Predictors of Trypanosoma cruzi PCR positivity in patients with chronic Chagas disease

BACKGROUND A positive Trypanosoma cruzi polymerase chain reaction (PCR) is associated with a worse prognosis in patients with chronic Chagas disease (CD). OBJECTIVES To study the association of clinical, electrocardiographic, and echocardiographic characteristics and biomarker blood levels with positive T. cruzi PCR in chronic CD. METHODS This is a single-centre observational cross-sectional study. Positive T. cruzi PCR association with clinical, electrocardiographic, and echocardiographic characteristics, and biomarker blood levels were studied by logistic regression analysis. p values < 0.05 were considered significant. FINDINGS Among 333 patients with chronic CD (56.4% men; 62 ± 10 years), T. cruzi PCR was positive in 41.1%. Stepwise multivariate logistic regression showed an independent association between positive T. cruzi PCR and diabetes mellitus {odds ratio (OR) 0.53 [95% confidence interval (CI) 0.30-0.93]; p = 0.03}, right bundle branch block [OR 1.78 (95% CI 1.09-2.89); p = 0.02], and history of trypanocidal treatment [OR 0.13 (95% CI 0.04-0.38); p = 0.0002]. Among patients with a history of trypanocidal treatment (n = 39), only four (10%) patients had a positive T. cruzi PCR. MAIN CONCLUSIONS Among several studied parameters, only diabetes mellitus, right bundle branch block, and history of trypanocidal treatment showed an independent association with positive T. cruzi PCR. History of trypanocidal treatment was a strong protective factor against a positive T. cruzi PCR.

Relación entre la enfermedad tuberculosa y la vacuna del bacilo de Calmette-Guérin (BCG) en niños

La tuberculosis (TB) es una enfermedad infecciosa, reemergente, ligada a condiciones de pobreza, curable, de presentación clínica variable y con formas graves de enfermedad prevenibles con la vacuna del BCG. Objetivo: Determinar las características de la enfermedad tuberculosa y su asociación con la presencia de la cicatriz de la vacuna (BCG) en los niños que asistieron a la unidad de Tisiología del Ambulatorio docente del HUC. Métodos: Se realizó un estudio de tipo descriptivo, observacional, de corte transversal mediante revisión de las históricas clínicas de todos los niños con el diagnóstico de enfermedad tuberculosa en cualquiera de sus formas clínicas que acudieron al Ambulatorio Docente del HUC durante los años 2014 al 2018, verificando la presencia de la cicatriz de la BCG y su correlación con las formas de la enfermedad. Resultados: Se incluyeron 68 pacientes que cumplieron con los criterios de inclusión y exclusión. El 57 % fue del sexo femenino, el grupo preescolar fue el más frecuente (41 %). La forma clínica predominante fue la pulmonar (63 %), seguida por ganglionar (10 %), meníngea y pleural (5,8 %), la TB miliar (2,9 %). 52 pacientes (76 %) presentaron cicatriz de BCG, siendo en este grupo la forma de presentación clínica más frecuente TB pulmonar (69 %). De los pacientes con ausencia de la cicatriz, el 43,6 % presentó formas graves y extrapulmonares. Conclusiones: La ausencia de cicatriz de BCG, se relacionó con mayoría de formas graves de TB, destacándose la importancia de realizar la vacunación con BCG para la prevención de la enfermedad o de sus formas graves.

Tuberculosis (TB) is an infectious disease, reemerging, linked to conditions of poverty, curable, with variable clinical presentation and with serious forms of disease, preventable through the BCG vaccine. Objective: To determine the characteristics of tuberculosis disease and its association with the presence of the BCG scar in children who attended the consultation of the Tisiology unit of the Teaching Outpatient HUC, in the period January 2014 to December 2018. Methods: A descriptive, observational, cross-sectional study was carried out by reviewing the clinical histories of all children with a diagnosis of tuberculosis disease in any of its clinical forms who attended the HUC Teaching Outpatient Clinic during the period of study, verifying the presence of the BCG scar and its correlation with the different forms of the disease. Results: 68 patients who met the inclusion and exclusion criteria were included. 57 % were female, the most frequent age group was preschool (41 %). The predominant clinical form was pulmonary (63 %), followed by lymph node (10 %), meningeal and pleural (5.8 %), miliary TB (2.9 %). 52 patients (76 %) presented BCG scar, being the most frequent clinical presentation of pulmonary TB (69 %) in this group. Of the patients with absence of the scar, 43.6 % presented severe and extrapulmonary forms. Conclusions: The absence of BCG scar was related to the majority of severe forms of TB, highlighting the importance of BCG vaccination for the prevention of the disease or its serious forms.

