Scielo RSS <![CDATA[Revista do Instituto de Medicina Tropical de São Paulo]]> http://www.scielo.br/rss.php?pid=0036-466520180050&lang=es vol. 60 num. lang. es <![CDATA[SciELO Logo]]> http://www.scielo.br/img/en/fbpelogp.gif http://www.scielo.br <![CDATA[Prevalence of Streptococcus agalactiae colonization in pregnant women from the 18<sup>th</sup> Health Region of Paraná State]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000200&lng=es&nrm=iso&tlng=es ABSTRACT Introduction The aim of this study was to determine the prevalence of GBS colonization in pregnant women in a public health service. Methods A study of 496 pregnant women at 35-37 gestational weeks was conducted from September 2011 to March 2014 in 21 municipalities of the 18th Health Region of Paraná State. Vaginal and anorectal samples of each woman were plated on sheep blood agar, and in HPTH and Todd-Hewitt enrichment broths. Results Of the 496 pregnant women, 141 (28.4%) were positive for GBS based on the combination of the three culture media with vaginal and anorectal samples. The prevalence was 23.7% for vaginal samples and 21.9% for anorectal ones. Among the variables analyzed in this study, only urinary infection was a significant factor (0.026) associated with GBS colonization in women. Conclusions Based on these results, health units should performs universal screening of pregnant women and hospitals should provide adequate prophylaxis, when indicated. <![CDATA[Evaluation of molluscicidal activity of three mangrove species (Avicennia schaueriana, Laguncularia racemosa and Rhizophora mangle) and their effects on the bioactivity of Biomphalaria glabrata Say, 1818]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000201&lng=es&nrm=iso&tlng=es ABSTRACT Schistosomiasis is a disease of global extent reaching populations in social vulnerability. One of the control measures of this parasitosis is the use of molluscicidal substances that can fight snails of the genus Biomphalaria, intermediate hosts of Schistosoma mansoni. The aim of this work was to study the toxic activity of three mangrove species (Avicennia schaueriana Stapf. &amp; Leech, ex Moldenke, 1939, Laguncularia racemosa (L.) CF Gaertn, 1807 and Rhizophora mangle L. 1753) on the biological activities of snails Biomphalaria glabrata. Hydroalcoholic extracts were prepared from the stem and leaves of each of the three plant species to which mollusks were exposed. The phytochemical analysis of plants showed the presence of important metabolites in the leaves and stems of L. racemosa and R. mangle, such as tannins and saponins, but the absence of these metabolites in A. schaueriana. Leaf and stem extracts of the three plant species showed low molluscicidal activity, not reaching the standards determined by the World Health Organization (WHO, 1983). L. racemosa and R. mangle has interfered with motility, feeding and oviposition of snails, unlike the extracts of A. schaueriana, which had no effect on these activities. <![CDATA[Histopathological characteristics of cutaneous lesions caused by Leishmania Viannia panamensis in Panama]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000202&lng=es&nrm=iso&tlng=es ABSTRACT Cutaneous leishmaniasis (CL) is an endemic disease in the Republic of Panama, caused by Leishmania (Viannia) parasites, whose most common clinical manifestation is the presence of ulcerated lesions on the skin. These lesions usually present a chronic inflammatory reaction, sometimes granulomatous, with the presence of lymphocytes, plasma cells and macrophages. This study describes the histopathological characteristics found in the skin lesions of patients with CL caused by Leishmania (V.) panamensis in Panama. We analyzed 49 skin biopsy samples from patients with clinical suspicion of CL, by molecular tests (PCR for subgenus Viannia and HSP-70) and by Hematoxylin-Eosin staining. Samples were characterized at the species level by PCR-HSP-70/RFLP. From the 49 samples studied, 46 (94%) were positive by PCR and were characterized as Leishmania (V.) panamensis. Of these, 48% were positive by Hematoxylin-Eosin staining with alterations being observed both, in the epidermis (85%) and in the dermis (100%) of skin biopsies. The inflammatory infiltrate was characterized according to histopathological patterns: lymphohistiocytic (50%), lymphoplasmacytic (61%) and granulomatous (46%) infiltration, being the combination of these patterns frequently found. The predominant histopathological characteristics observed in CL lesions caused by L. (V.) panamensis in