Maternal immunization in Argentina: A storyline from the prospective of a middle income country.

The importance of vaccination during pregnancy lies not only in directly protecting vaccinated women, but also by indirectly protecting small infants during the first few months of life. Vaccination against the flu and whooping cough is a priority within the comprehensive care strategy for pregnant women and small infants in Argentina, in the context of transitioning from child vaccination to family vaccination. In 2011, the flu vaccine was included in the National Immunization Schedule (NIS) as mandatory and free of charge, with the aim of decreasing complications and death due to influenza in the at-risk population in Argentina. The national vaccination coverage attained in pregnant women in the past 4 years (2011-2014) has been satisfactory; 88% coverage was attained in the year this program was introduced to the schedule. In the following years, coverage was maintained at greater than 95%. In February 2012, Argentina became the first country in Latin America to have universal vaccination strategy for pregnant women against whooping cough. This recommendation was implemented throughout the country by vaccination with the diphtheria toxoid, tetanus toxoid, and acellular pertussis (Tdap) vaccine starting at 20 weeks of pregnancy, with the aim of decreasing morbimortality due to whooping cough in infants under 6 months of age. The vaccine was incorporated into the NIS in 2014. More than 1,200,000 doses were applied in this period. Both vaccines showed a suitable safety profile and no serious events were reported. Argentina is an example of a middle-income country that has been able to implement a successful strategy for primary prevention through vaccines, making it a health policy.

Use of fluorescent probes as a useful tool to identify resistant Schistosoma mansoni isolates to praziquantel.

The use of chemotherapy on a mass scale in endemic areas may lead to the appearance of resistant isolates through the mechanism of selective drug pressure. Studies have demonstrated that praziquantel (PZQ) is able to inhibit the excretory activity and to cause tegumental damage in Schistosoma mansoni adult worms. The use of the probe resorufin to evaluate excretory activity, as well as the probe Hoechst 33258 to detect tegumental damage in adult worms, may represent a method to identify resistant (or less susceptible) isolates. The purpose of the present work was to compare the changes caused by PZQ in the function of the excretory system and in the integrity of the tegument of adult worms from the LE isolate (susceptible to PZQ) and the LE-PZQ isolate (less susceptible to PZQ). Worms from the isolate LE-PZQ showed less severe tegumental lesions, in both in vitro and in vivo experiments, detected by labelling with Hoechst 33258 and continued to have a functional excretory system as shown by labelling with resorufin in vitro.

Clinical therapy of schistosomiasis mansoni: the Brazilian contribution.

The review gives a detailed account of the history of drug development, treatment and drug resistance for clinical therapy of schistosomiasis mansoni, specially emphasizing the importance of Brazilian contribution on antischistosomal chemotherapy, as well as on the control of this parasitic disease.

Comparison between morphological and staining characteristics of live and dead eggs of Schistosoma mansoni

Schistosoma mansoni eggs are classified, according to morphological characteristics, as follows: viable mature and immature eggs; dead mature and immature eggs, shells and granulomas. The scope of this study was to compare the staining characteristics of different morphological types of eggs in the presence of fluorescent labels and vital dyes, aiming at differentiating live and dead eggs. The eggs were obtained from the intestines of infected mice, and put into saline 0.85 percent. The fluorescent labels were Hoechst 33258 and Acridine Orange + Ethidium Bromide and vital dyes (Trypan Blue 0.4 percent and Neutral Red 1 percent). When labelled with the probe Hoechst 33258, some immature eggs, morphologically considered viable, presented fluorescence (a staining characteristic detected only in dead eggs); mature eggs did not present fluorescence, and the other types of dead eggs, morphologically defined, showed fluorescence. As far as Acridine Orange + Ethidium Bromide are concerned, either the eggs considered to be live, or the dead ones, presented staining with green color, and only the hatched and motionless miracidium was stained with an orange color. Trypan Blue was not able to stain the eggs, considered to be dead but only dead miracidia which had emerged out of the shell. Neutral Red stained both live and dead eggs. Only the fluorescent Hoechst 33258 can be considered a useful tool for differentiation between dead and live eggs.

Comparison between morphological and staining characteristics of live and dead eggs of Schistosoma mansoni.

