An entomological surveillance system based on open spatial information for participative dengue control

Aedes aegypti is a very efficient disseminator of human pathogens. This condition is the result of evolutionary adaptations to frequent haematophagy, as well as to the colonization of countless types of habitats associated with environmental and cultural factors that favor the proliferation of this mosquito in urban ecosystems. Studies using sensitive methods of monitoring demonstrate that the methods of surveillance used in the Brazilian program do not show the high degrees of the infestation of cities by this vector. To increase the capacity of the health sector, new tools are needed to the practice of surveillance, which incorporate aspects of the vector, place and human population. We describe here the SMCP-Aedes - Monitoring System and Population Control of Aedes aegypti, aiming to provide an entomological surveillance framework as a basis for epidemiological surveillance of dengue. The SMCP-Aedes is uphold in the space technology information, supported by the intensive use of the web and free software to collect, store, analyze and disseminate information on the spatial-temporal distribution of the estimated density for the population of Aedes, based on data systematically collected with the use of ovitraps. Planned control interventions, intensified where and when indicated by the entomological surveillance, are agreed with the communities, relying on the permanent social mobilization.

Associadas a fatores bióticos, climáticos e culturais que favorecem a proliferação do Aedes aegypti em ecossistemas urbanos, adaptações evolutivas à hematofagia freqüente e quase exclusiva em humanos e à colonização de tipos infinitos de habitats, fazem deste mosquito um disseminador extremamente eficiente de patógenos ao homem. Estudos utilizando métodos sensíveis de monitoramento demonstram que os métodos de vigilância usados no programa brasileiro não revelam as elevadas intensidades da infestação das cidades por este vetor. Para ampliar a capacidade do setor de saúde novos instrumentos são necessários à prática da vigilância, incorporando aspectos do vetor, do lugar e das pessoas do lugar. Apresentamos aqui o SMCP-Aedes - Sistema de Monitoramento e Controle Populacional do Ae. aegypti, cuja meta é a instrumentalização da vigilância entomológica como base para a vigilância epidemiológica da dengue. Para isso ele se apóia em tecnologias da informação espacial baseadas no uso intensivo da web e de software livre para coletar, armazenar, analisar e disseminar informações relativas à distribuição espaço-temporal da densidade estimada para a população do Aedes, com base em amostras obtidas continuamente com ovitrampas. Intervenções de controle planejadas e intensificadas onde e quando indicado pela vigilância entomológica, são pactuadas com os habitantes, apoiando-se na mobilização social permanente.

Evaluation of real time PCR technique to diagnosis of human T-lymphotropic virus type I (HTLV-I) in patients in the Hematologia da Fundação Hemope Hospital, in Northeastern Brazil / Avaliação da técnica de PCR em tempo real para o diagnóstico do virus linfotrópico tipo I de células T humana (HTLV-I) em pacientes do Hospital de Hematologia da Fundação Hemope, no Nordeste do Brasil

As a high degree of homology exists between the proviral genomes of HTLV-I and HTLV-II, there is significant cross-reactivity. Therefore although detection of HTLV antibodies is characteristic of viral infection, it is not sufficient to confirm the presence of the viral type. Molecular tests used to diagnose the HTLV-I/II viruses are based oninvestigations of proviral genomic sequences, and allow for an infection to be diagnosed prior to the appearance of any sign or symptom. The HTLV proviral load in infected individuals can be determined using real-time PCR, a faster method with less risk of contamination than simple or nested PCR. We analyzed 63 samples from the Hemope Hospital, of which 33 were from HTLV seropositive individuals and 30 from blood donors, to determine the type of virus and the proviral load. The sensitivity of qualitative PCR in comparison to ELISA was 87.5% (95% IC: 70.1 - 95.9%) and the specificitywas 100% (IC 95%: 85.9 - 100.0%). The sensitivity and specificity of real-time PCR in comparison to the serological test (ELISA) were 100% (95% IC: 86.7 - 100.0%) and 96.67% (95% IC: 80.9 - 99.8%) respectively. The proviral load in the seropositiveindividuals ranged from 13 to 343820 copies/106 PBMC cells. Our study also observed that individuals with TSP/HAM had a higher proviral load than those who showed no symptoms. The use of real time PCR for routine clinical testing of infected individuals will play a significant role in identifying the virus type and determining the proviral load, thereby providing more appropriate treatment.

Como os genomas provirais do HTLV-I e HTLV-II exibem grande homologia, há uma expressiva sororeatividade cruzada. Assim, a detecção de anticorpos anti-HTLV-I/II embora caracterize infecção viral, não permite estabelecer distinção entre os agentes. Os testes moleculares empregados para o diagnóstico dos vírus HTLV-I/II, baseiam-se na pesquisa de seqüências genômicas provirais permitindo o diagnóstico da infecção antes de aparecer sinal ou sintoma. A carga proviral de HTLV pode ser determinadaatravés da utilização da PCR em tempo real, uma técnica rápida e com menor risco de contaminação que a PCR simples ou nested PCR. Analisamos, 63 amostras do Hospital HEMOPE, das quais 33 foram de indivíduos com sorologia reagente para HTLV e 30 de doadores de sangue, para determinar o tipo de vírus e a carga proviral. A sensibilidade da PCR qualitativa emrelação ao ELISA foi de 87,9% (IC 95%: 70,9-96,0%) e a especificidade foi de 100% (IC 95%: 85,9-100,0%). A sensibilidade e especificidade da PCR em tempo real foram de 100% (IC95%: 86,7-100,0%) e 96,67% (IC 95%: 80,9-99,8%), respectivamente.A carga proviral variou entre 13 cópias/106 células PBMC e 343820 cópias/106 células PBMC. Nosso estudo também observou que os indivíduos com PET/MAH tiveram carga proviral mais elevada que a dos indivíduos assintomáticos. A utilização da PCR em tempo real na rotina clínica dos indivíduos infectados poderá desempenhar um papel relevante na identificação do vírus e na determinação da carga proviral, contribuindo para direcionar um tratamento adequado.

