Epidemiological profile of patients co-infected with visceral leishmaniasis and HIV/AIDS in Northeast, Brazil

Abstract INTRODUCTION: Visceral leishmaniasis (VL) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) co-infection has been a research topic of interest worldwide. In Brazil, it has been observed that there is a relative underreporting and failure in the understanding and management of this important association. The aim of this study was to analyze epidemiological and clinical aspects of patients with VL with and without HIV/AIDS. METHODS: We conducted an observational and analytical study of patients with VL followed in a Reference Service in the State of Maranhão, Brazil from 2007-2013. RESULTS: In total 126 patients were enrolled, of which 61 (48.4%) were co-infected with HIV/AIDS. There were more males among those with HIV/AIDS (85.2%, P>0.05) or with VL only (81.5%, P>0.05). These findings significantly differed based on age group (P<0.003); the majority of patients were aged 31-40 years (41.0%) and 21-30 years (32.3%) among those with and without HIV/AIDS co-infection, respectively. The incidence of diarrhea and splenomegaly significantly differed between the two groups (P=0.0014 and P=0.019, respectively). The myelogram parasitic examination was used most frequently among those with HIV/AIDS (91.8%), followed by those with VL only (69.2%). VL recurrences and mortality were significantly higher in the HIV/AIDS co-infected patients (P<0.0001 and P=0.012, respectively). CONCLUSIONS: Patients with VL with or without HIV/AIDS co-infection were mostly adult men. Diarrhea was more frequent in HIV/AIDS co-infected patients, whereas splenomegaly was more common in patients with VL only. In the group of HIV/AIDS co-infected patients, there was a higher rate of VL recurrence and mortality.

O tratamento para a esquistossomose e seu efeito nas morbidades: revisão sistemática e metanálise

A esquistossomose ainda é um importante problema de saúde pública em regiões tropicais e subtropicais. Em áreas endêmicas, o estado crônico da infecção gera impacto na saúde dos indivíduos decorrente da patologia desencadeada. Desde a década de 1980, a OMS elegeu a quimioterapia como o método mais adequado para controlar as morbidades associadas à infecção por espécies de Schistosoma. Assim, o uso extensivo do medicamento requer uma compreensão abrangente do seu impacto no controle das morbidades relacionadas. Diante disto, o estudo teve como objetivo avaliar o impacto do tratamento medicamentoso nas morbidades e manifestações clínicas associados à infecção por espécies de Schistosoma por meio de uma revisão sistemática e metanálise. O projeto de revisão foi registrado na plataforma PROSPERO (CRD42015026080)...

Schistosomiasis is an important public health problem in tropical and subtropical regions. In endemic areas, the chronic state of the infection generates an impact on the health of the individuals due to the disease. Since the 1980s, WHO has chosen chemotherapy as the most appropriate method to control the morbidities associated with infection with Schistosoma species. Thus, extensive use of the drug requires a comprehensive understanding of its impact on the control of related morbidities. The objective of this study was to evaluate the impact of drug treatment on the morbidities and symptoms associated with Schistosoma species infection through a systematic review and meta-analysis. The review project was registered on the PROSPERO (CRD42015026080)...

Clinical presentation of hemophagocytic lymphohistiocytosis in adults is less typical than in children

OBJECTIVE: Hemophagocytic lymphohistiocytosis in adults is largely underdiagnosed. To improve the rate and accuracy of diagnosis in adults, the clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis were analyzed in and compared between adults and children in a Chinese cohort. METHOD: Data from 50 hemophagocytic lymphohistiocytosis patients, including 34 adults and 16 children who fulfilled the 2004 hemophagocytic lymphohistiocytosis diagnostic criteria, were collected and analyzed. RESULTS: 1. Etiological factors: The proportion of Epstein-Barr virus infection was lower in adults compared with children, whereas fungal infection and natural killer/T cell lymphoma were more frequent in adults (P<0.05). 2. Clinical manifestations and laboratory findings: Over 90% of adults and pediatric patients presented with fever, thrombocytopenia and high serum ferritin levels. However, in adults, the proportions of hepatomegaly, splenomegaly and jaundice were much lower (P<0.01) than in children, and serous cavity effusion was more frequent in adult patients (P<0.05). More children had hemoglobin <90 g/L, total bilirubin >19 mmol/L and lactate dehydrogenase >500 U/L compared with adults (P<0.05). 3. The time interval from the onset of symptoms to clinical diagnosis was significantly shorter in pediatric patients than in adults (P<0.05). CONCLUSIONS: Certain clinical features were different between the two groups. The less characteristic clinical presentation of hemophagocytic lymphohistiocytosis in adults may make the disease more difficult to diagnose. Our findings suggest that hemophagocytic lymphohistiocytosis should be considered when an adult patient presents with the above-mentioned symptoms.

