Lesões orais e correlação com aspectos clínicos, epidemiológicos e laboratoriais da paracoccidioidomicose / Oral lesions and correlation with clinical, epidemiological and laboratory aspects of paracoccidioidomycosis

Introdução: a paracoccidioidomicose (PCM) é uma micose sistêmica endêmica cuja incidência vem aumentando de forma significativa na região norte do Brasil. Duas espécies, Paracoccidioides brasiliensis e Paracoccidioides lutzii podem causar a doença. A última aparenta ter maior importância em Rondônia, estado com as maiores taxas de incidência e mortalidade por PCM do Brasil. Objetivo: descrever as características clínicas, epidemiológicas e laboratoriais de pacientes portadores de PCM e estabelecer correlação com lesões orais. Material e Métodos: estudo retrospectivo de pacientes atendidos no Centro de Referência em Medicina Tropical de Rondônia durante o período de janeiro de 2013 a dezembro de 2016. Resultados: foram diagnosticados 107 pacientes com média de idade de 53,8 anos, sendo 100 homens e 07 mulheres. Observou-se que 77% mantinham contato ou relataram experiência anterior com lavoura. A maioria (98,1%) apresentou a forma crônica da doença. O diagnóstico foi confirmado em 74,7%, e baseado em achados clínicos e/ou epidemiológicos no restante. O diagnóstico sorológico não esteve disponível no período. O tempo médio entre o início dos sintomas e a realização do diagnóstico foi de 7,3 meses. Os principais locais acometidos foram os pulmões (95,3%), seguidos da cavidade oral (55,1%) e dos gânglios (28%). Na cavidade oral, a faringe/laringe predominou (33%), seguida da mucosa jugal (17,8%) e palato mole (13,1%). Houve 58,3% de associação com tabagismo. O medicamento mais utilizado para o tratamento foi o Itraconazol, fornecido pelo governo. Conclusão: não houve diferença entre os grupos com ou sem comprometimento da cavidade oral. A presença de lesões orais em mais da metade dos casos, com diagnóstico mais acessível, sugere que se pode diminuir o tempo entre o início dos sintomas e o início do tratamento, e contribuir para uma menor proporção de sequelas. Sugere-se ainda que o P. lutzii pode manifestar doença com características clínicas, epidemiológicas e laboratoriais semelhantes ao P. brasiliensis, exceto pela menor proporção de formas agudas de PCM. Mas novos estudos são necessários(AU)

Background: Paracoccidioidomycosis (PCM) is an endemic systemic mycosis whose incidence has been increasing significantly in the northern region of Brazil. Two species, Paracoccidioides brasiliensis and Paracoccidioides lutzii can cause the disease. The latter appears to be more important in Rondônia, the state with the highest incidence and mortality rates by PCM in Brazil. Objective: To describe the clinical, epidemiological and laboratory characteristics of PCM patients and to establish correlation with oral lesions. Material and Methods: a retrospective study of patients attended at the Reference Center in Tropical Medicine of Rondônia during the period from January 2013 to December 2016. Results: A total of 107 patients were diagnosed, with mean age of 53.8 years, 100 men and 7 women. It was observed that 77% maintained contact or reported previous experience with rural areas. The majority (98.1%) presented the chronic form of the disease. The diagnosis was confirmed by the finding of the fungus in clinical specimens in 74.7%, and based on clinical and/or epidemiological findings in the rest. The serological diagnosis was not available in the period. The mean time between onset of symptoms and the diagnosis was 7.3 months. The main sites were the lungs (95.3%), followed by the oral cavity (55.1%) and the ganglia (28%). In the oral cavity, the pharynx/larynx predominated (33%), followed by jugal mucosa (17.8%) and soft palate (13.1%). There was an 58,3% association with smoking. The most commonly used drug was Itraconazole in 93.5% of patients. Conclusion: There was no difference between groups with or without oral cavity involvement. The presence of oral lesions in more than half of the cases, with a more accessible diagnosis, suggests that the time between onset of symptoms and the beginning of treatment can be shortened and contribute to a lower proportion of sequelae. It is also suggested that P. lutzii can manifest disease with clinical, epidemiological and laboratory characteristics similar to P. brasiliensis, except for the smaller proportion of acute forms of PCM. But new studies are needed(AU)

Enteropathogens associated with diarrheal disease in infants of poor urban areas of Porto Velho, Rondônia: a preliminary study

One hundred and thirty cases of diarrhea and 43 age-matched controls, 0 to 5 years old, were studied in a pediatric outpatient unit from a poor peri urban area of Porto Velho, Rondônia. Eighty percent of diarrheal cases were observed in the groups under 2 years of age. Rotavirus (19.2 percent) was the most frequent enteropathogen associated with diarrhea, followed by Shigella flexneri (6.15 percent) and S. sonnei (1.5 percent) and Salmonella sp. (6.9 percent). Four cases of E. coli enterotoxigenic infections (3.1 percent), E. coli enteropathogenic (EPEC)(2.3 percent) one case of E. coli enteroinvasive infection (0.8 percent) and one case of Yersinia enterocolitica (0.8 percent) were also identified. Mixed infections were frequent, associating rotavirus, EPEC and Salmonella sp. with Entamoeba histolytica and Giardia lamblia

Antimalarial drug susceptibility testing of Plasmodium falciparum in Brazil using a radioisotope method

From March 1996 to August 1997, a study was carried out in a malaria endemic area of the Brazilian Amazon region. In vivo sensitivity evaluation to antimalarial drugs was performed in 129 patients. Blood samples (0.5 ml) were drawn from each patient and cryopreserved to proceed to in vitro studies. In vitro sensitivity evaluation performed using a radioisotope method was carried out with the cryopreserved samples from September to December 1997. Thirty-one samples were tested for chloroquine, mefloquine, halofantrine, quinine, arteether and atovaquone. Resistance was evidenced in 96.6 percent (29/30) of the samples tested for chloroquine, 3.3 percent (1/30) for quinine, none (0/30) for mefloquine and none for halofantrine (0/30). Overall low sensitivity was evidenced in 10 percent of the samples tested for quinine, 22.5 percent tested for halofantrine and in 20 percent tested for mefloquine. Means of IC 50 values were 132.2 (SD: 46.5) ng/ml for chloroquine, 130.6 (SD: 49.6) ng/ml for quinine, 3.4 (SD: 1.3) ng/ml for mefloquine, 0.7 (SD: 0.3) ng/ml for halofantrine, 1 (SD: 0.6) ng/ml for arteether and 0.4 (SD: 0.2) ng/ml for atovaquone. Means of chloroquine IC 50 of the tested samples were comparable to that of the chloroquine-resistant strain W2 (137.57 ng/ml) and nearly nine times higher than that of the chloroquine-sensitive strain D6 (15.09 ng/ml). Means of quinine IC 50 of the tested samples were 1.7 times higher than that of the low sensitivity strain W2 (74.84 ng/ml) and nearly five times higher than that of the quinine-sensitive strain D6 (27.53 ng/ml). These results disclose in vitro high resistance levels to chloroquine, low sensitivity to quinine and evidence of decreasing sensitivity to mefloquine and halofantrine in the area under evaluation