Study on the zoonotic cycle of tegumentary leishmaniasis in an endemic area of a metropolitan region in the Northeastern region of Brazil

ABSTRACT This study was conducted to characterize the transmission cycle of the tegumentary leishmaniasis (TL) in an old colonization area at Pernambuco State, Brazil. The aims were to identify autochthonous cases, sandflies fauna, domestic animals as possible reservoir hosts and the Leishmania species involved in this endemic area. A total of 168 suspected human cases of TL and 272 domestic animals (canine, feline, equine, goat, and sheep) were included. The sandflies were captured and identified by species. Patients were predominantly male and the average age was 37+18.1 years old. Of 85 patients who had skin lesions, 25.6% of them had direct positive smears for TL and 34 isolates were identified as Leishmania (Viannia) braziliensis. The confirmation for TL diagnosed by molecular detection (PCR) was almost three times more sensitive than the direct test [p < 0.001; PR = 2.72] associated with clinical examination. The Kappa test on PCR between two different specimens, biopsy, and skin lesion swab was 60.8% (p < 0.001). More than 200 specimens of sandflies (80 males and 159 females) were captured and identified as Lutzomyia whitmani (99.6%) and Lu. evandroi (0.4%). The detection of L. (V.) braziliensis by Real-Time PCR in the blood of a captured fed female was positive in 59.3% of Lu. whitmani. Of the 272 domestic animals included, 61.76% were male (n = 168). Thirty-six animals (13.2%) had lesions compatible with TL (34 dogs, 1 cat and 1 sheep) and 3 of them, all dogs, had lesions on the snout, showing destruction of cartilage and mucosa. The study suggests the participation of domestic animals as possible reservoirs. However, further studies are necessary to better understand the transmission cycle and take recommended measures in order to control the disease.

Leishmania (Viannia) braziliensis isolated from the saliva of patients in a cutaneous leishmaniasis-endemic area of northeastern Brazil

Several studies have described the use of non-invasive collection methods, mostly based on the detection of parasite DNA, for diagnosis. However, no Leishmania specimens have been isolated from saliva. Here, we report the first isolation of Leishmania braziliensis from the saliva of humans with cutaneous leishmaniasis but without lesions on their mucosa. The isolates were obtained from salivary fluid inoculated in hamsters and were tested by multilocus enzyme electrophoresis. Seven samples from 43 patients suspected of having the disease were identified for in vivo culture. These findings suggest that saliva is a clinical sample that allows the isolation of Leishmania sp.

Tratamento da doença de Hailey-Hailey com laser de CO2 fracionado: uma série de três casos / Treatment of the Hailey-Hailey disease with fractional CO2 laser: a three-case series

A doença de Hailey-Hailey ou pênfigo familiar benigno é condição rara, que se caracteriza por lesões vesiculares e erosões, associadas a dor e queimação, que comprometem a qualidade de vida dos pacientes. Existem vários tratamentos tópicos e sistêmicos que podem promover temporariamente a remissão das lesões, não existindo tratamento curativo. Algumas opções de tratamento com resultados duradouros abrangem a dermoabrasão e a vaporização com laser de Erbium YAG ou CO2. Relatamos três casos de pacientes com lesões recorrentes e respostas limitadas aos tratamentos clássicos, que apresentaram melhora clínica importante e alívio sintomático após terapia com laser de CO2 fracionado.

The Hailey-Hailey disease or familial benign pemphigus is a rare condition, characterized by vesicular lesions and erosions with a predilection for intertriginous areas associated with pain and burning sensation that affect the quality of life of patients. There are many topical and systemic treatments for the injuries that can temporarily promote partial or complete remission, but there is no curative treatment. Some treatment options with lasting results include dermabrasion and Erbium laser resurfacing (YAG or CO2). We report three cases of patients with recurrent lesions and limited responses to classical treatments, which showed significant clinical improvement after fractional CO2 laser therapy.

