Operational effectiveness of tafenoquine and primaquine for the prevention of Plasmodium vivax recurrence in Brazil: a retrospective observational study

BACKGROUND

Prevention of Plasmodium vivax malaria recurrence is essential for malaria elimination in Brazil. We evaluated the real-world effectiveness of an updated treatment algorithm for P vivax radical cure in the Brazilian Amazon.

METHODS

In this non-interventional observational study, we used retrospective data from the implementation of a P vivax treatment algorithm at 43 health facilities in Manaus and Porto Velho, Brazil. The treatment algorithm consisted of chloroquine (25 mg/kg over 3 days) and point-of-care quantitative glucose-6-phosphate dehydrogenase (G6PD) testing followed by single-dose tafenoquine 300 mg (G6PD normal, aged ≥16 years, not pregnant and not breastfeeding), 7-day primaquine 0·5 mg/kg per day (G6PD intermediate or normal, aged ≥6 months, not pregnant, and not breastfeeding or breastfeeding for >1 month), or primaquine 0·75 mg/kg per week for 8 weeks (G6PD deficient, aged ≥6 months, not pregnant, and not breastfeeding or breastfeeding for >1 month). P vivax recurrences were identified from probabilistic linkage of routine patient records from the Brazilian malaria epidemiological surveillance system. Recurrence-free effectiveness at day 90 and day 180 was estimated using Kaplan-Meier analysis and hazard ratios (HRs) by multivariate analysis. This clinical trial is registered with ClinicalTrials.gov, NCT05096702, and is completed.

FINDINGS

Records from Sept 9, 2021, to Aug 31, 2022, included 5554 patients with P vivax malaria. In all treated patients of any age and any G6PD status, recurrence-free effectiveness at day 180 was 75·8% (95% CI 74·0-77·6) with tafenoquine, 73·4% (71·9-75·0) with 7-day primaquine, and 82·1% (77·7-86·8) with weekly primaquine. In patients aged at least 16 years who were G6PD normal, recurrence-free effectiveness until day 90 was 88·6% (95% CI 87·2-89·9) in those who were treated with tafenoquine (n=2134) and 83·5% (79·8-87·4) in those treated with 7-day primaquine (n=370); after adjustment for confounding factors, the HR for recurrence following tafenoquine versus 7-day primaquine was 0·65 (95% CI 0·49-0·86; p=0·0031), with similar outcomes between the two treatments at day 180 (log-rank p=0·82). Over 180 days, median time to recurrence in patients aged at least 16 years who were G6PD normal was 92 days (IQR 76-120) in those treated with tafenoquine and 68 days (52-94) in those treated with 7-day primaquine.

INTERPRETATION

In this real-world setting, single-dose tafenoquine was more effective at preventing P vivax recurrence in patients aged at least 16 years who were G6PD normal compared with 7-day primaquine at day 90, while overall efficacy at 180 days was similar. The public health benefits of the P vivax radical cure treatment algorithm incorporating G6PD quantitative testing and tafenoquine support its implementation in Brazil and potentially across South America.

FUNDING

Brazilian Ministry of Health, Municipal and State Health Secretariats; Fiocruz; Medicines for Malaria Venture; Bill & Melinda Gates Foundation; Newcrest Mining; and the UK Government.

TRANSLATION

For the Portuguese translation of the abstract see Supplementary Materials section.

Operational feasibility of Plasmodium vivax radical cure with tafenoquine or primaquine following point-of-care, quantitative glucose-6-phosphate dehydrogenase testing in the Brazilian Amazon: a real-life retrospective analysis

BACKGROUND

To achieve malaria elimination, Brazil must implement Plasmodium vivax radical cure. We aimed to investigate the operational feasibility of point-of-care, quantitative, glucose-6-phosphate dehydrogenase (G6PD) testing followed by chloroquine plus tafenoquine or primaquine.

