Hemophagocytic lymphohistiocytosis secondary to visceral leishmaniasis in an endemic area in the north of Minas Gerais, Brazil

Abstract INTRODUCTION Visceral leishmaniasis (VL) is an ill-studied disease that is endemic to several regions of Brazil. It is often complicated by hemophagocytic lymphohistiocytosis (HLH), a potentially fatal disorder resulting from excessive non-malignant activation/proliferation of T lymphocytes and macrophages. Considering the overlapping clinical and laboratory characteristics of these diseases, diagnosing HLH is a challenge. Therefore, tracking the association between VL and HLH is necessary in endemic areas. Although HLH can be inapparent and resolve with antileishmanicides, this may not always occur. HLH causes high lethality; therefore, immunosuppressive therapy should be instituted immediately in order to avoid a fatal outcome. METHODS: We described the epidemiological, clinical, laboratory, and therapeutic profile of this association in a region of Brazil endemic for VL. RESULTS We presented 39 patients with this association in a retrospective cohort of 258 children who were admitted from January 2012 to June 2017. Of the 39 patients, 31 were from urban areas (79.5%), and 21 (53%) were males. The mean age and weight were 2.86 (2.08) years and 14.03 (5.96) kg, respectively. The main symptoms were fever (100%), hepatosplenomegaly (100%), pallor of the skin and mucosa (82.5%), edema (38.5%), bleeding (25%), and jaundice (7.5%). Hemophagocytosis was identified in 16/37 (43.24%) patients, and direct examination revealed that 26/37 (70.27%) patients were positive for VL. The patients were treated as recommended by the Ministry of Health. CONCLUSIONS It was observed that HLH is a common complication in endemic areas, and its diagnosis must consider the overlapping of clinical characteristics and pancytopenia.

Estudo da associação entre talassemia alfa e doença falciforme em pacientes do hemocentro regional de Montes Claros / Study of the association between alpha thalassemia and falciform disease in patiensts of the hemocentro regional de Montes Claros

OBJETIVO: Avaliar a coexistência da talassemia alfa (a-Tal) e sua interferência no curso clínico dos pacientes com Doença Falciforme no Hemocentro Regional de Montes Claros-MG. Metodologia: Estudo transversal analítico, com amostra aleatorizada, na qual foram incluídos pacientes triados pelo Programa Estadual de Triagem Neonatal de Minas Gerais e encaminhadas ao Hemocentro Regional de Montes Claros, com perfil eletroforético compatível com anemia falciforme, nascidos no período entre 26/01/2000 e 13/05/2014. Os dados clínicos dos pacientes foram coletados nos prontuários médicos do Ambulatório do Hemocentro Regional de Montes Claros. A genotipagem de a-Tal foi realizada por PCR multiplex (alelos: -a3.7; -a4.2; --SEA; --FIL; --MED; -(a) 20.5 e --THAI) no Serviço de Pesquisa Serviço de Pesquisa da Fundação Hemominas. Os dados foram analisados em teste estatísticos qui-quadrado em Software SPSS versão 16.0. Resultados: Foram estudados 50 pacientes, sendo 25 (50%) do sexo masculino e 25 (50%) do sexo feminino. A idade dos pacientes variou de 9 meses a 15 anos de idade. A prevalência da a-Tal foi de 30%. Não houve associação estatística significativa entre a presença de a-Tal e infecção, internação, crises álgicas, sequestro esplênico, esplenectomia, transfusão sanguínea e Acidente Vascular Cerebral (AVC). No entanto, a frequência de crises álgicas, esplenectomia e AVC foi menor nos pacientes que apresentavam coexistência da a-Tal. Conclusões: A prevalência de a-Tal em indivíduos com anemia falciforme no nosso estudo foi 30%. Algumas manifestações graves da AF ocorreram de forma menos frequente nos pacientes com a interação da a-Tal/anemia falciforme. (AU)