Post-kala-azar dermal Leishmaniasis in two different clinical contexts

In Brazil, visceral Leishmaniasis is caused by Leishmania chagasi. The development of cutaneous lesions in visceral leishmaniasis patients has been described in two different clinical contexts. Patients with compromised immunity can develop skin lesions as a direct consequence of a current visceral disease. Equally, patients with a history of kala-azar and progressive, immune improvement occasionally develop skin lesions as a consequence of immune reconstitution infl ammatory syndrome. These cases manifest in similar fashion to the classic form of post-kala-azar dermal Leishmaniasis. We describe different cases that exemplify these two clinical presentations.

Pigmented eccrine poroma: report of an atypical case with the use of dermoscopy / Poroma ecrino pigmentado: relato de caso atipico com descricao da dermoscopia

Poromas are uncommon benign neoplasms originating from the terminal ductal portion of the sweat glands, mainly characterized by skin-colored or pink pa pules or nodules, usually on the extremities. Due to their rarity, the pigmented form clinical hypothesis is hardly ever suggested and psychopathology is fundamental. We report a case of pigmented eccrine poroma in the right palmer area, a location considered atypical. We stress the importance of dermoscopy as a method for diagnosis of poromas, especially in the differential diagnosis with other pigmented nodular-popular lesions.

Os poromas são neoplasias benignas incomuns oriundas das porções ductais terminais das glândulas sudoríparas. Caracterizam-se principalmente por pápula ou nódulo cor da pele ou róseo, em geral nas extremidades. Devido à raridade, a hipótese clínica da forma pigmentada dificilmente é aventada, sendo fundamental a histopatologia. Relata-se caso de poroma écrino pigmentado na região palmar direita, localização considerada atípica. Ressalta-se a importância da dermoscopia como método auxiliar no diagnóstico do poroma e, principalmente, no diagnóstico diferencial com outras lesões pápulo-nodulares pigmentadas.

Tratamento da foliculite decalvante com laser Nd: YAG / Treatment of folliculitis decalvans with Nd: YAG laser

O tratamento da foliculite decalvante representa grande desafio, com inúmeras recidivas e manutenção da atividade da doença por longo período. A remoção de pelo com laser vem sendo utilizada no manejo de desordens foliculares cicatriciais. Este relato tem por objetivoilustrar o caso de paciente portador de foliculite decalvante em membro inferior que realizou cinco sessões terapêuticas com laser neodímio:YAG (Nd:YAG) e assim obteve remissão completa das lesões inflamatórias.

Treatment of folliculitis decalvans is a major challenge, with a great number of recurrences and required maintenance of disease activity over a long period. Laser-based hair removal has been used in the management of scarring follicular disorders. The present case report aims to illustrate the case of a patient bearing folliculitis decalvans in the lower limb who underwent five therapeutic sessions of neodymium:YAG laser (Nd:YAG), achieving complete remission of the inflammatory lesions with the treatment.

Tratamento dos grânulos de Fordyce com laser de CO2 - Relato de dois casos / Treatment of Fordyce granules with a CO2 laser: report of two cases

Os grânulos de Fordyce são referidos como glândulas sebáceas ectópicas benignas caracterizadas por múltiplas pápulas amareladas, principalmente em lábio superior e observadas na maioria dos casos em homens adultos. Descrevem-se dois casos de pacientes com grânulos de Fordyce que foram submetidos ao tratamento com laser de CO2 obtendo bom resultado cosmético.

Fordyce granules are referred to as benign ectopic sebaceous glands characterized by multiple yellow papules, occurring mainly in the lower lip. It is mainly observed in adult men. The present study describes two cases of patients with Fordyce granules who were treated using a CO2 laser and obtained good cosmetic results.

Estenose aórtica severa em idosos: avaliação clínica, eletrocardiográfica, ecocardiográfica e angiográfica / Severe aortic stenosis in the elderly: clinical, eletrocardiographic, ecocardiographic and angiographic assessment