Panama were: an intense inflammatory reaction in the dermis with a combination of lymphohistiocytic, lymphoplasmacytic and granulomatous presentation patterns and the presence of ulcers, acanthosis, exocytosis and spongiosis in the epidermis. <![CDATA[Risk perception and level of knowledge of diseases transmitted by <em>Aedes aegypti</em>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000203&lng=es&nrm=iso&tlng=es ABSTRACT Diseases caused by viruses such as dengue, chikungunya and zika are mosquito-borne diseases transmitted by Aedes aegypti. We performed a cross-sectional study of healthcare personnel and the general population using questionnaires to identify the level of knowledge, attitudes and practices, and risk perception for dengue, chikungunya and zika. A total of 248 questionnaires were applied, 63.3% to healthcare personnel and 36.7% to the general population. Of the healthcare personnel, 53% were men, and in the general population 74% were women. Nahuatl and Spanish were spoken by both, healthcare personnel (28%) and the general population (23%). The level of knowledge, attitudes and practices and risk perception of the population and personnel showed significant differences (p&lt;0.05). Among healthcare personnel, nurses and vector operating staff had the lowest level of knowledge. On the other hand, the questions with the lowest scores were 1) symptoms of Zika in both groups, 2) circulating dengue serotypes in healthcare personnel and 3) symptoms of chikungunya in the general population. The results of this work allow us to identify information gaps in which knowledge, attitudes and practices, and risk perception need to be increased. <![CDATA[Prevalence of asymptomatic urethritis by <em>Chlamydia trachomatis</em> and <em>Neisseria gonorrhoeae</em> and associated risk factors among males living with HIV-1]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000204&lng=es&nrm=iso&tlng=es ABSTRACT Objectives The increase in HIV transmissibility in non-ulcerative sexually transmitted infection is already well-established. It is estimated that symptomatic carriers of N. gonorrhoeae and C. trachomatis have a relative risk of 4.8-fold and 3.6-fold, respectively, for the sexual acquisition of HIV. This type of evaluation for asymptomatic urethritis is necessary to reinforce strategies to combat HIV transmission. This study aims to assess the prevalence of patients with asymptomatic urethritis among men diagnosed with HIV-1 and determine the risk factors associated with this infection. Methods We enrolled a total of 115 male patients aged 18 years or older who have been diagnosed with HIV infection and have no symptoms of urethritis or other sexually transmitted infections and who have been evaluated between May and August 2015 in a follow-up visit at the Immunology Outpatient Clinic of a Brazilian University Hospital. Results Four asymptomatic patients were positive for C. trachomatis and were considered asymptomatic carriers of urethritis. Prevalence was 3.47%. Patients who were positive for C. trachomatis urethritis had a lower mean age (p = 0.015). Conclusion The presence of asymptomatic sexually transmitted infection is a challenge in clinical practice. We recommend that, in outpatient practice, the habit of inquiring on previous sexual behavior to obtain more information about risks and associations with asymptomatic sexually transmitted infection, a routine physical examination and complementary tests to detect STI pathogens should be performed to discard these conditions. The development of rapid tests for this purpose should also be encouraged. <![CDATA[Visceral leishmaniasis in a Brazilian endemic area: an overview of occurrence, HIV coinfection and lethality]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000205&lng=es&nrm=iso&tlng=es ABSTRACT The Brazilian municipality of Rondonópolis, Mato Grosso State, represents an important visceral leishmaniasis (VL) endemic area. This study described epidemiological and clinical aspects of the occurrence, VL/HIV coinfection and lethality related to VL in Rondonópolis. Data from autochthonous cases reported between 2011 and 2016 were obtained from official information systems. During this period, 81 autochthonous cases were reported, with decreasing incidence through 2016. Contrastingly, the lethality rate was 8.6% overall, but varied widely, reaching a peak (20%) in 2016. Almost 10% of patients had VL/HIVcoinfection. The occurrence of VL prevailed among men (56.8%), brown-skinned (49.4%), urban residents (92.6%), aged 0-4 