Homozygous sickle cell disease in Uganda and Jamaica a comparison of Bantu and Benin haplotypes / La anemia de células falciformes homocigóticas en Uganda y Jamaica comparación de haplotipos Bantú y Benin

OBJECTIVE: To compare the haematological and clinical features of homozygous sickle cell (SS) disease in Bantu and Benin haplotypes in a cross-sectional study of 115 Ugandan patients attending the Sickle Cell Clinic at Mulago Hospital, Kampala, Uganda, with 311 patients in the Jamaican Cohort Study. METHODS: This involved comparison of clinical features and haematology with special reference to genetic determinants of severity including fetal haemoglobin levels, beta-globin haplotype and alpha thalassaemia status. RESULTS: The Bantu haplotype accounted for 94% of HbS chromosomes in Ugandan patients and the Benin haplotype for 76% of HbS chromosomes in Jamaica. Ugandan patients were marginally more likely to have alpha thalassaemia, had similar total haemoglobin and fetal haemoglobin levels but had higher reticulocyte counts and total bilirubin levels consistent with greater haemolysis. Ugandan patients had less leg ulceration and priapism, but the mode of clinical presentation, prevalence of dactylitis, features of bone pain and degree of delay in sexual development, assessed by menarche, were similar in the groups. In Ugandan patients, a history of anaemic episodes was common but these were poorly documented. CONCLUSION: The haematological and clinical features of the Bantu haplotype in Uganda were broadly similar to the Benin haplotype in Jamaica except for less leg ulceration and priapism and possibly greater haemolysis among Ugandan subjects. Anaemic episodes in Uganda were treated empirically by transfusion often without a clear diagnosis; better documentation including reticulocyte counts and observations on spleen size is necessary to evolve appropriate models of care.

OBJETIVO: Comparar los rasgos clínicos de la anemia de células falciformes homocigóticas (SS) en los haplotipos Bantú y Benin en un estudio transversal de 115 pacientes ugandeses que asisten a la Clínica de la anemia de células falciformes en el Hospital de Mulago, Kampala, Uganda, con 311 pacientes en un estudio de cohorte jamaicano. MÉTODOS: El estudio conllevó la comparación de los rasgos clínicos y hematológicos con referencia especial a los determinantes genéticos de la severidad, incluyendo los niveles de la hemoglobina fetal, haplotipos del gen de la globina beta, y el estado de la alfa talasemia. RESULTADOS: El haplotipo Bantú dio cuenta del 94% de los cromosomas HbS en los pacientes ugandeses, en tanto que los haplotipos Benin dieron cuenta del 76% de los cromosomas de HbS en Jamaica. Los pacientes de Uganda presentaron una probabilidad marginalmente mayor de alfa talasemia, tenían niveles similares de hemoglobina total y hemoglobina fetal, pero en cambio presentaban conteos más altos de reticulocitos así como niveles mayores de bilirrubina total, en correspondencia con una mayor hemólisis. Los pacientes ugandeses presentaban menor ulceración de las piernas y priapismo, pero el modo de presentación clínica, la prevalencia de dactilitis, los rasgos de dolor óseo, y el grado de retraso en el desarrollo sexual, evaluado por la menarquia, fueron similares en todos los grupos. Los pacientes de Uganda se caracterizaron comúnmente por una historia de episodios de anemia, pobremente documentados. CONCLUSIÓN: Los rasgos clínicos y hematológicos del haplotipo Bantú en Uganda fueron considerablemente similares al haplotipo Benin en Jamaica, salvo por una menor presencia de ulceración de las piernas y priapismo, así como posiblemente mayor hemólisis entre los sujetos de Uganda. Los episodios de anemia en Uganda fueron tratados empíricamente mediante transfusión, a menudo sin un diagnóstico claro. Se necesita una mejor documentación - incluyendo conteos de reticulocitos - así como observaciones del tamaño del bazo, a fin de desarrollar modelos de cuidado apropiados.

