Maria José Conceição

Cat-Transmitted Sporotrichosis Epidemic in Rio de Janeiro, Brazil: Description of a Series of Cases

Sporotrichosis is the most common subcutaneous mycosis in South America. Classic infection is associated with traumatic inoculation of soil, vegetables, and organic matter contaminated with Sporothrix schenckii. Zoonotic transmission has been described in isolated cases or in small outbreaks. Since 1998, we have been observing an increasing number of cases of sporotrichosis in persons from the city of Rio de Janeiro, Brazil, and surroundings. From 1998 to 2001, 178 cases of culture-proven sporotrichosis had been diagnosed. Female patients predominated, and the median age was 39 years. The most frequent clinical presentation was lymphocutaneous disease. Of the 178 patients, 156 reported domiciliary or professional contact with cats with sporotrichosis, and 97 of these patients had a history of receipt of cat scratch or bite. The patients received itraconazole as first-line treatment. This study suggests that feline transmission of sporotrichosis was associated with a large and long-lasting outbreak of the disease in Rio de Janeiro.

Study of Schistosoma mansoni isolates from patients with failure of treatment with oxamniquine

After three successive treatments with oxamniquine the continuing elimination of Schistosoma mansoni eggs was observed in patients, who came from various regions of Brazil, with different clinical forms of schistosomiasis. The objective of the present study was to determine the experimental behaviour of five different S. mansoni isolates in Swiss Webster mice that were submitted to treatment with the same drug. The experimental group with failure of treatment showed higher mean number of surviving male worms when it was compared to the group without failure of treatment. These date suggest the possibility of resistance to oxamniquine.

Prognosis of schistosomiasis mansoni patients infected with hepatitis B virus

A clinical study on the evolution of patients with schistosomiasis mansoni has been conducted since 1983 at the outpatient clinic of the Infectious and Parasitic Disease Service in the Clementino Fraga Filho University Hospital in Rio de Janeiro, Brazil, comparing prevalence of positive tests for HBsAg, anti-HBsAg, and anti-HBc among patients infected with Schistosoma mansoni coming from various regions of Brazil and with different clinical forms of the disease. A non-significant predominance of HBsAg, anti-HBsAg, and anti-HBc was detected among patients with the hepatosplenic form of schistosomiasis, who presented a more severe clinical evolution with a higher frequency of hematemesis and/or melena, in addition to the development of macronodular cirrhosis and a worse prognosis as compared to patients with the toxemic form, schistosomiasis-infection and the hepatointestinal form.

Specific schistosomiasis treatment as a strategy for disease control

The great hope for schistosomiasis treatment began with the development of oxamniquine and praziquantel. These drugs can be administered orally in a single dose and have a high curative power with minor side effects. In this study, we carried out a field experiment involving a population of 3,782 people. The population was examined at four localities in Minas Gerais within the valleys of the Doce and Jequitinhonha Rivers. In this cohort, there were 1,790 patients infected with Schistosoma mansoni (47.3%) and we showed that only 1,403 (78.4%) could be treated with oxamniquine in a single dose of 12.5-20 mg/kg orally. The other 387 (21.6%) were not treated during the first stage because of contraindications (pregnancy or impeditive diseases), absences or refusals. It was observed that, on average, 8.8-17% of the infected patients continued to excrete S. mansoni eggs at the end of the 2nd month after treatment and 30-32% of the cohort was infected by the end of the 24th month. In one of the areas that we followed-up for a total of 30 years, the prevalence of the infection with S. mansoni fell from 60.8-19.3% and the hepatosplenic form of the disease dropped from 5.8-1.3%. We conclude that specific treatment of schistosomiasis reduces the prevalence of infection in the short-term and the morbidity due to schistosomiasis in medium to long-term time frames, but does not help to control disease transmission.

A thirty years follow-up study on Schistosomiasis mansoni in a community of Minas Gerais, Brazil

During thirty years - 1973-2003 - a group of individuals infected by Schistosoma mansoni in Capitão Andrade, Rio Doce Valley, Minas Gerais, Brazil, was evaluated by the same authors, being one of the longest follow-up studies on schistosomiasisis mansoni in an endemic area. The diagnosis of S. mansoni was based on parasitological stool tests. In the clinical classification, three groups were considered: type I - schistosomiasis-infection, type II - hepatointestinal form, and type III- hepatosplenic form. The prevalence of infection were 60.8% in 1973, 36.2% in 1984, 27.3% in 1994, and 19.4% in 2003, while the index of hepatosplenomegaly were respectively 5.8%, 2.8%, 2.3% and 1.3%. The maintenance of high prevalence and severity of clinical forms are probably related to reinfection.

