Suicide in Brazilian indigenous communities: clustering of cases in children and adolescents by household

ABSTRACT OBJECTIVE To estimate age and sex-specific suicide rates, compare suicide rates between indigenous communities, and quantify the frequency of intrafamilial suicide clustering. METHODS We performed a retrospective cohort study involving 14,666 indigenous individuals in reservations in Dourados, state of Mato Grosso do Sul, Brazil, from 2003 through 2013 using national and local census. RESULTS The overall suicide rate was 73.4 per 100,000 person-years. Adolescent males aged 15-19 and girls aged 10-14 had the highest rates for each sex at 289.3 (95%CI 187.5-391.2) and 85.3 (95%CI 34.9-135.7), respectively. Comparing the largest reservations, Bororo had a higher suicide rate than Jaguapiru (RR = 4.83, 95%CI 2.85-8.16) and had significantly lower socioeconomic indicators including income and access to electricity. Nine of 19 suicides among children under 15 occurred in household clusters. Compared with adult suicides, a greater proportion of child (OR = 5.12, 95%CI 1.89-13.86, p = 0.001) and adolescent (OR = 3.48, 95%CI 1.29-9.44, p = 0.017) suicides occurred within household clusters. CONCLUSIONS High rates of suicide occur among children and adolescents in these indigenous reservations, particularly in poor communities. Nearly half of child suicides occur within household clusters. These findings underscore the need for broad public health interventions and focused mental health interventions in households following a suicide.

Puerperal brain cryptococcoma in an HIV-negative woman successfully treated with fluconazole: a case report

Cryptococcus spp. cerebral abscesses are uncommon in immunocompetent subjects. The recommended induction treatment is the administration of amphotericin B plus flucytosine combined with resection for lesions ≥3cm. In this paper, we describe an HIV-negative woman diagnosed with a large cryptococcoma in the immediate postpartum period. The lesion was not resected, and due to amphotericin B intolerance, she received an extended course of fluconazole monotherapy. There was no disease recurrence during the 4 years of follow-up. The abrupt onset of her symptoms following delivery suggests that she developed a postpartum immune reconstitution syndrome. This case also demonstrates that in specific situations fluconazole monotherapy can be attempted in immunocompetent patients with cryptococcoma.

Surveillance for leptospirosis in the Americas, 1996-2005: a review of data from ministries of health / Vigilancia de la leptospirosis en la Región de las Américas, de 1996 al 2005: análisis de los datos de los ministerios de salud

Objective. To characterize current leptospirosis reporting practices in the Americas.Methods. Information was collected from the official websites of national ministries ofhealth from the Americas region and two international organizations; personal communications;and three international morbidity databases. For all sources other than the morbiditydatabases, the review was limited to official reports citing clinically suspected and laboratoryconfirmed leptospirosis cases or deaths during the period 1996–2005.Results. A total of 73 out of 1 644 reports met the selection criteria and were included inthe analysis. Published leptospirosis data were available from half of the countries/sovereignterritories (24 out of 48), and 18 of them had mandatory notification policies for leptospirosis.The sum of the median number of leptospirosis cases notified annually by the 24 countries/territories was 4 713.5, but just three countries (Brazil, Costa Rica, and Cuba) accounted for83.1% (3 920 cases) of the notifications. Eight (16.7%) countries reported deaths due to leptospirosis.The sum of the median number of deaths reported annually for the eight countrieswas 380, but 349 (91.8%) were reported by Brazil.Conclusions. Notification practices in the Americas for leptospirosis are limited. Therefore,the numbers of cases and deaths reported are not representative for the region. The lack ofleptospirosis data for many countries/territories may reflect weaknesses in certain aspects ofnational surveillance systems, including mandatory reporting policies, clinical laboratory infrastructurefor performing case confirmation, and capacity to collect reported cases. Improvedsurveillance of leptospirosis cases and deaths in the Americas is needed to allow monitoring ofregional epidemiological patterns and to estimate the burden of this important disease.

Leptospirosis serosurvey in bovines from Brazilian Pantanal using IGG ELISA with recombinant protein LipL32 and microscopic agglutination test

This investigation was carried out in Brazilian Pantanal: region with important biodiversity. This region's climatic conditions, hydrology and geomorphology as well as the existence of great variety of wild species favor the maintenance of the Leptospira in the environment. The aim of this study was to evaluate IgG ELISA with recombinant protein LipL32 in comparison with microscopic agglutination test (MAT) and additionally contribute to the knowledge of the distribution of the one of most important worldwide zoonotic infection, assessing the seropositivity of bovine leptospirosis in beef cattle herds of Brazilian Pantanal, an important ecological preserved area, where cattle constitute not only the most important economic resource but also the major activity compatible of the conservation of natural resource of the region. Out of 282 samples of cattle serum analyzed, 143 (50.71 percent) were positive in MAT. The serovar Hardjo (genotypic Hardjoprajitno and Hardjobovis), Wolffi and Ballum showed the largest frequency of reactive samples. In the IgG ELISA rLipL32, 161 samples (57.09 percent) were positive. This result was higher than obtained by MAT (p<0.001). The sensitivity of the ELISA test was 99.30 percent and the specificity was 86.33 percent, based on the MAT. This test was shown to be a more sensitive, specific and accurate test for the diagnosis of bovine leptospirosis compared to the MAT.

