Epidemiological and control aspects of schistosomiasis in Brazilian endemic areas

The present work analyzes the epidemiology of schistosomiasis in Brazil, its expansion, the attempts to control the disease, and the overall difficulties. The authors present the distribution of schistosomiasis intermediary hosts in Brazil, the migration routes of the human population, and disease distribution in highly and lowly endemic areas and isolated foci. They also analyze the controlling programs developed from 1977 to 2002, indicating the prevalence evolution and the reduction of disease morbi-mortality. In addition, the authors also evaluate controlling methods and conclude that: (a) no isolated method is able to control schistosomiasis, and every controlling program should consider the need of a multidisciplinary application of existing methods; (b) in long term, basic sanitation, potable water supply, as well as sanitary education, and community effective participation are important for infection control; (c) in short term, specific treatment at endemic areas, associated with control of intermediary hosts at epidemiologically important foci, are extremely relevant for controlling disease morbidity, although not enough for interrupting infection transmission.

Sucesso terapêutico com uso de esteróide em um caso de nefrite intersticial aguda secundária à rifampicina / Therapeutic success with use of steroid in a case of acute interstitial nephritis secondary to rifampin

O uso de corticosteróides e/ou outras drogas imunossupressoras no tratamento de nefrite intersticial aguda (NIA) permanece controverso. Os autores relatam um caso de NIA, secundária ao uso de rifampicina, tratado com prednisona, no qual se obteve excelente resposta: paciente feminina com diagnóstico de tuberculose pulmonar, que se apresentava com funçäo renal normal, foi submetida a terapêutica tríplice (rifampicina e pirazinamida). No quadragésimo dia de tratamento, mostrou creatinina de 2,4mg/dl e BUN de 27mg/dl; após três dias, foi submetida a exames que mostraram: creatinina plasmática, 5,5mg/dl; nitrogênio uréico plasmático, 74mg/dl; sódio urinário, 78mEq/1; osmolalidade urinária, 416mOsm/Kg de H2O e fraçäo de excreçäo de sódio de 4,3%; exame do sedimento urinário com leucocitúria, hematúria e eosinofilúria; proteinúria de 24 horas de 900mg; ultra-som renal normal. A biopsia renal revelou tratar-se de NIA, sendo suspensa a rifampicina e, como a funçäo renal continuava a piorar, iniciou-se prednisona. Houve estabilizaçäo dos níveis de escórias nitrogenadas e queda a partir do quarto dia de tratamento, recebendo alta hospitalar com funçäo renal normal