Marcus Vinitius de Farias Guerra

Comparison of Cutaneous Leishmaniasis Due to Leishmania (Viannia) braziliensis and L. (V.) guyanensis in Brazil: Clinical Findings and Diagnostic Approach

We compared the clinical findings and diagnostic methods for 66 patients with cutaneous leishmaniasis in the state of Bahia, Brazil, who were infected by Leishmania (Viannia) braziliensis (group A), with those for 68 patients in the state of Amazonas, Brazil, who were mainly infected by Leishmania (Viannia) guyanensis (group B). Differences were observed with regard to number, size, and location of skin lesions and to the pattern of lymphatic involvement. Patients in group B had smaller and more numerous lesions, which were frequently located above the waist, versus the larger but less numerous lesions among patients in group A, which were usually located on the lower limbs. Lymphatic involvement was present in 55 (83.3%) of the 66 patients in group A and in 42 (61.8%) of the 68 patients in group B (P=0.005). The positivity rates of imprints and skin culture procedures were higher in group B. Sensitivity of in vitro culture of skin aspirates was 47.0% and 91.2% for groups A and B, respectively (P<.001). Although hamster inoculation showed similar results in both groups, the interval before development of disease was shorter in group B. Our data provide substantial evidence that indicate that the disease caused by these species differs with regard to clinical presentation and diagnostic approach.

Sensitivity of the polymerase chain reaction for the diagnosis of cutaneous leishmaniasis due to Leishmania (Viannia) guyanensis

The sensitivity of the polymerase chain reaction (PCR) in 35 consecutive outpatients with cutaneous leishmaniasis caused by Leishmania (Viannia) guyanensis was evaluated using, as gold standard, the in vitro isolation of the parasite through culture of aspirates of the cutaneous ulcers. All isolates were identified using electrophoretic enzyme analysis. Patients were mainly young males with recent onset disease without prior specific treatment. PCR was performed using DNA extracted from fresh frozen biopsies of cutaneous ulcers. The reaction used a pair of oligonucleotides that amplify the conserved region of the minicircle molecule. PCR showed 100% sensitivity (95% CI from 90.0 to 100.0). These results were similar to the visualization of amastigotes in imprint preparations of cutaneous biopsy tissue and the inoculation of biopsy material in golden hamsters. Despite the high sensitivity of the PCR, in this particular clinical setting of cutaneous leishmaniasis caused by L. (V.) guyanensis in the Brazilian Amazon, it appears that the method of choice for diagnosis should be the direct visualization of amastigotes using imprint preparations and the PCR reserved for those patients with negative imprint results.

Doenças exantemáticas e primeira epidemia de dengue ocorrida em Manaus, Amazonas, no período de 1998-1999

In 1998, the FMT/IMT-AM foundation implemented the surveillance system to diagnose acute undifferentiated febrile syndromes, with the objective of active and passive surveillance in Brazilian western Amazonian rainforest to identify and diagnose the etiologic agents of acute fever. The diagnoses were performed using serological tests to detect IgM antibodies by ELISA (Enzyme-linked-immunosorbent assay) CDC/OPAS or using commercial kits. A total of 8,557 serum samples obtained from patients with clinical suspicion of dengue virus were analyzed. ELISA positive reaction to dengue virus was presented by 40% of the serum samples and 26% of the serum samples had positive ELISA reactions to other exanthematous viral diseases, such as rubella, measles, parvovirus, Oropouche virus and Mayaro virus.

Leishmaniose visceral entre índios no Estado de Roraima, Brasil: aspectos clínicoepidemiológicos de casos observados no período de 1989 a 1993

A description of the epidemiological profile of visceral leishmaniasis among Indians in the State of Roraima, Brazil, was based on the clinical characteristics of human and dog disease, ecological aspects of the area where the cases occurred and entomologic investigations performed from 1989 to 1993. The 82 human cases were reported in six out of eight Counties that existed then in the state; there was a 69.5% predominance of male cases among those registered and a greater (52.4%) occurrence of the disease in children from zero to ten years old. The rate of natural infection was 10.3% out of 3,773 dogs examined in 74 different locations. Lutzomyia longipalpis was found in 31 areas with greater prevalence of the disease. The human and animal cases as well as the vectors were concentrated in areas where mountains and arable soil predominate, typical locations for the occurrence of American visceral leishmaniasis.

Registro de Culicidae de importância epidemiológica na área rural de Manaus, Amazonas

The biodiversity of the Amazon region includes many species of arthropod vectors in different ecotopes, thus enabling occurrences of diseases like malaria, filariasis and arbovirosis. From August 2001 to July 2002, we gathered culicids from inside homes, from areas surrounding these homes and from forested areas of the Sao Joao Community, in the rural zone of Manaus, State of Amazonas. 1240 specimens were collected, belonging to the Culicinae (99%) and Anophelinae (1%) subfamilies, with 50 species. The Culicini tribe clearly predominated, with 904 specimens (72.9%), and the species Culex usquatus (22.6%) and Culex quinquefasciatus (17.7%) were prominent. Out of the total number of culicids, 1,077 (86.9%) were caught in the forests, 101 (8.1%) in the areas surrounding homes and 62 (5%) inside homes. Forests were the ecotope that presented the highest species diversity. The presence of Anopheles darlingi, Anopheles triannulatus, Aedes aegypti, Haemagogus janthinomys and other proven or potential vectors was recorded.