Objetivos: Analisar o perfil clínico e laboratorial de idosos portadores de estenose aórtica severa e possíveis diferenças entre os sexos. Método: Foram estudados 30 pacientes (18 homens e 12 mulheres), com média de idade de 70,7±5,3 anos, portadores de estenose aórtica acentuada, sendo avaliados quanto a sintomas clínicos, presença de fatores de risco, padrões eletrocardiográficos, ecocardiográficos e associação com doença arterial coronariana, pela realização de angiografia coronariana. Resultados: Dispnéia foi o sintoma mais frequente (40%). Mulheres tinham mais angina que os homens. Apenas dois pacientes tinham fração de ejeção baixa. Homens apresentaram menores frações de ejeção que mulheres (p<0,05). Houve alta prevalência (53,3%) de doença arterial coronariana associada através de coronariografia. Conclusões: Os achados de dispnéia como sintoma mais frequente no grupo total, diferença da frequência de sintomas entre os sexos e fração de ejeção menor nos homens sugeriram que os mecanismos de adaptação ventricular à estenose aórtica possam ser diferentes entre os sexos. Existe forte associação entre estenose aórtica senil calcificada e doença arterial coronariana em idosos.

Objectives: To evaluate clinical and laboratorial profile in elderly patients with severe aortic stenosis and possible gender differences. Method: We studied 30 patients (18 males and 12 females) aged 70,7±5,3 years with severe aortic stenosis, analyzing clinical manifestations, risk factors, eletrocardiographic and ecocardiographic indexes and association with coronary artery disease by coronary angiographic assessment. Results: Dyspnea was the most frequent symptom with overall prevalence of 40%. Women had more angina than men. Ejection fraction was low in only two patients. Male patients had lower ejection fraction (p<0,05). High prevalence (53,3%) of associated coronary artery disease was observed. Conclusions: Data showed dyspnea as the most common clinical manifestation, gender differences of clinical manifestations and lower ejection fraction in male patients suggest that adaptive mechanisms to this condition may be different in both genders. There is a strong association between aortic stenosis in elderly and coronary artery disease.

Clinical epidemiological profile of American tegumentary leishmaniasis at the Pinto Sugar Mill in Moreno Municipality, Greater Metropolitan Recife, Pernambuco State, Brazil / Perfil clínico-epidemiológico da leishmaniose tegumentar americana no Engenho Pinto, Município de Moreno, Região Metropolitana do Recife, Pernambuco, Brasil

American tegumentary leishmaniasis (ATL) is present in all regions of Pernambuco State, Brazil, where it is spreading, with the emergence of foci in new areas like the Municipality (County) of Moreno in Greater Metropolitan Recife. The objective of the current study was to assess the prevalence of infection and identify autochthonous cases of ATL. In April 2006 a population survey was performed using a questionnaire and the Montenegro skin test (MST) in 481 individuals from the Pinto Sugar Mill, of whom 47 percent were males and 74 percent were younger than 30 years. One hundred forty-four individuals (30 percent) showed a positive MST. Of these, five presented active lesions, 41 were cured after meglumine antimoniate treatment, and one showed a spontaneous cure. Indirect immunofluorescence (IIF) was performed on sera from 89 individuals and showed a 36 percent positive rate. The high ATL prevalence demonstrates the epidemiological spread of the disease in Greater Metropolitan Recife, a worrisome development since there are no effective measures for ATL control except ecological awareness raising to minimize the risk of infection.

A leishmaniose tegumentar americana incide em todas as regiões do Estado de Pernambuco, Brasil, onde se apresenta em expansão, com o surgimento de focos em novas áreas, como o Município de Moreno, na região metropolitana do Recife. O objetivo deste estudo foi avaliar a prevalência da infecção e identificar os casos autóctones de leishmaniose tegumentar americana. Em abril de 2006, realizou-se um inquérito populacional por meio da aplicação de um questionário e do teste de intradermoreação de Montenegro a 481 indivíduos do Engenho Pinto, dos quais 47 por cento eram do sexo masculino e 74 por cento menores de 30 anos. Cento e quarenta e quatro (30 por cento) indivíduos apresentaram reação positiva ao teste. Dentre estes, cinco apresentaram lesões ativas, 41 foram curados após quimioterapia e um curado espontaneamente. A RIFI realizada nos soros de 89 indivíduos apresentou 36 por cento de positividade. A alta prevalência aponta para a expansão epidemiológica da doença nessa área da região metropolitana, fato preocupante, pois não há medidas eficazes para o controle da leishmaniose tegumentar americana, a não ser uma conscientização ecológica para minimizar o risco de infecção.