Factores pronósticos de amputación mayor en pacientes con pie diabético sometidos a cirugía / Major amputation´s prognostic factors in patients with diabetic feet undergoing surgery

Introducción: El pie diabético es una causa importante de morbilidad y constituye una complicación crónica de la diabetes mellitus que repercute en la calidad de vida. Los pacientes con pie diabético tienen una tasa alta de amputación, procedimiento quirúrgico que afecta emocional y económicamente a pacientes, familiares, médicos de asistencia y a la sociedad. Objetivos: Identificar los factores pronósticos de amputación mayor en pacientes con pie diabético sometidos a cirugía. Métodos: Se realizó un estudio descriptivo analítico de corte transversal en 73 pacientes con diagnóstico de pie diabético: 29 con amputación mayor y 44 con amputación menor. Las variables estudiadas fueron: edad, sexo, tipo de diabetes y su tiempo de evolución, pulsos arteriales, tipo de pie diabético, presencia de úlcera isquémica infectada, absceso, osteomielitis, úlcera neuropática, gangrena digital, necrosis tisular progresiva e infección. Se calcularon las frecuencias absolutas y relativas, y se asociaron las variables. Resultados: Hubo predominio del sexo masculino (56,2 por ciento) y de la diabetes mellitus de tipo 2 (93,2 por ciento). La necrosis tisular progresiva se observó en 30 pacientes y la úlcera isquémica representó el 30,1 por ciento. Conclusiones: La úlcera isquémica con infección, la gangrena digital y la necrosis tisular progresiva resultaron los factores pronósticos de amputación mayor identificados en los pacientes con pie diabético sometidos a cirugía(AU)

Introduction: Diabetic foot ulcer is a major cause of morbidity and it is a chronic complication of diabetes mellitus that impacts quality of life. Patients with diabetic feet have a high amputation rate, a surgical procedure that emotionally and economically affects patients, family members, physicians and society. Objective: To identify the prognostic factors for major amputation in patients with diabetic foot ulcer undergoing surgery. Methods: A descriptive cross-sectional analytical study was conducted in 73 patients diagnosed with diabetic foot ulcer: 29 with major amputation and 44 with minor amputation. The variables studied were: age, sex, type of diabetes and its evolution time, arterial pulses, type of diabetic foot, presence of infected ischemic ulcer, abscess, osteomyelitis, neuropathic ulcer, digital gangrene, progressive soft-tissue necrosis and infection. Absolute and relative frequencies were calculated, and variables were associated. Results: There was predominance of the male sex (56.2 percent) and of diabetes mellitus type 2 (93.2 percent). Progressive soft-tissue necrosis was observed in 30 patients and the ischemic ulcer represented the 30.1 percent. Conclusions: Ischemic ulcer with infection, digital gangrene and progressive soft-tissue necrosis resulted in the major amputation´s prognostic factors identified in diabetic foot patients undergoing surgery(AU)

Sobrevida en pacientes con Esclerosis Lateral Amiotrófica / Survival in patients with Amyotrophic Lateral Sclerosis

RESUMEN Introducción: La esclerosis lateral amiotrófica (ELA) es la más frecuente del grupo heterogéneo de las enfermedades de la motoneurona. Objetivo: Caracterizar la sobrevida de los pacientes con diagnóstico de esclerosis lateral amiotrófica partiendo de factores relacionados con su comportamiento clínico en el Instituto Nacional de Neurología y Neurocirugía "Dr. José Rafael Estrada González" de a Habana, Cuba. Material y Métodos: Se realizó una investigación descriptiva y retrospectiva de una serie de 147 casos de pacientes diagnosticados con ELA, por la confirmación clínica, neurofisiológica e imágenes, atendidos en la consulta multidisciplinaria en el periodo de octubre de 2005 a octubre de 2015, de los cuales ya han fallecido 110. Resultados: La mayor frecuencia de la enfermedad por grupos de edades estuvo entre 51 y 60 años. En los primeros 40 meses murió la mayor parte de los pacientes (80). La forma clínica espinal predominó en varones quienes, además, tuvieron mayor sobrevida, la bulbar prevaleció en mujeres. El mayor número de pacientes no tenía factores de riesgo. Entre las comorbilidades destacan la diabetes, hipertensión arterial, enfermedad cerebrovascular isquémica, neoplasias, hepatitis C, traumatismo craneal, asma bronquial y la cardiopatía isquémica, y hubo casos de la enfermedad en una misma familia. Conclusiones: La mayor sobrevida desde el diagnóstico de la enfermedad estuvo en el grupo de 51 a 60 años alcanzando algunos hasta 10 años. El promedio general de sobrevida estuvo entre 2 y 5 años. En los pacientes con comorbilidades, antecedentes familiares y forma bulbar, la sobrevida fue menor. La supervivencia al evaluar la efectividad del tratamiento con Riluzol no fue significativa.

