Uso da miltefosina no tratamento clínico de cães com leishmaniose visceral: revisão de literatura / Use of miltefosin in the clinical treatment of dogs with visceral leishmaniosis / Uso de miltefosina en el tratamiento clínico de perros con leishmaniosis visceral: revisión de la literatura

A leishmaniose visceral canina é uma doença de caráter zoonótico, acometendo os seres humanos e diversas espécies de animais silvestres e domésticos. Objetivou-se com o presente estudo realizar uma revisão de literatura sobre o uso da miltefosina no tratamento clínico de cães com leishmaniose visceral. Trata- se de uma revisão de literatura, a qual foi realizada por meio de consultas à periódicos e livros presentes na biblioteca do Cesmac. Foram utilizadas bases de dados como: portal Capes, SCIELO, Google Acadêmico; pesquisa em monografias, teses e dissertações. Causada pelo protozoário Leishmania chagasi, sendo o cão doméstico o principal reservatório desse protozoário. Por representar um problema grave de saúde pública e ser considerada uma doença potencialmente fatal (quando não tratada precocemente e adequadamente), faz- se importante que o clínico esteja familiarizado com os sinais clínicos, exames complementares e principais protocolos terapêuticos, em especial a utilização da miltefosina no tratamento da leishmaniose visceral em cães. Por ser uma zoonose que causa graves problemas de saúde pública e que vem crescendo cada vez mais no Brasil, cabe aos médicos veterinários assumirem o compromisso na conscientização sobre a importância do diagnóstico precoce além de promoverem o bem-estar animal e a saúde pública.(AU)

Canine visceral leishmaniasis is a zoonotic disease, affecting humans and several species of wild and domestic animals. The objective of the present study was to carry out a literature review on the use of miltefosine in the clinical treatment of dogs with visceral leishmaniasis. This is a literature review, which was carried out through consultations with periodicals and books present in the Cesmac library. Databases such as: Capes portal, SCIELO, Google Scholar; research in monographs, theses and dissertations. Caused by the protozoan Leishmania chagasi, with the domestic dog being the main reservoir of this protozoan. As it represents a serious public health problem and is considered a potentially fatal disease (when not treated early and properly), it is important that the clinician is familiar with the clinical signs, complementary exams and main therapeutic protocols, especially the use of miltefosine in the treatment of visceral leishmaniasis in dogs. As it is a zoonosis that causes serious public health problems and that has been growing more and more in Brazil, it is up to veterinarians to make a commitment to raise awareness of the importance of early diagnosis in addition to promoting animal welfare and public health.(AU)

La leishmaniosis visceral canina es una enfermedad zoonótica que afecta a los seres humanos y a varias especies de animales salvajes y domésticos. El objetivo de este estudio fue realizar una revisión bibliográfica sobre el uso de la miltefosina en el tratamiento clínico de perros con leishmaniosis visceral. Se trata de una revisión bibliográfica, que se realizó mediante consultas a publicaciones periódicas y libros presentes en la biblioteca del Cesmac. Se utilizaron bases de datos como: portal Capes, SCIELO, Google Académico; investigación en monografías, tesis y disertaciones. Causada por el protozoo Leishmania chagasi, siendo el perro doméstico el principal reservorio de este protozoo. Dado que representa un grave problema de salud pública y se considera una enfermedad potencialmente mortal (cuando no se trata de forma temprana y adecuada), es importante que el clínico esté familiarizado con los signos clínicos, las pruebas adicionales y los principales protocolos terapéuticos, especialmente el uso de miltefosina en el tratamiento de la leishmaniosis visceral en perros. Siendo una zoonosis que causa graves problemas de salud pública y que viene creciendo cada vez más en Brasil, corresponde a los veterinarios asumir el compromiso de concienciar sobre la importancia del diagnóstico precoz y promover el bienestar animal y la salud pública.(AU)

Informe diário de evidências: COVID-19 busca realizada em 22 de abril de 2020 / Daily evidence report: COVID-19 search conducted on April 22, 2020

