Zélia Maria Profeta da Luz

An experimental and clinical assay with ketoconazole in the treatment of Chagas disease

Ketoconazole, an azole antifungic drug which is already in the market has also been demonstrated to be active against Trypanosoma cruzi experimental infections. In this paper we confirmed the drug effect and investigated its range of activity against different T. cruzi strains naturally resistant or susceptible to both standard drugs Nifurtimox and Benznidazole used clinically in Chagas disease. Moreover, we have shown that the association of Ketoconazole plus Lovastatin (an inhibitor of sterol synthesis), which has an antiproliferative effect against T. cruzi in vitro, failed to enhance the suppressive effect of Ketoconazole displayed when administered alone to infected mice. Finally, administration in chronic chagasic patients of Ketoconazole at doses used in the treatment of deep mycosis also failed to induce cure as demonstrated by parasitological and serological tests. The strategy of identify and test drugs which are already in the market and fortuitously are active against T. cruzi has been discussed.

Hemocultura: técnica sensível na detecção do Trypanosoma cruzi em pacientes chagásicos na fase crônica da doença de Chagas

The sensitivity of hemocultures, performed once or three times, was investigated in 52 patients in the chronic phase of Chagas disease. Modifications were introduced in the technique such as, processing the blood more rapidly, gently homogenizing the cultures and examining them after 120 days of culture. Our results show a high percent age of positivity i.e. 79% and 94% of patients submitted, respectively, to one or three tests. No significant differences related to the patients age were detected, which varied from 14 to 82 years old. Our results demonstrate that hemoculture is a sensitive method for the parasitological diagnosis of Chagas disease and is ideal for monitoring cure in treated patients.A sensibilidade de hemoculturas, realizadas uma ou tres vezes, foi estudada em 52 pacientes na fase cronica da doenca de Chagas. Modificacoes foram introduzidas na tecnica tais como, diminuicao do periodo de processamento do sangue, homogeneizacao suave e exame ate 120 dias do cultivo. Os resultados mostram alto percentual de positividade, ou seja, 79% e 94% dos pacientes foram positivos, respectivamente, com um ou tres testes. A julgar pela numero de tubos positivos, em cada paciente, a parasitemia foi baixa em 59% deles, media em 16% e alta em 25%. Nao houve diferencas significativas nos resultados positivos em funcao da idade dos pacientes, que variou de 14 a 82 anos. Nossos resultados demonstram que a hemocultura e uma metodologia sensivel para o diagnostico parasitologico da doenca de Chagas e ideal para monitorar cura em pacientes submetidos a tratamento.

Evaluation of a pamphlet on visceral leishmaniasis as a tool for providing disease information to healthcare professionals and laypersons

Although educational materials are frequently produced and used as part of control programs in Brazil, little is known about the efficacy of this type of information. This study evaluated the potential for disseminating information on visceral leishmaniasis using a pamphlet. The sample consisted of 551 healthcare workers and 379 laypeople from a metropolitan area located in southeast Brazil. Both before and after reading the pamphlet, subjects completed a multiple-choice questionnaire. Overall baseline knowledge of the disease was estimated by the proportion of correct answers before reading the pamphlet. Although specific knowledge among zoonosis control workers was higher (90.0% on average), overall baseline knowledge of the disease varied from 45.0% to 77.0%. After reading the pamphlet, the levels increased to 71.0% and 96.0%, respectively. Before reading, the lowest proportion of correct answers in all groups related to the disease symptoms. Analysis of incorrect answers showed that visceral leishmaniasis is mainly confused with leptospirosis. The increased proportion of correct answers after reading the pamphlet is evidence of its potential as an educational tool.

Lesion aspirate culture for the diagnosis and isolation of Leishmania spp. from patients with cutaneous leishmaniasis.

The detection of Leishmania spp. in skin lesion aspirates, using a puncture technique, was evaluated in 76 patients with cutaneous leishmaniasis (CL) who were referred to a Leishmaniasis Reference Centre in Brazil. CL was defined based on skin lesions suggestive of the disease and on a positive result of the Montenegro skin test or Giemsa-stained imprints of biopsy fragments. The aspirates were cultured using a vacuum tube device containing culture medium and evaluated for the presence of Leishmania spp. The biphasic medium culture was examined once a week for three weeks. Promastigotes were observed in 53/76 (69.7%) cultures. Stained smears from 60 of the 76 patients were evaluated using PCR-RFLP to detect the conserved minicircle region of Leishmania spp. and to classify the parasite. Of these patients, 45 (75%) showed positive results in aspirate culture and 15 presented negative results. The PCR was positive in 80% (53/60) samples. The PCR-RFLP profile was determined in 49 samples, of which 45 (92%) showed a pattern compatible with Leishmania (Viannia) braziliensis. The aspirate culture is a sensitive and feasible method for diagnosing CL and may be routinely adopted by health services for L. (V.) braziliensis isolation and identification.

The organization of health services and visceral leishmaniasis: an integrated intervention to improve diagnosis and treatment

The objective of this study, carried out in municipalities located in a metropolitan region of Brazil, was to promote the early diagnosis and prompt treatment of visceral leishmaniasis. In the intervention model a health professional underwent training that covered all procedures involved in assisting patients with suspected visceral leishmaniasis. The professionals then returned to their municipalities where they implemented a workplan with the following aims: (a) at least one physician able to diagnose and treat patients; (b) training of professionals for the laboratorial diagnosis of visceral leishmaniasis; (c) delivery of information on visceral leishmaniasis to the health workers. The implementation process was evaluated by follow-up meetings. Attendance of health professionals at the meetings, implementation of the workplan, and the visceral leishmaniasis case fatality rate before (1998-1999) and after (2001-2002) implementation of the model were used in the analysis. Among the 36 municipalities in the region, 22 were enrolled. Eight (36.3%) guaranteed at least 50% attendance in the meetings, and 14 (63.6%) had less than 50% attendance with no activities implemented. The fatality rate decreased in the municipalities that implemented the activities.