Chronic myeloid leukaemia at the University Hospital of the West Indies A 17-year review / Leucemia mieloide crónica en el Hospital Universitario de West Indies un estudio de 17 años

OBJECTIVE: To determine the presenting features and evolution of patients diagnosed with chronic myeloid leukaemia between 1983 and 1999 at the University Hospital of the West Indies. METHODS: Forty-one records were retrospectively analyzed for the patients' demographics, reasons for referral, clinical features, laboratory investigations and the time to blast transformation and death. RESULTS: Seventy-one per cent were males and 29% were females. The male to female ratio was 2.4:1. The median age at presentation was 37 years (range 14-81 years). Seventy-eight per cent of the patients presented in the chronic phase. Weight loss and splenomegaly were the most frequent presenting features being seen in 54 and 83 per cent respectively. The median survival was 36 months. CONCLUSION: In this study, the clinical features and evolution were comparable to existing data. Improved accrual and routine Philadelphia chromosome testing would provide a more accurate reflection of the status of CML in our population.

OBJETIVO: Determinar los rasgos presentes y la evolución de los pacientes diagnosticados con leucemia mieloide crónica entre 1983 y 1999 en el Hospital Universitario de West Indies. MÉTODOS: Cuarenta historias clínicas fueron analizadas respectivamente en busca de los datos demográficos de los pacientes, las razones para la remisión de casos, las características clínicas, las investigaciones de laboratorio y el tiempo hasta la transformación blástica y la muerte. RESULTADOS: El setenta y uno por ciento eran varones y el 29% eran hembras. La proporción varones-hembras fue 2.4:1. La mediana de la edad en el momento de la presentación fue de 37 años (rango 14-81 años). Setenta y ocho por ciento de los pacientes se presentaron en la fase crónica. Pérdida de peso y esplenomegalia fueron las características más frecuentemente observadas en el 54 y el 83 por ciento respectivamente. La mediana de la supervivencia fue 36 meses. CONCLUSIÓN: En este estudio, las características clínicas y la evolución fueron comparables con los datos existentes. El mejoramiento de la acumulación y las pruebas de rutina para identificar el cromosoma Filadelfia, reflejarían con mayor precisión el estatus de la LMC en nuestra población.

Efficacy of permethrin-impregnated bed nets on malaria control in a hyperendemic area in Irian Jaya, Indonesia: differentiation between two age groups.

A malaria intervention trial was conducted for two years to evaluate the efficacy of permethrin-impregnated bed nets in reducing malaria infection and splenomegaly in two different age groups, ie below and over age of ten, in a hyperendemic area in Irian Jaya, Indonesia. Permethrin-impregnated or placebo-treated bed nets were provided to a treated and a control village, respectively. Immediately after periods with moderate rainfall in the first year, treated bed nets decreased P. falciparum and P. vivax density in the blood of children <10 years (group 1) but did not reduce the percentage of infection with either species. Children >10 and adults (group 2) showed significant reduction only in P. falciparum infection rates and density, whereas P. vivax was not influenced. After an excessive rainfall season in the second year, the risk for P. falciparum infections in both age groups using treated nets was less than half of that in the control village. P. vivax infection rates were significantly lower in the treated village at the beginning of and after these heavy rainfalls. In the treated village, spleen enlargement was markedly reduced in the younger age group during the second year.

An epidemic of dengue hemorrhagic fever and dengue shock syndrome in children in Delhi.