Objective: To evaluate the coexistence of alpha thalassemia (a-Tal) and its interference in the clinical course of patients with sickle cell disease at Hemocentro Regional de Montes Claros-MG. Methodology: This is a cross-sectional, analytical study with a randomized sample carried out with patients screened by the State Neonatal Screening Program of Minas Gerais and referred to the Hemocentro Regional de Montes Claros with an electrophoretic profile compatible with sickle cell anemia, born between 01.26.2000 and 05.13.2014. The clinical data of the patients were collected in the medical records of the Outpatient Clinic of the Hemocentro Regional de Montes Claros. The a-Tal genotyping was performed by multiplex PCR (alleles: -a3.7; -a4.2; --SEA; --FIL; --MED; - (a) 20.5 and --THAI) in the Research Service Fundação Hemominas. The data were analyzed in chi-square statistical test in SPSS Software version 16.0. Results: Fifty patients were studied, 25 (50%) were male, and 25 (50%) were female. Patients´ ages ranged from 9 months to 15 years old. The prevalence of a-Tal was 30%. There was no significant statistical association between the presence of a-Tal and infection, hospitalization, painful crises, splenic sequestration, splenectomy, blood transfusion and cerebrovascular accident (CVA). However, the frequency of painful seizures, splenectomy and CVA was lower in patients with a-Tal coexistence. Conclusions: The prevalence of a-Tal in individuals with sickle cell anemia in our study was 30%. Some severe manifestations of SCA occurred less frequently in patients with a-Tal/sickle cell anemia interaction. (AU)

Evaluation of cross reactivity between Trypanosoma cruzi and Leishmania infantum in serologically ineligible blood donors due to chagas diseas

Inconclusive serological screening for Trypanosoma cruzi has been a problem for blood banks. This study examined the performance of serological techniques for Chagas disease in reagent samples from blood bank screenings and verified the possibilities of cross reactivity with visceral leishmaniasis. 68 samples of reagent donors tested with ELISA for Chagas disease were evaluated by other techniques and for the detection of anti-Leishmania antibodies. Four donors (5.9%) with positive results for T. cruzi were positive for ELISA Kalazar Detect (visceral leishmaniasis),three of which were confirmed by Western blot. This study confirms the specificity of the tests for Chagas disease in blood banks and reinforces the urgent adoption of measures to assess the real risk of transfusion transmission of visceral leishmaniasis

Prevalência de inaptidão sorológica dos doadores de sangue no hemocentro regional de Montes Claros, Minas Gerais / Prevalencia de imposibilidad serológico de donantes de sangre en hemocentro regional de Montes Claros, Minas Gerais / Prevalence of serological inability of blood donors in regional blood center of Montes Claros, Minas Gerais

To estimate the prevalence of disability serological of blood donors at the Regional Blood Center of Montes Claros, in the period 2009 to 2013. Methods: this is a transversal study, exploratory, through retrospective data collection, involving 2.101 donors unfit serologically. The study was approved by the CEP of Hemominas Foundation 381/2014. Results: of the 82.743 candidates suitable for blood collection, 2.101 (2.5%) had reactive serologic tests, but only 1.434 (1.9%) confirmed the result through the 2nd sample collection. Among the diseases investigated, therewas the following distribution prevalence of hepatitis B (anti-HBc) donors with 0.77% about the total of suitable, syphilis (0.41%), Chagas (0.40%), and others showed values below 0.08%. Conclusion: we concluded that in comparison with other studies, it was found that the prevalence of disability in our blood bank serological is similar, showing that the measures taken are safe...

Estimar a prevalência da inaptidão sorológica dos doadores de sangue no Hemocentro Regional de Montes Claros, no período de 2009 a 2013. Métodos: trata-se de um estudo transversal, de caráter exploratório, através da coleta de dados retrospectivos, que envolveu 2.101 doadores inaptos sorologicamente. O estudo foi aprovado pelo CEP da Fundação Hemominas nº381/2014. Resultados: do total de 82.743 candidatos aptos para a coleta de sangue, 2.101(2,5%) apresentaram testes sorológicos reativos, porém apenas 1.434 (1,9%) confirmaram o resultado através da coleta de 2ª amostra. Dentre as doenças pesquisadas, houve a seguinte distribuição de prevalência: hepatite B (anti-HBc) com 0,77% doadores em relação ao total dos aptos; sífilis (0,41%); Chagas (0,40%); e demais apresentaram valores abaixo de 0,08%. Conclusão: concluímos que em comparação com outros estudos, verificou-se que a prevalência de inaptidão sorológica em nosso hemocentro é semelhante, mostrando que as medidas adotadas são seguras...