METHODS

This non-interventional, observational study was done at 43 health facilities in Manaus (Amazonas State) and Porto Velho (Rondônia State), Brazil, implementing a new P vivax treatment algorithm incorporating point-of-care quantitative G6PD testing to identify G6PD status and single-dose tafenoquine (G6PD normal, aged ≥16 years, and not pregnant or breastfeeding) or primaquine (intermediate or normal G6PD, aged ≥6 months, not pregnant, or breastfeeding >1 month). Following training of health-care providers, we collated routine patient records from the malaria epidemiological surveillance system (SIVEP-Malaria) retrospectively for all consenting patients aged at least 6 months with parasitologically confirmed P vivax malaria mono-infection or P vivax plus P falciparum mixed infection, presenting between Sept 9, 2021, and Aug 31, 2022. The primary endpoint was the proportion of patients aged at least 16 years with P vivax mono-infection treated or not treated appropriately with tafenoquine in accordance with their G6PD status. The trial is registered with ClinicalTrials.gov, NCT05096702, and is completed.

FINDINGS

Of 6075 patients enrolled, 6026 (99·2%) had P vivax mono-infection, 2685 (44·6%) of whom were administered tafenoquine. G6PD status was identified in 2685 (100%) of 2685 patients treated with tafenoquine. The proportion of patients aged at least 16 years with P vivax mono-infection who were treated or not treated appropriately with tafenoquine in accordance with their G6PD status was 99·7% (95% CI 99·4-99·8; 4664/4680).

INTERPRETATION

Quantitative G6PD testing before tafenoquine administration was operationally feasible, with high adherence to the treatment algorithm, supporting deployment throughout the Brazilian health system.

FUNDING

Brazilian Ministry of Health, Municipal and State Health Secretariats; Fiocruz; Medicines for Malaria Venture; Bill & Melinda Gates Foundation; Newcrest Mining; and the UK Government.

TRANSLATION

For the Portuguese translation of the abstract see Supplementary Materials section.

Development and validation of a minimum requirements checklist for snakebite envenoming treatment in the Brazilian Amazonia

BACKGROUND

Currently, antivenoms are the only specific treatment available for snakebite envenoming. In Brazil, over 30% of patients cannot access antivenom within its critical care window. Researchers have therefore proposed decentralizing to community health centers to decrease time-to-care and improve morbidity and mortality. Currently, there is no evidence-based method to evaluate the capacity of health units for antivenom treatment, nor what the absolute minimum supplies and staff are necessary for safe and effective antivenom administration and clinical management.

METHODS

This study utilized a modified-Delphi approach to develop and validate a checklist to evaluate the minimum requirements for health units to adequately treat snakebite envenoming in the Amazon region of Brazil. The modified-Delphi approach consisted of four rounds: 1) iterative development of preliminary checklist by expert steering committee; 2) controlled feedback on preliminary checklist via expert judge survey; 3) two-phase nominal group technique with new expert judges to resolve pending items; and 4) checklist finalization and closing criteria by expert steering committee. The measure of agreement selected for this study was percent agreement defined a priori as ≥75%.

RESULTS

A valid, reliable, and feasible checklist was developed. The development process highlighted three key findings: (1) the definition of community health centers and its list of essential items by expert judges is consistent with the Brazilian Ministry of Health, WHO snakebite strategic plan, and a general snakebite capacity guideline in India (internal validity), (2) the list of essential items for antivenom administration and clinical management is feasible and aligns with the literature regarding clinical care (reliability), and (3) engagement of local experts is critical to developing and implementing an antivenom decentralization strategy (feasibility).

CONCLUSION

This study joins an international set of evidence advocating for decentralization, adding value in its definition of essential care items; identification of training needs across the care continuum; and demonstration of the validity, reliability, and feasibility provided by engaging local experts. Specific to Brazil, further added value comes in the potential use of the checklist for health unit accreditation as well as its applications to logistics and resource distribution. Future research priorities should apply this checklist to health units in the Amazon region of Brazil to determine which community health centers are or could be capable of receiving antivenom and translate this expert-driven checklist and approach to snakebite care in other settings or other diseases in low-resource settings.