O objetivo da revisão sistemática foi investigar a eficácia e a segurança de tratamentos com antivirais para COVID-19, SARS e MERS. Ao todo, 22 estudos foram incluídos: 1 ensaio clínico, 16 séries de casos e 5 relatos de caso. Os antivirais mais utilizados foram lopinavir / ritonavir, oseltamivir, ribavirina e arbidol. Todos os estudos usaram outras terapias, como antibióticos, imunoglobulina, interferon, glicocorticoides, metilprednisolona e medicamentos antiparasitários e antifúngicos, além da terapia antiviral para pacientes com COVID-19. No único ECR incluído, os pacientes que receberam lopinavir / ritonavir tiveram um processo de recuperação semelhante aos pacientes que receberam tratamento padrão. Os desfechos de mortalidade em 28 dias e carga viral de RNA não foram significativamente diferentes entre os dois grupos. Dentre os achados dos demais estudos, vale destacar que estudos de séries e relatos de casos não avaliam a eficácia de medicamentos, e que em geral as amostras foram pequenas. O estudo de Guan, com 1099 pacientes, chegou a conclusão que oseltamivir foi ineficaz na diminuição da taxa de admissão na UTI, na necessidade de ventilação e na taxa de mortalidade entre os pacientes. O estudo de Shang, com 416 pacientes, indicou que medicamentos antivirais não têm efeito na taxa de mortalidade de pacientes com COVID-19. O estudo de Li, com cinco crianças com COVID-19, indicou que os agentes antivirais não alteraram o resultado ou a duração da internação. A revisão cita outros estudos que foram publicados com os pacientes ainda sob tratamento, sem o desfecho final dessas populações. Quanto a busca por ensaios clínicos para SARS e MERS, foram encontrados protocolos, mas nenhum resultado publicado.

Éxito terapéutico con esquema de ivermectina oral en sarna costrosa / Therapeutic success with oral ivermectin regimen in crusted scabies

Se expone el caso de una paciente obesa inmunodeprimida que presentó una sarna costrosa. Luego de la sospecha clínica se confirmó el diagnóstico mediante acarotest. La paciente sufrió algunas complicaciones asociadas a su condición general, como sobreinfección de sus lesiones cutáneas, epistaxis e insuficiencia renal aguda, que fueron tratadas. La sarna costrosa fue tratada con ivermectina oral con dosis de 15 mg (200 ug/kilo de peso ideal según la talla), los días 1, 2, 7, 8 y 15, obteniendo una excelente respuesta terapéutica.

We present the case of an immunosuppressed obese patient who presented with crusted scabies. After clinical suspicion, the diagnosis was confirmed with skin scraping for the diagnosis of scabies. The patient presented some complications associated with her baseline condition, such as superinfection of her skin lesions, epistaxis and acute renal failure, which were treated. Crusted scabies was treated with oral ivermectin with a dose of 15 mg (200 ug/kg of ideal weight according to height), on days 1,2,7,8 and 15, obtaining an excellent therapeutic response.

Efficacy of afoxolaner in the flea control in experimentally infested cats / Eficácia do afoxolaner no controle de pulgas em gatos experimentalmente infestados

Abstract The aim of this study was to evaluate the efficacy of a single dose of oral afoxolaner in controlling fleas in cats. Fourteen cats were used. The cats were given identification numbers, housed individually, artificially infested with Ctenocephalides felis felis, and treated (or not) with afoxolaner. Were divided into a treatment group and a control group (n = 7/group), on the basis of the fleas count hours after an infestation applied on Day (one-by-one allocation after ordering by count). At the start of the experimental protocol (designated day 0), the treated group received afoxolaner in a single dose of 2.5 mg/kg and the control group animals received a placebo. All animals were infested with 100 C. felis felis fleas two days before day 0, as well as on days 5, 12, 19, 26, 33, 40, 47, 54, and 63, parasite loads being evaluated at 48 h after each infestation. The efficacy of afoxolaner was 100% on day 2 and remained above 98% until day 42, decreasing to 95.3% by day 63. The findings confirm that a single dose of oral afoxolaner was effective in controlling C. felis felis in cats, and there were no observed adverse events.

Resumo O objetivo do estudo foi avaliar a eficácia de uma dose única de afoxolaner oral no controle de pulgas em gatos. Foram utilizados 14 gatos. Os animais foram identificados, alojados individualmente, infestados artificialmente com C. felis felis e tratados (ou não) com afoxolaner. Foram divididos em um grupo de tratamento e um grupo controle (n = 7/ grupo), com base na contagem de pulgas, horas após a infestação aplicada no dia (alocação de um por um após o período por contagem). No início do protocolo experimental (dia 0), o grupo tratado recebeu afoxolaner em dose inicial de 2,5 mg / kg e os animais do grupo controle receberam um placebo. Todos os animais foram infestados com 100 pulgas C. felis felis dois dias antes do dia 0, assim como nos dias 5, 12, 19, 26, 33, 40, 47, 54 e 63, sendo avaliadas as cargas parasitárias às 48 h após cada infestação. A eficácia do afoxolaner foi de 100% no dia 2 e permaneceu acima de 98% até o dia 42, diminuindo para 95,3% no dia 63. Os resultados confirmam que uma dose única de afoxolaner oral foi eficaz no controle de C. felis felis em gatos, e não houve eventos adversos observados.

