Adherence to malaria prophylaxis among travelers from a middle-income country

Abstract INTRODUCTION: Malaria is the main cause of death by infection among travelers and is preventable through a combination of chemoprophylaxis and personal protective measures. METHODS: Travelers were interviewed by phone 28-90 days after returning, to assess adherence to pre-travel advice for malaria prevention. RESULTS: A total 57 travelers were included. Adherence to chemoprophylaxis was significantly higher among participants prescribed mefloquine (n=18; 75%) than doxycycline (n=14; 45%). Adherence to mosquito repellent and bed net use was 65% and 67%, respectively. CONCLUSIONS: Adherence to malaria prophylaxis was lower than expected. Further studies testing innovative approaches to motivate travelers' compliance are required.

Preventing diseases in round-the-world travelers: a contemporary challenge for travel medicine advice

Abstract Providing advice for travelers embarking on long-term trips poses a challenge in travel medicine. A long duration of risk exposure is associated with underuse of protective measures and poor adherence to chemoprophylaxis, increasing the chances of acquiring infections. Recently, in our clinic, we observed an increase in the number of travelers undertaking round-the-world trips. These individuals are typically aged around 32 years and quit their jobs to embark on one-to-two-year journeys. Their destinations include countries in two or more continents, invariably Southeast Asia and Indonesia, and mostly involve land travel and visiting rural areas. Such trips involve flexible plans, increasing the challenge, especially with regard to malaria prophylaxis. Advising round-the-world travelers is time-consuming because of the amount of information that must be provided to the traveler. Advisors must develop strategies to commit the traveler to his/her own health, and verify their learnings on disease-prevention measures. Contacting the advisor after the appointment or during the trip can be helpful to clarify unclear instructions or diagnosis made and prescriptions given abroad. Infectious diseases are among the most frequent problems affecting travelers, many of which are preventable by vaccines, medicines, and precautionary measures. The dissemination of counterfeit medicines, particularly antibiotics and antimalarial medicines, emphasizes the need for travelers to carry medicines that they may possibly need on their trip. Additional advice on altitude, scuba diving, and other possible risks may also be given. Considering the difficulties in advising this group, we present a review of the main recommendations on advising these travelers.

Osteomyelitis caused by Sporothrix schenckii in an immunocompetent patient

Abstract Sporotrichosis is the most common subcutaneous mycosis in South America and its association with zoonotic transmission remains a relevant public health problem in Rio de Janeiro, Brazil. The disease most commonly presents as subacute or chronic cutaneous lesions, although dissemination to various organs and systems occurs in rare cases, mainly in immunosuppressed individuals. This report describes a case of sporotrichosis with severe bone and subcutaneous damage in an immunocompetent patient who did not exhibit the characteristic skin lesions of sporotrichosis, including ulcers, nodules, and lymphangitis.

Severity of tegumentary leishmaniasis is not exclusively associated with Leishmania RNA virus 1 infection in Brazil

Leishmania RNA virus (LRV) has been shown to be a symbiotic component of Leishmania parasites in South America. Nested retro-transcription polymerase chain reaction was employed to investigate LRV1 presence in leishmaniasis lesions from Brazil. In endemic areas of Rio de Janeiro (RJ), no LRV1 infection was observed even with mucosal involvement. LRV1 was only detected in Leishmania (V.) guyanensis cutaneous lesions from the northern region, which were obtained from patients presenting with disease reactivation after clinical cure of their primary lesions. Our results indicated that the severity of leishmaniasis in some areas of RJ, where Leishmania (V.) brazi-liensis is the primary etiological agent, was not associated with Leishmania LRV1 infection.