OBJECTIVE: To study clinical profiles and outcome of children of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) during 1996 Delhi epidemic. DESIGN: Retrospective study. SETTING: Hospital based study. METHODS: Children hospitalized from September to November 1996 were studied. All patients were diagnosed, managed and monitored according to a standard protocol. RESULTS: One hundred and thirty four children (80 (60%) males and 54 (40%) females) were studied. Sixty (45%) children were less than 6 years of age of which 12 presented during infancy. There were 92 (67%) cases of DHF and 42 (33%) cases of DSS. Common symptoms were fever (93%), abdominal pain (49%) and vomiting (68%). The commonest hemorrhagic manifestation was hematemesis (39%) followed by epistaxis (36%) and skin bleeds (33%). Hepatomegaly was observed in 97 (72%) cases and splenomegaly in 25 (19%). Serology was positive (IgM hemaglutination antibody titres > 1: 160) for dengue type 2 in 31 (80%) of 39 patients in whom sera was tested during the acute phase of illness. Mortality was 6%. Hematocrit > 40% was observed in only 25 (18%) patients and hence the management protocol was based on clinical signs and symptoms and not on hematocrit. CONCLUSIONS: A management protocol of DHF/DSS in which fluid therapy is not based on haematocrit values needs to be formulated.

Health status of Orang Asli (aborigine) community in Pos Piah, Sungai Siput, Perak, Malaysia.

A study of health status of Orang Asli population (based on physical examination findings) was conducted in 4 villages in Pos Piah, Sungai Siput Perak, Malaysia. In all 356 individuals between 4 months-72 years old (178 males and 178 females) participated in this study. Poor general health status, physical and mental handicaps were seen in 7.8%, 0.3% and 0.3% of the population, respectively. About one-fifth of the population had dental caries. Splenomegaly, hepatomegaly and hepatosplenomegaly were among the commonest abnormalities with the occurrence rates of 19.8%, 13.7% and 6.7%, respectively, being detected in the population. About one-fifth of the population showed signs suggestive of protein-energy deficiency; whilst less than 5% showed signs indicative of riboflavin, iodine and iron deficiencies. Vitamin A deficiency was the commonest nutritional deficiency identified in this community with almost 38.4% of them showing signs of the deficiency. The commonest skin infection was scabies.

Está desaparecendo a glomerulopatia da esquistossomose mansônica? / Is glomerulopathy due to schistosomiasis mansoni disappearing?

As formas severas de esquistossomose mansônica, particularmente a hépato-esplênica, se acompanham de glomerulopatia geralmente manifesta por síndrome nefrótica. Nos últimos 10 anos reduziu-se muito o número de casos observados desta glomerulopatia no Hospital Universitário Prof. Edgard Santos, um hospital geral num estado onde esta parasitose é endêmica. O objetivo deste estudo foi verificar se estava havendo, de fato, desaparecimento desta patologia ou se este número decrescente refletia apenas diminuição marcante de casos graves de esquistossomose mansônica acompanhados neste Hospital. Para isso foram comparadas as prevalências de glomerulopatia em hepatosplênicos esquistossomóticos autopsiados no Hospital Universitário Prof. Edgard Santos em duas décadas: de 1960-70, antes da intervenção terapêutica nas áreas endêmicas de esquistossomose com oxamniquine, e de 1980-1990, após a adoção desta intervenção. Houve grande redução no número de doentes com hepatosplenomegalia esquistossomótica autopsiados no Hospital Universitário Prof. Edgard Santos quando comparadas a década antes (140 autópsias) e depois (31 autópsias) do tratamento com oxamniquine. A prevalência de glomerulopatia, entretanto, persistiu a mesma (11,4% comparada com 12,9%, respectivamente). A conclusão é que a redução do achado de glomerulopatia esquistossomótica em nossos dias reflete apenas a redução das formas graves da parasitose após a intervenção terapêutica nas áreas endêmicas.

