ABSTRACT
The aim of this study was to evaluate the specificity of a rapid immunochromatographic test that was developed to detect antibodies against the rK39 antigen for the diagnosis of visceral leishmaniasis (VL). This evaluation was performed using sera from patients with a confirmed diagnosis of active cutaneous leishmaniasis. The sera from 272 patients with a confirmed diagnosis of localised cutaneous leishmaniasis (CL) who resided in an area endemic for Leishmania braziliensis in Brazil were obtained before the initiation of antileishmanial treatment. Kalazar Detect(r)(InBios, Seattle, WA) recombinant K39 antigen-based immunochromatographic strips were used according to the manufacturer's instructions. The test results were evaluated independently by two examiners in sequential order. The positive controls for the test included five serum samples from five patients with parasitologically confirmed diagnosis of VL caused by Leishmania infantum in Brazil. Overall, 100% of the samples obtained from patients with CL were negative, confirming the absence of a serological cross-reaction for individuals with cutaneous disease when these patients were evaluated using the rapid test. The lack of a cross-reaction in patients who were infected by parasites of the same genus highlights the specificity of the rK39 antigen for the diagnosis of VL in areas with the sympatric circulation of L. braziliensis and L. infantum.
Subject(s)
Antigens, Protozoan , Leishmania braziliensis/immunology , Leishmaniasis, Cutaneous/diagnosis , Protozoan Proteins , Adolescent , Adult , Child , Chromatography, Affinity , Female , Humans , Leishmaniasis, Cutaneous/immunology , Male , Middle Aged , Reagent Kits, Diagnostic , Reproducibility of Results , Sensitivity and Specificity , Young AdultABSTRACT
The aim of this study was to evaluate the specificity of a rapid immunochromatographic test that was developed to detect antibodies against the rK39 antigen for the diagnosis of visceral leishmaniasis (VL). This evaluation was performed using sera from patients with a confirmed diagnosis of active cutaneous leishmaniasis. The sera from 272 patients with a confirmed diagnosis of localised cutaneous leishmaniasis (CL) who resided in an area endemic for Leishmania braziliensis in Brazil were obtained before the initiation of antileishmanial treatment. Kalazar Detect(r)(InBios, Seattle, WA) recombinant K39 antigen-based immunochromatographic strips were used according to the manufacturer's instructions. The test results were evaluated independently by two examiners in sequential order. The positive controls for the test included five serum samples from five patients with parasitologically confirmed diagnosis of VL caused by Leishmania infantum in Brazil. Overall, 100% of the samples obtained from patients with CL were negative, confirming the absence of a serological cross-reaction for individuals with cutaneous disease when these patients were evaluated using the rapid test. The lack of a cross-reaction in patients who were infected by parasites of the same genus highlights the specificity of the rK39 antigen for the diagnosis of VL in areas with the sympatric circulation of L. braziliensis and L. infantum.
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Antigens, Protozoan , Leishmania braziliensis/immunology , Leishmaniasis, Cutaneous/diagnosis , Protozoan Proteins , Chromatography, Affinity , Leishmaniasis, Cutaneous/immunology , Reagent Kits, Diagnostic , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
BACKGROUND: Cutaneous leishmaniasis is a public health problem in Brazil, where meglumine antimoniate is the drug of choice for treatment. Ulcers treated with pentavalent antimonials show increasing diameters during the first weeks of drug exposure. METHOD: We evaluated data from patients previously enrolled into an open study to compare changes in the ulcerated area of 189 lesions in 101 patients with localized cutaneous leishmaniasis caused by Leishmania braziliensis and L. guyanensis who were treated with i.v. meglumine antimoniate (Glucantime), 20 mg kg(-1) day(-1) for 20 days. RESULTS: An average increase in the ulcerated area of 0.3 cm(2) (95% CI 0.13-0.47 cm(2); p = 0.001) was observed at Day 10 compared with the baseline measurement. Comparison of Day 20 with Day 10 showed a significant decrease of 0.76 cm(2) (95% CI 0.53-0.99 cm(2); p < 0.001) in ulcer size. At Day 50, compared with Day 20, the ulcerated area was decreased by 0.77 cm(2) (95% CI 0.53-1.01 cm(2); p < 0.001). CONCLUSION: We conclude that early enlargement of the ulcerated area during treatment of localized cutaneous leishmaniasis with antimonials in Brazil is a common feature and easily detected by the 10th day of treatment. Following the end of the treatment period (20 days), it would be reasonable to observe a significant decrease in size of the ulcerated area.
