Translation and cross-cultural adaptation of the Pregnancy Physical Activity Questionnaire (PPAQ) to the Brazilian population.

OBJECTIVE: To evaluate the total activity performed by women with low-risk pregnancy as well as translate and pursue a cross-cultural adaptation of the Pregnancy Physical Activity Questionnaire (PPAQ) to the Brazilian reality. DESIGN: We conducted a cross-sectional quantitative study including 305 women between 16 and 40 years of age with low-risk pregnancies. SETTING: The Department of Public Health, State University of Ceará, Fortaleza, Brazil. METHODS: We applied an adapted version of PPAQ to assess the levels of physical activity and the intensity in the metabolic equivalent task (MET), which could be distinguished as follows: sedentary (< 1.5 METs), light (1.5-3.0 METs), moderate activity (3.0-6.0 METs), and vigorous activity (>6.0 METs). The Kruskal-Wallis test was used to compare energy expenditure (MET) with socio-demographic variables. RESULTS: More than half of the participants performed activities that were classified as light (51.4%). If we group the activities that were categorized as sedentary and light, this value increases to 74.7%, showing a high prevalence of insufficiently active pregnant women. Lower energy expenditure was observed in the third gestational trimester among pregnant women with lower educational level, single women, and mixed-race women (p < 0.05). CONCLUSION: There is a prevalence of physical inactivity during the three trimesters of pregnancy. The results validate PPAQ for the Brazilian population to serve as a basis for future public policies focused on combating the health problems of mother-infant pairs.

Chronic electroacupuncture of the ST36 point improves baroreflex function and haemodynamic parameters in heart failure rats.

Electroacupuncture (EA) has been used to treat many diseases, including heart failure (HF). This study aimed to evaluate the effects of chronic stimulation in the ST36 acupuncture point on haemodynamic parameters and baroreflex function in rats with HF. Cardiovascular parameters assessed were heart rate (HR), blood pressure (BP), and the reflex cardiovascular response of HR triggered by stimulation of baroreceptors in animals with HF subsequent to acute myocardial infarction (AMI). Male Wistar rats were divided into three groups: Sham Control - animals without HF and without EA; HF Control group - animals with HF and without EA; and HF EA group - animals with HF that received the EA protocol. Six weeks after surgical induction of AMI, the EA protocol (8 weeks, 5 times a week) was performed. The protocol was applied with EA at the ST36 point, frequency of 2 Hz, pulse of 0.3 ms and intensity of 1-3 mA for 30 min. Haemodynamic parameters and baroreceptor function were assessed. There was no difference between groups in the variables HR, systolic blood pressure (SBP) and diastolic blood pressure (DBP), which were evaluated with awake animals (p>0.05). There was an increase in the mean arterial pressure (MAP) in the HF EA group compared to the HF Control group (p<0.05). The maximum gain of the baroreflex heart rate response (Gain) was higher in the HF EA group than the HF Control and Sham Control groups. Chronic EA in the ST36 point increased the MAP and baroreflex sensitivity in rats with HF.

Pathophysiological, cardiovascular and neuroendocrine changes in hypertensive patients during the hemodialysis session.

The pathophysiological mechanisms of arterial hypertension during hemodialysis (HD) in patients with end-stage renal disease (ESRD) are still poorly understood. The aim of this study is to investigate physiological, cardiovascular and neuroendocrine changes in patients with ESRD and its correlation with changes in blood pressure (BP) during the HD session. The present study included 21 patients with ESRD undergoing chronic HD treatment. Group A (study) consisted of patients who had BP increase and group B (control) consisted of those who had BP reduction during HD session. Echocardiograms were performed during the HD session to evaluate cardiac output (CO) and systemic vascular resistance (SVR). Before and after the HD session, blood samples were collected to measure brain natriuretic peptide (BNP), catecholamines, endothelin-1 (ET-1), nitric oxide (NO), electrolytes, hematocrit, albumin and nitrogen substances. The mean age of the studied patients was 43 ± 4.9 years, and 54.6% were males. SVR significantly increased in group A (P<0.001). There were no differences in the values of BNP, NO, adrenalin, dopamin and noradrenalin, before and after dialysis, between the two groups. The mean value of ET-1, post HD, was 25.9 pg ml(-1) in group A and 13.3 pg ml(-1) in group B (P = < 0.001). Patients with ESRD showed different hemodynamic patterns during the HD session, with significant BP increase in group A, caused by an increase in SVR possibly due to endothelial dysfunction, evidenced by an increase in serum ET-1 levels.