Clinical, epidemiological and laboratory aspects of patients with American cutaneous leishmaniasis in the State of Pernambuco / Aspectos clínicos, epidemiológicos e laboratoriais de pacientes com leishmaniose cutânea americana no Estado de Pernambuco

The diagnosis for American cutaneous leishmaniasis is based on an association of clinical, epidemiological and laboratory characteristics. The present study identified the circulating species of Leishmania in the State of Pernambuco, described its clinical-epidemiological characteristics and diagnosed the disease. Nineteen patients presenting active lesions who had been diagnosed through clinical evaluation and laboratory tests were selected. The tests included direct investigation, in vitro culturing, Montenegro skin test, indirect immunofluorescence and polymerase chain reaction. The Montenegro Skin Test showed positive results in 89 percent of the patients; indirect immunofluorescence, in 79 percent; direct investigation, in 58 percent; and polymerase chain reaction in 75 percent. Seven Leishmania (Viannia) braziliensis samples were isolated from these patients and were characterized by means of specific monoclonal antibodies. These data confirm that a combination of different diagnosis techniques is needed in order to obtain efficient results and that, so far, Leishmania (Viannia) braziliensis is the only species responsible for American cutaneous leishmaniasis infection in Pernambuco. Thus, it is essential to identify the parasite species involved in cases of human disease in an endemic area in order to determine the clinical and epidemiological characteristics, especially with regard to diagnosis, therapy development and disease prognosis.

O diagnóstico da leishmaniose cutânea americana é baseado na associação dos aspectos clínicos, epidemiológicos e laboratoriais. O presente estudo identificou a espécie de Leishmania circulante no Estado de Pernambuco, descreveu os aspectos clínico-epidemiológicos e diagnosticou a doença. Foram selecionados 19 pacientes apresentando lesão ativa e diagnosticados através de avaliação clínica e pelos exames laboratoriais que incluíram a pesquisa direta, cultivo in vitro, intradermorreação de Montenegro, imunofluorescência indireta e reação em cadeia de polymerase. A intradermorreação de Montenegro apresentou resultado positivo em 89 por cento dos pacientes. A imunofluorescência indireta apresentou 79 por cento de positividade, a pesquisa direta apresentou 58 por cento e a reação em cadeia de polymerase 75 por cento de positividade. Sete amostras de Leishmania (Viannia) braziliensis foram isoladas desses pacientes e caracterizadas através de anticorpos monoclonais específicos. Esses dados confirmam que é necessário a combinação de diferentes técnicas diagnósticas para se obter resultados eficientes e que, até o momento, a Leishmania (Viannia) braziliensis é a única espécie responsável pela infecção da leishmaniose cutânea americana em Pernambuco. Portanto, a identificação da espécie do parasito envolvido nos casos da doença no homem em uma área endêmica é essencial para o conhecimento dos aspectos clínicos e epidemiológicos, sobretudo para o diagnóstico e para o desenvolvimento da terapia e prognóstico da doença.

DNA sequencing confirms the involvement of Leishmania (L.) amazonensis in american tegumentary leishmaniasis in the state of São Paulo, Brazil

INTRODUCTION: American tegumentary leishmaniasis (ATL) represents one of the most important public health issues in the world. An increased number of autochthonous cases of ATL in the Northeastern region of São Paulo State has been documented in the last few years, leading to a desire to determine the Leishmania species implicated. METHODS: PCR followed by DNA sequencing was carried out to identify a 120bp fragment from the universal kDNA minicircle of the genus Leishmania in 61 skin or mucosal biopsies from patients with ATL. RESULTS: DNA sequencing permitted the identification of a particular 15bp fragment (5' …GTC TTT GGG GCA AGT... 3') in all samples. Analysis by the neighbor-joining method showed the occurrence of two distinct groups related to the genus Viannia (V) and Leishmania (L), each with two subgroups. Autochthonous cases with identity to a special Leishmania sequence not referenced in Genbank predominated in subgroup V.1, suggesting the possible existence of a subtype or mutation of Leishmania Viannia in this region. In the subgroup L.2, which showed identity with a known sequence of L. (L.) amazonensis, there was a balanced distribution of autochthonous and non-autochthonous cases, including the mucosal and mucocutaneus forms in four patients. The last observation may direct us to new concepts, since the mucosal compromising has commonly been attributed to L. (V.) braziliensis, even though L. (L.) amazonensis is more frequent in the Amazonian region. CONCLUSIONS: These results confirm the pattern of distribution and possible mutations of these species, as well as the change in the clinical form presentation of ATL in the São Paulo State.

