Post-kala-azar dermal leishmaniasis associated with AIDS

Post-kala-azar dermal leishmaniasis (PKDL) is rarely reported in South America. In spite of the fact that there are many reports about the association of visceral leishmaniasis and AIDS, PKDL is very uncommon in HIV-positive patients, and so far only four cases have been documented in the literature. We present another case with unusual clinicopathological aspects. The patient, a 28-year-old male, from Salvador, Bahia (an endemic area) presented with clinical manifestations of visceral leishmaniasis three years after the diagnosis of AIDS. During treatment for visceral leishmaniasis he developed disseminated miliary papules. Microscopically, the skin biopsy showed a "saw-tooth" pattern with a lichenoid mononuclear infiltrate simulating lichen planus. The histopathological diagnosis was achieved through the finding of amastigotes. The authors discuss the clinicopathological aspects of this case based on a review of the specific literature

A randomized, pilot trial comparing full versus escalating dose regimens for the desensitization of AIDS patients allergic to sulfonamides

Sulfonamides are drugs extensively used in the management of AIDS patients. However, the use of sulfonamides is often associated with the development of allergic reactions, provoking the substitution of the drug (by another that may be less effective); alternatively attempts are made to desensitize the patient. OBJECTIVE: Compare two drug regimens (full vs. escalating doses) for the oral desensitization of AIDS patients allergic to sulfonamides. MATERIAL AND METHODS: AIDS patients with previous allergic reactions to sulfonamides and requiring prophylaxis against Pneumocistis carinii, central nervous system toxoplasmosis and diarrhea caused by Isospora belli were randomly assigned to a group receiving a routine dose of cothrimoxazole, or another that received escalating doses of an oral suspension of the same drug, initiating with 75mg/day of sulfamethoxazole that was doubled every 48 hours till the full dose was reached, if no allergic reaction occurred. Patients were monitored for at least 6 months after enrollment in the trial. The major end-point was the ability to maintain prophylactic treatment after that period of time. Plasma viral load (PVL) and CD4/CD8 counts were measured at baseline. Liver enzymes and hematological parameters were measured at baseline and after 1, 3 and 6 months. RESULTS: Eighteen patients were enrolled in the study (15 men and 3 women), with ages ranging from 30 to 57 years (mean 39.9). The mean CD4 counts were slightly higher for patients receiving a full dose; there was also a trend towards higher baseline CD8 counts among patients developing new reactions. The mean PVL was similar among the patients in both desensitization groups. The incidence of new allergic reactions was identical (40 percent) in the two groups. All adverse reactions were mild and no significant increase in liver enzymes were observed. CONCLUSON: Dose regimen is not a predictor of the development of new allergic reactions amongst patients challenged with sulfonamides after an initial allergic reaction.

Post-kala-azar dermal leishmaniasis associated with AIDS

Post-kala-azar dermal leishmaniasis (PKDL) is rarely reported in South America. In spite of the fact that there are many reports about the association of visceral leishmaniasis and AIDS, PKDL is very uncommon in HIV-positive patients, and so far only four cases have been documented in the literature. We present another case with unusual clinicopathological aspects. The patient, a 28-year-old male, from Salvador, Bahia (an endemic area) presented with clinical manifestations of visceral leishmaniasis three years after the diagnosis of AIDS. During treatment for visceral leishmaniasis he developed disseminated miliary papules. Microscopically, the skin biopsy showed a "saw-tooth" pattern with a lichenoid mononuclear infiltrate simulating lichen planus. The histopathological diagnosis was achieved through the finding of amastigotes. The authors discuss the clinicopathological aspects of this case based on a review of the specific literature.

Estado imune contra o vírus vacinal (17D) da febre amarela em duas populaçöes do Estado da Bahia / Immunity against yellow fever vaccinal virus (17D) in two population of the Bahia State, Brazil

A ocorrência de casos de febre amarela (FA) e a ampla distribuiçäo do A. aegypti no Brasil, motivou o estudo da estimativa da proteçäo imune contra o vírus amarílico vacinal (17D) em moradores de duas cidades do Estado da Bahia, Ipupiara (n = 461) e Prado (n = 228). Nesta área näo-endêmica de FA, a pesquisa de anticorpos séricos contra o 17D (Acl7D) e contra 18 outros arbovírus, foi realizada pelo método da inibiçäo da hemaglutinaçäo (IH). Somente 1,2 por cento (8/689) dos indivíduos apresentaram Acl7D, sendo seis com resposta monotípica. A resposta sorológica do tipo heterotípica para Flavivírus (FLV) foi interpretada também como associada à resposta imune ao 17D, sendo mais freqüente em Prado (30,3 por cento) do que em Ipupiara (23,2 por cento). A idade >/= 50 anos e moradia em outros Estados foram associadas com a soropositividade para FLV, do mesmo modo que a história de vacinaçäo (17D). Mas, a história de vacinaçäo apresentou baixos percentuais de sensibilidade (£ 45,4 por cento) e de valor preditivo-positivo (/= 70,8 por cento) e do valorpreditivo-negativo (>/= 78,8 por cento). Em conclusäo, foi baixa a frequência (1,2 por cento) de moradores com Acl7D, apesar da freqüência maior (25,5 por cento) de portadores de anticorpos FLV, o que significa que 26,7 por cento da populaçäo estudada pode apresentar proteçäo contra o vírus da FA

Epidemia de dengue em Ipupiara e Prado, Bahia: Inquérito soro-epidemiológico / Outbreak of dengue in Ipupiara and Prado, Bahia State: Seroepidemiologic survey

No Brasil os inquéritos sorológicos têm assinalado taxa de infecçäo pelo vírus do dengue de 25 por cento a 56 por cento, porém esses estudos foram realizados em populaçöes de cidades de médio ou grande porte. No presente estudo, säo descritas duas epidemias de febre clássica de dengue (DEN) no Estado da Bahia. A primeira, ocorrida em 1987 e causada pelo sorotipo DEN-1 em Ipupiara e, a segunda, causada pelo DEN-2, em Prado e que ocorreu em 1995. O diagnóstico laboratorial foi realizado utilizando o teste de inibiçäo da hemaglutinaçäo (IH). Em 1995, foram coletadas 461 amostras sorológicas de uma populaçäo de 3.868 habitantes em Ipupiara (regiäo da Chapada Diamantina) e 228 de um total de 9.126 habitantes em Prado (Litoral Extremo Sul). A soro-positividade das amostras foi de 11,9 por cento (55/461) em Ipupiara e 17,5 por cento (40/228) em Prado. Näo houve diferença, estatisticamente significante, quanto a idade e o gênero entre os indivíduos soro-positivos e negativos das duas cidades estudadas. Entretanto, em Ipupiara os soro-positivos (15,9 por cento vs. 9,3 por cento) relataram, mais freqüentemente (p < 0,03), residência ou viagens para outros Estados do Brasil. Com base nos dados, estimou-se a ocorrência de 460 e 1.597 casos da infecçäo em Ipupiara e Prado, respectivamente. Em conclusäo, nas cidades de menor porte a dinâmica da infecçäo pelo vírus do dengue, provavelmente, tem características peculiares, porque nessas localidades a prevalência é menor em conseqüência das menores potencialidades de desenvolvimento do Aedes aegypti