Flow-mediated dilation of brachial artery and endothelial dysfunction in pregnant women with preeclampsia: a case control study.

AIM: Aim of the present study was to evaluate the association between endothelial dysfunction, evaluated through flow-mediated dilation (FMD) of the brachial artery, and preeclampsia. METHODS: A case-control prospective cross-sectional study was conducted on 81 pregnant women of between 20 and 39 weeks and 5 days, among whom 40 had preeclampsia and 41 were controls. The right brachial artery was identified using color Doppler, between 2 and 5 cm above the cubital fold. The diameter of the brachial artery was measured by calculating the distance between the proximal and distal intima (D1) during diastoles. Ischemia was caused for five minutes and the artery measurement was repeated 60 seconds after ending the compression (D2), during diastoles. The FMD (%) was calculated through the equation: (D2-D1)/D1 × 100. The association between independent variables and the presence of preeclampsia was estimated through odds ratios (OR) and their 95% confidence intervals (95% CI). RESULTS: Seventy-five percent of the pregnant women with preeclampsia and 26.8% of the normotensive women presented reduction in the diameter of the brachial artery (OR = 8.18; 95% CI: 2.74-25.04) (P = 0.000). A greater proportion of the pregnant women with pre-eclampsia (42.1% vs. 14.3%) had a history of a mother with hypertension during pregnancy (OR = 4.36; 95% CI: 0.89-23.51) (P = 0.045). CONCLUSION: We identified an association between endothelial dysfunction, evaluated through FMD of the brachial artery, and preeclampsia.

The susceptibility of domestic cats (Felis catus) to experimental infection with Leishmania braziliensis.

Over the last few years, several cases of feline leishmaniasis (FL) with cutaneous and visceral forms have been reported around the world. Nonetheless, the real susceptibility of cats to infection with Leishmania spp. and the outcome of leishmaniasis in these animals are poorly understood. Experimental studies on feline models will contribute to the knowledge of natural FL. Thus, in order to determine the susceptibility of domestic cats (Felis catus) to experimental infection with Leishmania braziliensis, 13 stray cats were infected with 10(7) promastigotes by the intradermal route in the ear and nose simultaneously and followed up for 72 weeks. Soon after infection, the earliest indication of a lesion was a papule on the ear at 2 weeks post-infection (w.p.i.). The emergence of satellite papules around the primary lesion was observed about 4 w.p.i. Two weeks later these papules coalesced and formed a huge and irregular nodule. Thereafter, there was lesion dissemination to the external and marginal surface of the ipsilateral ear, and later to the contralateral ear. At 10 w.p.i., some nodules became ulcerated. Nose lesions presented a similar evolution. At both sites, the largest lesion sizes occurred at 10 w.p.i. and started to decrease 15 days later. Ear and nose nodules healed at 32 and 40 w.p.i., respectively. Specific L. braziliensis IgG antibody titers (optical density> or = 0.01 as positive result) were detected as early as 2 w.p.i. (0.09 +/- 0.02) in only three animals (23%), and all cats had positive titers at 20 w.p.i. (0.34 +/- 0.06). Only three animals (38%) continued to show positive serology at 72 w.p.i. (0.08 +/- 0.02). Up to that time, none of the cats had lesion recurrence. In a feline model of cutaneous leishmaniasis, it seems that there is no correlation between active lesions and positive serology. The implications of these data are discussed.

Deltamethrin-impregnated dog collars have a potent anti-feeding and insecticidal effect on Lutzomyia longipalpis and Lutzomyia migonei.