Dissemination of information on visceral leishmaniasis from schoolchildren to their families: a sustainable model for controlling the disease

A model for the dissemination of information on visceral leishmaniasis from schoolchildren to their families was evaluated in two schools in Caeté, Minas Gerais State, Brazil. Age ranged from 9 to 17 years in the two schools, one receiving the intervention (with 92 students) and the other serving as the control (96 students). All the students attended a class and received a pamphlet on visceral leishmaniasis. The intervention consisted of a homework assignment in which the student discussed the class content and pamphlet with a family member. Knowledge by family members (n = 100) on visceral leishmaniasis was evaluated with a pre and post-intervention questionnaire applied by a health agent, who also completed a form on hygiene around the household as observed during the home visit. A significant improvement was observed in knowledge and hygiene (e.g., sweeping of leaves, fruit, and branches from the yards) among the families that were exposed to the intervention (p < 0.05). The spread of information on visceral leishmaniasis by schoolchildren can contribute to measures for preventing the disease.

Identification of Leishmania chagasi from skin in Leishmania/HIV co-infection: a case report

A case of HIV/Leishmania co-infection presenting both visceral and cutaneous manifestations is reported. Leishmania infection was confirmed by conventional methods (parasitological approach and serology) and by PCR. Leishmania chagasi isolated from the skin lesion was characterized by enzyme electrophoresis and by restriction fragment length polymorphism of the internal transcribed spacer of the ribosomal gene.

Análise da informação sobre a leishmaniose visceral disponível em portais brasileiros da rede mundial de computadores: internet

With the aim of analyzing the adequacy of the information on visceral leishmaniasis that is available through Brazilian portals, a survey was conducted through a search portal, with selection and analysis of electronic page content. Twenty-four pages with informative purposes were identified, of which eight belonged to government bodies, 10 were commercial and six were classified as others. Using a systematized analysis form, the content of topics considered essential, relating to transmission, reservoirs, control and disease, was evaluated. The regulatory manuals of the Ministry of Health and the scientific literature were defined as the standards for information. High percentages of absences of information relating to the topics discriminated in each of the four content categories were observed in all of the pages. Analysis of the adequacy of the information, when it was present, showed 100% adequacy on the pages of the government bodies and the others. However, the commercial pages displayed high percentages of incorrect or incomplete information, particularly in the disease category. Overall, the content on leishmaniasis on the electronic pages analyzed was considered to be of low informative value.

Assessment of informative material on leishmaniasis distributed in Brazil: criteria and improvement of health educational material.

Based on categories related to structure, content, language, and illustrations, the present study provides an evaluation of the quality of educational materials on leishmaniasis available to health services in Brazil. The 18 publications evaluated consisted of four handbooks, four guided studies, four booklets, and six leaflets. Of the total publications assessed, nine were produced by the Brazilian National Health Foundation (FUNASA), five by State and Municipal Health Departments jointly with FUNASA, and one by the Pan-American Health Organization. The evaluations were also performed by three professionals: a physician specialized in leishmaniasis, a parasitologist, and an information/communications expert. The publications failed to specify key items such as target public, objective, and bibliography. The illustrations, especially in the booklets and leaflets, failed to clarify the text, portrayed biased concepts, and omitted credits and scale. According to this study, informative materials on leishmaniasis distributed in Brazil present major limitations which jeopardize the quality of information they contain.

Avaliação da implantação do Sistema de Informação sobre Nascidos Vivos em municípios de Minas Gerais, Brasil

This study evaluated the degree of implementation of the Information System on Live Births (SINASC) and its relationship to the organizational context in municipalities (counties) of Minas Gerais State, Brazil, in 2010. The sample included 132 municipalities that had healthcare facilities providing childbirth care and the decentralized SINASC. Data collection used a semi-structured questionnaire. Degree of implementation was defined by a scoring system with different weights for each indicator, according to the respective levels of importance assigned to them, using the following classification: adequate, inadequate, and critical. Data analysis used the median as the summary measure and the Pearson chi-square test for comparison of proportions. SINASC is not adequately implemented in the majority of the municipalities in the sample. Population size and quality of the municipal administration did not influence the degree of implementation. In terms of organization of information in the SINASC, the structure was evaluated as better than the process. Limitations included lack of qualified staff, unsatisfactory collection and completion of certificates of live birth, underutilization of data, and limited publication of the information.Estudo avaliativo do grau de implantacao do Sistema de Informacoes sobre Nascidos Vivos (SINASC) em municipios de Minas Gerais, Brasil, em 2010. Foram avaliados 132 municipios dotados de estabelecimentos de saude onde ocorriam partos e que tinham o SINASC descentralizado. Para a coleta de dados, utilizou-se um questionario semiestruturado. O grau de implantacao foi definido por meio de um sistema de escores, com pesos diferenciados para cada indicador, segundo nivel de importância atribuido, sendo classificado como: adequado, nao adequado e critico. Para a analise dos dados, utilizou-se a mediana como medida-resumo e o teste do quiquadrado de Pearson, para a comparacao de proporcoes. O SINASC nao esta implantado adequadamente na maioria dos municipios avaliados. O porte populacional e a condicao de gestao do municipio nao influenciaram o grau de implantacao. Na organizacao da informacao do SINASC, a estrutura foi mais bem avaliada que o processo. Como limitacoes, destacam-se insuficiencia de profissional qualificado, coleta e preenchimento da Declaracao de Nascidos Vivos insatisfatorios, subutilizacao dos dados e precaria divulgacao das informacoes.