Low dose systemic or intralesional meglumine antimoniate treatment for American tegumentary leishmaniasis results in low lethality, low incidence of relapse, and low late mucosal involvement in a referral centre in Rio de Janeiro, Brazil (2001-2013)

BACKGROUND American tegumentary leishmaniasis (ATL) is a non-lethal parasitic disease that presents with cutaneous (CL) and mucosal (ML) clinical forms. ATL treatment aims at healing the lesions and preventing the development of the late mucosal form. Systemic meglumine antimoniate (MA) therapy with 10-20 mg Sb5+/kg/day is the first choice of treatment. However, alternative therapies using 5 mg Sb5+/kg/day or intralesional (IL) MA are the usual regimens at the National Institute of Infectious Diseases (NIID), Rio de Janeiro, Brazil. OBJECTIVES To evaluate lethality and the incidence of relapse and development of late ML in CL patients treated at NIID from 2001 until 2013. METHODS Data were recovered from records of all ATL patients diagnosed during that period. FINDINGS Out of 777 patients, 753 were treated with MA (96.9%). Of those, 89.1% received alternative therapy of 9.9% IL and 79.2% systemic 5 mg Sb5+/kg/day. Some patients required 1-3 additional courses of treatment, thus making a total of 997 courses; 85.2% of them were subjected to alternative therapies. Lethality was 0.1%, relapse incidence 5.8%, and late ML incidence 0.25%. As a final outcome for the 777 patients, 95.9% were cured, 0.1% died and 4.0% were not able to follow-up. MAIN CONCLUSIONS Alternative MA schedules resulted in low lethality without increase of relapse or late ML incidence.

Colonização cutâneo-mucosa e/ou infecção por cryptococcus neoformans em indivíduos infectados pelo HIV, com e sem síndrome de imunodeficiência adquirida: estudo prospectivo e evolutivo de coorte interrompida

No período de abril de 1990 a maio de 1999 foi realizado estudo prospectivo decolonização cutâneo-mucosa e/ou infecção por Cryptococcus neoformans em100 indivíduos infectados pelo HIV, com e sem SIDA. Os espécimes clínicosexaminados foram respectivamente: raspados de interdígito dos pés e das mãos,da superfície dorsal da língua, swab de fossa nasal, urina e escarro. Todos osespécimes foram semeados em placas contendo meio niger. As colôniasfenoloxidase positivas foram subcultivadas e identificadas. O estudo foisubdividido em três etapas. Na primeira fase, de abril de 1990 a dezembro de1992, dos 100 indivíduos investigados, obtivemos isolamento de C.neoformans de seis, sendo uma colonização transitória, dois casos compatíveiscom colonização ou infecção brônquica inicial e outros três com doençadisseminada. Na segunda fase, correspondente à interrupção do protocolo dejaneiro de 1993 a dezembro de 1995, foi realizada a revisão dos 100prontuários desta casuística, sendo apurados cinco casos de criptococosedisseminada e 60 óbitos por variadas causas, dos quais seis relacionados comcriptococose disseminada. Na terceira fase, 28 indivíduos remanescentes dacasuística original foram resubmetidos ao protocolo inicial de investigação,sendo encontrado um caso de colonização brônquica por C. neoformans var.gattii sorotipo B em mulher grávida, a qual três anos após este achado,apresentou criptococose disseminada por C. neoformans var. neoformans.

Mucocutaneous colonization and/or infection by Cryptococcus neoformans wasprospectively studied from April 1990 to May 1999 in 100 individuals infectedby HIV, with and without AIDS. Clinical specimens included in the studywere: interdigital scrapings of hands and feet, scraping of the dorsal surface ofthe tongue, nasal swab, urine and sputum. All specimens were plated onto nigerseed agar. Phenoloxidase-positive colonies were subcultivated and identified.The study was performed in three steps. In the first step, from April 1990 untilDecember 1992, C. neoformans was isolated from 6 out of the 100 individualsstudied: one had transient colonization, two were compatible with colonizationor initial bronchial infection and three had disseminated cryptococcosis. In thesecond step, corresponding to the period of interruption of the protocol fromJanuary 1993 to December 1995, review of the case history of the patientsshowed that 5 had disseminated cryptococcosis and at least 60 died fromvarious causes, 6 of whom related to disseminated cryptococcosis. In the thirdstep, 28 remaining individuals from the original casuistic were re-evaluatedaccording to the protocol of the first step, disclosing one case of bronchialcolonization by C. neoformans var. gattii serotype B in a pregnant woman whothree years later presented disseminated cryptococcosis by C. neoformans var. neoformans.

Doença de Chagas / Chagas disease

Os autores apresentam em trabalho de revisao, a etiologia, a patogenia, a epidemiologia, a patologia, as manifestaçoes clínicas, o diagnóstico, o tratamento e a profilaxia da doença, descoberta há 85 anos pelo eminente médico Carlos Chagas. Uma referência é feita ao Programa de Controle Nacional da Doença de Chagas, da Fundaçao Nacional de Saúde, que prevê o controle da endemia na próxima década.