Case Report: Late-Onset Pneumonitis after Apoica pallida (Insecta: Hymenoptera) Sting with Anaphylactic Reaction in the Brazilian Amazon

Hymenopteran venoms, inoculated during stings by ants, bees, and wasps, are the most frequent cause of an IgE-mediated systemic hypersensitivity reaction in adults, which is a key process in drastic manifestations of anaphylaxis. Respiratory involvement is usually caused by pulmonary edema but is rarely described as including interstitial pneumonitis or acute respiratory distress syndrome. Here, we describe a case of severe allergic reaction after a sting by Apoica pallens with late-onset pulmonary involvement, including signs of vasoplegia (pleural effusion) and interstitial pneumonitis with mild rhabdomyolysis. The presence of late onset of pulmonary involvement after a severe allergic reaction after a sting by A. pallens shows the importance of keeping a patient with severe reactions under medical care for a minimum of 5 days to avoid serious late complications outside the hospital environment.

Kidney function and daily emtricitabine/tenofovir disoproxil fumarate pre-exposure prophylaxis against HIV: results from the real-life multicentric demonstrative project PrEP Brazil

Background

Pre-Exposure Prophylaxis (PrEP) has demonstrated efficacy in the reduction of sexually transmitted HIV infections. The prolonged use of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) co-formulation (TDF/FTC), however, may result in augmented risk of renal toxicity. We aimed to evaluate changes in the estimated Glomerular Filtration Rate (eGFR) in a real-world population setting of participants enrolled in PrEP Brazil, a 48-week prospective, open-label, demonstration study to assess the feasibility of daily oral TDF/FTC used by men who have sex with men and transgender women at high-risk of HIV infection, all over 18 years old.

Methods

Kidney function was assessed by serial measurement of serum creatinine and eGFR with the Modification of Diet in Renal Disease Study (MDRD) formula on weeks 4, 12, 24, 36 and 48. Adherence to PrEP was assessed by dosing TDF concentration in dried blood spots at weeks 4 and 48, measured by liquid chromatography-mass spectrometry or mass spectrometry.

Results

Of 392 participants completing the 48-week follow-up protocol with TDF blood detectable levels and eGFR measures, 43.1% were young adults, of Caucasian ethnic background (57.9%), with BMI below 30 kg/m², without arterial hypertension. At screening, median eGFR was 93.0 mL/min/1.73 m². At week 4 follow-up, 90 (23% of the study population) participants presented reductions in eGFR greater than 10 mL/min/1.73 m² as compared to baseline eGFR, some as large as 59 mL/min/1.73 m², but with no clinical outcomes (adverse events and renal adverse events) severe enough to demand TDF/FTC discontinuation. A negative relationship was observed between TDF blood levels and eGFR at weeks 4 (r = − 0.005; p < 0.01) and 48 (r = − 0.006; p < 0.01).

Conclusions

These results suggest that the renal function profile in individuals on TDF/FTC may be assessed on week 4 and then only annually, allowing a more flexible medical follow-up in primary care centers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12981-022-00437-4.

Marine-Derived 2-Aminoimidazolone Alkaloids. Leucettamine B-Related Polyandrocarpamines Inhibit Mammalian and Protozoan DYRK & CLK Kinases

A large diversity of 2-aminoimidazolone alkaloids is produced by various marine invertebrates, especially by the marine Calcareous sponges Leucetta and Clathrina. The phylogeny of these sponges and the wide scope of 2-aminoimidazolone alkaloids they produce are reviewed in this article. The origin (invertebrate cells, associated microorganisms, or filtered plankton), physiological functions, and natural molecular targets of these alkaloids are largely unknown. Following the identification of leucettamine B as an inhibitor of selected protein kinases, we synthesized a family of analogues, collectively named leucettines, as potent inhibitors of DYRKs (dual-specificity, tyrosine phosphorylation regulated kinases) and CLKs (cdc2-like kinases) and potential pharmacological leads for the treatment of several diseases, including Alzheimer's disease and Down syndrome. We assembled a small library of marine sponge- and ascidian-derived 2-aminoimidazolone alkaloids, along with several synthetic analogues, and tested them on a panel of mammalian and protozoan kinases. Polyandrocarpamines A and B were found to be potent and selective inhibitors of DYRKs and CLKs. They inhibited cyclin D1 phosphorylation on a DYRK1A phosphosite in cultured cells. 2-Aminoimidazolones thus represent a promising chemical scaffold for the design of potential therapeutic drug candidates acting as specific inhibitors of disease-relevant kinases, and possibly other disease-relevant targets.