Antibody isotype responses to egg antigens in human chronic Schistosomiasis mansoni before and after treatment

In the present communication we analyzed the levels of IgG1, IgG2, IgG3, IgG4 and IgE isotypes to soluble egg antigen of Schistosoma mansoni by ELISA in individuals from an endemic area for schistosomiasis in Northeast Brazil. The analysis was performed before and after treatment to evaluate the age-dependent pattern, and to identify differences in the reactivities to antigens. Our results suggest that schistosomiasis treatment would not interfere with this sort of immune response

Radiographic features of pulmonary tuberculosis in patients infected by HIV: is there an objective indicator of co-infection?

This study aimed to compare the radiographic characteristics of patients with pulmonary tuberculosis (TB) and human immunodeficiency virus (HIV) infection with those of HIV-negative patients. In all, 275 TB patients attending the outpatients clinics at the University Hospital/UFPE, were studied from January 1997 to March 1999. Thirty nine (14.2%) of them were HIV(+), with a higher frequency of males in this group (p=0.044). Seventy-five percent of the HIV(+) patients and 19% of the HIV(-) had a negative tuberculin test (PPD) (p < 0.001). The proportion of positive sputum smears in the two groups was similar. The radiological finding most strongly associated with co-infection was absence of cavitation (p < 0.001). It may therefore be concluded that the lack of cavitation in patients with pulmonary TB may be considered a useful indicator of the need to investigate HIV infection. This approach could contribute to increasing the effectiveness of local health services, by offering appropriate treatment to co-infected patients.

Este trabalho objetivou comparar características radiológicas de doentes com tuberculose (TB) pulmonar, soropositivos para o vírus da imunodeficiência humana (HIV), com aquelas de doentes HIV-. Estudou-se, prospectivamente, 275 doentes com TB pulmonar, atendidos no Hospital das Clínicas da UFPE, entre janeiro de 1997 e março de 1999. Destes, 39 (14,2%) eram HIV+, com um predomínio maior de homens neste grupo (p=0,044). setenta e cinco por cento dos doentes HIV+ e 19% dos HIV- apresentavam reação negativa ao teste tuberculínico (PPD) (p<0,001). A proporção de baciloscopias positivas nos dois grupos foi semelhante. A característica radiológica mais fortemente associada à co-infecção tuberculose pulmonar/HIV+ foi a ausência de cavidades (p<0,001). Conclui-se que, diante de doentes com TB pulmonar, a ausência de cavidades na telerradiografia de tórax constitui-se num indicador útil da necessidade de se investigar a infecção pelo HIV. Esta conduta pode contribuir para aumentar a efetividade dos serviços locais de saúde, permitindo oferecer tratamento adequado a estes doentes.

Intestinal helminthiasis and anaemia in youngsters from Matriz da Luz, district of Säo Lourenço da Mata, State of Pernambuco, Brazil

A group of youngsters (4-18 years old) in northeast Brazil was studied to stablish the prevalence of anaemia and intestinal parasitism, as well as to analyse the correlation between them. Two criteria were used to determine the state of anaemia, the level of haemoglobin and the mean of corpuscular volume. The first was considered a single criterion and the second an associated criteria, used in an attempt to correlate anaemia with iron deficiency. The prevalence of intestinal parasitism was 93 per cent while the prevalence of anaemia was 43.1 per cent and 16.1 per cent according to the criteria employed (single or associated respectively). Anaemia was significantly associated with both sex and age. No significant statistical difference was observed when the association was made between each parasite and anaemia even with those more related to anaemia.

Factors involved in Schistosoma mansoni infection in rural areas of northeast Brazil

Two contiguous villages in Tracunhaem country (State of Pernambuco) endemic for schistosomiasis, were studied: Itapinassu (138 inhabitants) and Sao Joaquim (91 inhabitants). Agriculture predominates in the former region while ceramics is the main activitiy in the latter. Although no statistical difference was found regarding prevalence, severe infection (<400 epg) predominated in Itapinassu, probably related to the kind of occupation. No association was found between parasite burden and severity of disease, in spite of the high infection rates for Schistosoma mansoni in both communities (aprox. 60 per cent). Typical epidemiological features of schistosomiasis such as age-realted prevalences and intensities of infection (high in children, low in adults) were also mutual characteristics. Nutritional status determined through anthropometric evaluation was carried out by measuring specific anthropometric indicators. A deficit of energy intake, as well as vitamin A and riboflavin deficiencies were detected. The prevalence of moderate or severe undernutrition in patients under 18 years old was 21.9 per cent in Itapinassu and 24.1 per cent in Sao Joaquim. In this group as association was found between prevalence of schistosomiasis and chronic undernutrition. Similarly, for patients over 18 years old the prevalence of undernutrition was higher than 20 per cent. However, in this case no association between nutritional status and either prevalence of schistosomiasis or parasite burden could be detected. The two communities had not been treated for eight years.