Deltamethrin-impregnated PVC dog collars were tested to assess if they were effective in protecting dogs from sand fly bites of Lutzomyia longipalpis and Lu. migonei. A protective effect against Old World species Phlebotomus perniciosus was demonstrated before. Four dogs wearing deltamethrin collars and three dogs wearing untreated collars (not impregnated with deltamethrin) were kept in separate kennels for over eight months in a village on the outskirts of Fortaleza in Ceará, Brazil. Periodically, a dog from each group was sedated, placed in a net cage for 2 h in which 150 female sand flies had been released 10-15 min before. Lu. longipalpis were used 4, 8, 12, 16, 22, 27, and 35 weeks after the attachment of the collars. Lu. migonei were used 3, 7, 11, 15, 22, 26, and 36 weeks after attachment. During 35 weeks, only 4.1% (81 of 2,022) Lu. longipalpis recovered from the nets with the deltamethrin collared dogs were engorged, an anti-feeding effect of 96%. Mortality initially was over 90% and at 35 weeks was 35% with half of the sand flies dying in the first 2 h. In contrast, 83% of the 2,094 Lu. longipalpis recovered from the nets containing the untreated collared dogs were engorged and the mortality ranged from zero to 18.8% on one occasion with 1.1% dying in the first 2 h. Similar findings were found with Lu. migonei: of 2,034 sand flies recovered over this period, only 70 were engorged, an anti-feeding effect of 96.5%, and mortality ranged from 91% initially to 46% at 36 weeks. In contrast, engorgement of controls ranged from 91 to71% and a mortality ranged from 3.5 to 29.8%. These studies show that deltamethrin impregnated collars can protect dogs against Brazilian sand flies for up to eight months. Thus, they should be useful in a program to control human and canine visceral leishmaniasis.

[Peridomiciliary changes and implications for Triatoma brasiliensis control]. / Alterações do peridomicílio e suas implicações para o controle do Triatoma brasiliensis.

A total of 9,906 annexes from 1,541 rural dwellings of Boa Viagem County, Ceará, Brazil, infested by Triatoma brasiliensis and Triatoma pseudomaculata were investigated and immediately sprayed with pyrethroid insecticide, followed by revisions at 6, 12, and 18 months. The initial infestation rate of annexes was 4.0%, with predominant infestation in animal shelters (7.0%). Mean insect density was low, regardless of triatomine species or type of annex. A progressive decrease in the number of initial annexes was observed (66% of remaining annexes), mainly those classified as "piles of materials". Only 3% of the annexes were modified by the population. New constructed annexes were important as new foci of infestation. Some 25% were infested at the end of observation period, significantly more than the "old" annexes (4.0%), a difference attributed to insecticide spraying at the beginning of the intervention. Reinfestation occurred slowly and was more frequent in animal shelters No differences were observed between traditional pyrethroid and slow-release organophosphate formulations. Selective spraying of "new" annexes is recommended.

[Focal and total residual insecticide spraying to control Triatoma brasiliensis and Triatoma pseudomaculata in Northeast Brazil]. / Tratamentos focais e totais com inseticidas de ação residual para o controle de Triatoma brasiliensis e Triatoma pseudomaculata no Nordeste brasileiro.

To efficiently control the triatomines Triatoma brasiliensis and Triatoma pseudomaculata, a field trial was performed to compare conventional versus focal spraying of deltamethrin 5% SC at 25 mg a. i./m2 and the slow-release organophosphate malathion 8.3% SR at 2g a. i./m2. The assay took place in the county of Boa Viagem, Ceará State, with 1541 households, randomly separated into 4 groups. Two of them received focal spraying: PT, treated with deltamethrin indoors and in the peridomicile, and PL, which received slow-release malathion in the same circumstances. The other groups received conventional, i.e., total application: PT with deltamethrin in the intra- and peridomicile, and PL, which was treated with deltamethrin indoors and slow-release malathion in the peridomicile. Entomological surveys at 6 and 12 months post-treatment showed better results for mixed treatment, the PL group, probably due to good indoor performance for the pyrethroid and better performance of the slow-release formulation under the hostile peridomiciliary conditions. Domestic animal shelters underwent numerous modifications over the course of the year, fostering reduced insecticide performance in the peridomicile.

Vector densities that potentiate dengue outbreaks in a Brazilian city.