ABSTRACT Introduction: Amyotrophic lateral sclerosis (ALS) is the most frequent disease in the heterogeneous group of disorders with motor neuron diseases. Objective: To characterize the survival of patients diagnosed with amyotrophic lateral sclerosis considering factors related to their clinical behavior at "Dr. Jose Rafael Estrada Gonzalez" National Institute of Neurology and Neurosurgery, Havana, Cuba. Material and Methods: A descriptive and retrospective research was conducted. The study included a case series of 147 patients diagnosed with ALS by clinical and neurophysiological confirmation and images. The patients were treated in the multidisciplinary consultation in the period from October 2005 to October 2015. A total of 110 of them already died. Results: The disease most often occurs between the ages of 51 and 60. In the first 40 months, most of the patients in the series died, for a total of 80 people. The spinal clinical form predominated in males who had higher survival; the bulbar form prevailed in women. Most of the patients had no risk factors. Diabetes, arterial hypertension, ischemic cerebrovascular disease, neoplasms, hepatitis C, head trauma, bronchial asthma and ischemic heart disease stand out as comorbidities. There were cases of the disease within a single family. Conclusions: The greatest survival from the diagnosis of the disease was observed in the group between 51 and 60 years of diagnosis of the disease, some of them reaching up to 10 years. The general average of survival was between 2 and 5 years. It was lower in patients with comorbidities, family history and bulbar form. After evaluating the effectiveness of the treatment with Riluzole, the survival was not significant.

Using a Chagas disease hospital database: a clinical and epidemiological patient profile

Abstract INTRODUCTION: Chagas disease (CD) prevention and control rely on studies of its distribution, characteristics of individuals affected and mode of transmission. CD data in Brazil are scarce; a retrospective analysis of the clinical characteristics of 80 patients treated at the Clinical Hospital of UNICAMP, Campinas, Brazil, was performed. METHODS: Patient data records were analyzed. RESULTS: Thirty percent of the patients probably got infected through vector-borne transmission, 65% came from endemic areas, a predominance of cardiac and cardiodigestive forms was found among males, and the cardiac form prevailed (51%). CONCLUSIONS: The results update the view on the epidemiology of CD in Campinas, Brazil.

25 (OH) D3 levels, incidence and recurrence of different clinical forms of benig paroxysmal positional vertigo / Níveis de 25 (OH) D3, incidência e recorrência de diferentes formas clínicas de vertigem posicional paroxística benigna

Abstract Introduction Benign paroxysmal positional vertigo is the most common cause of dizziness in the general population. It is a condition with potential impact of reduced levels of vitamin D on its recurrent attacks. Objectives The aim of this study was to measure the serum levels of 25-hydroxyvitamin D3 (25-OH D3) in patients with benign paroxysmal positional vertigo and determine whether there is a difference in the serum levels of vitamin D3 between patients with and without recurrence, as well as between the different clinical forms of benign paroxysmal positional vertigo. Methods The study included 40 patients who came to the regular medical examination, diagnosed with posterior canal-benign paroxysmal positional vertigo based on the positive Dix-Hallpike's test. All patients underwent Epley manoeuvre after the diagnosis. Patients were classified according to current guidelines for levels of vitamin D3 in the serum in three groups: the deficiency, insufficiency and adequate level. Results The average serum level of 25-OH D3 among respondents was 20.78 ng/mL, indicating a lack or insufficiency of the aforementioned 25-OH D3. According to the levels of 25-OH D3, most patients suffer from deficiency (47.5%). 7 (17.5%) respondents had adequate blood level of 25-OH D3, and 14 (35%) respondents suffer from insufficiency. A significant difference was not found in the serum level of 25-OH D3 between patients with and without benign paroxysmal positional vertigo recurrence. There was a significant difference in the serum levels of 25-OH D3 in comparison to the clinical form of the disease. Lower 25-OH D3 values were found in patients with canalithiasis compared to those with cupulolithiasis. Conclusions There were no significant differences in the vitamin D3 serum level in patients with and without recurrence. The study showed a low level of serum vitamin D3 in most patients, indicating the need for supplemental therapy.