Hepatosplenic form of S. mansoni infection may be accompanied by a glomerulopathy in 12-15% of cases, manifested in the majority by a nephrotic. This type of renal involvement is becoming a rare occurrence in our University Hospital (Hospital Universitário Prof. Edgard Santos) a typical general hospital in an endemic state for this parasitic disease. To investigate this fact, autopsied cases with patients with hepatosplenic form of schistosomiasis mansoni during two decades in our Hospital-1960-70, (before a therapeutic intervention in endemic areas with oxamniquine) and 1980-1990 (after the intervention) were compared in reference to number of cases and the finding of glomerulonephritis by histological examination. Even though there was a striking decrease in number of patients with advanced forms of this disease (140 as compared to 31 autopsies in these two decades), the prevalence of glomerulonephritis diagnosed was 11.4 (16 cases) in the first and 12.9 (4 cases) in the second. As there was no change in pattern of attendance in this Hospital, the drastic decrease in number of severe forms of this parasitic infection following massive therapy of the endemic population with oxamniquine is the most likely explanation not only for the decrease in number of hepatosplenic cases but, also, and as a consequence, the scarcity of cases of the schistosomal glomerulopathy observed.

Relaçäo entre a patogenicidade do Schistosoma mansoni em camundongos e a susceptibilidade do molusco vetor. III. Mortalidade, pesos corporal e das vísceras / Relationship between the pathogenicity of Schistosoma mansoni in mice and the susceptibility of the vector mollusc. III. Mortality, body weight and viscera weights

Estuda a relaçäo entre o desenvolvimento da hepatomegalia, da esplenomegalia, peso corporal e taxa de mortalidade em camundongos experimentalmente infectados por Schistosoma mansoni com o grau de susceptibilidade de Biomphalaria glabrata e B. tenagophila nas quais se desenvolveram as cercárias infectantes respectivamente, das linhagens BH e SJ. Foram utilizados como hospedeiro definitivo camundongos Swiss, SPF e como hospedeiros intermediários populaçöes de moluscos selecionados geneticamente para o caráter susceptibilidade. Foram observados menores pesos corporais e das vísceras em camundongos infectados com cercárias provenientes de moluscos que apresentaram elevado grau de susceptibilidade. A maior susceptibilidade dos moluscos à infecçäo pelo S. mansoni correspondeu a uma menor sobrevivência dos camundongos infectados. Os resultados fazem crer que a maior adaptaçäo do parasita ao hospedeiro intermediário, traduzidos pelas taxas mais elevadas de susceptibilidade, pode levar a um comportamento diferente deste parasita no hospedeiro definitivo

Splenomegaly in Arab children with idiopathic thrombocytopenic purpura

Splenomegaly was found in 31 [55%] of 56 Arab children with idiopathic thrombocytopenic purpura. Of those with splenomegaly, 84% had evidence of iron deficiency anemia compared to 48% in those without splenomegaly [P<0.001]. There was no significant difference in the prevalence of beta-thalassemia trait or history of preceding viral infection between those with or without splenomegaly. This study demonstrates a much higher prevalence of splenomegaly in Arab children with idiopathic thrombocytopenic purpura, most probably related to associated iron deficiency

Family occurrence of schistosomal hepatosplenomegaly and maternal effect

As formas clínicas da esquistossomose mansônica, anteriores ao tratamento com oxamniquine, foram estudadas nos membros de 265 famílias, com seis anos ou mais de idade. A probabilidade da ocorrência de dois ou mais casos, na mesma família, da hepatosplenomegalia esquistossomótica (HE) é baixa, no entanto foi obsrevada em 38 famílias; menor probabilidade (P = 0,002) devia ocorrer três ou mais casos, porém dezessete famílias estavam nesta situaçäo. A concentraçäo da forma HE foi alta entre irmäos, comparativamente á observada entre mäes e filhos e pais e filhos. Näo sendo significante a concentraçäo encontrada no casal entre marido e mulher. Estas observaçöes reforçam a evidência do efeito do componente genético da susceptibilidade para a forma HE. Também, quando a mäe era hepatosplênica (HE) a prevalência desta forma nos filhos foi maior; o risco relativo foi cinco vezes superior (efeito materno), comparado ao encontrado quando era o pai hepatosplênico. Quando ambos os genitores eram hepatointestinal os riscos relativos da forma HE, nos filhos, foi semelhante ao da populaçäo geral. Assim, provavelmente fatores pré e pós-natais também estaräo envolvidos na predisposiçäo da forma hepatosplênica