New Leucettidae de Laubenfels, 1936 (Porifera, Calcarea) from Western Australia

This paper reports four new Leucettidae (Porifera, Calcarea) from Western Australia, with two representatives of Leucetta and two of Pericharax: L. foliata sp. nov., L. purpurea sp. nov., Pericharax crypta sp. nov., and P. vallii sp. nov. This is the first time tripods have been described within Pericharax. In addition, one species (L. foliata sp. nov.) has an external morphology not previously reported for Leucetta, and for the first time tetractines of the inhalant and exhalant canals have been distinguished. Leucettidae now comprises 28 species, eight of them occur in Western Australia, which means this Australian State has the highest species richness for this family in Australia. The WA coastline has been largely unexplored for Calcarea so it is likely that further collecting will yield additional species. Leucetta microraphis is the most widespread species of Leucettidae in Australia, occurring in all States except the Northern Territory and Tasmania. We highlight the importance of a revision of the Leucettidae using molecular and morphological characters to determine which morphological characters have a phylogenetic signal.

Inhibition of Amazon deforestation and fire by parks and indigenous lands

Conservation scientists generally agree that many types of protected areas will be needed to protect tropical forests. But little is known of the comparative performance of inhabited and uninhabited reserves in slowing the most extreme form of forest disturbance: conversion to agriculture. We used satellite-based maps of land cover and fire occurrence in the Brazilian Amazon to compare the performance of large (> 10,000 ha) uninhabited (parks) and inhabited (indigenous lands, extractive reserves, and national forests) reserves. Reserves significantly reduced both deforestation and fire. Deforestation was 1.7 (extractive reserves) to 20 (parks) times higher along the outside versus the inside of the reserve perimeters and fire occurrence was 4 (indigenous lands) to 9 (national forests) times higher. No strong difference in the inhibition of deforestation (p = 0. 11) or fire (p = 0.34) was found between parks and indigenous lands. However, uninhabited reserves tended to be located away from areas of high deforestation and burning rates. In contrast, indigenous lands were often created in response to frontier expansion, and many prevented deforestation completely despite high rates of deforestation along their boundaries. The inhibitory effect of indigenous lands on deforestation was strong after centuries of contact with the national society and was not correlated with indigenous population density. Indigenous lands occupy one-fifth of the Brazilian Amazon-five times the area under protection in parks--and are currently the most important barrier to Amazon deforestation. As the protected-area network expands from 36% to 41% of the Brazilian Amazon over the coming years, the greatest challenge will be successful reserve implementation in high-risk areas of frontier expansion as indigenous lands are strengthened. This success will depend on a broad base of political support.

Positive feedbacks in the fire dynamic of closed canopy tropical forests

The incidence and importance of fire in the Amazon have increased substantially during the past decade, but the effects of this disturbance force are still poorly understood. The forest fire dynamics in two regions of the eastern Amazon were studied. Accidental fires have affected nearly 50 percent of the remaining forests and have caused more deforestation than has intentional clearing in recent years. Forest fires create positive feedbacks in future fire susceptibility, fuel loading, and fire intensity. Unless current land use and fire use practices are changed, fire has the potential to transform large areas of tropical forest into scrub or savanna.

[Results of intracerebral inoculation of the cerebrospinal fluid of patients with Parkinson disease in experimental animals]

Intracerebral inoculation of parkinsonian's cerebrospinal fluid were carried out in 720 mice, under strict observation during 48 weeks. The inoculations led to a mortality rate of 157 mice (21.8%), being 31% (76) in the first, 17% (41) in the second, and 16% (40) after the third one. High mortality rates occurred, most prevalent in the first inoculation and during the first 7 weeks. Dendrite tumefaction and disintegration as well as nerve cell swelling were the ultrastructural changes observed in the brain of mice.