Resumo Introdução Vertigem posicional paroxística benigna é a causa mais comum de tonturas na população em geral. É uma condição no qual níveis reduzidos de vitamina D podem ter um potencial impacto para o desenvolvimento de crises recorrentes. Objetivos O objetivo desse estudo foi medir os níveis séricos de 25-hidroxivitamina D3 (25-OH D3) em pacientes com vertigem posicional paroxística benigna e determinar se há diferença nos níveis séricos de vitamina D3 entre pacientes com e sem recorrência, bem como entre as diferentes formas clínicas de vertigem posicional paroxística benigna. Método O estudo incluiu 40 pacientes submetidos a exame médico regular, diagnosticados com vertigem posicional paroxística benigna de canal posterior baseado no resultado positivo do teste de Dix-Hallpike. Todos os pacientes foram submetidos à manobra de Epley após o diagnóstico. Os pacientes foram classificados de acordo com as diretrizes atuais para os níveis de vitamina D3 sérica em três grupos: deficiência, insuficiência e nível adequado. Resultados O nível sérico médio de 25-OH D3 entre os indivíduos avaliados foi de 20,78 ng/mL, indicando falta ou insuficiência desta vitamina. De acordo com os níveis de 25-OH D3, a maioria dos pacientes apresentou deficiência (47,5%). Sete indivíduos (17,5%) entrevistados tinham nível sanguíneo adequado de 25-OH D3 e 14 (35%) apresentavam insuficiência. Não foi encontrada diferença significativa no nível sérico de 25-OH D3 entre pacientes com e sem recidiva de vertigem posicional paroxística benigna. Houve uma diferença significativa nos níveis séricos de 25-OH D3 de acordo com a forma clínica da doença. Baixos níveis de 25-OH D3 foram mais encontrados em pacientes com canalitíase em comparação com aqueles com cupulolitíase. Conclusões Não houve diferenças significativas no nível sérico de vitamina D3 em pacientes com e sem recorrência. O estudo mostrou um baixo nível de vitamina D3 sérica na maioria dos pacientes, indicando a necessidade de terapia suplementar.

Lepra en Santa Fe: Características clínico-epidemiológicas / Leprosy in Santa Fe: Clinical-epidemiological characteristics

La lepra es una enfermedad infecto-contagiosa crónica, no hereditaria, curable y controlable, causada por el Mycobacterium leprae, que afecta principalmente la piel, mucosas y nervios periféricos. En Argentina es un problema regional y nacional, por la migración que abarca a las provincias de Formosa, Chaco, Corrientes, Entre Ríos, Misiones, Santa Fe y Buenos Aires. Objetivo General: determinar el comportamiento clínico-epidemiológico de la lepra en la Provincia de Santa Fe, desde el 1º de Enero del año 2012 al 31 de Agosto del año 2016. Métodos y Materiales: la información se obtuvo de la revisión de las fichas epidemiológicas, de pacientes con diagnóstico de lepra en el período abarcado. Las variables utilizadas fueron: edad y sexo del paciente, residencia, foco epidemiológico, condiciones ambientales y económicas, clínica, tipo de lepra, grado de discapacidad general y tratamiento. Resultados: se diagnosticaron 86 casos de lepra; 59,3% correspondieron al sexo masculino y 40, 7% al sexo femenino. El promedio de edad fue de 56 años. El 86% de los casos fueron multibacilares y la lepra lepromatosa, fue la forma clínica más frecuente. El 26,7% presentó discapacidad al momento del diagnóstico, 16,3% grado 1 y 10,5% grado 2. Conclusión: la detección de nuevos casos en la Provincia de Santa Fe, fue en promedio de 18 casos anuales, excluido el año 2016, en vigencia. Rosario fue el departamento con más casos registrados. El 60% de los casos se comunicó entre los 35 y 66 años; el sexo masculino fue el más afectado. Los casos multibacilares prevalecieron sobre los paucibacilares; la forma clínica más frecuente fue la lepra lepromatosa. Se estableció discapacidad en uno de cada cuatro pacientes.

Leprosy is a chronic disease which, despite having a variable clinic, is diagnosable and treatable when receiving a multidrug therapy (MDT) as the one proposed by the World Health Organization (WHO). In Argentina, it is characterized by moderate endemicity and focus on certain geographic areas (provinces of northeastern, northwest and center of Argentina). General Objective: determine the clinical and epidemiological behavior of leprosy in the province of Santa Fe. Methods and Materials: the cases reported since 1º January 2012 to 31 August 2016, were retrospectively collected from the review of the epidemiological records of the Ministry of Health, Environment and Social Action of the Province of Santa Fe. The variables were: age and sex of the patient, residence, epidemiological focus, environmental and economic conditions, kind of leprosy, degree of disability and finally the treatment. Results: 86 cases of leprosy were diagnosed: 59,3% were male and 40,7% sex, were female. The average age was 56 years. 86% of cases were multibacillary and lepromatous leprosy was the most frequent clinical form. The 26,7% had disability at the moment of diagnosis, 16,3% 10,5% grade 1 and grade 2. Conclusion: in the Province of Santa Fe, the detection of new leprosy cases have been stable in the last years, with a minimun of 17 and a maximum of 29 cases per year. Rosario was the city with more registered cases, followed by: La capital, General Obligado y Nueve de Julio. The most affected patients were male, and 60% of cases reported between 35 and 66 years. Multibacillary cases prevailed over paucibacillary; the most frequent clinical form was lepromatous leprosy. One in four patients had disability at the moment of diagnosis.

