Maria Zélia Fernandes

An urban outbreak of visceral leishmaniasis in Natal, Brazil

The epidemiological pattern of visceral leishmaniasis in north-eastern Brazil is changing. The disease was typically seen in rural, endemic areas, but is now occurring as an epidemic in the city of Natal where 316 cases have been reported since 1989; 49% were in children less than 5 years of age. The principle clinical and laboratory findings were weight loss, fever, hepato-splenomegaly, anaemia, leucopenia and hypergammaglobulinaemia. Elevated transaminases and hyperbilirubinaemia were also observed. The diagnosis was confirmed in 87% of cases by identifying amastigotes in aspirates from bone marrow or spleen. Five isolates were identified as Leishmania (L.) chagasi by isoenzyme analysis. The mortality rate was 9%; all deaths occurred during the first week in hospital. One person had concurrent human immunodeficiency virus infection. Among 210 household contacts and neighbours of patients from the endemic area examined for evidence of L. (L.) chagasi infection, 6 additional cases of visceral leishmaniasis were diagnosed. Thirty-eight percent of house-mates and neighbours gave a positive Montenegro skin test reaction, indicating prior subclinical infection.

Evaluation of an oral preventive protocol in children with acute lymphoblastic leukemia

This study was designed to assess the effectiveness of a preventive oral protocol in children receiving antineoplastic treatment for acute lymphoblastic leukemia (ALL) before initiating a larger intervention study. During a seven month period, fourteen children from two to ten years old with a diagnosis of ALL were evaluated. Patients with ALL who received a 0.12% chlorhexidine mouth rinse (seven children) were compared to a control group of patients who were not given the same preventive treatment (seven children) as to the occurrence of oral mucosal complications. Children in both groups received daily oral hygiene care, and were examined daily by the pediatric dentistry team until discharge. A significant decrease in the incidence of oral mucositis and ulceration was observed in the children who received a 0.12% chlorhexidine mouth rinse (p < 0.05 by Fishers exact test). The findings obtained in the present trial are encouraging, and suggest that the systematic application of a preventive protocol reduces the incidence of oral complications in children with ALL receiving chemotherapy.

Evaluación clínica de la salud oral de niños con neoplasias malignas

Objetivo: este estudio de caracter descriptivo viso evaluar clinicamente ninos con neoplastias malignas y poner de manifiesto la relacion entre es status de salud bucal y la ocurrencia de complicaciones estomatologicas. Pacientes y metodos: la salud bucal de 40 ninos con neoplasias malignas (grupo I) fue evaluada clinicamente mediante examen fisico extra e intra oral, obtencion del indice de placa visible, indice de sangrado gingival e indice de dientes cariados, ausentes y obturados y simultaneamente fueron observadas las complicaciones qestomatologicas desarrolladas en esos pacientes. El status de salud bucal de estos ninos fue comparado al de ninos saludables (grupo II). Resultados: los ninos del grupo I presentaron indices de sangrado gingival y experiencia de caries menores que los del grupo II, por otro lado, el indice de placa visible fue ligeramente mayor en los ninos del grupo I, sin embargo, solo hubo diferencia estadisticamente significativa en el valor del CAO-D/cao-d entre ambos grupos (p=0.002). En el grupo I, 16 ninos desarrollaron conjuntamente 61 complicaciones estomatologicas, con predominancia de la mucositis, seguida de sangrado oral espontaneo, candidiasis y xerostomia. COnclusion: pacientes bajo tratamiento antineoplasico, presentando higiene oral deficiente, tienen mayor riesgo de desarrollar complicaciones estomatologicas

Socioeconomic and demographic characteristics of sickle cell disease patients from a low-income region of northeastern Brazil

Objective To characterize the socioeconomic and demographic aspects of sickle cell disease patients from the state of Rio Grande do Norte (RN), Northeast Brazil, and their adherence to the recommended treatment. Methods This cross-sectional descriptive study was performed at referral centers for the treatment of hematological diseases. One hundred and fifty-five unrelated individuals with sickle cell disease who went to these centers for outpatient visits were analyzed. All the patients, or their caregivers, were informed about the research procedures and objectives, and answered a standardized questionnaire. Results The patients were predominantly younger than 12 years old, self-declared as mulatto, lived in small towns fairly distant from the referral center, and had low education and socioeconomic levels. Individuals who were ten or younger were diagnosed at an earlier age. Almost 50% of the patients were taking hydroxyurea, 91.4% reported having received pneumococcal/meningococcal vaccinations and 76.1% received penicillin as antibiotic prophylaxis. However, the majority of them reported having difficulties following the recommendations of the physicians, mainly in respect to attaining the prescribed medications and transportation to the referral centers. Conclusion These individuals have a vulnerable socioeconomic situation that can lead to an aggravation of their general health and thus deserve special attention from the medical and psychosocial perspectives. Thus, it is necessary to improve public policies that provide Brazilian sickle cell disease patients with better access to medical treatment, living conditions, and integration into society.