To identify the critical vector density that potentiates dengue outbreaks in an endemic site and to identify obstacles to anti-dengue activities, we correlated a series of dengue outbreaks in a Brazilian city with the intensity of its anti-vector source-reduction activities. The proportion of houses infested by vector mosquitoes correlated inversely with intensity of anti-mosquito interventions, and the vector population developed independently of rainfall. Local periods of drought promoted vector abundance in two ways: residents stored water in which vector mosquitoes could breed, and cholera outbreaks due to contaminated water diverted local health workers from routine anti-vector activities. One dengue outbreak became apparent to authorities more than two months after it commenced but would have been identified almost immediately had dengue-like disease in indicator hospitals been monitored. Active surveillance, therefore, offers a window of opportunity for promptly executed anti-dengue interventions. Source-reduction measures that suppress vector infestations to less than 1% of houses effectively avert outbreaks of dengue.

[Development of a strategy to optimize the indications for the upper gastrointestinal endoscopy in patients with dyspepsia at the primary care level]. / Desenvolvimento de uma estratégia para otimizar a indicação de endoscopia digestiva alta em pacientes com dispepsia atendidos em nível primário de saúde.

BACKGROUND: Although dyspepsia is a highly prevalent complaint, only a small percentage of patients are found to have serious disease and to need full investigation. The selection of dyspeptic patients who really need upper gastrointestinal endoscopy (UGE) is crucial in order to avoid unnecessary costs and overload services. MATERIAL AND METHODS: 200 primary care patients (age range 16-76 years) with dyspepsia and without any evidence of organic disease were interviewed with a structured questionnaire, and afterwards they underwent UGE. Multiple logistic regression analysis identified variables that could discriminate individuals with abnormal UGE from individuals with normal UGE, as well as individuals with peptic ulcer from individuals with normal UGE. RESULTS: The variables to discriminate individuals with abnormal UGE from individuals with normal UGE were age 45 years or above, and male sex, whereas to discriminate individuals with peptic ulcer in UGE from individuals with normal UGE were age 45 years or above, male sex, smoking, fullness, and absenteeism. A practical model based on these variables was developed, showing sensitivity of 78,9%, specificity of 51,7%, positive predictive value (PPV) of 39,4 % and negative predictive value (NPV) of 86% for the detection of individuals with UGE abnormal; and sensitivity of 84%, specificity of 70%, PPV of 38% and NPV of 95% for the identification of individuals with UGE identifying peptic ulcer. CONCLUSIONS: A strategy based on a model containing clinical and social characteristics of dyspeptic patients could potentially decrease the number of unnecessary UGEs.

Desenvolvimento de uma estratégia para otimizar a indicação de endoscopia digestiva alta em pacientes com dispepsia atendidos em nível primário de saúde / Development of a strategy to optimize the indication to the upper gastrointestinal endoscopy in patients with dyspepsia at the primary health care level

OBJETIVO: Desenvolver uma estratégia capaz de otimizar a indicação de endoscopia digestiva alta (esofagogastroduodenoscopia-EGD) em pacientes com dispepsia e sem sinal de alarme para doença orgânica, baseada em variáveis clínicas e sociais com maior valor em discriminar indivíduos com EGD com alteração de indivíduos com EGD normal. CASUÍSTICA E MÉTODO: 200 pacientes (idade: 16-76 anos) com dispepsia e sem evidência de doença orgânica, atendidos em nível primário, foram entrevistados com um questionário estruturado e submetidos a EGD. Análise de regressão logística múltipla identificou variáveis com maior valor em discriminar indivíduos com EGD com alteração de indivíduos com EGD normal, bem como indivíduos com EGD com úlcera péptica daqueles com EGD normal. RESULTADOS: As variáveis com maior valor em discriminar indivíduos com EGD com alteração daqueles com EGD normal foram: idade igual ou superior a 45 anos e sexo masculino. Para discriminar indivíduos com EGD com úlcera péptica daqueles com EGD normal, as variáveis foram: idade igual ou superior a 45 anos; sexo masculino; tabagismo; empachamento e absenteísmo. Um modelo prático foi desenvolvido, visando a apoiar a decisão de indicar ou não EGD, apresentando sensibilidade de 78,9 por cento, especificidade de 51,7 por cento, valor preditivo positivo (VPP) de 39,4 por cento e preditivo negativo (VPN) de 86 por cento, para a identificação de indivíduos com EGD com alteração; e sensibilidade de 84 por cento, especificidade de 70 por cento, VPP de 38 por cento e VPN de 95 por cento, para a identificação de indivíduos com EGD com úlcera péptica. CONCLUSÃO: Uma estratégia baseada em variáveis clínicas e sociais de pacientes com dispepsia poderia potencialmente diminuir o número de EGD desnecessárias.