Golpe de calor: a propósito de un caso clínico / Heat stroke. a case report

El golpe de calor es una entidad poco frecuente y subdiagnosticada. La elevación de la temperatura corporal es la que desencadena las disfunciones metabólicas que pueden incluso llevar a la muerte. Se presenta el caso de un militar que se encontraba realizando ejercicios de infantería, durante el mes de septiembre, en días donde se produjeron condiciones climáticas extremas y desarrolla un cuadro de Disfunción Orgánica Múltiple (DOM) primaria; fue llevado al Servicio de Emergencia del Hospital de Fray Bentos, Río Negro. La evolución inicial se caracterizó por deterioro de la función neurológica, respiratoria, necesidad de ventilación mecánica, falla renal aguda y disfunción hematológica; se establecieron los diagnósticos de golpe de calor, injuria renal, rabomiólisis, insuficiencia respiratoria aguda y coagulación intravascular diseminada (CID). A pesar del tratamiento y manejo de sostén tiene una mala evolución, falleciendo a las 48 horas del ingreso. El caso nos recuerda que la exposición a condiciones de calor por arriba de la temperatura corporal, deteriora los mecanismos de control de calor corporal y metabólico. Es necesario un diagnóstico rápido y un manejo de sostén para conseguir una evolución satisfactoria.

A heat stroke is a very rare and under diagnosed entity. The rise in the body’s temperature is the element that triggers the metabolic dysfunctions that can even lead to death. A case of a soldier is presented; this soldier was training, doing his infantry exercises routine, during September, in days were extreme climate situations were happening, installing a case of primary Multiple Organ Dysfunction (MOD) syndrome. The soldier was taken to the Emergency Service in Fray Bentos’ Hospital, in Rio Negro. The initial evolution was clumsy and slowly, and the neurologic and breathing functions were worsening, with acute renal failure, and also hematological dysfunction. In addition to this, the patient was in need of mechanic ventilation. The diagnosis of temperature shock, acute renal injury, Rhabdomyolysis, acute respiratory failure and disseminated intravascular coagulation (DIC) were established. Supportive care was given to the patient, with an un satisfactory development, leading to death 48 hours after the hospital admission. This case reminds us that, the exposure to weather conditions that are over the body temperature interferes in the metabolism and the body’s mechanisms for controlling heat. A quick diagnosis and supportive care are needed in order to achieve a satisfactory evolution.

Relationship between clinical and pathological signs and severity of canine leishmaniasis / Relação entre sinais clínico-patológicos e gravidade da leishmaniose visceral canina

Canine visceral leishmaniasis (CVL) is a zoonotic disease that presents variable clinical and laboratory aspects. The aims of this study were to identify the main biochemical/hematological status of dogs naturally infected with Leishmania (Leishmania) infantum and to associate theses parameters with clinical forms of CVL. Blood samples were analyzed from 51 dogs, 15 uninfected (control group) and 36 infected, which were classified clinically in three groups: asymptomatic (n=12), oligosymptomatic (n=12) and symptomatic (n=12). All the infected dogs showed lower albumin/globulin ratios (A-G ratio) than the limit of reference. The mean values of total protein, urea, α-globulin 2, globulin and A-G ratio of infected dogs were outside the reference interval and differed significantly from those of the controls. Anemia was detected only in groups that showed clinical signs of the disease, and a statistical analysis indicated a significantly higher frequency of lower eritrogram in these groups than in the asymptomatic group. In addition, a significant association was observed between anemia and the presence of the symptoms, with dogs displaying higher erythrogram values showing better clinical conditions. These results provide additional evidence that the clinical forms of CVL may reflect on the erythrogram status.

A leishmaniose visceral canina (LVC) é uma zoonose com aspectos clínicos e laboratoriais variáveis. O objetivo deste trabalho foi identificar os principais achados hematológicos e bioquímicos em cães naturalmente infectados com Leishmania (Leishmania) infantum e associar esses parâmetros com as formas clínicas da LVC. Foram analisadas amostras sanguíneas provenientes de 51 cães, sendo 15 cães não infectados (grupo controle) e 36 infectados, os quais foram classificados clinicamente em três grupos: assintomáticos (n=12), oligossintomáticos (n=12) e sintomáticos (n=12). Todos os cães infectados apresentaram valores na relação albumina/globulina (A/G) abaixo do limite inferior de referência. Os valores médios de proteína total, uréia, α-2 globulina, globulina e A/G dos grupos de cães infectados permaneceram fora dos intervalos de referências e significativamente diferente quando comparados aos do grupo controle. Anemia foi registrada somente nos grupos de animais que manifestavam sinais clínicos da enfermidade, sendo que nas análises estatísticas constatou-se frequência significativamente maior de alterações no eritrograma quando comparados ao grupo assintomático. Associação significativa foi observada entre anemia e a presença de sinais clínicos, onde os cães com os maiores valores de eritrograma apresentavam a melhor condição clínica. Os resultados fornecem evidência adicional que as formas clínicas da LVC podem refletir no eritrograma.

