 53 thousand cases have been registered in this city since the first epidemic in 1998. We evaluated the hypothesis that different ecological conditions result in different patterns of vector infestation in Manaus, by measuring the infestation level in four neighborhoods with different urbanization patterns, during the rainy (April), dry (August), and transitional (November) seasons. Ae. aegypti predominated throughout the study areas and sampling periods, representing 86% of all specimens collected in oviposition traps. High frequencies of houses positive for both species were observed in all studied sites, with Ae. aegypti present in more than 84% of the houses in all seasons. Ae. albopictus, on the other hand, showed more spatial and temporal variation in abundance. We found no association between infestation level and house traits. This study highlights the homogeneity of dengue vector distribution in Manaus.

Leishmaniose visceral na cidade do Rio de Janeiro - Brasil

A recente ocorrencia de casos humanos e caninos de leishmaniose visceral, autoctones de areas peri-urbanas da cidade do Rio de Janeiro, a partir de 1977, motivou pesquisadores da Escola Nacional de Saude Publica e do Instituto Oswaldo Cruz da Fundacao Oswaldo Cruz (FIOCRUZ), da Universidade Federal do Rio de Janeiro, da Universidade Federal Rural do Rio de Janeiro, da Secretaria Municipal da Saude do Rio de Janeiro e da Superintendencia das Campanhas do Ministerio da Saude (SUCAM-RJ), a participarem de um programa de estudo dessa zooantroponose, visando a uma abordagem ecologica, epidemiologica, parasitologica, imunologica, clinico-terapeutica e de avaliacao das medidas de controle adotadas. Resultados gerais dessas pesquisas sao apresentados na presente comunicacao.

Prevalência de marcadores para o vírus da hepatite B em contatos domiciliares no Estado do Amazonas

The aim of our investigation was to evaluate, with a prevalence study, the modes of transmission of Hepatitis B virus (HBV), within infected subjects and their household contacts in the state of Amazon, western Brazilian Amazon. We studied 97 index cases and 258 household contacts. Out of the 258 household contacts of HBV, 51.6% had serological markers of a past infection, 12.0% signs of active infection, suggesting that the virus circulates within household members. The high prevalence among siblings (23.6%) demonstrates the importance of personal contact in the transmission of this virus. Another indirect indicator of intra-familial transmission was the high prevalence of HBV markers within contacts of a fulminant hepatitis. The vertical transmission of HBV in our region may or may not occur, but if it does it as a rare event. Our results demonstrate the importance of the presence of HBV, and demand other investigations to clarify the inter-familial transmission of these viruses in our region.

Leishmaniose visceral canina no Rio de Janeiro - Brasil

No recente e mais meridional foco endemico de leishmaniose visceral do Brasil, associado a presenca de Lutzomyia longipalpis e a infeccao canina, os autores discutem a importância do cao domestico como reservatorio natural da infeccao, assim como sumarizam os achados epidemiologicos, clinicos, parasitologicos e terapeuticos da doenca canina observados no Municipio do Rio de Janeiro, Brasil.

Mortalidade Infantil em Remanescentes de Quilombos do Município de Santarém - Pará, Brasil

Este trabalho e uma analise preliminar da mortalidade infantil em areas quilombolas do municipio de Santarem-Para. Trata-se de uma Pesquisa Domiciliar Censitaria realizada no periodo de marco/abril de 2006, por meio de procedimentos de busca ativa de obitos em menores de um ano de idade, com identificacao de sub-registro na populacao das comunidades de terra firme e de varzea. Os niveis de mortalidade foram obtidos pela tecnica indireta de estimacao. Encontrou-se diferencial na mortalidade de menores de um ano de idade para os quilombos da area de terra firme e varzea, de 30,4 obitos/por mil nascidos vivos e de 50,2 obitos/por mil nascidos vivos, respectivamente. Os resultados evidenciam profundas desigualdades, na medida em que as taxas de mortalidade das comunidades quilombolas sao maiores quando comparadas com as do pais (27,0 obitos/por mil nascidos vivos), da regiao Norte (26,2 obitos/por mil nascidos vivos), e da populacao negra rural do estado do Para (32,9 obitos/por mil nascidos vivos). Observa-se que nenhuma das taxas de mortalidade dos quilombos alcancou niveis considerados satisfatorios quando comparadas com os parâmetros preconizados pelo Ministerio da Saude em 2005 (menos de 20 obitos/por mil nascidos vivos). Constata-se que, enquanto a mortalidade infantil vem diminuindo no pais como um todo, nos quilombos de Santarem, principalmente os da area de varzea, a probabilidade de uma crianca quilombola morrer antes de completar o primeiro ano de vida e bastante elevada, superando a media nacional, regional e estadual e classificando-se como alta, conforme os criterios definidos pelo Ministerio da Saude.