years (33.3%). Housewives or retired (29.6%) were the most affected occupational groups. Lower age was the main difference among the total VL cases and those who were coinfected or died. Clinically, fever, weakness and splenomegaly were more frequent among all VL cases and VL/HIV coinfected individuals. Bacterial infections (p=0.001) and bleeding (p&lt;0.001) were associated with death due to VL. Pentavalent antimonial and liposomal amphotericin B were the first choices for treatment among all VL cases (71.6%) and those who died (71.4%), respectively. VL/HIV patients were equally treated with both drugs. These findings may support control measures and demonstrate the need for further investigations. <![CDATA[Opportunistic and non-opportunistic intestinal parasites in HIV/ AIDS patients in relation to their clinical and epidemiological status in a specialized medical service in <em>Goiás</em>, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000206&lng=es&nrm=iso&tlng=es ABSTRACT Patients infected with the Human Immunodeficiency Virus (HIV) often have opportunistic infections, among which strongyloidiasis and coccidiosis are the most common parasitic infections that aggravate their health status. This study examined the prevalence of intestinal parasites, particularly of Strongyloides stercoralis and intestinal coccidia in patients with the Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) who were treated at the Specialized Assistance Service (SAE) of Jataí, State of Goiás, Brazil, and analyzed its correlation with clinical, laboratory, and socio-epidemiological parameters. A total of 270 stool samples were analyzed by the Lutz technique, Rugai’s method, Agar Plate Culture, Ritchie’s method and specific staining, Ziehl-Neelsen modified technique, Kinyoun’s method and the rapid safranin method. The prevalence of intestinal parasites was 28.88% including 3.8% of S. stercoralis, Cryptosporidium sp. and Cystoisospora belli. There was a significant positive correlation between intestinal parasites and the clinical status and the use of antiretroviral therapy (ART), smoking, CD4+ lymphocyte counts and sexual orientation. In conclusion, the widespread use of antiretroviral therapy and health assistance contributed to the low prevalence of S. stercoralis and coccidiosis in patients with HIV/ AIDS who were followed up at the SAE. <![CDATA[American tegumentary leishmaniasis: diagnostic and treatment challenges in a clinical case]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000500&lng=es&nrm=iso&tlng=es ABSTRACT This clinical case presents a patient with a raised and ulcerative lesion with erythematous edges in the mouth, on the lower lip that was unsuccessfully treated as herpes labialis. Clinical data and laboratory tests (Montenegro skin test, indirect immunofluorescence, direct parasite search and polymerase chain reaction) led to the diagnosis of American tegumentary leishmaniasis caused by Leishmania (Viannia) sp. Treatment with pentavalent antimonial (Glucantime®) for 120 days was not effective and administration of amphotericin B for 30 days resulted in wound healing. Glucantime® treatment protocol was longer than the recommended by the Brazilian Ministry of Health in the handbook of mucosal leishmaniasis. This suggests that amphotericin B should have been administered earlier, preventing the psychological and social problems faced by the patient. This study reports a rare clinical case of primary mucosal leishmaniasis on the lip that had a delayed diagnosis, highlighting the precariousness in the management of disease and showing that, despite the importance of leishmaniasis in Brazil, it is still neglected by health professionals. <![CDATA[First case report of atypical disseminated cutaneous leishmaniasis in an opium abuser in Iran]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000501&lng=es&nrm=iso&tlng=es ABSTRACT Leishmaniasis is a worldwide tropical infectious disease caused by different species of intracellular protozoa parasites of the genus Leishmania . Herein, we report a 78-year-old man with unusual diffuse cutaneous leishmaniasis (DCL) who had a history of opium abuse and chronic obstructive pulmonary disease (COPD). He had multiple papular, crusted and severely ulcerated lesions extended to his arm and chest. Direct smears and skin punch biopsy of the lesions were suggestive of leishmaniasis. Parasite DNA was amplified from ulcers, and identified as Leishmania major by PCR-RFLP, confirmed by sequencing analyses. The aim of the current study was to bring to