Escabiasis costrosa imitando una acrodermatitis continua de Hallopeau / Crusted scabies mimicking an acrodermatitis continua of Hallopeau

Resumen Introducción: La escabiasis costrosa (EC) es una variante poco común de sarcoptiosis clásica, altamente contagiosa. Las lesiones poseen una elevada concentración del ácaro Sarcoptes scabiei var hominis, lo que conlleva a un cuadro clínico más extenso que en la escabiasis clásica. Se observa principalmente en pacientes con algún tipo de inmunocompromiso y se relaciona con el síndrome de Down. Caso clínico: Se describe una paciente pediátrica con síndrome de Down quien presentó placas escamosas que afectaron la porción distal de los dedos, asociadas con distrofia ungueal e hiperqueratosis subungueal, por lo que se consideró acrodermatitis continua de Hallopeau como diagnóstico diferencial. Se realizó una biopsia tipo punch con lo que se llegó al diagnóstico de EC. La paciente recibió tratamiento sistémico con ivermectina vía oral y tratamiento tópico con crema hidratante y desonida al 0.1%. Mostró mejoría clínica notoria dos semanas después de finalizar el tratamiento. Conclusiones: La EC es una variante prevalente en pacientes inmunocomprometidos y con síndrome de Down que fácilmente puede confundirse con patologías inflamatorias con alteración de la queratinización epidérmica. Este caso se considera una presentación atípica debido a la afección localizada en los dedos de las manos asociada con distrofia ungueal. El estudio histopatológico fue necesario para realizar el diagnóstico y descartar diagnósticos diferenciales.

Abstract Background: Crusted scabies (CS) is an uncommon, highly contagious, variant of classic scabies. Elevated concentrations of the mite Sarcoptes scabiei var. hominis are found in the skin lesions, which lead to a more exaggerated clinical picture than in classic scabies. This disease is mainly observed in patients with any kind of immunosuppression and relates to Down syndrome. Case report: A pediatric female patient with Down syndrome, who presented a crusty white plaque associated with nail dystrophy and subungual hyperkeratosis affecting the distal portion of the fingers is described. Because of these findings, the diagnosis of acrodermatitis continua of Hallopeau was considered. A punch biopsy was performed, attaining the diagnosis of CS. She received systemic treatment with oral ivermectin, topical treatment with emollient cream and desonide 0.1%. Notorious clinical improvement was observed two weeks after finalizing treatment. Conclusions: CS is variant of scabies prevalent in immunocompromised patients and Down syndrome that can be easily confused with inflammatory pathologies with abnormal epidermal keratinization. This case is considered as an atypical presentation of the disease because of local affection of the fingers and nail dystrophy. The histopathological study was necessary to obtain the diagnosis and rule out differential diagnosis.

Mansonelliasis, a neglected parasitic disease in Haiti

Reported in Haiti as early as 1923, Mansonella ozzardi is still a neglected disease ignored by the health authorities of the country. This review is an update on the geographic distribution of the coastal foci of mansonelliasis in Haiti, the epidemiological profile and prevalence rates of microfilariae in people living in endemic areas, the clinical impact of the parasite on health and the efficiency of the transmission of the parasite among three Culicoides biting-midge species identified as vectors in Haiti. Additionally, interest in establishing a treatment programme to combat this parasite using a single dose of ivermectin is emphasised.

Four Human Cases of Acanthotrema felis (Digenea: Heterophyidae) Infection in Korea

Acanthotrema felis is an intestinal trematode of cats originally reported from the Republic of Korea. Only 1 human case infected with a single adult worm has been previously recorded. In the present study, we report 4 human cases infected with a total of 10 worms recovered after anthelmintic treatment and purging. All 4 patients reside in coastal areas of Jeollanam-do, Korea, and have consumed brackish water fish including the gobies, Acanthogobius flavimanus. The worms averaged 0.47 mm in length and 0.27 mm in width, and had 3 sclerites on the ventrogenital sac; 1 was short and thumb-like, another was long and blunt-ended, and the 3rd was long and broad-tipped. They were identified as A. felis Sohn, Han, & Chai, 2003. Surveys on coastal areas to detect further human cases infected with A. felis are required.