Cytokines and visceral leishmaniasis: a comparison of plasma cytokine profiles between the clinical forms of visceral leishmaniasis

It is not well established whether cytokine production differs in response to different clinical forms of visceral leishmaniasis (VL). In this work, we performed a cross-sectional study to investigate the plasma levels of cytokines [interferon (IFN)-γ, tumour necrosis factor (TNF)-α, interleukin (IL)-2, IL-4, IL-10 and IL-12] involved in the pathogenesis of VL in 80 subjects from VL endemic areas, including subjects with active VL, subjects with asymptomatic infection, subjects with cured VL and uninfected controls. The patients were recruited by sampling from a referral hospital and by random selection from a population-based cohort study. The results showed significant differences in the plasma concentration of all cytokines between the groups (p < 0.05). Patients with the active disease had higher plasma levels of IL-10, IL-4, INF-γ and TNF-α relative to the other groups and they produced more IL-12 than asymptomatic and cured subjects. Only the IL-2 concentration was higher in the asymptomatic and cured subjects relative to the patients with active disease (p < 0.05). Our results suggest that these cytokines can be used as markers in epidemiological studies conducted in endemic areas to distinguish between different clinical forms of VL. However, their usefulness should be confirmed in investigations conducted in other endemic areas.

Seroprevalence of Helicobacter pylori infection in chagasic and nonchagasic patients from the same geographical region of Brazil / Soroprevalência da infecção por Helicobacter pylori em indivíduos chagásicos e não-chagásicos da mesma região geográfica do Brasil

INTRODUCTION: In this study, we evaluated the seroprevalence of Helicobacter pylori infection among chagasic and non-chagasic subjects as well as among the subgroups of chagasic patients with the indeterminate, cardiac, digestive, and cardiodigestive clinical forms. METHODS: The evaluated subjects were from the Triângulo Mineiro region, Minas Gerais, Brazil. Chagasic patients showed positive reactions to the conventional serological tests used and were classified according to the clinical form of their disease. Immunoglobulin G antibodies specific to H. pylori were measured using a commercial enzyme-linked immunosorbent assay kit. RESULTS: The overall H. pylori prevalence was 77.1% (239/310) in chagasic and 69.1% (168/243) in non-chagasic patients. This difference was statistically significant even after adjustment for age and sex (odds ratio = 1.57; 95% confidence interval, 1.02-2.42; p = 0.04) in multivariate analysis. The prevalence of infection increased with age in the non-chagasic group (p = 0.007, χ2 for trend), but not in the chagasic group (p = 0.15, χ2 for trend). H. pylori infection was not associated with digestive or other clinical forms of Chagas disease (p = 0.27). CONCLUSIONS: Our findings demonstrate that chagasic patients have a higher prevalence of H. pylori compared to non-chagasic subjects; a similar prevalence was found among the diverse clinical forms of the disease. The factors contributing to the frequent co-infection with H. pylori and Trypanosoma cruzi as well as its effects on the clinical outcome deserve further study.

INTRODUÇÃO: No presente estudo, foi comparada a soroprevalência da infecção por Helicobacter pylori entre os indivíduos chagásicos e não-chagásicos, bem como entre subgrupos de chagásicos com as formas clínicas indeterminada, cardíaca, digestiva e cardiodigestiva. MÉTODOS: Os indivíduos avaliados eram provenientes da região do Triângulo Mineiro, Minas Gerais, Brasil. Foram realizados testes sorológicos convencionais para diagnóstico da infecção pelo T. cruzi e os chagásicos foram classificados de acordo com a forma clínica. O diagnóstico de infecção por H. pylori foi estabelecido pela detecção de anticorpos IgG específicos utilizando-se um kit comercial de ELISA. RESULTADOS: A prevalência da infecção por H. pylorifoi 77,1% (239/310) no grupo de pacientes chagásicos e 69,1% (168/243) no grupo de não-chagásicos. Esta diferença foi estatisticamente significativa mesmo após ajuste para idade e sexo (OR = 1,57; 95% CI, 1,02-2,42; p = 0,04) na análise multivariada. A prevalência da infecção aumentou de acordo com a idade no grupo não-chagásicos (p = 0,007, χ2 for trend) mas este aumento não foi observado no grupo dos chagásicos (p = 0,15, χ2 for trend). Não houve associação da infecção por H. pylori com a forma digestiva ou com qualquer outra forma clínica da doença de Chagas (p = 0,27). CONCLUSÕES: Foi demonstrado que pacientes chagásicos apresentam maior prevalência da infecção por H. pylori quando comparados com não-chagásicos, independente da forma clínica da doença. Os fatores que contribuem para a frequente co-infecção Helicobacter pylori e Trypanosoma cruzi, bem como seus efeitos na evolução clínica das doenças associadas devem ser melhor estudados.