attention this atypical form of disease in CL endemic countries. Thus, this is the first case of DCL in an opium abuser with COPD due to L. major in Northeastern Iran indicating that atypical and extensive forms of CL (DCL) owing to L. major are increasing in Iran. <![CDATA[Isolation of infectious Zika virus from a urine sample cultured in SIRC cells from a patient suspected of having rubella virus]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000502&lng=es&nrm=iso&tlng=es ABSTRACT A great variety of viruses which cause exanthema share other clinical manifestations, making the etiologic identification a very difficult task, relying exclusively on the clinical examination. Rubella virus (RV) infection during the early stages of pregnancy can lead to serious birth defects, known as congenital rubella syndrome (CRS). In the present report, we described the presence of Zika virus (ZIKV) particles in urine samples and also ZIKV isolation in SIRC cells from the urine of a patient in acute phase of suspected rubella disease. The 50-year-old unvaccinated woman living in Sao Paulo, Brazil, was admitted to the emergency room with fever, headache, rash, arthralgia and prostration. Urine samples were collected for virus isolation and RT-qPCR. SIRC and Vero cells were inoculated with urine samples during 7 days. RT-qPCR was performed using measles virus (MV) and RV primers and both were found to be negative. After this result, RT-qPCR was performed for parvovirus B19, herpes virus 6 and ZIKV. The urine sample and the isolate were positive by Real Time PCR for ZIKV and negative for all other viruses tested. The sequences isolated are from the Asiatic lineage. <![CDATA[Performance of cryptococcal antigen lateral flow assay in serum, cerebrospinal fluid, whole blood, and urine in HIV-infected patients with culture-proven cryptococcal meningitis admitted at a Brazilian referral center]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000600&lng=es&nrm=iso&tlng=es ABSTRACT Cryptococcal meningitis is the most common cause of opportunistic meningitis in HIV-infected patients in Brazil and causes unacceptable high mortality rates. In this study, HIV-infected patients with a first episode of culture-proven cryptococcal meningitis in cerebrospinal fluid (CSF) were prospectively included in order to evaluate sensitivity of cryptococcal antigen (CrAg) lateral flow assay (LFA) in serum, CSF, whole blood (fingerstick), and fresh urine. In addition, HIV-infected patients with other neurological confirmed diseases were included in order to evaluate the specificity of CrAg LFA in serum. Twenty patients with cryptococcal meningitis were included and in 19 of them, CrAg LFA in CSF, serum, and whole blood were positive (95% sensitivity). In 18 patients, India ink test was positive in CSF (90% sensitivity), and in 16 cases, CrAg LFA was positive in urine (80% sensitivity). Thirty-six HIV-infected patients with other neurological diseases had negative results of CrAg LFA in serum (100% specificity). In conclusion, CrAg LFA in serum, CSF, and whole blood showed high sensitivity and specificity. Whole blood CrAg LFA seems to be a good and reliable strategy to improve AIDS-related cryptococcal meningitis diagnosis in Brazil. <![CDATA[Achatina fulica infected by Angiostrongylus cantonensis on beaches, in the west zone of Rio de Janeiro, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000601&lng=es&nrm=iso&tlng=es ABSTRACT Angiostrongylus cantonensis is considered the main etiological agent of eosinophilic meningitis in humans. At present, this zoonosis is considered an emerging disease mainly in the Americas. The aim of this study was to determine the prevalence of Achatina fulica infected by Angiostrongylus cantonensis in restinga areas along beaches in the west zone of Rio de Janeiro city, Brazil. The study areas included the following beaches: Barra da Tijuca, Recreio dos Bandeirantes, Reserva, Prainha and Grumari. Ninety specimens of Achatina fulica were collected. Positive molluscs were found only in Barra da Tijuca. Infection prevalence was 5.5%. The presence of this parasite in the beachfront areas, in the west zone of Rio de Janeiro city demonstrates the potential risk of infection for visitors and the expansion of this helminth in the State of Rio de Janeiro. <![CDATA[Nontuberculous mycobacteria in milk from positive cows in the intradermal comparative cervical tuberculin test: implications for human tuberculosis infections]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000602&lng=es&nrm=iso&tlng=es