[Ultrastructural analysis of the cerebrospinal fluid in patients with Parkinson disease]

Ultrastructural cerebrospinal fluid of 20 parkinsonian patients examined by negative staining showed not recognizable structures thought to be of viral origin in 6 cases (30%). However, mortality rate analysis failed to disclose significant differences between the inoculated animals. Either artefact or not, such structures deserve to be reported.

[Ultrastructural aspects of Parkinson disease]

Brains from four parkinsonian patients and one control patient were analysed by electron microscopy. The most consistent abnormal findings were nerve fibers rarefaction, great interstitial space enlargement, neuropil disruption, mitochondrial tumefaction and degenerative changes. These findings occurred regularly in the brain of parkinsonian patients. Furthermore, except for mitochondrial changes, they were distinctively absent in the control patient, and therefore cannot be attributed to technical problems. Contrary-wise, they clearly reflect chronic neuronal loss. Also noteworthy was the demonstrative of deposits of amorphous substance into mitochondria, axons, cytoplasm and into the interstitial space.

Amyloidosis in experimental tegumentary leishmaniasis in mice

Renal and hepatosplenic amyloidosis was found in chronic cutaneous leishmaniasis in mice infected with 10(6) purified amastigotes from lesions produced by the H21 strain of Leishmania mexicana amazonensis. After 1 year a progressive lesion leading to metastasis was observed in most animals.

Role of T lymphocytes in the resistance and immunopathology of experimental Chagas' disease. I. Histopathological studies

The results reported here show that Trypanosoma cruzi can parasitize almost all tissues of mice; however, the T-dependent immune response controls parasite invasion, leading undesirable immunopathological effects. Inflammatory infiltrate was rare in heart or skeletal muscle and other organs of Nu/Nu, but was abundant in tissues of Nu/+ mice. Cellular inflammatory lesions could be induced in Nude mice by the transfer of lymph node cells from Nu/+ animals infected with T. cruzi.

Melanotic meningioma complicated by disseminated intravascular coagulation

The purpose of this paper is fourfold: First, to confirm the rarity of melanotic meningioma, as we have found only 11 reported cases; second to demonstrate that this tumor is not always totally pigmented, a fact that has not been mentioned before; third, to show an unusual recurrence as a hemorrhagic cystic meningioma 10 years and 8 months after removal; and fourth, to describe the association of disseminated intravascular coagulation, a rare disorder with brain tumors.

[Pathogenicity, for newborn mice, of echovirus type 9 samples isolated from cases of meningitis during an outbreak in Rio de Janeiro]

A patogenicidade do echovirus tipo 9 para camundongos recém-nascidos foi estudada, utilizando-se 12 amostras isoladas em cultura de células primárias de rim de macaco, a partir do liquor de crianças com meningite. Os animais inoculados com o fluido da primeira passagem em células desenvolveram paralisia flácida, após um período de 5 dias, com a morte ate o 8º dia. Os especimens originais de liquor não continham suficiente vírus para provocar sinais clínicos nos animais inoculados no período de 21 dias de observação. Ao exame histopatológico os animais doentes apresentaram miopatia necrotizante da musculatura paravertebral, língua e diafragma. Animais inoculados que não desenvolveram paralisia durante o período de observação apresentaram miosite discreta, sem que tenha sido encontrada necrose das fibras musculares.

Experimental paracoccidioidomycosis in immunosuppressed mice

Mice were immunosuppressed by means of wholebody irradiation or cyclophosphamide, in order to investigate the influence on the initial phase of infection induced by a strain of the fungus, Paracoccidioides brasiliensis, in the yeast phase and inoculated intraperitoneally. A group of mice was irradiated with 600 rad (cobalt gamma-irradiation) 24 h before infection. Two groups were treated with cyclophosphamide (200 mg/kg intravenously), one two days before, and the other, one day after infection. A control group received the fungus, but no radiation or cyclophosphamide. All animals developed lesions at the site of inoculation. Metastatic lesions were observed in 100% of the animals in the irradiated group, 67% in each of the cyclophosphamide-treated groups and 33% in the control group. These lesions were found both in the liver and lungs, being more numerous in the irradiated group, followed by the cyclophosphamide-treated group in which the drug was given after the infection; they were slight in both viscera in the other cyclophosphamide-treated group and also slight in the liver and absent in the lungs of the controls.