Estudo comparativo da prevalência de Staphylococcus aureus importado para as unidades de terapia intensiva de hospital universitário, Pernambuco, Brasil / Comparative study on the prevalence of Staphylococcus aureus imported to intensive care units of a university hospital, Pernambuco, Brazil

O Staphylococcus aureus é um dos principais patógenos que coloniza indivíduos saudáveis na comunidade e responde por infecções em pacientes hospitalizados. Um estudo transversal foi realizado para determinar a prevalência de S. aureus meticilina-resistente e sensível entre 231 pacientes, internados entre janeiro e abril de 2003, nas unidades de terapia intensiva (UTIs) do Hospital Universitário Oswaldo Cruz, assim como os possíveis fatores associados à colonização. Foram coletadas secreções de narinas, axilas, região perineal e dermatoses com soluções de continuidade, de todos os pacientes, nas primeiras 48 horas de internamento nas UTIs. O material foi semeado em meios de cultura adequados. A prevalência de S. aureus igualou-se a 37,7 por cento (87/231), sendo 13 por cento (30/231) meticilina-resistente e 24,8 por cento (57/231) meticilina-sensível. Idade, sexo, uso de antibioticoterapia, corticoterapia, motivo e local do internamento não se associaram à presença do S. aureus ou do meticilina-resistente. Houve associação significante entre procedência hospitalar e colonização por S. aureus, independente da cepa, e entre internamento anterior e presença do S. aureus meticilina-resistente. As narinas foram o sítio de colonização mais significante, por S. aureus meticilina-resistente (47/57=82,4 por cento) e sensível (23/30=76,7 por cento). Foi alta a prevalência do S. aureus (meticilina resistente ou sensível), assim como do meticilina-resistente entre os pacientes das UTIs deste hospital. Estudos futuros poderão comprovar se os resultados aqui descritos e medidas de rastreamento para S. aureus poderiam ser adotadas, de forma prospectiva, para se avaliar o risco, assim como a magnitude do efeito, no controle de infecções hospitalares provocadas por estes patógenos.

Staphylococcus aureus is the most important pathogen that colonizes healthy individuals in the community and is responsible for infections in hospitalized patients. A cross-sectional study was carried out to determine the prevalence of methicillin-resistant and sensitive S. aureus, in 231 patients, hospitalized from January to April 2003, in the Intensive Care Units (ICU) of Hospital Universitário Oswaldo Cruz, as well as possible factors associated with colonization. Secretions, from the anterior nostrils, armpits, perineum and dermatosis with continuity solutions, were collected from all patients, within the first 48 h of admission at the ICU. These samples were spread on appropriate media. The prevalence of S. aureus was 37.7 percent (87/231), of which 13 percent (30/231) methicillin-resistant and 24.8 percent (57/231) methicillin-sensitive. Age, gender, antibiotic therapy, corticoid therapy and cause and place of hospitalization were not associated to colonization by S. aureus or methicillin-resistance. There was a significant association between hospital of origin and S. aureus colonization, regardless of strain, as well as between previous hospitalization and the presence of methicillin-resistant S. aureus. Regardless of strain, nostrils were the most significant colonization site for methicillin-resistant (47/57=82.4 percent) and methicillin-sensitive S. aureus (23/30=76.7 percent). There was a high prevalence of S aureus, (methicillin resistant or sensitive), as well as of methicillin resistance among ICU patients in this hospital. Future studies may prove the results reported here and screening routines for S. aureus should be adopted, prospectively, to evaluate risk, as well as the magnitude of the effect, on the control of hospital infections caused by these pathogens.