ABSTRACT Although the tuberculin test represents the main in vivo diagnostic method used in the control and eradication of bovine tuberculosis, few studies have focused on the identification of mycobacteria in the milk from cows positive to the tuberculin test. The aim of this study was to identify Mycobacterium species in milk samples from cows positive to the comparative intradermal test. Milk samples from 142 cows positive to the comparative intradermal test carried out in 4,766 animals were aseptically collected, cultivated on Lowenstein-Jensen and Stonebrink media and incubated for up to 90 days. Colonies compatible with mycobacteria were stained by Ziehl-Neelsen to detect acid-fast bacilli, while to confirm the Mycobacterium genus, conventional PCR was performed. Fourteen mycobacterial strains were isolated from 12 cows (8.4%). The hsp65 gene sequencing identified M. engbaekii (n=5), M. arupense (n=4), M. nonchromogenicum (n=3), and M. heraklionense (n=2) species belong to the Mycobacterium terrae complex. Despite the absence of M. tuberculosis complex species in the milk samples, identification of these mycobacteria highlights the risk of pathogen transmission from bovines to humans throughout milk or dairy products, since many of mycobacterial species described here have been reported in pulmonary and extrapulmonary diseases both in immunocompetent and immunocompromised people. <![CDATA[Preliminary report of body lice infesting homeless people in Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000700&lng=es&nrm=iso&tlng=es ABSTRACT Although the tuberculin test represents the main in vivo diagnostic method used in the control and eradication of bovine tuberculosis, few studies have focused on the identification of mycobacteria in the milk from cows positive to the tuberculin test. The aim of this study was to identify Mycobacterium species in milk samples from cows positive to the comparative intradermal test. Milk samples from 142 cows positive to the comparative intradermal test carried out in 4,766 animals were aseptically collected, cultivated on Lowenstein-Jensen and Stonebrink media and incubated for up to 90 days. Colonies compatible with mycobacteria were stained by Ziehl-Neelsen to detect acid-fast bacilli, while to confirm the Mycobacterium genus, conventional PCR was performed. Fourteen mycobacterial strains were isolated from 12 cows (8.4%). The hsp65 gene sequencing identified M. engbaekii (n=5), M. arupense (n=4), M. nonchromogenicum (n=3), and M. heraklionense (n=2) species belong to the Mycobacterium terrae complex. Despite the absence of M. tuberculosis complex species in the milk samples, identification of these mycobacteria highlights the risk of pathogen transmission from bovines to humans throughout milk or dairy products, since many of mycobacterial species described here have been reported in pulmonary and extrapulmonary diseases both in immunocompetent and immunocompromised people. <![CDATA[Presence of <em>Bartonella</em> spp. in domestic cats from a state park in Rio de Janeiro, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652018005000701&lng=es&nrm=iso&tlng=es ABSTRACT Although the tuberculin test represents the main in vivo diagnostic method used in the control and eradication of bovine tuberculosis, few studies have focused on the identification of mycobacteria in the milk from cows positive to the tuberculin test. The aim of this study was to identify Mycobacterium species in milk samples from cows positive to the comparative intradermal test. Milk samples from 142 cows positive to the comparative intradermal test carried out in 4,766 animals were aseptically collected, cultivated on Lowenstein-Jensen and Stonebrink media and incubated for up to 90 days. Colonies compatible with mycobacteria were stained by Ziehl-Neelsen to detect acid-fast bacilli, while to confirm the Mycobacterium genus, conventional PCR was performed. Fourteen mycobacterial strains were isolated from 12 cows (8.4%). The hsp65 gene sequencing identified M. engbaekii (n=5), M. arupense (n=4), M. nonchromogenicum (n=3), and M. heraklionense (n=2) species belong to the Mycobacterium terrae complex. Despite the absence of M. tuberculosis complex species in the milk samples, identification of these mycobacteria highlights the risk of pathogen transmission from bovines to humans throughout milk or dairy products, since many of mycobacterial species described here have been reported in pulmonary and extrapulmonary diseases both in immunocompetent and immunocompromised people.