Este estudo foi realizado no Pantanal brasileiro: região que apresenta importante biodiversidade. As condições de clima, hidrologia e geomorfologia dessa região, bem como a existência de grande variedade de espécies animais silvestres, favorecem a manutenção da Leptospira no meio ambiente. O objetivo desse estudo foi avaliar o ELISA IgG com proteína recombinante LipL32 em comparação com a soroaglutinação microscópica (SAM) para o diagnóstico sorológico de Leptospira. Adicionalmente, contribuir para o conhecimento da distribuição da leptospirose bovina, uma das mais importantes zoonoses mundialmente distribuída. Foi avaliada a soropositividade para essa bactéria em rebanhos bovinos de corte da região do Pantanal, uma área onde o bovino constitui não apenas o recurso econômico mais importante, como também a principal atividade econômica compatível com a conservação dos recursos naturais da região. Das 282 amostras de soro bovino analisadas, 143 (50,71 por cento) foram positivas na SAM. O sorovar Hardjo (genótipos Hardjoprajitno e Hardjobovis), Wolffi e Ballum apresentaram freqüências altas de amostras reativas. No IgG ELISA rLipL32, 161 amostras (57,09 por cento) foram positivas, apresentando esse teste uma maior soropositividade em relação à SAM (p<0,001). A Sensibilidade do ELISA em comparação com a SAM foi de 99,30 por cento e a especificidade de 86,33 por cento. O IgG ELISA rLipL32 mostrou ser um teste sensível, específico e de alta acurácia para o diagnóstico de leptospirose bovina.

Monoclonal antibodies against an outer membrane protein from pathogenic Leptospira

Foram obtidos dois hibridomas secretores de anticorpos monoclonais (MAbs) que reagem com uma lipoproteína (LipL32) da membrana externa de leptospiras patogênicas. Para a produção dos hibridomas, células do baço de camundongos BALB/c, imunizados com LipL32 recombinante (rLipL32), foram fusionadas com células SP2/O-Ag14, selecionadas em meio HAT e testadas em ELISA indireto. Um dos MAbs secretados pelos hibridomas é do isotipo IgG2b e o outro do isotipo IgM. A especificidade dos MAbs foi confirmada em ELISA indireto e immunoblotting usando rLipL32 purificada, Escherichia coli (E. coli) expressando LipL32 e sorovares patogênicos e saprófitas. Os dois MAbs reagiram com a maioria dos sorovares patogênicos e não reagiram com sorovares saprófitas. Os MAbs possuem potencial para uso em testes de diagnóstico de leptospirose.

Monoclonal antibodies against an outer membrane protein from pathogenic Leptospira

Two hybridomas secreting monoclonal antibodies (MAbs) that react with a lipoprotein (LipL32) of the outer membrane of pathogenic Leptospira were obtained. For hybridoma production, spleen cells from BALB/c mice imunized with recombinant LipL32 (rLipL32) were fused to SP2/O-Ag14 cells, selected in HAT medium and screened in an indirect ELISA. One MAb produced was of the IgG2b isotype and the other was an IgM. MAbs specificity was confirmed by indirect ELISA and immunoblotting using purified rLipL32 and whole-cell antigen preparations from Escherichia coli (E. coli) expressing LipL32 and from pathogenic and non-pathogenic serovars. Both Mabs reacted with most of the pathogenic serovars tested and none reacted with non-pathogenic Leptospira. The MAbs described have potential for use in diagnostic tests for leptospirosis.

Foram obtidos dois hibridomas secretores de anticorpos monoclonais (MAbs) que reagem com uma lipoproteína (LipL32) da membrana externa de leptospiras patogênicas. Para a produção dos hibridomas, células do baço de camundongos BALB/c, imunizados com LipL32 recombinante (rLipL32), foram fusionadas com células SP2/O-Ag14, selecionadas em meio HAT e testadas em ELISA indireto. Um dos MAbs secretados pelos hibridomas é do isotipo IgG2b e o outro do isotipo IgM. A especificidade dos MAbs foi confirmada em ELISA indireto e immunoblotting usando rLipL32 purificada, Escherichia coli (E. coli) expressando LipL32 e sorovares patogênicos e saprófitas. Os dois MAbs reagiram com a maioria dos sorovares patogênicos e não reagiram com sorovares saprófitas. Os MAbs possuem potencial para uso em testes de diagnóstico de leptospirose.

Síndrome da meningite asséptica por enterovírus e Leptospira sp em crianças de Salvador, Bahia / Aseptic meningitis syndrome due to enterovirus and Leptospira sp in children of Salvador, Bahia

Objetivando verificar a freqüência de enterovírus (EV), leptospiras e arbovírus como agentes causais da síndrome da meningite asséptica (SMA), em períodos näo-epidêmicos, e comparar os pacientes com e sem diagnóstico etiológico determinado, foram selecionados 112 pacientes de idade entre 3 meses e 15 anos, com suspeita clínica de SMA, referenciados para Hospital Couto Maia, especializado em Doenças Infecciosas e Parasitárias (Salvador, Bahia), Em 44,6 por cento (n=50) a etiologia foi determinada: enterovírus em 37,7 por cento (n=42) dos casos, pelo teste de PCR Amplicor, por cultura do líquor e/ou de fezes; a Leptospira sp. em 7,1 por cento (n=8), pelo método da micro-aglutinaçäo, e nenhum caso de arbovírus foi detectado (inibiçäo da hemaglutinaçäo passiva). Entre os 14 enterovírus dos 22 isolados, foram identificados seis diferentes sorotipos, sendo o Echovirus-4 predominante (27,2 por cento; 6/22) entre outros (Coxsackie B2, B3, B6 e B9; EV 71). Conclui-se que, os enterovírus foram os agentes mais freqüentes, e que a leptospirose deve ser lembrada no diagnóstico diferencial da SMA. Uma vez que as características clínicas e liquóricas dos pacientes dos grupos com e sem determinaçäo do agente etiológico foram semelhantes, pode-se supor que o diagnóstico presuntivo de SMA é de provável etiologia viral ou pela leptospira