Comparative analyses of whole genome sequences of Leishmania infantum isolates from humans and dogs in northeastern Brazil

The genomic sequences of 20 Leishmania infantum isolates collected in northeastern Brazil were compared with each other and with the available genomic sequences of 29 L. infantum/donovani isolates from Nepal and Turkey. The Brazilian isolates were obtained in the early 1990s or since 2009 from patients with visceral or non-ulcerating cutaneous leishmaniasis, asymptomatic humans, or dogs with visceral leishmaniasis. Two isolates were from the blood and bone marrow of the same visceral leishmaniasis patient. All 20 genomic sequences display 99.95% identity with each other and slightly less identity with a reference L. infantum genome from a Spanish isolate. Despite the high identity, analysis of individual differences among the 32 million base pair genomes showed sufficient variation to allow the isolates to be clustered based on the primary sequence. A major source of variation detected was in chromosome somy, with only four of the 36 chromosomes being predominantly disomic in all 49 isolates examined. In contrast, chromosome 31 was predominantly tetrasomic/pentasomic, consistent with its regions of synteny on two different disomic chromosomes of Trypanosoma brucei. In the Brazilian isolates, evidence for recombination was detected in 27 of the 36 chromosomes. Clustering analyses suggested two populations, in which two of the five older isolates from the 1990s clustered with a majority of recent isolates. Overall the analyses do not suggest individual sequence variants account for differences in clinical outcome or adaptation to different hosts. For the first known time, DNA of isolates from asymptomatic subjects were sequenced. Of interest, these displayed lower diversity than isolates from symptomatic subjects, an observation that deserves further investigation with additional isolates from asymptomatic subjects.

New challenges in the epidemiology and treatment of visceral leishmaniasis in periurban areas

Visceral leishmaniasis (VL) represents a major public health problem in many areas of the world. This review focuses on the impact of periurbanization on the epidemiology and treatment of VL, using Brazil as an example. VL continues to be primarily a disease of poverty with impact on families. However, the disease has expanded in Latin America, with foci reported as far south as Argentina. There is an increasing overlap of Leishmania infantum chagasi and human immune deficiency virus (HIV) infections and other immunosuppressive conditions, resulting in the emergence of VL as an opportunistic infection. This new setting poses new challenges for VL disease control and patient management. Drug Dev Res 72:451–462, 2011.

Incidência pós-transfusional do HBsAg em crianças com doenças neoplásicas

There are 350 million individuals infected by the hepatitis B virus (HBV). The development and the severity of the infection depend on several factors, such as: age at the first infection and the immunity response of the subject. The risk of chronic infection is less than 5% for adults and greater than 90% for newborn babies. An individual who is chronically infected by HBV during childhood has a 25% risk of dying due to cirrhosis or liver cancer. This data led the authors to design a study with the objective of estimating the post-transfusion incidence of the hepatitis B virus surface antigen (HBsAg) in children with neoplasias who were transfused during treatment or during the follow up. A retrospective study was performed that revisited 333 medical records from the oncology service in the HIVS from January 1993 to January 2005. The inclusion criteria were: age less than 16 years old, diagnosis of cancer and the results of the HBsAg test. Thus, 199 patients were excluded because they did not fulfill the criteria. The remaining 134 patients’ records were analyzed in regards to blood transfusion. Of the 134 children who satisfied the criteria, 116 were transfused and 18 were not. Results of the HBsAg test were positive in 32.8% of the transfused patients and in only 5.6% of non-transfused individuals. The Fisher Exact Test demonstrated a statistically significant difference (p = 0.023). The ODDS ratio of a transfused patient presenting with reactive results for HBsAG was calculated at 8.28 times greater than non-transfused individuals.