Cross-sectional and evolutive studies of schistosomiasis mansoni in untreated and mass treated endemic areas in the southeast and northeast of Brazil

Cross-sectional and evolutive studies on schistosomiasis mansoni were carried out before and after mass treatment in the endemic areas of Capitão Andrade and Padre Paraiso, state of Minas Gerais, Riachuelo, state of Sergipe, Alhandra, state of Paraiba, and Aliança, Alegre and Coroatá, lowland of the state of Maranhão, Brazil, in the last eighteen years. The studies included clinical and fecal examination by the Kato-Katz quantitative technique, skin test for Schistosoma mansoni infection, evaluation of man-water contact and other epidemiological investigations such as infection rate and dynamic of the snail population. Results showed: (1) Higher prevalence of S. mansoni infection, greater egg load elimination and higher and earlier morbidity of the chronic forms of the disease in the southeast areas of Capitão Andrade and Padre Paraiso; (2) The incidence of hepatosplenic form is higher in some family clusters, in whites and mulattos in all the endemic areas but develop earlier in the southeast; (3) The prevalence and morbidity of schistosomiasis are decreasing both in the mass treated northeast and in the untreated southeast areas; (4) The mass treatment reduces rapidly the prevalence of the infection and the morbidity of the disease but can not control it because of the frequent reinfections due to the intensity of man-water contact.

Ascaris lumbricoides, Ascaris suum, or “Ascaris lumbrisuum”?

Financial support. This work was supported by the Fundacao de Amparo a Pesquisa do Estado do Rio de Janeiro, Universidade Federal Fluminense and Laboratorio de Doencas Parasitarias, Instituto Oswaldo Cruz-Fiocruz. The authors thank Andre Barbosa for their technical support and UFF-Platform sequencing.

Schistosomiasis haematobia: histopathological course determined by cystoscopy in a patient in whom praziquantel treatment failed

Schistosomiasis haematobia or urinary schistosomiasis is one of the main public health problems in Africa and the Middle East. A single dose of 40 mg praziquantel per kg body weight continues to be the treatment of choice for this infection. The aims of this follow-up were to study the post-treatment course of a patient infected with S. haematobium and not submitted to re-exposure, and to identify complications of the disease and/or therapeutic failure after praziquantel treatment by histopathological analysis. Treatments were repeated under medical supervision to ensure the correct use of the drug. In view of the suspicion of lesions in cystoscopy, the patient was submitted to bladder biopsy. The histopathological characteristics observed in biopsies obtained, after each treatment, indicated viability of parasite eggs and activity of granulomas.

Morbidade da esquistossomose mansoni no brasil. Ii-estudo em quatro areas de campo nos estados de minas gerais sergipe e paraiba

The authors have carried out a comparative study on the morbidity of schistosomiasis mansoni in four field areas of Brazil, two in the Southeast Region (Capitao Andrade, Itanhomi Municipality, and Padre Paraiso, both in Minas Gerais State) and two others in the Northeast Region (Riachuelo, Sergipe State and Alhandra, Paraiba State). The total sample studied in the four areas was 4,870, divided as follows: Capitao Andrade (area1) - 1,369; Riachuelo (area 2) - 850; Padre Paraiso (area 3) - 1,736; and Alhandra (area 4) - 915. In area 1, with a total population of 1,480 inhabitants, a study of the entire population was attempted. In areas 2, 3, and 4, due to the large number of inhabitants, a systematic sample by conglomerates was studied, of approximately 25 per cent of the population (family grouping of one in every four residences). The study consisted of an evaluation of the economic and sanitary conditions of the population, of contact with the local foci of transmission of schistosomiasis, of the frequency and intensity of infection by S. mansoni and of the relation between parasite load and the different clinical forms of the disease in different age groups. In parallel, a study was carried out of the intermediate hosts in each area and of the frequency of infection with S. mansoni cercariae. The prevalence of active S. mansoni infection was 60.8, 50.5, 63.1 and 46.6 per cent in areas 1, 2, 3 and, with a median egg elimination of 207, 77.6, 391 and 211 per gram, respectively. Progressive increases in frquency of infection of parasite load and of serious forms of the disease were observed from the first to the third decade in the areas of the Southeast Region and a later increase in the same parameters in the Northeast Region. Other correlations between clinical forms of the disease and age groups, sex, and ethnical origins of the patients, as well as frequency among the planorbids, were carried out.

Correlação entre carga parasitária de S. mansoni e gravidade das formas clínicas em uma comunidade rural de Minas Gerais

Strong correlation was observed between severe cases in 11 to 15 years oid and higher infection rates as shown by the average number of eggs of S. mansoni per gram of faeces.