Estimar la prevalencia de la discapacidad serológica de donantes de sangre en el Centro Regional de Sangre de Montes Claros, en el período de 2009 a 2013. Métodos: estudio transversal, exploratorio, retrospectivo, involucrando 2.101 donantes no aptos serológicamente. El estudio fue aprobado por el CEP de Fundación Hemominas 381/2014. Resultados: de los 82.743 candidatos adecuados para la recogida de sangre, 2.101 (2,5%) tenían pruebas serológicas reactivas, pero sólo 1.434 (1,9%) confirmaron el resultado a través de la segunda toma de muestras. Entre las enfermedades investigadas, hubo la siguiente prevalencia de distribución: hepatitis B (anti-HBc) con 0,77% de donantes en relación al total de adecuados, sífilis (0,41%), Chagas (0,40%) y otros mostraron valores por debajo de 0,08%. Conclusión: en comparación con otros estudios, se encontró que la prevalencia de la discapacidad serológica en banco de sangre es similar, lo que demuestra que las medidas adoptadas son seguras...

Conhecimento de educadores sobre doença falciforme nas escolas públicas de Montes Claros-MG / Educators' knowledge about sickle cell disease in the public schools of Montes Claros-MG

Este estudo transversal, quantitativo e descritivo, avaliou o grau de informação de educadores da rede pública de Montes Claros sobre a doença falciforme, em escolas que possuíam aluno(s) com o subtipo homozigótico SS (anemia falciforme). Participaram da pesquisa 136educadores, sendo 94,9% professores, 2,9% diretores e 1,5% supervisores. Verificou-se que 67,6% desconheciam alunos matriculados com anemia falciforme, 83,1% já tinham ouvido falar sobre anemia falciforme, 47,8% a classificaram como doença hereditária, 39% comodevido à falta de nutrientes, 64,7% não sabiam a diferença entre anemia e traço falciforme, 65,4% desconheciam sua sintomatologia e 95,6% desconheciam a existência do Manual do Professor, da ANVISA, sobre doença falciforme. Constatou-se desconhecimento dos educadoressobre a existência de alunos com doença falciforme na escola, o que demonstra a necessidade de promover educação em saúde para melhor assistência a esses alunos.

This cross-sectional, quantitative and descriptive study assessed the level of information about sickle cell disease among educators in the public schools of Montes in which there are students with the SS homozygous subtype (sickle cell anemia). There were 136 educators in the research,94.9% of them teachers, 2.9% principals and 1.5% supervisors We found that 67.6% had no knowledge there were enrolled students with sickle cell disease, 83.1% had heard of sickle cell disease, 47.8% classified it as an hereditary disease, 39% related it to nutrient defficiency, 64.7%could not differentiate between sickle cell disease and sickle cell traits, 65.4% had no information on symptoms, and 95.6% had no knowledge of the Teacher's Manual on sickle cell disease distributed by the Brazilian Health Surveillance Agency (ANVISA). Educators were unaware ofthe presence of students with sickle cell disease in the school, thus demonstrating the need for health education actions to promote better care for these students.

Determinação da aceitabilidade para os parâmetros do hemograma utilizando amostras-controle de pacientes / Determining acceptability for the parameters of hemogram using patients samples control

A padronização e o controle da qualidade represetnam elementos imprescindíveis para a rotina laboratorial. Para cumprir a norma em vigor na rotina laboratorial. RDC 302/2005 e assegurar resultados confiáveis, o controle interno deve ser utilizado sistematicamente. O hemograma possui notável importância para o diagnóstico e controle evolutivo das doenças e no acompanhamento de tratamentos. O objetivo deste estudo foi determinar o intervalo de aceitabilidade para os parâmetros hematológicos (hemácias, hemoglobina, hematócritos, global de leucócitos e plaquetas) utilizando 50 amostras-controle de pacientes e doadores colhidas na Fundação Centro de Hematologia e Hemoterapia de Minas Gerais - Hemominas - Hemocentro Regional de Montes Claros. Os resultados obtidos neste estudo, demonstram a conformidade do uso uso das amostras-controle no controle da rotina hematológica, represetnando uma alternativa complementar de controle interno para laboratórios de análises clínicas.