[A seroepidemiological survey on the island of São Luis during a dengue epidemic in Maranhão]. / Inquérito soro-epidemiológico na ilha de São Luis durante epidemia de dengue no Maranhão.

The island of São Luis in the State of Maranhão, constituted by the municipalities of São Luis-SL (835,428 inhabitants), São José de Ribamar-SJR (60,633 inhabitants) and Paço do Lumiar-PL (80,274 inhabitants), has been suffering dengue (DEN) fever epidemics since 1995, caused by DEN-1. In 1996, from August through October, an aleatory sero-epidemiologic survey was carried out in order to estimate the incidence of DEN infection and to analyze other clinical and epidemiological parameters. A questionnaire was applied and serum samples were simultaneously obtained. Serum samples were tested by hemagglutination inhibition (HI). Results were analyzed using Lotus 123, Epi-info 6.0, Excel 5.0 and STATA softwares. A total of 1,217 serum samples were obtained (101 of PL, 100 of SJR and 1017 of SL). The rate of DEN was 55.4% in PL, 28% in SJR and 41.4% in SL, suggesting the occurrence of 401,933 infections. No difference was seen between males and females, but infection occurred more in the upper social class than in poor people (p < 0.003), and was more frequent in adults than in children (p < 0.0004). In SL, the incidence was stratified into seven sanitary districts (SD), and prevalence was found to range from 26.1% in SD4 to 56.8% in SD1 (p < 0.0001). Symptoms were more frequently reported by people whose HI was positive: they included fever, headache, chills, dizziness, retrobulbar pains, muscle and joint pains, nausea, anorexia and skin rash. In spite of the high incidence of infection, no hemorrhagic cases were reported.

[Control of canine visceral leishmaniasis: comparison of results from a rapid elimination program of serum-reactive dogs using an immunoenzyme assay and slower elimination of serum-reactive dogs using filter paper elution indirect immunofluorescence]. / Controle do calazar canino: comparação dos resultados de um programa de eliminação rápida de cães sororreagentes por ensaio imuno-enzimático com outro de eliminação tardia de cães sororreagentes por teste de imunofluorescência indireta de eluato de papel filtro.

The kala-azar control program, adopted by the Fundação Nacional de Saúde-FNS (National Health Foundation) has not been able to reduce to an acceptable level the incidence of human cases. The diagnostic method utilized is a blood eluate immunofluorescence. A dogs diagnosed as infected is eliminated a mean of eighty days after the blood collection. The low sensitivity of the test used and the continuing residence of the infected dog in the region due to the elimination delay may be critical in the lack of success of this program. In this study, the FNS standard canine control method is compared to a strategy based on ELISA identification of infected dog and elimination within 7 days. In both study areas the canine seroprevalence was noted ten months before and ten months after the intervention. In the routine FNS area a 9% decrease in seroprevalence was noted, compared to statistically significant greater 27%, reduction (p = 0.0015) in the ELISA intervention area.

Controle do calazar canino: comparação dos resultados de um programa de eliminação rápida de cães sororreagentes por ensaio imuno-enzimático com outro de eliminação tardia de cães sororreagentes por teste de imunofluorescência indireta de eluato de papel filtro / Control of canine visceral leishmaniasis: comparison of results from a rapid elimination program of serum-reactive dogs using an immunoenzyme assay and slower elimination of serum-reactive dogs using filter paper elution indirect immunofluorescence

O programa de controle do calazar, adotado pela Fundação Nacional de Saúde (FNS), não tem conseguido reduzir a níveis aceitáveis a incidência de calazar humano. Utiliza como método diagnóstico a imunofluorescência de eluato de sangue e sacrifíca os cães infectados com uma média de 80 dias após a coleta. A longa permanência do cão infectado na área e a baixa sensibilidade do teste utilizado podem ser importantes para esta falha. Neste trabalho, compara-se o programa de rotina da FNS, com outra estratégia baseada na identificação de cães infectados pelo enzyme-linked immunosorbent assay (ELISA) e eliminação dos cães infectados dentro de um prazo máximo de 7 dias. A prevalência do calazar canino foi medida nas duas áreas, antes e 10 meses após a medição inicial. Na área submetida ao controle de rotina da FNS observou-se um decréscimo de 9% na prevalência, enquanto na submetida ao método proposto a redução observada foi de 27%, sendo esta diferença sinificativamente maior (p = 0,0015).