Occurrence of anti-Neospora caninum and anti-Toxoplasma gondii antibodies in dogs with visceral leishmaniasis / Ocorrência de anticorpos anti-Neospora caninum e anti-Toxoplasma gondii em cães com leishmaniose visceral

Uninfected dogs and those naturally infected with Leishmania chagasi exhibiting different clinical forms of disease were evaluated for the presence of anti-Neospora caninum and anti-Toxoplasma gondii antibodies. Blood samples were collected from 110 mongrel dogs. Sera were tested using the indirect fluorescent antibody test (IFAT), and the animals with visceral leishmaniasis (VL) (n=60) were classified clinically. Out of the 110 sera investigated, 5 (4.5 percent) were positive for N. caninum (IFAT>50) and 36 (32.7 percent) for T. gondii (IFAT>16). Anti-L. chagasi antibody titers in asymptomatic dogs (n=10) were found to be significantly lower (P<0.05) than those in oligosymptomatic ones (n=22), which were in turn significantly lower (P<0.05) than those in symptomatic ones (n=28). No association between Leishmania and N. caninum infections was observed. Among dogs infected with L. chagasi, a tendency (P=0.053) towards an association between the infection with T. gondii and the appearance of VL symptoms was observed, suggesting that the clinical manifestation of VL in dogs may enhance their susceptibility to T. gondii. The possible influence of the immunosuppressive status of canine leishmaniasis in the different clinical forms of the disease is discussed.

A presença de anticorpos anti-Neospora caninum e anti-Toxoplasma gondii foi avaliada em cães não infectados e naturalmente infectados com Leishmania chagasi manifestando diferentes formas clínicas da enfermidade. Amostras de sangue foram coletadas de 110 cães sem raça definida. Os soros foram avaliados por meio da reação de imunofluorescência indireta (RIFI) e os animais com leishmaniose visceral (LV) (n=60) foram classificados clinicamente. Dos 110 soros analisados, 5 (4,5 por cento) foram reativos para N. caninum (RIFI>50) e 36 (32,7 por cento) para T. gondii (RIFI>16). Os títulos de anticorpos anti-L. chagasi em cães assintomáticos (n=10) foram significativamente (P<0,05) mais baixos que aqueles verificados em oligossintomáticos (n=22), que por sua vez foram significativamente menores (P<0,05) que em cães sintomáticos (n=28). Não foi observada associação entre infecções por Leishmania e N. caninum. Entre os cães infectados com L. chagasi, verificou-se uma tendência de associação (P=0.053) entre infecção com T. gondii e aparecimento de sinais clínicos da LV, o que sugere que a manifestação clínica da LV em cães pode aumentar sua susceptibilidade ao T. gondii. A provável influência do quadro de imunossupressão em diferentes formas clínicas da leishmaniose canina é abordada.

Doença meningocócica: comparação entre formas clínicas / Meningococcal disease: comparison between clinical forms

Visando avaliar formas clínicas da doença meningocócica, foram revistos 201 casos diagnosticados como doença meningocócica, em Hospital Universitário da Universidade Federal Fluminense; durante o período de 1971 a 1996, dos quais 185 preencheram os critérios de inclusão. A caracterização clínico-laboratorial permitiu reagrupá-los nas formas de doença meningocócica com meningite, 18 por cento, meningite e septicemia, 62 por cento, e septicemia, 20 por cento. Dados epidemiológicos disponíveis não diferenciaram formas clínicas. Na meningite meningocócica foi significativamente maior: tempo de história clínica; freqüência de manifestações neurológicas; e positividade da bacterioscopia, cultura e teste do látex no líquor. Na septicemia menigocócica, houve predomínio significativamente de: choque; letalidade e níveis maiores de tempo parcial de tromboplastina. Septicemia meningogócica e septicemia com meningite se diferenciaram da meningite meningocócica quanto a: tempo de história clínica; ocorrência de sinais neurológicos focais; coagulação intravascular disseminada e artrite. Dados clínico-laboratoriais levam a admitir meningite como forma localizada de doença meningocócica, e septicemia com meningite e septicemia como variações de gravidade da forma sistêmica da doença.