A rede de causalidade da insegurança alimentar e nutricional de comunidades quilombolas com a construção da rodovia BR-163, Pará, Brasil

Objective This work describes results based on the participative and encompassing development of a model of causal determination done in six quilombola communities of Santarem, Para State, regarding the causality of food and nutrition insecurity with the construction of the BR-163 highway. Methods The research process used socio-anthropological approach methods based on the development of a causality model constructed by forming focal groups with community representatives. Result The results of the study show that the use of participative approaches stimulates the community’s self-esteem and takes control of the factors that determine its problems. The causal model reveals that, for the communities, nutrition and food insecurity establish that historical factors associated with land ownership and current use based on predatory practices are essential to understand the causal determination of food and nutrition insecurity. Conclusion Racism and its social nuances have contributed for the social invisibility of these communities in public Brazilian policies. The quilombola communities consider themselves in a state of nutritional and food insecurity and indicate that the construction of the BR-163 highway can be a threat to the sustainable ethnic development in the region. They also state that the economic development expected with the construction of this highway can increase hunger, poverty and racism if the communities do not participate.

O sistema de informação de AIDS do Município do Rio de Janeiro: suas limitações e potencialidades enquanto instrumento da vigilância epidemiológica

This study analyzes the Rio de Janeiro Municipal AIDS Information System, specifically the systems strengths and limitations in the epidemics current context, from a broader perspective of epidemiological surveillance. The objective was to provide a brief description of the system, considering its different components. The authors further analyzed records pertaining to the reporting and investigation of AIDS cases from 1985 to 1995 and an update of the database as a contribution to the systems quality. The results showed improvement in the consistency of the AIDS database, particularly for the following variables: occupation, neighborhood, school, and exposure category, although the study found concrete limitations in the systems design and structure for dealing with the complexity and heterogeneity of AIDS surveillance. The study thus identified the need to construct an efficient HIV/AIDS surveillance system, based on epidemiological indicators aimed at monitoring and evaluating changes in the epidemiological pattern and analysis of the impact on morbidity and mortality resulting from access to more efficient forms of prevention and new treatments.

Utilização da reação de imunofluorescência indireta no acompanhamento da terapêutica da leishmaniose tegumentar americana

Seventeen persons, from 2 to 78 years of age, with clinical, epidemiological,immunological and parasitological diagnosis of american tegumentary leishmaniasis, were studied. All came from the endemic area of Jacarepagua, a suburb of the city of Rio de Janeiro. The patients were treated with n-methylglucanine antimonate, using a dosage of 60 mg/kg/day, in three series of ten days duration each series, with intervals of ten days between each series, venous blood samples having been taken for the indirect immunefluorescent tests (IF-IgG) before, during and after medication. The seventeen individuals were reactive to the intradermal reaction of Montenegro (= 5 mm) and serum-reactive (= 1:45 mm) to the IF-IgG test; Leishmania b. braziliensis ssp was demonstrated or isolated in six cases (31.7%). Before treatment, the IF-IgG test showed positive in 76.4% of the cases (13 cases with titers = 1:90). The geometric averages of the reciprocal titer were as follows: before the first antimonial series (89,9); during treatment (63.6 to 29.3) and 10, 30 and 120 days after medication which revealed a clearly decreasing scale (14.9; 2.1 and 1.2), respectively. All lesions were healed upon termination of treatment, the scarring being most evident after the second series. Only 120 days after therapy were titers lower than 1:45 in all patients (16 cases - 94.1%). This suggests that, when the IF-IgG test is used as a control of cures, serological follow up is necessary during a minimum of three to four months.

Uso de indicadores de nível local para análise espacial da morbidade por diarreia e sua relação com as condições de vida

Nos paises em desenvolvimento, cada crianca, apresentou em media tres episodios de diarreia por ano, no seculo XX. No Brasil, a diminuicao do numero de obitos por diarreia esteve mais associada a aplicacao de tecnicas de controle do que por transformacoes nas condicoes de vida. Este artigo tem por objetivo analisar a distribuicao espacial da morbidade por diarreia em criancas e sua associacao com condicoes de vida. Estudo ecologico, tendo como unidade de analise os bairros do municipio de Itaborai. A populacao do estudo foram as criancas < 5 anos hospitalizadas por diarreia, nos anos 2006 a 2009, disponiveis no SIH. Foram estabelecidos os indicadores Razao de Internacoes por Diarreia (RID) e Indicador Composto de condicoes de vida (ICV). As diarreias ainda representam elevada parcela das hospitalizacoes em criancas (15,5% entre 2006 e 2009). A RID foi elevada no periodo (69,7 hospitalizacoes/ 1.000 NV). A analise espacial identificou que os bairros com maiores valores de RID foram, em sua maioria, aqueles com maiores aglomeracoes populacionais e melhores condicoes de vida.The use of thalidomide was never discontinued in Brazil where it is prescribed for leprosy type 2 reaction. Babies with birth defects compatible with the thalidomide embryopathy phenotype were born after 1965, an indication that control on drug dispensing and use failed in the country. The article reports data on thalidomide dispensing and clinical uses in the Federal District in 2011/12, when new rules were put into effect, and data on drug dispensing and use obtained ten years earlier. It was found that the number of patients making use of thalidomide declined from 819 in 2001 to 369 in 2011/12. Leprosy accounted for over 70% of prescriptions in both time periods analyzed in this study. In the same time interval, however, use for lupus erythematosus decreased from 13.7 to 4.9%, while that for multiple myeloma increased from 2.9 to 20.3% of all prescriptions. Thalidomide prescription for the remaining approved indications was far less frequent, and so was the use for off label indications that accounted for <1% of prescriptions in 2001 and 2011/12. Registration of prescribing doctors, patients and dispensing units at the state department of health, apparently rendered this control more effective and reliable.