Association between human parvovirus B19 and arthropathy in Belém, Pará, North Brazil.

A total of 220 patients with arthropathy were selected in Belém, Pará between January 1994 and December 2000, and screened for the presence of human parvovirus B19 IgM and IgG antibodies by enzyme-linked immunosorbent assay (ELISA). A subgroup (n = 132) of patients with high levels of antibodies (either IgM+/IgG+ or IgM-/IgG+) were examined for the presence of DNA by polymerase chain reaction/nested PCR. Recent/active infection (detection of IgM and/or IgG-specific antibodies and presence of viral DNA) was identified in 47.7% of the 132 individuals with arthropathy. In our study, women were significantly more affected (59.7%) than men (35.4%) (P = 0.0006). The age group of 11-20 years (84.6%), among female patients, and 21-30 years (42.1%), among male, were those with the highest incidence rates. The analysis of the temporal distribution of B19-associated arthropaties showed a cyclic pattern, with peak incidence rates occuring at 3-5 year intervals. Significant diference (P = 0.01) was observed when comparing both the highest (39.0%) and the lowest (11.0%) seropositivity rates for the years of 1995 and 2000, respectively. The interfalangial joints of hands and feet were mostly affected, with 50.0% and 48.0% of cases among both women and men, respectively. In a smaller proportion, other joints such as those of knee, ankle, pulse and shoulder were affected. As for the duration, symptoms lasted 1 to 5 days in 54.0% of the individuals, whereas in 46.0% of them the disease lasted 6-10 days, if considered the subgroup (n = 63) of patients with recent/active infection by parvovirus B19. In our study, joint clinical manifestations occurred symmetrically. Our results indicate that B19 may be an important agent of arthropathies in our region, and this underscores the need for specific laboratory diagnosis when treating patients suffering from acute arthropathy, mainly pregnant women.

Association between human parvovirus B19 and arthropathy in Belém, Pará, North Brazil

A total of 220 patients with arthropathy were selected in Belém, Pará between January 1994 and December 2000, and screened for the presence of human parvovirus B19 IgM and IgG antibodies by enzyme-linked immunosorbent assay (ELISA). A subgroup (n = 132) of patients with high levels of antibodies (either IgM+/IgG+ or IgM-/IgG+) were examined for the presence of DNA by polymerase chain reaction/nested PCR. Recent/active infection (detection of IgM and/or IgG-specific antibodies and presence of viral DNA) was identified in 47.7 percent of the 132 individuals with arthropathy. In our study, women were significantly more affected (59.7 percent) than men (35.4 percent) (P = 0.0006). The age group of 11-20 years (84.6 percent), among female patients, and 21-30 years (42.1 percent), among male, were those with the highest incidence rates. The analysis of the temporal distribution of B19-associated arthropaties showed a cyclic pattern, with peak incidence rates occuring at 3-5 year intervals. Significant diference (P = 0.01) was observed when comparing both the highest (39.0 percent) and the lowest (11.0 percent) seropositivity rates for the years of 1995 and 2000, respectively. The interfalangial joints of hands and feet were mostly affected, with 50.0 percent and 48.0 percent of cases among both women and men, respectively. In a smaller proportion, other joints such as those of knee, ankle, pulse and shoulder were affected. As for the duration, symptoms lasted 1 to 5 days in 54.0 percent of the individuals, whereas in 46.0 percent of them the disease lasted 6-10 days, if considered the subgroup (n = 63) of patients with recent/active infection by parvovirus B19. In our study, joint clinical manifestations occurred symmetrically. Our results indicate that B19 may be an important agent of arthropathies in our region, and this underscores the need for specific laboratory diagnosis when treating patients suffering from acute arthropathy, mainly pregnant women

Malária por Plasmodium vivax em crianças e adolescentes - aspectos epidemiológicos, clínicos e laboratoriais / Plasmodium vivax malaria in children and adolescents - epidemiological, clinical and laboratory features