[Cerebral germinomas (atypical teratomas of the pineal)]

São estudados três casos de germinomas cerebrais, sendo um tópico, da região pineal, e dois ectópicos, chamados germinomas supra-selares ou quiasmáticos. Estes últimos parecem ser mais agressivos que os seus congeneres tópicos, pois alem de se disseminarem pelas cisternas basais, costumam infiltrar as paredes do III ventrículo, fórnix, hipotálamo, nervos e quiasma ópticos. Caracteristicamente produzem um enorme aumento das proteínas liquóricas, desacompanhado de uma pleocitose proporcional. As proteínas liquóricas aumentadas sao globulinas cujas reações mostram-se fortemente positivas, possivelmente produzidas pelas celulas de aspecto linfocitario que constituem parte desta neoplasia. O aumento das proteinas liquoricas e tao acentuado que em presenca de uma crianca ou adolescente com sindrome de hipertensão intracraniana, hiperproteinoraquia sem pleocitose e sinais clínicos ou radiológicos sugestivos de localização na base do crânio a possibilidade de um germinoma quiasmático deve ser seriamente considerada, pois o quadro e muito sugestivo.

[Morphologic aspects of hypothalamic neurosecretion in man]

Foi realizado um estudo histológico da região hipotalâmica anterior humana empregando-se a colocação pela hematoxilina crômica e a impregnação pelo carbonato de prata a fim de comparar os resultados obtidos com os dois métodos. Verificou-se que a impregnação argêntica fornecia imagens equivalentes ás obtidas com a hematoxilina crômica. Todavia, não pode ser empregada isoladamente, devendo-se sempre fazer o controle com a hematoxilina crômica. Em uma segunda parte do trabalho discute-se o fenômeno da degeneração das porções terminais e subterminais das fibras nervosas do feixe supra-óptico-hipofisário, coincidindo com a formação dos chamados "corpos de Herring". Conceitua-se estes neurônios que formam os núcleos supra-ópticos e paraventricular como um tipo de célula glandular, não obstante sua natureza neuronal, cuja eliminação do produto de elaboração coincide com a desagregação do pólo apical da célula.

[Subacute sclerosing panencephalitis: correlation between immunologic and histopathologic aspect]

Foi realizado um estudo clínico, laboratorial, eletroencefalográfico, sorológico e virológico em 4 pacientes com o diagnóstico clínico de "panencefalite subaguda esclerosante". Em todos constatou-se uma elevada concentração de anticorpos contra sarampo, tanto no líquido céfalo-raquidiano como no soro sangüíneo, sendo que em 3 pacientes a concentração de anticorpos era mais elevada no líquido céfalo-raquidiano. Em dois destes pacientes foram feitas biópsias cerebrais, que evidenciaram um processo meningo-encefalítico crônico, com focos de neuroniofagia esparsos e infiltrados inflamatórios perivasculares de natureza linfoplasmocitária. Ao mesmo tempo fez-se uma revisão de 18 casos desta enfermidade, já publicados, agora no sentido de estudar mais detidamente a natureza da infiltração inflamatória meníngea e perivascular. O aspecto histopatológico resumia-se em infiltração linfoplasmocitária meníngea esparsa, contrastando com densos infiltrados inflamatórios perivasculares também linfoplasmocitários, muitas vezes com grande riqueza em "corpos de Russell". Em vista destes achados sugere-se a possibilidade de que os anticorpos contra sarampo, encontrados em elevada concentração no líquido céfalo-raquidiano destes pacientes, sejam produzidos nos infiltrados perivasculares do próprio tecido nervoso.