Registro da ocorrência de Aedes albopictus em área urbana do município de Manaus, Amazonas

A partir de exemplares de Aedes albopictus coletados em area urbana no municipio de Manaus, AM, Brasil, e das informacoes sobre a presenca desse mosquito em varios municipios do Estado do Amazonas, registra-se pela primeira vez a introducao dessa especie nesse Estado.

Fauna de Culicidae em municípios da zona rural do estado do Amazonas, com incidência de febre amarela

After the occurrence of 14 sylvatic yellow fever cases in 10 cities in the State of Amazonas during 1996, an investigation into the presence of sylvatic yellow fever vectors was carried out. The material of larvae and adult insects was collected around residences and canopy trees within forests, using a light trap (CDC) and human bait. A total of 424 insects was collected. Thirty seven species were identified, some of which were sylvatic yellow fever vectors: Haemagogus janthinomys, Ha. leucocelaenus, Aedes fulvus.

Estudo de dois anos com animais reservatórios em área de ocorrência de leishmaniose tegumentar americana humana em bairro de urbanização antiga na cidade de Manaus-AM, Brasil

This is the result of a two year follow-up of a Cutaneous Leishmaniasis (CL) foci in the Hileia urban neighborhood in Manaus. It is important to point out that this is not the usual pattern of Leishmaniasis occurrence in this area. The authors investigated the animal potential reservoir in households and in the surrounding forest area. Samples were tested for leishmaniasis antibodies by RIFI. Eight (20.51%) of the examined domestic dogs showed reactivity. In captured wild animals, the Didelphis marsupialis was predominant in twenty specimens, three with homoflagelated in the blood and two with suspicious cutaneous lesions. We believe that the disordered population growth in the nearby area pushed the population of vectors and natural reservoir toward the homes in the Heleia neighborhood creating conditions for this outbreak.

Epidemiology of infectious meningitis in the State of Amazonas, Brazil

INTRODUCTION In the State of Amazonas, particularly in the capital Manaus, meningitis has affected populations of different cultures and social strata over the years. Bacterial meningitis is caused by several different species and represents a major issue of public health importance. The present study reports the meningitis case numbers with different etiologies in Amazonas from January 1976 to December 2012. METHODS Since the 1970s, the (currently named) Tropical Medicine Foundation of Doutor Heitor Vieira Dourado [Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD)] has remained a reference center in Amazonas for the treatment of meningitis through the diagnosis and notification of cases and the confirmation of such cases using specific laboratory tests. RESULTS The foundation has achieved coverage of over 90% of the state medical records for many years. Between 1990 and 2012, meningitis cases caused by Haemophilus influenzae decreased with the introduction of the H. influenzae vaccine. Meningococcal disease previously had a higher frequency of serogroup B disease, but starting in 2008, the detection of serogroup C increased gradually and has outpaced the detection of serogroup B. Recently, surveillance has improved the etiological definition of viral meningitis at FMT-HVD, with enteroviruses, Epstein-Barr virus (EBV) and varicella zoster virus (VZV) prevailing in this group of pathogens. With the advent of acquired immunodeficiency syndrome (AIDS), cryptococcal meningitis has become an important disease in Amazonas. Additionally, infectious meningitis is an important burden in the State of Amazonas. CONCLUSIONS Changes in the epidemiological profile for the different etiology-defined cases are the result of continuous epidemiological surveillance and laboratory capacity improvements and control measures, such as Haemophilus influenzae vaccination.

Tegumentary leishmaniasis in the State of Amazonas: what have we learned and what do we need?

This study evaluated the occurrence of American tegumentary leishmaniasis (ATL) in the State of Amazonas, Brazil, in the last 30 years with emphasis on the last 10 years (2001 to 2010). The disease was predominantly observed in males (76.2%), in the 21- to 30-year-old age group (26.6%) and in extractive workers (43.7%); 3.3% of the cases were the mucosal form. The endemic channel shows the disease seasonality, with a predominance of cases at the beginning and end of each year. The number of cases by municipality in the period of 2001-2010 shows the maintenance of the endemic in the localities where the highest numbers of cases have always been registered, namely, Manaus, Rio Preto da Eva, Itacoatiara and Presidente Figueiredo. The comparison of data from 2001 to 2005 and from 2006 to 2010 showed the emergence of this disease in municipalities that had been previously unaffected. In the last years, there has been a significant increase in the activities of control, diagnosis and treatment of leishmaniasis in the State of Amazonas. In conclusion, the historical series of ATL analyzed in this study suggests that the transmission foci remain and are even expanding, though without continuous transmission in the intra- or peridomicile settings. Moreover, the disease will persist in the Amazon while the factors associated with infection acquisition relative to forest exploitation continue to have economic appeal. There is a real expectation of wide variations in disease incidence that can be influenced by climate and economic aspects.