Subject(s)
Antiprotozoal Agents/therapeutic use , Leishmaniasis, Cutaneous/drug therapy , Meglumine/therapeutic use , Organometallic Compounds/therapeutic use , Skin Ulcer/pathology , Brazil , Humans , Leishmaniasis, Cutaneous/pathology , Meglumine Antimoniate , Outcome Assessment, Health Care/methods , Skin Ulcer/etiologyABSTRACT
In Brazil, hepatitis delta virus (HDV) is only reported in Western Amazonia, where severe cases of acute and chronic HDV hepatitis have been described. The study area was chosen in the States of Acre and Rondonia where most cases of hepatitis B virus (HBV)/HDV are reported. From December 2003 to October 2004, 40 HBsAg carriers with anti-HDV IgM were selected. An epidemiologic questionnaire, including demographic and clinical/epidemiologic variables was filled out. HDV amplification and genotyping were performed. Genotype I was detected in 22 patients (55.0%), whereas genotype III was identified in 18 (45.0%). Patients who were infected with genotype I were older (45.1 +/- 17.8 years) than patients infected with genotype III (32.8 +/- 10.9 years; P = 0.01). No symptoms were reported by 21 (52.5%) patients. Otherwise, 19 (47.5%) had symptoms (fatigue, abdominal pain, weight loss, and decompensated liver disease) that motivated them to seek medical care. Genotype III carriers were more symptomatic, but no statistical significance was achieved. Our preliminary results show that HDV genotypes I and III are present in Brazilian Amazonia and that HDV genotype III is not limited to the Amerindian population.
Subject(s)
Hepatitis B/virology , Hepatitis Delta Virus/genetics , Adolescent , Adult , Brazil , Carrier State , Child , Female , Genotype , Humans , Male , Nucleic Acid HybridizationABSTRACT
Se realizo un estudio en el Grupo Basico de Trabajo No. 3 del Policlinico Comunitario Docente "Jorge Ruiz Ramirez", del municipio Playa, a todas las embarazadas atendidas alli en el periodo comprendido entre el 1ro de enero de 1992 al 31 de enero de 1993 (ambos inclusive) y que su parto ocurrio en los hospitales ginecoobstetricos de nuestra area de atencion, "Eusebio Hernandez" y "Clodomira Acosta"; se analizo la atencion brindada a ellas hasta la terminacion del embarazo. Se entreno a todos los medicos para la realizacion de la prueba de Gant y se investigaron conjuntamente los siguientes parametros: edad, peso de la gestante previo al embarazo, ganancia total de peso, paridad y los resultados obtenidos al realizar la prueba. Se concluye que la hipertension inducida por el embarazo es frecuente en las edades extremas, que el sobrepeso antes del embarazo y la ganancia global mayor de 12 kg fueron factores predisponentes de importancia en la aparicion de la enfermedad, y que la prueba de Gant es de gran efectividad en la prediccion de esta afeccion
Subject(s)
Humans , Female , Pregnancy , Hypertension , Infant Mortality , Maternal Mortality , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/prevention & control , Primary Health CareABSTRACT
Se realizó un estudio en el Grupo Básico de Trabajo No. 3 del Policlínico Comunitario Docente "Jorge Ruiz Ramírez", del municipio Playa, a todas las embarazadas atendidas allí en el período comprendido entre el 1ro de enero de 1992 al 31 de enero de 1993 (ambos inclusive) y que su parto ocurrió en los hospitales ginecoobstétricos de nuestra área de atención, "Eusebio Hernández" y "Clodomira Acosta"; se analizó la atención brindada a ellas hasta la terminación del embarazo. Se entrenó a todos los médicos para la realización de la prueba de Gant y se investigaron conjuntamente los siguientes parámetros: edad, peso de la gestante previo al embarazo, ganancia total de peso, paridad y los resultados obtenidos al realizar la prueba. Se concluye que la hipertensión inducida por el embarazo es frecuente en las edades extremas, que el sobrepeso antes del embarazo y la ganancia global mayor de 12 kg fueron factores predisponentes de importancia en la aparición de la enfermedad, y que la prueba de Gant es de gran efectividad en la predicción de esta afección (AU)