Schistosoma mansoni eggs are classified, according to morphological characteristics, as follows: viable mature and immature eggs; dead mature and immature eggs, shells and granulomas. The scope of this study was to compare the staining characteristics of different morphological types of eggs in the presence of fluorescent labels and vital dyes, aiming at differentiating live and dead eggs. The eggs were obtained from the intestines of infected mice, and put into saline 0.85%. The fluorescent labels were Hoechst 33258 and Acridine Orange + Ethidium Bromide and vital dyes (Trypan Blue 0.4% and Neutral Red 1%). When labelled with the probe Hoechst 33258, some immature eggs, morphologically considered viable, presented fluorescence (a staining characteristic detected only in dead eggs); mature eggs did not present fluorescence, and the other types of dead eggs, morphologically defined, showed fluorescence. As far as Acridine Orange + Ethidium Bromide are concerned, either the eggs considered to be live, or the dead ones, presented staining with green color, and only the hatched and motionless miracidium was stained with an orange color. Trypan Blue was not able to stain the eggs, considered to be dead but only dead miracidia which had emerged out of the shell. Neutral Red stained both live and dead eggs. Only the fluorescent Hoechst 33258 can be considered a useful tool for differentiation between dead and live eggs.

Exploring the subsite specificity of Schistosoma mansoni aspartyl hemoglobinase through comparative molecular modelling.

Blood flukes of the genus Schistosoma currently infect millions of people in tropical and subtropical countries. An enzyme playing a major role in hemoglobin (Hb) degradation by Schistosoma mansoni has been cloned and shown to be highly similar to the human cathepsin D aspartyl proteinase, although presenting a distinct substrate specificity from the latter. Investigating the structural features responsible for this difference has a major application in the design of selective anti-schistosomal drugs. In order to achieve this goal a homology model for the S. mansoni aspartyl hemoglobinase was constructed and then used to simulate the complexes formed with two transition state analogues of Hb-derived octapeptide substrates. Comparison with human cathepsin D showed that different pocket volumes and surface electrostatic potentials arise from substitutions in residues comprising the S4, S3, S2 and S3' subsites. Since the primary specificity of the S. mansoni enzyme resembles that of HIV-1 protease, we have discussed the applicability of current retroviral protease inhibitors as leads for the design of new anti-schistosomal drugs.

Antibody subclass profile and avidity during acute and chronic human Schistosoma mansoni infection.

The avidity of IgA, IgM, IgG and IgG subclass antibodies against Schistosoma mansoni soluble egg antigen (SEA) was determined by ELISA in serum samples collected in 1995 from individuals in Brazil with acute (n = 36) and chronic (n = 40) schistosomiasis. Fifteen individuals at the acute phase were also evaluated 6 months after clinical diagnosis. Predominance of low-avidity IgG, IgG1, IgG2, IgG3 and IgA characterized the acute phase. IgG4 was detected in only 2 individuals with acute disease (5.6%). Levels of anti-SEA IgM were similar between the study groups. IgG1 avidity showed the strongest association with the chronological evolution of the infection, presenting 100% of low avidity during the acute infection and reaching 100% of high avidity 6 months after. It is suggested that distinct anti-Schistosoma egg antigens subclass profile and antibody avidity characterize the clinical phases of S. mansoni infection. In particular, determination of anti-SEA IgG1 offers a new tool for the laboratory analysis of the disease.

The role of nutritional status and insulin-like growth factor in reduced physical growth in hepatosplenic Schistosoma mansoni infection.

The influence of nutritional status and hormonal growth activity on the impaired somatic development of adolescents with the hepatosplenic clinical form of Schistosoma mansoni infection (HS), the intestinal form with high (IH) or low (IL) egg output and non-infected (NI) individuals was evaluated (in Comercinho, Minas Gerais State, Brazil, in 1996-97) by measuring body mass index (BMI), insulin-like growth promoting factor (IGF-I) and its carrier protein (IGFBP-3). BMI, IGF-I and IGFBP-3 concentrations were significantly lower in the HS group compared with the IH and the NI groups, irrespective of age. BMI did not remain associated with the clinical form in the bi-variate model that included IGF-I and BMI or IGFBP-3 and BMI, suggesting that in these groups IGF-I and IGFBP-3 levels were related to the clinical form but independent of nutritional status. It is suggested that physical growth impairment in hepatosplenic S. mansoni infection results from the synergistic action of both hepatic damage and nutritional restriction.

[Assessment of schistosomiasis and other intestinal parasitoses in school children of the Bambuí municipality, Minas Gerais, Brazil]. / Avaliação da esquistossomose e de outras parasitoses intestinais, em escolares do município de Bambuí, Minas Gerais, Brasil.

This work was carried out with the purpose of determining the prevalence of intestinal parasitoses in the school children of Bambuí, through parasitological examinations (direct and Kato-Katz methods) and reevaluating the snails' breeding places described in the county. Of the 2,091 school children examined, 20.1% had at least one parasitic infection. Giardia lamblia, Entamoeba coli, Ascaris lumbricoides and hookworm are the most frequent parasites, with a prevalence of 6.2%, 6.2%, 4.8% and 1.4%, respectively. The hookworms were significantly more frequent among students from the rural area and in those aged over 14 years, while the prevalence of E. coli was greater in the urban area and the G. lamblia was more frequent in children under 6 years old. Only three children shed eggs of Schistosoma mansoni. The only intermediate host found was Biomphalaria glabrata and none of them was shedding cercariae of S. mansoni. When these data were compared with data from other surveys previously effected in the county, a decline was observed in the prevalence of all parasites. Some hypotheses which may explain this decline are discussed, such as: intense urbanization process and improvement of social-sanitary conditions of the county.