Patrón espacio-temporal de larvas y huevecillos de nemátodos gastrointestinales en pastizales ganaderos de Veracruz, México / Spatio-temporal pattern of larvae and eggs of gastrointestinal nematodes in cattle pastures in Veracruz, Mexico

The spatial and temporal distribution of gastrointestinal nematodes of cattle has been little studied in Mexico. Previous studies have described periods of higher larval presence, vertical and horizontal migration in grasslands, and the frequency of adult nematodes; as well as the effect of pasture trichomes on the migration and survival of Haemonchus larvae. The aim of this study was to determine the time-space layout and spread of gastrointestinal nematode larvae on pasture, and to estimate the effect of ivermectin applied to cattle on the time-dependent abundance of their eggs in a ranch in Veracruz. To determine the spatio-temporal arrangement, monthly morning grass samples were obtained from 30 sampling points from July 2008 to June 2009. Third stage larvae (L3) from each point were counted, and aggregation patterns were estimated through variance/mean and negative binomial K indices. Additionally, the number of eggs per gram in cattle feces was determined, from samples with (CI) and without ivermectin (SI), using standard techniques. A total of 20 276L3 larvae were recovered in the pasture, of which an 80% corresponded to Haemonchus contortus. The highest nematode density with more than 5 000L3/kgDM was detected in October 2008, and the lowest in February and March 2009. The L3 showed an aggregated spatial pattern of varying intensity throughout the year. The number of eggs in the stool was not reduced with the ivermectin application to cattle, which suggested a failure of control. However, the highest parasite loads were observed from July to November 2008. We concluded that the application of ivermectin was not effective to control nematodes eggs, and that L3 populations fluctuated on pasture for ten months, providing an infection source to grazing animals afterwards. Rev. Biol. Trop. 61 (4): 1747-1758. Epub 2013 December 01.

El conocer la disposición espacio-temporal y diseminación de las larvas de nematodos gastrointestinales en los pastizales, y estimar el efecto de la ivermectina aplicada a bovinos sobre la abundancia de sus huevecillos, permite estimar dónde y cuándo se presentan las poblaciones más altas, que puede servir para establecer planes de muestreo y orientar medidas de control, así como para definir el riesgo de contaminación de los pastizales de manera diferencial. Para la determinación de la disposición espacio-temporal de L3 en el pastizal, se recolectaron, contaron e identificaron mensualmente las larvas en 30 puntos de muestreo, posteriormente se generaron mapas de disposición espacial con los datos obtenidos de los conteos de L3 en cada punto y mes de muestreo, y se calculó el patrón de disposición mediante los índices varianza/media y K binomial negativa. El número de huevecillos por gramo de heces de los bovinos con (CI) y sin ivermectina (SI), se calculó con la técnica de McMaster. En el pastizal se recuperaron 20 276L3, correspondiendo el 80% a H contortus. En octubre 2008 se detectó la más alta densidad de nematodos con más de 5 000L3/kgMS. Las L3 presentaron un patrón espacial agregado de intensidad variable durante todo el año. Las mayores densidades poblacionales de nematodos fueron en octubre 2008 y las menores en febrero y marzo 2009. La aplicación de ivermectina a los bovinos no redujo el número de huevecillos presentes en las heces, debido a que los tratamientos fueron estadísticamente iguales. De julio a noviembre 2008, se observaron las mayores cargas parasitarias.

Acaricidal efficacy of topical formulation of fipronil in naturally infested dogs in Amazonic region, Brazil / Eficácia carrapaticida de fipronil tópico em cães naturalmente infestados na região amazônica, Brasil

This study was conducted to show the effectiveness of a novel formulation of fipronil in a spot-on formulation for the therapeutic and preventive control of Rhipicephalus sanguineus in naturally infested dogs. Ticks on all dogs were counted at the moment of treatment and weekly after treatment (therapeutic efficacy) or infestation (preventive efficacy). The profile of the therapeutic efficacy for Rhipicephalus sanguineus suggested that the formulation was able to control the Ixodid species for at least 42 days after the treatment.

Este estudo teve como objetivo avaliar a eficácia de uma nova formulação "spot-on" à base de fipronil na terapêutica e prevenção do parasitismo por Rhipicephalus sanguineus em cães naturalmente infestados. Foi realizada contagem dos carrapatos no momento da aplicação do produto e semanalmente após o tratamento (eficácia terapêutica), bem como avaliando sua reinfestação (eficácia preventiva). Perfis terapêuticos e preventivos sugerem que a formulação controla o parasitismo por R. sanguineus em cães por pelo menos 42 dias após o tratamento.