[Subacute sclerosing panencephalitis: comparative study between human and experimental lesions determined by encephalitogenic agents of human origin]

Neste trabalho estudamos as alterações histopatológicas encontradas no sistema nervoso central de dois pacientes com "panencefalite subaguda esclerosante" comparando-as com as modificações estruturais determinadas no sistema nervoso central de sete macacos rhesus nos quais este material foi inoculado. Os animais apresentaram sinais de comprometimento neurológico, traduzido por caquexia e paralisia do trem posterior, após um longo período de incubação, em torno de 18 meses. Dois animais morreram antes de qualquer manifestação neurológica, de infecção pulmonar intercorrente acidental. Nas passagens sucessivas houve um encurtamento do periódo de incubação para cerca de 40 dias. As alterações histopatológicas encontradas, consistiram, nos casos humanos, em leptomeningite focal, focos de neuronofagia, granulomas corticais e nos núcleos basais, grande perda da população neuronal com ocasional estado esponjoso do córtice cerebral, infiltrados perivasculares, e gliose da substância branca, sem perda de mielina. No material experimental foram observadas estas mesmas modificações, se bem que de caráter muito menos intenso. Tanto no material humano como no experimental a mielina estava praticamente normal. Sugere-se que o quadro anátomo-clínico chamado "panencefalite subaguda esclerosante (SSPE) possa ser determinado, não apenas pelo vírus do sarampo, mas também por outros vírus, especialmente os do grupo papova, já encontrado por outros autores, em casos de "panencefalite subaguda esclerosante".

[Subacute sclerosing panencephalitis: transmission of a human encephalitogenic agent to Macacus rhesus]

Material proveniente do cérebro de um paciente com "panencefalite subaguda esclerosante" foi inoculado, por via intracerebral, em dois Macacus rhesus. Os animais permaneceram assintomáticos, aparentemente bem, por mais de um ano. Entretanto, 21 e 22 meses após as inoculações começaram a apresentar sinais de comprometimento neurológico, traduzido por paralisia dos membros posteriores, com apatia e caquexia progressivas. Os animais foram sacrificados. O exame histopatológico do sistema nervoso central mostrou gliose marginal e gliose da substância branca, com os neurônios exibindo sinais de "lesão celular crônica". Foram vistos discretos manguitos inflamatórios perivasculares. Em um animal foi encontrada inclusão acidófila intra- nuclear. Havia também proliferação da glia satélite perineuronal, com satelitose, notadamente no tronco cerebral. No exame das vísceras foi encontrado discreto processo de miocardite crônica. Foram retirados fragmentos dos encéfalos destes animais e inoculados em 4 outros, também por via intracerebral. Estes animais de 2.ª passagem após 2 meses de inoculação, em média, apresentaram sinais de comprometimento do sistema nervoso central semelhante ao dos animais doadores, de 1ª passagem. Houve, portanto, um encurtamento do período de inoculação da moléstia. Estes animais também foram sacrificados, sendo encontradas gliose marginal, gliose da substância branca, "lesão celular crônica" neuronal e proliferação da glia satélite, notadamente no tronco cerebral; vasos sangüíneos congestos; espongiose cortical. Os animais testemunhas, do mesmo lote, permaneceram normais. Acreditamos que as lesões observadas nos animais de 1.ª passagem, e que se repetiram com maior intensidade e com menor tempo de incubação nos de 2.ª passagem somente podem ser explicadas admitindo-se a existência de um agente virai que, pela natureza do quadro histopatológico (gliose, "lesão celular crônica" neuronal e espongiose cortical) bem como pelo período longo de incubação, deva pertencer ao grupo dos chamados vírus lentos.

[Histopathologic aspects of toxoplasmic acute encephalitis (human and experimental)]

Realizaram os Autores um estudo histopatológico de dois casos de encefalite aguda toxoplásmica humana mostrando a distribuição dos acúmulos inflamatórios, nitidamente em relação com rêde vascular, a composição celular dêstes acúmulos e a sua histogênese. Os resultados são discutidos e comparados com material experimental de coelhos.