Oral fluids for the immunodiagnosis of Schistosoma mansoni infection.

Saliva and oral transudate were evaluated for their potential as human specimens in the detection of IgG antibodies against soluble Schistosoma mansoni egg antigen (SEA). Preliminary laboratory testing of 49 subjects, 37 with parasitological proven infection and 12 negative controls, displayed 100% sensitivity in ELISA using serum and oral transudate and 94.6% using saliva. The specificity of the ELISA with serum was 100% versus 91.7% with both oral fluids. Significant Spearman rank correlations of anti-SEA IgG levels with egg counts were observed for serum, oral transudate and saliva (P < 0.05). The sensitivity of dot-ELISA was 100% for serum, 89% for transudate and 81% for saliva, and specificity was 100% for all 3 samples. The immunodiagnostic value of ELISA for the detection of anti-SEA IgG antibodies in oral transudate was further evaluated in 197 individuals from an endemic area of Brazil. The ELISA using serum and oral transudate showed sensitivities of 98.8% and 100% respectively and specificities of 67.8% and 64.3% respectively. Use of oral fluids for the diagnosis of S. mansoni infection was equivalent to sera with respect to test efficacy, offering an alternative to blood collection.

[Critical analysis of the estimated number of Schistosomiasis mansoni carriers in Brazil]. / Análise crítica da estimativa do número de portadores de esquistossomose mansoni no Brasil.

The number of carriers of Schistosoma mansoni infection in Brazil was estimated based on the results of parasitological examinations of feces carried out by the Fundação Nacional de Saúde (FNS - National Health Foundation) in 1996 and 1997, as well as population data from 18 states collected by the Instituto Brasileiro de Geografia e Estatística (IBGE - Brazilian Institute of Geography and Statistics). This information allowed the number of carriers of schistosomiasis mansoni to be estimated at 7.1 million in 1996 and 6. 3 million in 1997. These figures may not reflect the true situation since the population sample used was not originally selected for this purpose. The absence of precise data indicates the need for an adequate national survey of the prevalence of schistosomiasis, which continues to be an important endemic parasitic disease, justifying greater efforts for its control in Brazil.

Traumatismo del riñon: tratamiento conservador / Renal trauma: conservative treatment

Se revisaron 10 historias clínicas de pacientes que ingresaron con diagnóstico de traumatismo renal, entre los años 1996 y 1997. Se considera el cuadro clínico, el laboratorio, el laboratorio, el diagnóstico por imágenes, la causa de los traumatismos, el grado de injuria renal y su tratamiento. En todos los pacientes la condicta fue expectante; sólo en 2 de ellos se practicó cirugía conservadora

Traumatismo del riñon: tratamiento conservador / Renal trauma: conservative treatment

Se revisaron 10 historias clínicas de pacientes que ingresaron con diagnóstico de traumatismo renal, entre los años 1996 y 1997. Se considera el cuadro clínico, el laboratorio, el laboratorio, el diagnóstico por imágenes, la causa de los traumatismos, el grado de injuria renal y su tratamiento. En todos los pacientes la condicta fue expectante; sólo en 2 de ellos se practicó cirugía conservadora(AU)

Circulating antigens levels in different clinical forms of the Schistosoma mansoni infection.

With the aim to evaluate the circulating cathodic antigen (CCA) levels in relation to the different clinical phases of Schistosoma sp. infection a sandwich ELISA using monoclonal antibody 5H11 was performed. The sera of three groups of 25 Brazilian patients with acute, intestinal and hepatosplenic forms of S. mansoni infection were tested and compared to a non-infected control group. Patients and control groups were matched for age and sex and the number of eggs per gram of feces was equally distributed among the three patient groups. Sensitivity of 100%, 72%, 52% of the assay was observed for the intestinal, hepatosplenic and acute toxemic groups respectively. The specificity was 100%. Intestinal and hepatosplenic groups presented CCA levels significantly higher in comparison to those observed for acute patients (F-ratio = 2,524; p = 0.000 and F-ratio = 6,314; p = 0.015 respectively). There was no significant difference of CCA serum levels between hepatosplenic and intestinal groups (F-ratio = 1,026; p = 0.316).

[Therapeutic evaluation of artesunate in experimental Schistosoma mansoni infection]. / Avaliação terapêutica do artesunato na infecção experimental pelo Schistosoma mansoni.