Atividade anti-leishmania e imunomodulatória in vitro da melitina natural na infecção experimental por Leishmania (L) infantum chagasi / Anti- leishmania activity and immunomodulatory in vitro natural melittin in experimental infection with Leishmania (L ) infantum chagasi

O objetivo deste trabalho foi avaliar o efeito da melitina natural na infecção experimental por Leishmania (L.) infantum chagasi, bem como seu efeito sobre a produção de citocinas pró e antinflamatórias e metabólitos do oxigênio e do nitrogênio. O fracionamento do veneno foi realizado por meio de cromatografia líquida de alta eficiência (HPLC-RP) usando-se colunas C8 e C18. As frações foram identificadas por sequenciamento peptídico pela química degradativa de Edman e espectrometria de massas do tipo eletrospray. A determinação da atividade anti-leishmania, contra formas promastigotas foi realizada de forma seriada partindo-se de uma concentração inicial de melitina de 100 μg/mL observando-se o valor de CE50 de 28,29 μg/mL. Foi realizado estudo de citotoxicidade em macrófagos peritoniais isolados de camundongos BALB/c, obtendo-se um valor de CE50 de 5,73 μg/mL. A viabilidade celular de ambos os ensaios foi avaliada por meio do estudo da atividade oxidativa mitocondrial (MTT). Os estudos em formas amastigotas intracelulares demostraram um valor de CE50 de 1,47 μg/mL. Quanto a produção de citocinas por celulas desafiadas com o parasita e tratados com a melitina observou-se que houve tendência de aumento para as citocinas inflamatórias IL12 e TNF-α nas concentrações utilizadas e nos respectivos períodos de tempo. A melitina não interferiu na produção de IFN-γ e TGF-β, porém observamos diminuição significativa nos níveis de IL-10, fato semelhante observado na produção de H2O2...

The purpose of this research was to evaluate the effect of natural melittin extracted and purified from the venom of Apis mellifera over an in vitro infection with Leishmania (L.) infantum chagasi, well as their effects on the production of proinflammatory and anti-inflammatory, and metabolites of oxygen and nitrogen. The fractionation of the venom was accomplished by high-performance liquid chromatography system (RP-HPLC) using C18 and C8 columns. These fractions were determined by peptide sequence using a combination of Edman degradation sequence analysis and electrospray ionization (ESI) mass spectrometry. The ascertainment of anti-leishmania activity against promastigote forms was conducted in a seriate form, beginning with an initial melittin concentration of 100μg/mL, noting an EC50 value of 28.29 μg/mL. Cytotoxicity study was conducted in isolated peritoneal macrophages from BALB/c mice, obtaining an EC50 value of 5.73μg/mL. The cell viability of both trials was assessed by means of the study of mitochondrial oxidative activity (MTT). The studies demonstrated an EC50 value of 1.47μg/mL on intracellular amastigotes. As the cytokines production by cells challenged with parasite and treated with melittin, was observed that there was an increased tendency for inflammatory cytokines IL-12 and TNF-α at used concentrations and in the respective periods of time analyzed. The melittin did not interfered in the IFN-γ and TGF-β production, however were observed a significant decrease in the IL- 10 levels, which was similarly observed in the H2O2 and NO production...

Isospora belli Infection with Chronic Diarrhea in an Alcoholic Patient

Chronic diarrhea with a 35 kg weight loss (75 kg to 40 kg) occurred during 2 years in an alcoholic patient was diagnosed with Isospora belli infection in the Republic of Korea. The patient, a 70-year old Korean male, had been a heavy drinker for more than 30 years. He was admitted to the Seoul National University Hospital because of long-standing diarrhea and severe weight loss. He had an increased white blood cell (WBC) count with high peripheral blood eosinophilia (36.8-39.9%) and lowered protein and albumin levels but without any evidence of immunosuppression. A parasitic infection was suspected and fecal examination was repeated 3 times with negative results. Peroral endoscopy with mural biopsy was performed in the upper jejunum. The biopsy specimens revealed villous atrophy with loss of villi together with various life cycle stages of I. belli, including trophozoites, schizonts, merozoites, macrogamonts, and microgamonts. The patient was treated successfully with oral doses of trimethoprim 160-320 mg and sulfamethoxazole 800-1,600 mg daily for 4 weeks. A follow-up evaluation at 2.5 years later revealed marked improvement of body weight (68 kg), increased protein and albumin levels, and normal WBC count with low eosinophils (3.1%). This is the first clinical case of isoporiasis with demonstration of various parasitic stages in the Republic of Korea.