Transposição dentária: um desafio na clínica ortodôntica - relato de caso / Dental transportation: a challenge to the orthodontic clinic - case report

Transposição dentária constitui uma rara anomalia de desenvolvimento, sendo considerada como um tipo de irrupção ectópica, em que dois dentes permanentes trocam de posição no arco. Estudos paleontológicos têm mostrado a presença de transposições dentárias em homens pré-históricos do sudeste e norte da Ásia, comprovando que este tipo de má oclusão não deve ser considerado uma desarmonia dos tempos modernos. A transposição dentária pode afetar ambos os gêneros, sendo mais encontrada em mulheres, no arco dentário superior, sendo a tipo unilateral mais frequente que a bilateral. A etiologia ainda não se encontra bem elucidada, existindo muitas controvérsias. O tratamento irá depender quase exclusivamente de como o caso de apresenta podendo o ortodontista optar pelo alinhamento dos elementos dentários na posição da transposição, pela extração de um ou ambos os dentes transportados ou então o alinhamento ortodôntico para duas reais posições no arco dentário. Apesar dos riscos do tratamento que exige do profissional uma mecânica de extremo controle, a transposição pode ser corrigida com sucesso, desde que sempre levado em consideração o limite fisiológico das estruturas periodontais e das reabsorções radiculares, para que o tratamento planejado possa ser revertido em um melhor ganho estético e funcional ao paciente. Em virtude da carência de casos clínicos tratados na literatura com a reversão da transposição, o objetivo do nosso trabalho foi apresentar um caso clínico de transposição entre o canino e o primeiro pré-molar superior do lado direito onde os elementos dentários foram alinhados e nivelados em suas reais posições.

Métodos subsidiários para o diagnóstico da Leishmaniose tegumentar americana (LTA): comparação dos resultados do seqüenciamento de DNA e da PCR-RFLP para determinação da espécie de leishmania em amostras cutâneo-mucosas / Subsidiary methods for the diagnosis of American tegumentar leishmaniasis (ATL): comparison of sequencing of DNA and PCR-RFLP for identification of leishmania species in skin samples

FUNDAMENTOS: Métodos moleculares têm-se mostrados mais eficazes para o diagnóstico da LTA. OBJETIVOS: Comparar os resultados da intradermorreação de Montenegro (IRM), presença de leishmania em biópsia (Bc), reação de imunofluorescência indireta (Rifi), seqüenciamento de DNA e PCR-RFLP (-restriction fragment lenght polymorphism) para o diagnóstico da LTA. MÉTODOS: Foram estudados 152 pacientes com LTA. Para a PCR em Bc, utilizaram-se primers específicos para seqüência de 120bp do kDNA do minicírculo comum a todas as espécies de leishmanias. O produto da PCR, utilizado para seqüenciamento e para restrição enzimática com Hae III, foi comparado às culturas L. (L.) amazonensis e L. (V.) braziliensis. RESULTADOS: Houve predomínio do sexo masculino (75 por cento), da cor branca (80 por cento) e da profissão urbana (48 por cento). A idade variou de três a 77 anos, com 56,5 por cento entre 21 e 50 anos. 65,8 por cento eram do Estado de São Paulo, prevalecendo a forma cutânea (79,6 por cento). A IRM foi positiva em 73,4 por cento, e a Rifi em 59,7 por cento, enquanto a Bc evidenciou presença de leishmania em 30,6 por cento. A PCR foi positiva em 81,6 por cento, e a PCR-RFLP identificou L. (V.) braziliensis como espécie predominante (66 por cento), o que também ocorreu com o seqüenciamento. Comparando PCR-RFLP e seqüenciamento, houve 61 por cento de concordância entre os resultados, mostrando significância da PCR-RFLP para L. (V.) braziliensis. CONCLUSÕES: A IRM e a PCR foram estatisticamente equivalentes como métodos subsidiários para o diagnóstico da LTA, a PCR-RFLP e o seqüenciamento também o foram na identificação das espécies de leishmania, o primeiro apresentando menores custo e tempo de execução comparado ao seqüenciamento de DNA.