Mice experimentally infected with Schistosoma mansoni were treated orally with artesunate (Lactab) in a single dose of 300 or 500 mg/kg or over a period of five consecutive days. The animals were sacrificed 7, 30, 60 or 90 days after treatment. Statistically significant differences were found in the distribution and mortality of the worms and in the alterations of the oogram in the treated group when compared to control in all of the tested schemes when the animals were sacrificed 30 days after treatment. Morphological analysis of female worms showed a reduction of ovarian volume and rarefaction of the vitelline follicles. These modifications were more marked after treatment with the higher dose, explaining the alteration of the oogram which reached 100%. However, when the animals were sacrificed 60 or 90 days after treatment, the differences and alterations were smaller, showing that the surviving worms recovered and restarted oviposition.

[Problems in the development of a vaccine against schistosomiasis mansoni]. / Dificuldades no desenvolvimento de uma vacina para a esquistossomose mansoni.

During the last two decades, studies on antigens that may confer protective immunity to experimental infection with Schistosoma mansoni have made great advances, due largely to increased knowledge in the fields of molecular biology and immunology. Although these studies have made new and important contributions, at the present time the degree of protection conferred remains at approximately 50% in reducing the number of flukes and, with some antigens, the number of eggs. The many questions still to be answered indicate the necessity of carrying out further research on small and large animals before these antigen candidates for vaccines can be used in clinical tests.

Questionnaires in the screening for Schistosoma mansoni infection: a study of socio demographic and water contact variables in four communities in Brazil.

The use of questionnaires has been recommended for identifying, at a lower cost, individuals at risk for schistosomiasis. In this study, validity of information obtained by questionnaire in the screening for Schistosoma mansoni infection was assessed in four communities in the State of Minas Gerais, Brazil. Explanatory variables were water contact activities, sociodemographic characteristics and previous treatment for schistosomiasis. From 677, 1474, 766 and 3290 individuals eligible for stool examination in the communities, 89 to 97% participated in the study. The estimated probability of individuals to be infected, if they have all characteristics identified as independently associated with S.mansoni infection, varied from 15% in Canabrava, to 42% in Belo Horizonte, 48% in Comercinho and 80% in São José do Acácio. Our results do not support the hypothesis that a same questionnaire on risk factors could be used in screening for S.mansoni infection in different communities.

Pielonefritis enfisematosa: una patología poco frecuente / Emphysematous pyelonephritis: an infrequent sisease

La pielonefritis enfisematosa es una rara afección del parénquima renal, provocada por bacilos formadores de gas, que se produce casi con exclusividad en pacientes portadores de una diabetes millitus no controlada. Su caracteristica más saliente es que junto con el cuadro infeccioso hay formación de gas que puede localizarse en el parénquima renal, en el tejido perirrenal o bien en la vía excretora. Se presenta una paciente portadora de esta entidad y se hace una revisión de la bibliografía

Pielonefritis enfisematosa: una patología poco frecuente / Emphysematous pyelonephritis: an infrequent sisease

La pielonefritis enfisematosa es una rara afección del parénquima renal, provocada por bacilos formadores de gas, que se produce casi con exclusividad en pacientes portadores de una diabetes millitus no controlada. Su caracteristica más saliente es que junto con el cuadro infeccioso hay formación de gas que puede localizarse en el parénquima renal, en el tejido perirrenal o bien en la vía excretora. Se presenta una paciente portadora de esta entidad y se hace una revisión de la bibliografía(AU)

Re-evaluation of schistosomiasis mansoni in Minas Gerais, Brazil. III. "Noroeste de Minas" mesoregion.

This study was conducted to assess the presence of schistosomiasis mansoni in the "Noroeste de Minas" mesoregion, an area considered non-endemic. A malacologic survey and parasitologic stool examinations were undertaken in 13 municipalities of the mesoregion. A sample of 3,283 primary school students was submitted to fecal examination by the Kato-Katz method. A total of 3,627 planorbids was collected and examined. The molluscs were identified as Biomphalaria straminea in seven municipalities (Unaí, Bonfinópolis de Minas, Paracatu, Jaão Pinheiro, Vazante, Lagamar and Lagoa Grande) and as Biomphalaria peregrina in one (Presidente Olegário). All planorbids were negative for Schistosoma mansoni. Four students were diagnosed with schistosomiasis in the municipalities of Buritis, Formoso, Paracatu and Unaí, but none of these cases was considered autochthonous. The data obtained indicate that the "Noroeste de Minas" mesoregion continues to be non-endemic for schistosomiasis mansoni, although the presence of intermediate hosts associated with parasitized individuals emphasizes the need for epidemiological surveillance of schistosomiasis in this mesoregion.