Therapeutic Potential of Myrrh and Ivermectin against Experimental Trichinella spiralis Infection in Mice

Trichinosis is a parasitic zoonosis caused by the nematode Trichinella spiralis. Anthelmintics are used to eliminate intestinal adults as well as tissue-migrating and encysted larvae. This study aimed to investigate the effects of ivermectin and myrrh obtained from the aloe-gum resin of Commiphora molmol on experimental trichinosis. Ninety albino mice were orally infected with 300 T. spiralis larvae. Drugs were tested against adult worms at day 0 and day 5 and against encysted larvae on day 15 and day 35 post-infection (PI). Mature worms and encysted larvae were counted in addition to histopathological examination of muscle specimens. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total protein, albumin, globulin, urea, and creatinine values were estimated. Significant reductions in mean worm numbers were detected in ivermectin treated mice at day 0 and day 5 PI achieving efficacies of 98.5% and 80.0%, while efficacies of myrrh in treated mice were 80.7% and 51.5%, respectively. At days 15 and 35 post-infection, ivermectin induced significant reduction in encysted larval counts achieving efficacies of 76.5% and 54.0%, respectively, while myrrh efficacies were 76.6% and 35.0%, respectively. AST, ALT, urea, and creatinine levels were reduced, while total proteins were increased in response to both treatments compared to their values in the infected non-treated mice. Ivermectin use for controlling T. spiralis could be continued. Myrrh was effective and could be a promising drug against the Egyptian strains of T. spiralis with results nearly comparable to ivermectin.

Salvage treatment of disseminated strongyloidiasis in an immunocompromised patient: therapy success with subcutaneous ivermectin

Disseminated strongyloidiasis is a disease with high mortality rate, especially in immunocompromised individuals. Paralytic ileus and intestinal malabsorption are frequent symptoms caused by this severe disease. As there are no licensed parenteral anthelmintic drugs for human use, off-label formulations are often used in the treatment of this disease. In this case report, the use of subcutaneous ivermectin is described as a successful therapy for this life-threatening infection.

Field study on the efficacy of an oral 2 percent ivermectin formulation in horses / Eficácia a campo de uma formulação oral de ivermectina a 2 por cento em equinos

Twenty horses naturally infected with nematodes were included in a blind, controlled field study on efficacy and safety of an oral 2 percent ivermectin formulation at a dose of 0.2 mg.kg-1. Horses were divided into treated and non-treated (control) groups with ten animals each based on preliminary counts of eggs per gram of feces (EPG). Stool samples were collected after treatment for identification of nematode species. Clinical evaluations and EPG counts were performed on days 0, +5, +14 and +19. Nineteen nematode species were identified: Coronocyclus ulambajari, Craterostomum acuticaudatum, Cyathostomum catinatum, Cyathostomum pateratum, Cylicocyclus brevicapsulatus, Cylicocyclus insigne, Cylicocyclus leptostomum, Cylicocyclus nassatus, Cylicocyclus ultrajectinus, Cylicocyclus spp., Cylicostephanus calicatus, Cylicostephanus longibursatus, Cylicostephanus poculatus, Habronema muscae, Habronema spp., Parascaris equorum, Poteriostomum imparidentatum, Oxyuris equi and Triodontophorus spp. The mean EPG counts of treated and non-treated (control) groups on Days -15, 0, +5, +14 and +19 were 1925, 1340, 0, 12.5, 0, 1470, 790, 875, 1605 and 1240 respectively. The efficacy of treatment on Days +5, +14 and +19 was 100, 99.2 and 100 percent respectively, with a significant difference compared to the control group (p < 0.01). The product was considered to be safe with no findings of clinical significant changes during the study.

Vinte equinos naturalmente infectados com nematódeos foram utilizados em estudo cego, controlado, de eficácia e segurança clínica a campo de uma formulação oral de ivermectina a 2 por cento, na dosagem de 0,2 mg.kg-1. Foram distribuídos em grupos: tratado e sem tratamento, de dez animais cada, baseados na contagem prévia de ovos por grama de fezes (OPG). Amostras de fezes foram colhidas pós-tratamento para identificação da helmintofauna. Avaliações clínicas e OPG foram realizados nos dias 0, +5, +14 e +19. Identificou-se dezenove espécies de nematódeos: Coronocyclus ulambajari, Craterostomum acuticaudatum, Cyathostomum catinatum, Cyathostomum pateratum, Cylicocyclus brevicapsulatus, Cylicocyclus insigne, Cylicocyclus leptostomum, Cylicocyclus nassatus, Cylicocyclus ultrajectinus, Cylicocyclus spp., Cylicostephanus calicatus, Cylicostephanus longibursatus, Cylicostephanus poculatus, Habronema muscae, Habronema spp., Parascaris equorum, Poteriostomum imparidentatum, Oxyuris equi e Triodontophorus spp.. As contagens médias de OPG dos grupos tratado e controle nos dias -15, 0, +5, +14 e +19 foram respectivamente 1925, 1340, 0, 12,5, 0 e 1470, 790, 875, 1605 e 1240. A eficácia do produto nos dias +5, +14 e +19 foi respectivamente de 100, 99,2 e 100 por cento, com diferença significativa em relação ao grupo controle (p < 0,01). O produto mostrou-se seguro, não sendo observadas alterações clínicas dignas de nota durante o experimento.