The kala-azar control program, adopted by the Fundação Nacional de Saúde-FNS (National Health Foundation) has not been able to reduce to an acceptable level the incidence of human cases. The diagnostic method utilized is a blood eluate immunofluorescence. A dogs diagnosed as infected is eliminated a mean of eighty days after the blood collection. The low sensitivity of the test used and the continuing residence of the infected dog in the region due to the elimination delay may be critical in the lack of success of this program. In this study, the FNS standard canine control method is compared to a strategy based on ELISA identification of infected dog and elimination within 7 days. In both study areas the canine seroprevalence was noted ten months before and ten months after the intervention. In the routine FNS area a 9% decrease in seroprevalence was noted, compared to statistically significant greater 27%, reduction (p = 0.0015) in the ELISA intervention area.

[Dengue epidemic in Fortaleza, Ceará: randomized seroepidemiologic survey]. / Epidemia de dengue em Fortaleza, Ceará: inquérito soro-epidemiológico aleatório.

OBJECTIVE: A seroepidemiological random survey was carried out in Fortaleza city, State of Ceará, Brazil, following an epidemic of dengue virus type 2 (DEN 2), with the purpose of evaluating the frequency of clinical manifestations (signs and symptoms) and the prevalence of dengue infection. METHOD: A questionnaire calling for information on address, sex, age, clinical, epidemiological and economic status was applied to the population, followed by venupuncture collection of 5-10 ml of blood for testing by hemagglutination-inhibition (HI). The sample was calculated to obtain a prevalence of 20% with relative risk of 10% and confidence interval of 95%. All information obtained was analyzed by computer using Epi Info 5.0, Lotus 123, Excel 5.0, and Stata software. RESULTS AND CONCLUSIONS: A total of 1,341 serum samples were obtained from nine Health Districts (SD) and tested by hemagglutination inhibition. Of these, 589 (44%) were positive and 752 (56%) negative. Of the positive results, 93 primary responses (PR) (7%) to DEN-2 and 496 secondary responses (SR) (37%) were observed. The global prevalence in the SD ranged from 21% to 71%. There were 41% (243/589) asymptomatic infections and 59% (346/589) symptomatic infections. Data analysis showed no difference in frequency by sex, age, on schooling, although a highly statistically significant difference was found as between the different social classes, the infection most commonly observed being among people of better social status. The stratification of positive cases showed greater prevalence of AI (p < 0.001) and SI (p < 0.0001) in both sexes, among people with SR rather than PR. The most prevalent symptoms were fever, headache, muscle pains, rash, dizziness, and joint pains. Moreover, itching, retro-bulbar pain, rash, and gingival bleeding, showed statistically significant differences. On the other hand, dizziness and joint pains were more associated in the patients with SR than PR, and statistically significant differences were also observed.

Bubonic leishmaniasis: a common manifestation of Leishmania (Viannia) braziliensis infection in Ceara, Brazil.

Enlarged regional lymph nodes have been reported to accompany the cutaneous lesions of Leishmania (Viannia) braziliensis (= L. braziliensis). A survey in Ceara State, Brazil indicated that 77% of persons (456 of 595) with parasitologically confirmed cutaneous leishmaniasis reported lymphadenopathy in addition to skin lesions. A group of 169 persons with recently diagnosed leishmaniasis and lymph nodes measuring > or = 2 cm in diameter (mean = 3.6 cm, maximum = 10.5 cm) underwent detailed clinical examination. Lymphadenopathy preceded the skin lesions in more than two-thirds of these, on the average by two weeks. Cultures of lymph node aspirates yielded Leishmania more frequently (86%) than cultures of aspirates of skin (53%) or biopsies of skin (74%). Parasites were isolated from the peripheral blood of one patient. Persons with lymphadenopathy gave a history of fever and had enlarged livers or spleens more often than a comparison group of 50 persons with cutaneous lesions but no lymphadenopathy. Persons with lymphadenopathy had more intense leishmanin skin reactions and lymphocyte proliferation following stimulation with specific antigens, whereas persons without lymphadenopathy had a higher frequency of previous infection. Isolates of parasites from both groups were identified as L. braziliensis. These data demonstrate the early spread of L. braziliensis beyond the skin and suggest differences in host immunity between persons with and without lymphadenopathy. Leishmaniasis braziliensis should be considered in cases of unexplained lymphadenopathy in endemic areas.