Objetivo: Avaliaçäo dos aspectos epidemiológicos, clínicos e laboratoriais da malária por Plasmodium vivax em crianças e adolescentes. Métodos: No ambulatório do Programa de Malária do Instituto Evandro Chagas (Belém-Pará), no período de janeiro de 1995 a novembro de 1996, foram estudadas de modo aleatório 100 crianças e adolescentes com diagnóstico positivo por gota espessa para malária por P. vivax. Elaborou-se um protocolo para avaliaçäo dos aspectos epidemiológicos, clínicos e laboratoriais dessa patologia. Resultados: Acometimento de ambos os sexos, com predomínio entre os adolescentes (37 por cento). As crianças e adolescentes em sua maioria (92 por cento) adquiriram a infecçäo no Pará. Os casos autóctones, área metropolitana de Belém, representaram 34 por ceneto da amostra. Primoinfecçäo ocorreu em 80 por cento dos pacientes. Febre foi a manifestaçäo clínica inicial mais freqüênte (88 por cento). Relato de paroxismo febril típico (febre terçä) foi obtido em somente 25 por cento da casuística. No 1§ dia de tratamento (DO) febre (97 por cento), calafrio (91 por cento), palidez (85 por cento), esplenomegalia (46 por cento) e hepatomegalia (29 por cento) foram alguns dos sinais e sintomas observados. Houve significância estatística (p=0,0004) na correlaçäo entre palidez (avaliaçäo clínica) e anemia (taxa de hemoglobina). Verificou-se uma correlaçäo negativa altamente significativa (p=0,0001) entre o retardo diagnóstico (média de 12,5 dias) e os níveis de hemoglobina. Em relaçäo ao exame parasitológico de fezes, somente crianças e adolescentes com resultado positivo para ancilostomídeos foram significativamente mais anêmicas (p=0,0133,p=0,0075) quando comparadas com aquelas com exame coprológico positivo para outros helmintos e/ou protozoários. Conclusöes: A malária acometeu crianças e adolescentes de ambos os sexos. A valorizaçäo de dados epidemiológicos e clínicos contribui para o diagnóstico precoce da doença. O retardo diagnóstico influenciou no agravamento da anemia

Eficácia de quatro esquemas terapêuticos para malaria vivax em crianças / Clinical efficacy of four schemes for vivax malaria treatment in children

Objetivo: A cura da malaria vivax permanece dificultada por um fator determinante de recaídas: a duraçäo do tratamento. Em Belém, a observaçäo de que um grande número de pacientes com malária vivax curava-se, a despeito do abandono do tratamento, levou à concretizaçäo deste estudo objetivando avaliar a eficácia de esquemas mais operacionais para malária em crianças. Métodos: Foi realizado ensaio clínico prospectivo e randomizado, em 200 crianças com malária vivax, atendidas ambulatorialmente. Variáveis observadas: velocidade de negativaçäo da parasitemia e respostas a quatro esquemas: a) cloroquina 10mg/kg - dose única (cloroquina DU) + primaquina 0,50/kg/dia por 7 dias; b) cloroquina DU + primaquina 0,25/kg/dia por 7 dias; c) cloroquina DU + primaquina 0,50/kg/dia por 5 dias; e d) cloroquina DU + primaquina 0,25/kg/dia por 5 dias. Para comparaçäo das resposwtas obtidas foi utilizado o teste exato de Fisher. Resultados: Todas as 144 crianças que completaram o estudo apresentaram negativaçäo da parasitemia até o quarto dia de tratamento. A comparaçäo das respostas aos esquemas, mostrou resultados significativos entre os esquemas A e D (p=0,022), e entre os esquemas C e D (p=0,005). Quanto à dose diária e ao tempo de duraçäo, a comparaçäo mostrou resultados significativos nos esquemas de doses duplicadas em relaçäo aos de dose padräo(p=0,0042)...