In order to asses the clinical forms of meningococcal disease, we reviewed 201 cases diagnosed as meningococcal disease in the University Hospital of the Fluminense Federal University in Rio de Janeiro, 185 of which met the inclusion criteria. Clinical and laboratorial characterization allowed for grouping of the cases as follows: meningococcal meningitis, 18 percent; meningitis with septicemia, 62 percent; and septicemia, 20 percent. Available epidemiological data did not differentiate clinical forms. The following were significantly greater in meningococcal meningitis: duration of clinical history; frequency of neurological manifestations; positive bacterioscopy; culture and latex test in cerebrospinal fluid. The following were significantly predominant in septicemia: shock; fatal outcome and higher partial thromboplastin time. Septicemia and meningitis with septicemia were differentiated from meningococcal meningitis in the following: duration of clinical history; occurrence of focal neurological signs; disseminated intravascular coagulation; and arthritis. Clinical and laboratory data lead us to admit meningococcal meningitis as a localized form of Meningococcal disease, and meningitis with septicemia and septicemia as variations in severity of the systemic form of the disease.

Tuberculosis en el Hospital Universitario San José, Popayán, 1998-2000

La tuberculosis es problema de salud pública. La Ley 100 de 1993 trajo cambios importantes en los programas de prevención, los cuales debieron asumirlos los municipios y las empresas prestadoras de salud. El programa para el control de la tuberculosis no es ajeno a esta situación; se han registrado menos búsquedas y exámenes de sintomáticos respiratorios. En esta nueva situación se necesita evaluar el manejo de la enfermedad en un hospital estatal de III nivel; por esta razón se adelantó un estudio descriptivo, retrospectivo, del perfil clínico, epidemiológico y de atención médica de los casos atendidos en el Hospital Universitario San José de Popayán en 2 años, mediante la revisión de las historias clínicas y los archivos de laboratorio. El Hospital Universitario San José informó 187 casos. De los 120 (64,2%) incluidos en el estudio, 89 fueron de tuberculosis, 27 con diagnóstico indeterminado y 4 no fueron tuberculosis. De los 89 casos con tuberculosis, 39 (43,8%) eran pulmonares y 50 (56,2%) extrapulmonar; 39 eran de tuberculosis miliar, 4 pleural, 3 ganglionar, 2 osteoarticular y 2 meníngea. El 49% tenía 15 a 59 años y 28%, 60 o más; 64% era de sexo masculino y 65% del área rural. La coloración de Ziehl Neelsen fue positiva en 22% de 59 esputos de casos de tuberculosis pulmonar y en 20,2% de 94 muestras de tuberculosis extrapulmonar. El cultivo fue positivo en 14,3% de 14 esputos de tuberculosis pulmonar y en 29,6% de 54 muestras de tuberculosis extrapulmonar. El promedio de días de hospitalización/sala fue de 4 a 26 y el promedio días de estancia/sala, antes del tratamiento de 4 a 8. Existe una importante demanda de atención médica por tuberculosis al Hospital Universitario San José. Se observa deficiencia en el abordaje diagnóstico y en el seguimiento y demora para el inicio del tratamiento. Se sugieren estrategias para mejorar el manejo.

Tuberculosis in the San José University Hospital in Popayán, Colombia, 1998-2000 TB is a public health problem in the world. In Colombia the Health 100 Law caused changes in prevention programs. The TB control program was compromised too. The actions in relation with active looking and examination of respiratory symptomatic people has been lowering. This retrospective study describes the clinical, epidemiological and medical care characteristics of tuberculosis patients attended in the Hospital Universitario San José de Popayán. The clinical expedients and laboratory registers were investigated. 120 cases of 187 registered patients were included; finally only 89 were tuberculosis cases: 39 pulmonary (43.8%) and 50 extrapulmonary (56.2%). The extrapulmonary forms were: miliar, 39 patients; pleural, 4: of lymhp nodes, 3; osteoarticular, 2, and meningitis, 2 cases. 49% of patients were 15-59 years old, 28% more than 59; males 64% and 65% coming from country areas. Ziehl Neelsen (ZN) smear was positive in 22% of 59 sputums of pulmonary TB and 20.2% of 94 extrapulmonary TB samples: mycobacteria culture positive in 14.3 % of 14 pulmonary TB sputum, and 29.6% of 54 extrapulmonary TB samples. The media days into hospital/yard was 4-26 and the media days to begin tuberculosis treatment/yard was 4-8. In summary there are important request for TB medical care to universitary hospital, however the diagnosis is difficult and takes a long time while mycobacteria can be transmitted to hospital contacts. It is necessary to get a better efficiency of diagnostic tests in the hospital and appropriated survey of the cases that begin treatment.