Ação anti-helmíntica de diferentes formulações de lactonas macrocíclicas em cepas resistentes de nematódeos de bovinos / Anthelmintic action of different formulations of macrocyclic lactones on resistant strains of nematodes of cattle

As lactonas macrocíclicas (LMs) (avermectinas e milbemicinas) são endectocidas amplamente utilizados em animais e em algumas parasitoses humanas. Em bovinos, a resistência parasitária às LMs é emergente, e o surgimento de formulações que diferem nas suas propriedades farmacológicas tornou complexa a escolha da droga mais indicada a cada caso. Com o objetivo de avaliar possíveis alternativas para recuperar a eficácia de LMs sobre cepas resistentes de nematódeos gastrintestinais, testaram-se, neste estudo, dez diferentes tratamentos a base de LMs sobre uma população de nematódeos gastrintestinais de bovinos a qual, sabidamente, sofrera pressão de seleção por avermectinas a 1 por cento. Adicionalmente, testou-se um benzimidazol. A eficácia das drogas foi calculada com base na redução de ovos por grama de fezes (OPG) dos bovinos. A resistência de cada gênero foi avaliada por meio de identificação de larvas, obtidas de cultivos nas fezes, pré- e pós-tratamentos. Não se obteve a eficácia desejada com o emprego de avermectinas de longa ação - com alta concentração e em associação - ou mesmo, com a aplicação de superdoses. Os gêneros Cooperia spp., Haemonchus spp. e Trichostrongylus spp. foram resistentes às avermectinas, e Ostertagia spp. à ivermectina. Observou-se que, uma vez estabelecida a resistência parasitária a LMs a 1 por cento, a aplicação de fármacos, deste mesmo grupo químico, ainda que em formulações mais concentradas, asso-ciações ou superdoses, pode não resultar na eficácia esperada.

The macrocyclic lactones (MLs) (avermectins and milbemycins) are endectocides broadly used in livestock and in some parasitic diseases of humans. In cattle, parasite resistance to MLs is emerging, and the appearance of formulations that differ in their pharmacological properties become complex the choice of the most appropriate drug to each case. In order to evaluate possible alternatives to restore the effectiveness of MLs on resistant strains of gastrointestinal nematodes, were tested, in this study, ten different treatments based on the MLs on a population of gastrointestinal nematodes of cattle which, known, was under pressure of selection by 1 percent avermectins. Additionally, was tested a benzimidazole. The efficacy of the drugs was calculated with basis on the reduction of eggs per gram of feces (EPG) of cattle. The resistance of each genus was evaluated by identification of the larvae, obtained from culture in the feces, pre- and post-treatments. The desired efficacy was not obtained using long action avermectins - with high concentration and in association - even with the application of high doses. The genera Cooperia spp., Haemonchus spp. and Trichostrongylus spp. were resistant to avermectins, and Ostertagia spp. to ivermectin. It was observed that, once established parasite resistance to the 1 percent MLs, the application of drugs, of this same chemical group, even in formulations of high concentration, association or in high doses, may not result in the expected efficacy.

Tratamiento anti-infeccioso de diarreas en pediatría: [revisión] / Anti-infective treatment of diarrhea in pediatrics: [review]

La diarrea es una de las causas más comunes de enfermedad en pediatría y la segunda causa de muerte infantil en el mundo. Cobra la vida de cerca de 4.000 niños cada día. La carga es mayor en el mundo en desarrollo donde el acceso al agua potable, saneamiento y atención médica son a menudo limitadas. Las características de las evacuaciones permiten orientar la terapia inicial. Las diarreas de etiología bacteriana se tratan según criterios muy bien especificados, la mayoría se autolimitan en más del 50 por ciento de los casos. Los virus constituyen la etiología más fecuente de las diarreas (más de 40 por ciento de los episodios agudos). Existen múltiples parásitos causales para los cuales existen también alternativas terapéuticas. La terapia anti-infecciosa cuando este indicado se debe iniciar precozmente, de esta manera, se reduce la duración y gravedad de la enfermedad, se previenen complicaciones, se disminuye la excreción del agente infeccioso y se evita la transmisión del patógeno.

Diarrhea disease is ona of the most commun causes of illness and the second leading cause of child dealth in the world. It claims the lives of nearly 4000 children each day. The burden is greatest in the developing world where access to safe water, sanitation, and medical care are often limited. Viruses are the most common cause of diarrhea (more than 40% of acute episodes). Episodes of bacterial diarrhea are self-limited in more than 50% of cases. There are multiple causative parasites for which there are also therapeutic alternatives. Anti-infective therapy should be initiated early, thus reducing the duration and severity of the disease, preventing complications, decreasing the excretion of the infectious agent and preventing the transmission of the pathogen.