[Analysis of the monthly incidence of cutaneous leishmaniasis in Ceará (Brazil) between 1986 and 1990]. / Analyse de l'incidence mensuelle de la leishmaniose tégumentaire dans le Ceará (Brésil) entre 1986 et 1990.

To determine the value of an epidemiological surveillance system, we evaluated the incidence rate and trends of American Cutaneous Leishmaniasis (ACL) in three health districts of Ceara state, Brazil. We used a retrospective time series analysis of ACL notifications in Ceara state between 1986 and 1990. The trend of this endemic/epidemic disease was analysed by using three types of modeling on the moving average graph: a linear, linear periodic and non linear periodic model. The study samples consisted of the 14,615 cases of ACL notified in Ceara state between 1986 and 1990. Males accounted for 54% of cases. Age was between 1 month and 19 years in 42% of cases. Most cases (81%) were diagnosed on clinical grounds only. After calculation of the moving average and application of a linear regression model to these means, the trend analysis revealed that 1) there was a significant trend towards an increase in two of the three health districts, with correlation coefficients of 0.31 and 0.49 (Student's t test = 2.24 and 3.88) and a significant trend towards a decrease in the remaining district (correlation coefficient = 0.51, t = 4.1). The linear periodic model showed a cyclic representation with a 36-month period and a base of 241. The non linear periodic model showed a cycle of 32 months and a base of 241, and was a better representation of the disease variations. Despite the limited study period, it appears that the 32-month cycle could be attributed to meteorological conditions. Field studies are underway to determine the precise causes of this periodicity.

Epidemiology of visceral leishmaniasis in northeast Brazil.

Epidemiologic aspects of the relationship between infection with Leishmania chagasi and development of clinical visceral leishmaniasis (VL) were studied in all children < 11 years old in a defined, endemic, rural area of the state of Ceará in northeast Brazil. Antileishmanial antibodies were measured in the same subjects by ELISA on six occasions between May 1987 and August 1989. Seroconversion was documented during this period in 108 children, with a cumulative annual incidence of 4.6%. Twelve (11.1%) of these children developed VL. Age < 4 years, hematocrit < 33%, and living in the mountains predicted the development of clinically apparent VL after seroconversion. Despite a high percentage of dogs serologically positive in the region (38%), there was no increased risk of infection for children living in the same household with dogs. Since children in households with a prior case of VL had a threefold increased risk of infection, human-sandfly-human transmission might have been important.

Canine visceral leishmaniasis in northeast Brazil: assessment of serodiagnostic methods.

Domestic dogs are considered to be a major reservoir of Leishmania donovani chagasi in northeast Brazil, and the elimination of infected dogs is an important part of the control program. We assessed 2 serological methods, IFA and ELISA. Of 405 dogs, 8% were positive by IFA obtained from blood collected by drying onto filter paper followed by elution, 17% were positive by IFA performed using sera, and 38% were positive by ELISA on the same sera. Thirty-five dogs, seropositive by 1 or more of the above tests, were killed and touch preparations were made of liver, spleen, and mesenteric lymph nodes. Samples were cultured in enriched NNN media. The ELISA recognized all dogs with proven infection; IFA detected 10 of 12. Eleven dogs were positive by touch preparations and 7 by culture. In addition, kDNA hybridization was undertaken with probes to L. donovani chagasi, L. braziliensis ssp., and L. mexicana amazonensis. Positive results were obtained from tissue in 19 instances, but 10 culture positive specimens were not recognized.