A influência do sistema de sinalização Notch e das citocinas inflamatórias IL-17 e IL-18 na resposta ao tratamento da leishmaniose tegumentar americana / The influence of Notch signaling system and the inflammatory cytokines IL-17 and IL-18 in response to the treatment of american tegumentary leishmaniasis

A Leishmaniose Tegumentar Americana (LTA) é uma doença que se caracteriza pela presença de lesões cultâneas (LCL) e, em um número pequeno de pacientes, pelo desenvolvimento de lesão mucosa (ML). A evolução clínica e a resposta ao tratamento dependem de múltiplos fatores, incluindo o equilíbrio entre as citocinas Th1 e Th2, influenciando no controle parasitário e na extensão da lesão. Nesse equilíbrio complexo é possível que outras citocinas inflamatórias como IL-17 e IL-18, bem como fatores que influenciem na diferenciação de queratinócitos e nos processos inflamatórios da pele, como o sistema Notch, também possam se relacionar ao prognóstico das lesões. IL-18 é uma potente citocina indutora de IFN-gama, já tendo sido observado efeito protetor em doenças por protozoários. IL-17 é produzida por uma linhagem de células T descritas mais recentemente, que são consideradas essenciais em processos inflamatórios de vários tecidos e em doenças auto-imunes. O sistema de sinalização Notch é composto por um grupo de proteínas transmembrana que regulam processos decisórios em diversos tecidos, tanto no período embrionário como na vida adulta, incluindo a diferenciação de queratinócitos e de linfócitos T, na dependência do ligante envolvido em sua ativação (Delta-like – DLL1/DLL3/DLL4 ou Jagged 1 e 2). Estudamos a expressão das proteínas do sistema Notch e das citocinas IL-17 e IL-18 em lesões e sangue de pacientes com LTA causada por Leishmania (Viannia) braziliensis, comparando os níveis de expressão de acordo com o tempo de evolução das lesões, diâmetro da reação de Montenegro e resposta ao tratamento. As lesões cutâneas de LTA apresentam maior expressão de receptores Notch que a pele normal...

Successful prevention of HIV transmission from mother to infant in Brazil using a multidisciplinary team approach

Objectives: To determine the HIV vertical transmission rate (VTR) and associated risk factors by use of zidovudine and infant care education in Brazil. Methods: Since 1995, a prospective cohort of HIV infected pregnant womwn has been followed at the Federal University of Rio de Janeiro. A multidisciplinary team was established to implement the best available strategy to prevent maternal-infant HIV transmission. Patients with AIDS or low CD4 and high viral load received anti-retroviral drugs in addition to zidovudine. Children were considered infected if they had 2 positive PCR-RNA test between 1 and 4 months of age, or were HIV antibody positive after 18 months. Education regarding infant treatment and use of formula insteadof breast feeding was provided. Results: Between 199 and August, 2000. HIV status was determined for 145 infants. Compliance with intra-partum treatment, infant treatment and use of formula was 88.2 percent. Intra-partum zidovudine treatment was completed in 134/145 (92.6 percent) of patients; 88.1 percent had rupture of membranes < 4 hours; 85.4 percent of mothers were asymptomatic. The mean CD4 count was 428,4 cells and mean viral load 39,050 copies. HIV vertical transmission rate was 4/145 (2.75 percent; CI: 0.1 percent - 5.4 percent). The only risk factor significantly associated with transmission was a failure to use zidovudine intra-partum in 2 of the 4 mothers (50 percent versus 6.4 percent in non-transmitting mothers). A trend toward low CD4 and high viral load at entry, and rupture of membranes > 4 hours were associated with increased HIV transmission. Conclusion: HIV vertical transmission in Brazil was reduced to a level similar to other countries with the most effective prevention programs using a multidisciplinary team approach. A high levelof compliance for use of anti-retroviral drugs, the provision of health education to mothers, and use of formula for all exposed infants.

AIDS e miopatia: relato de um caso e revisäo da literatura / AIDS and myopathy: report of a case and review of the literature

É relatado o caso de um paciente com miopatia de apresentaçäo clínica incomum como manifestaçäo inicial da infecçäo por HIV. O paciente apresentava aumento de volume dos membros acompanhado de sinais flogísticos e elevaçäo dos níveis séricos de enzimas musculares. A alteraçäo histopatológica predominante consistia em necrose segmentar de fibrocélulas musculares esqueléticas. Evoluiu com pneumonia por Pneumocytis carini, tratada satisfatoriamente com sulfametaxazol e trimetropim. Apesar do uso sucessivo de indometacina, predinisona e dexametasona, a miopatia continuava a progredir. Após administraçäo de methotrexate, houve regressäo do quadro neurológico