Community-directed interventions for priority health problems in Africa: results of a multicountry study

Objective To determine the extent to which the community-directed approach used in onchocerciasis control in Africa could effectively and efficiently provide integrated delivery of other health interventions.Methods A three-year experimental study was undertaken in 35 health districts from 2005 to 2007 in seven research sites in Cameroon; Nigeria and Uganda. Four trial districts and one comparison district were randomly selected in each site. All districts had established ivermectin treatment programmes; and in the trial districts four other established interventions - vitamin A supplementation; use of insecticide-treated nets; home management of malaria and short-course; directly-observed treatment for tuberculosis patients - were progressively incorporated into a community-directed intervention (CDI) process. At the end of each of the three study years; we performed quantitative evaluations of intervention coverage and provider costs; as well as qualitative assessments of the CDI process. Findings With the CDI strategy; significantly higher coverage was achieved than with other delivery approaches for all interventions except for short-course; directly-observed treatment. The coverage of malaria interventions more than doubled. The district-level costs of delivering all five interventions were lower in the CDI districts; but no cost difference was found at the first-line health facility level. Process evaluation showed that: (i) participatory processes were important; (ii) recurrent problems with the supply of intervention materials were a major constraint to implementation; (iii) the communities and community implementers were deeply committed to the CDI process; (iv) community implementers were more motivated by intangible incentives than by external financial incentives. Conclusion The CDI strategy; which builds upon the core principles of primary health care; is an effective and efficient model for integrated delivery of appropriate health interventions at the community level in Africa

Prevalence of the Intestinal Flukes Haplorchis taichui and H. yokogawai in a Mountainous Area of Phongsaly Province, Lao PDR

Phongsaly Province, located in the northernmost area of Lao PDR, was previously suggested to be endemic for the liver fluke Opisthorchis viverrini infection. To confirm, or rule out, this suggestion, the Phonxay village in the Khoua District, Phongsaly Province, was selected for a survey. Ten volunteers (8 men and 2 women aged 31-57 years) who consumed raw freshwater fish and had gastrointestinal troubles were treated with a single dose of praziquantel (40 mg/kg) and pyrantel pamoate (10 mg/kg) and purged with magnesium sulfate to recover any worm parasites. Eight of the 10 volunteers expelled 1 or more species of trematodes, nematodes, or cestodes (worm positive rate; 80%). The worms were morphologically identified as H. taichui (861 worms from 8 people), H. yokogawai (59 from 6 people), Phaneropsolus bonnei (1 from 1 person), Trichostrongylus sp. (2 from 2 people), Ascaris lumbricoides (2 from 1 person), Enterobius vermicularis (11 from 3 people), and Taenia saginata (1 strobila with scolex from 1 person). The results indicate that the mountainous area of Phongsaly Province, Lao PDR, is not endemic for the liver fluke but endemic for intestinal flukes, in particular, Haplorchis taichui and H. yokogawai.

Mejoría clínica y serológica de pacientes con enfermedad de Chagas crónica tratados con benznidazol / Improvement of clinic and serological long-term evolution of chronic Chagas disease patients treated with benznidazole

Objetivos: Comparar la evolución alejada de pacientes crónicos tratados con benznidazol y sin tratamiento. Métodos: Se incluyeron 1835 pacientes con enfermedad de Chagas crónica y más de 1 año de seguimiento. El punto final principal de evaluación fue la progresión de la miocardiopatía y los puntos finales secundarios incluyeron los cambios electrocardiográficos y la negativización serológica. Los resultados del tratamiento se evaluaron en un modelo multivariado (Cox) ajustados para la edad, sexo, síntomas y ECG. Los pacientes tratados recibieron 5 mg/kg de peso/día de benznidazol oral, durante 30 días (760 pacientes) o continuaron sin tratamiento (1075 pacientes). Resultados: La edad, los síntomas y el ECG anormal fueron predictores independientes de progresión de la miocardiopatía. El tratamiento con benznidazol redujo la progresión de la cardiopatía (HR 0.63; IC 95%: 0.47-0.95; p = 0.02), la mortalidad (HR 0.54; IC 95%: 0.30-0.97; p = 0.04) y los cambios del ECG (HR 0.59; IC 95%: 0.44-0.79; p < 0.001), mientras que aumentó la frecuencia de negativización completa de la serología (HR 1.78; IC 95%: 1.16-2.73; p = 0.008). Conclusiones: El tratamiento con benznidazol mostró un beneficio clínico y serológico sobre la evolución de la enfermedad de Chagas crónica.