BACKGROUND: ATL is endemic in Brazil, and molecular methods have been shown more effective for its diagnosis. OBJECTIVES: Our purpose was to compare the results of Montenegros skin reaction (MR), presence of leishmania in skin biopsy (Bx), indirect immunofluorescence (IIF) for leishmania in sera samples, PCR, sequencing of DNA and PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) as subsidiary exams for ATL diagnose. METHODS: 152 patients were studied, with accomplishment of MR, Bx, IIF and PCR for leishmania in skin samples. For PCR, a specific pair of primers for a sequence of 120bp from kDNA minicircle, common to all leishmanias species, was used. The product of PCR was used for DNA sequencing and for RFLP with the enzyme Hae III. The analysis of the restriction pattern was compared to the cultures of L. (L.) amazonensis and L. (V.) braziliensis. RESULTS: The predominant sex was male (75 percent), the white color (80 percent) and urban professional occupation (48 percent). The age varied from 3 to 77 years, with prevalence from 21 to 50 years (56.5 percent). In relation to the origin, 65.8 percent was from the state of São Paulo, being the cutaneous form the more prevalent (79.6 percent). MR was positive in 73.4 percent and there was presence of leishmania in 30.6 percent of the samples, while IIF presented 59.7 percent of positivity. PCR was positive in 81.6 percent of skin samples, and PCR-RFLP identified L. (V.) braziliensis (66 percent) as predominant species, fact that also happened with DNA sequencing, with 64.4 percent of the positive results for L. (V.) braziliensis. Comparing PCR-RFLP and DNA sequencing there was 61 percent of agreement amongst the results, being significant in PCR-RFLP for L. (V.) braziliensis. CONCLUSION: MR and PCR were equivalent as subsidiary methods for the diagnosis of ATL, such as PCR-RFLP and DNA sequencing in the identification of the leishmania species. On the other...

Prevalence of Staphylococcus aureus introduced into intensive care units of a University Hospital

Staphylococcus aureus is one of the principal human pathogens that colonize healthy individuals in the community in general, and it is responsible for severe infections in hospitalized patients. Due to an increase in the prevalence of strains of methicillin-resistant S. aureus (MRSA), combating these microorganisms has become increasingly difficult. A descriptive study was carried out on 231 patients in intensive care at the Oswaldo Cruz University Hospital (HUOC) in Recife, Brazil between January and April 2003 to determine the prevalence of S. aureus and MRSA and to evaluate risk factors for colonization by these bacteria when introduced into Intensive Care Units (ICUs). Body secretions were collected from the nostrils, axillary and perineal regions, and from broken skin lesions, of all patients during the first 48 hours following admission to the ICU. Samples were inoculated into blood agar and mannitol-salt-agar culture medium and identified by Gram staining, and by coagulase, DNAse and agglutination (Slidex Staph Test®) tests. Growth in Mueller-Hinton agar with 4 percent sodium chloride and 6mg/L oxacillin was used to identify MRSA. In addition, the latex agglutination test was performed to identify penicillin-binding protein, PBP 2A. The prevalence of S. aureus and MRSA was 87/231 (37.7 percent) and 30/231 (12.98 percent), respectively. There was no association between any risk factor studied (age, sex, origin of the patient - whether hospital or community, previous hospitalization, use of current or previous antibiotic therapy, corticotherapy and/or immunotherapy, reason for hospitalization and place of hospitalization) and the presence of S. aureus. However, a significant association was established between previous hospitalization and the presence of MRSA (RR:1.85; CI:1.00-3.41; p=0.041). The nostrils were the principal site of colonization by both S. aureus (80.4 percent) and MRSA (26.4 percent), followed by the perineal area, with rates of 27.6 percent and 12.6 percent, respectively. If only the nostrils had been investigated, the study would have failed to diagnose 17 patients (19.5 percent) as carriers of the pathogen into the ICU, thus contributing towards cross-dissemination.

Leishmaniose tegumentar americana: do histórico aos dias de hoje / Cutaneous american leishmaniasis: from the beginning until nowadays

Sintética revisäo sobre leishmaniose tegumentar americana enfatizando aspectos históricos, características do ciclo da leishmaniose, relaçäo vetor-parasita-hospedeiro, epidemiologia, formas clínicas, diagnóstico, técnicas laboratoriais e tratamento