Survey for tick-borne zoonoses in the state of Espirito Santo, southeastern Brazil

Blood samples collected from 201 humans, 92 dogs, and 27 horses in the state of Espirito Santo, Brazil, were tested by polymerase chain reaction, indirect immunofluorescence assays, and indirect enzyme-linked immunosorbent assay for tick-borne diseases (rickettsiosis, ehrlichiosis, anaplasmosis, borreliosis, babesiosis). Our results indicated that the surveyed counties are endemic for spotted fever group rickettsiosis because sera from 70 (34.8%) humans, 7 (7.6%) dogs, and 7 (25.9%) horses were reactive to at least one of the six Rickettsia species tested. Although there was evidence of ehrlichiosis (Ehrlichia canis) and babesiosis (Babesia canis vogeli, Theileria equi) in domestic animals, no human was positive for babesiosis and only four individuals were serologically positive for E. canis. Borrelia burgdorferi-serologic reactive sera were rare among humans and horses, but encompassed 51% of the canine samples, suggesting that dogs and their ticks can be part of the epidemiological cycle of the causative agent of the Brazilian zoonosis, named Baggio-Yoshinari Syndrome.

Prediction of significant liver fibrosis in kidney transplant patients with chronic hepatitis C virus infection: the TX-3 index

HCV infection is highly prevalent among kidney transplant (KT) recipients. The natural history and management of these patients are controversial. We sought to assess the diagnostic value of noninvasive markers of liver fibrosis in KT HCV-infected patients. This cross-sectional study included 102 KT individuals with positive HCV-RNA. Bivariate and multivariate analyses were used to identify variables associated with significant fibrosis (METAVIR > or = F2). Significant fibrosis was observed in 20 patients (20%). Time after transplantation, AST level, and platelet count were identified as independent predictors of significant fibrosis. Based on the regression model, a simplified index was devised. The AUROC for the TX-3 model was 0.867 +/- 0.081 (0.909, when adjusted by DANA). Values < or =4.0 of TX-3 showed a NPV of 97% and scores >9.6 exhibited a PPV of 71%. If biopsy indication was restricted to scores in the intermediate range of TX-3, this could have been correctly avoided in 68% of cases. The APRI score provided a correct diagnosis in only 47 individuals (46%) and exhibited lower diagnostic indices for both cutoffs, as compared to the TX-3 index. Comparison of AUROCs showed a trend towards superior diagnostic accuracy for TX-3 over APRI, although the difference between AUROCs did not reach statistical significance (0.867 +/- 0.053 vs 0.762 +/- 0.066, respectively, P = 0.064). In conclusion, significant liver fibrosis can be reliably predicted in KT HCV-infected subjects by simple and widely available parameters. If additional studies confirm our results, this model might obviate the requirement for a liver biopsy in a significant proportion of those patients.

Fatores de risco para a leptospirose em fêmeas bovinas em idade reprodutiva no Estado da Bahia, Nordeste do Brasil

Foram identificados fatores de risco associados à leptospirose em fêmeas bovinas em idade reprodutiva no Estado da Bahia. Foram amostradas aleatoriamente 10.823 fêmeas bovinas com idade igual ou superior a 24 meses procedentes de 1.414 propriedades. Para o diagnóstico sorológico da infecção por Leptospira spp., foi utilizada a Soroaglutinação Microscópica (SAM) utilizando 24 sorovares como antígenos. Um rebanho foi considerado foco quando apresentou pelo menos um animal soropositivo. Das 1.414 propriedades investigadas, 1.076 (77,9%; IC 95% = 75,7-80,0%) apresentaram pelo menos um animal reagente na SAM para qualquer sorovar. O sorovar Hardjo (Hardjoprajitno) foi o mais prevalente, com 34,49% (IC 95% = 31,97-37,14%) das propriedades positivas. Presença de mais de 28 fêmeas bovinas em idade reprodutiva no rebanho (OR=2,11; p<0,001), presença de cervídeos (OR=2,02; p=0,010), compra de animais (OR=1,57; p<0,001), abate de animais na própria fazenda (OR=1,58; p=0,030) e utilização de partos compartilhados (OR=1,63; p<0,001) foram identificados como fatores de risco para leptospirose por qualquer sorovar. Os fatores de risco para leptospirose pelo sorovar Hardjo (Hardjoprajitno) foram a presença de suínos (OR=1,28; p=0, 040) e a compra de animais (OR=1,48; p<0,001).

Prevalence of Rickettsia felis in the Fleas Ctenocephalides felis felis and Ctenocephalides canis from Two Indian Villages in Sao Paulo Municipality, Brazil

We evaluated the presence of Rickettsia infection among fleas collected on domestic dogs in two Guarani Indian communities in the suburban area of São Paulo Municipality, Brazil. A total of 114 Ctenocephalides felis felis and 47 Ctenocephalides canis were collected from 40 dogs. A total of 41 C. felis felis (36.0%) and 9 C. canis (19.1%) fleas yielded expected bands by PCR, which were all shown by DNA sequencing to be indentical to the corresponding sequence of a fragment of the Rickettsia felis gltA gene deposited in GenBank. The overall prevalence of R. felis was 31.0% (49/161).

Inquérito sorológico e fatores de risco para a brucelose por Brucella canis em cães do município de Santana de Parnaíba, Estado de São Paulo

Foi investigada a prevalência da brucelose causada por Brucella canis em cães do município de Santana de Parnaíba, SP, Brasil, e realizado um estudo de possíveis fatores de risco associados à soropositividade para B. canis. Foram examinadas 410 amostras de soro sanguíneo de cães colhidas durante a campanha de vacinação anti-rábica animal, realizada em agosto de 1999. A imunodifusão em gel de ágar (IDGA), utilizando antígeno de lipopolissacarídeos e proteínas de Brucella ovis, amostra Reo 198, foi empregada em soros normais como teste de triagem, e, para a confirmação, a mesma técnica foi aplicada em soros tratados pelo 2-mercaptoetanol (IDGA-ME). A reação de fixação de complemento (CFT), utilizando antígeno de B. ovis, amostra 63/290, também foi utilizada como prova confirmatória. A determinação da prevalência considerou como positivos os animais que reagiram positivamente nos dois testes confirmatórios (IDGA-ME e CFT). A prevalência da B. canis foi de 2,2% (I.C. 95% = 1,01-4,13%). A análise estatística mostrou que os cães com acesso irrestrito à rua o dia todo (manejo do tipo solto) estiveram mais expostos ao risco da infecção por B. canis, com um valor de odds ratio de 8,73 (I.C. 95% = 1,48-51,55) e p=0,04.

[Infection and disease caused by the human T cell lymphotropic viruses type I and II in Brazil]

HTLV-I/II infection is present in all regions of Brazil, but its prevalence varies according to the geographical area, being higher in Bahia, Pernambuco and Pará. It has been estimated that Brazil has the highest absolute number of infected individuals in the world. Blood donors screening and research conducted with special groups (indigenous population of Brazil, IV drug users and pregnant women) are the major sources of information about these viruses in our Country. HTLV-I causes adult T cell leukemia/lymphoma (ATLL), HTLV associated myelopathy/tropical spastic paraparesis (HAM/TSP), HTLV associated uveitis (HAU), dermatological and immunological abnormalities. HTLV-II is not consistently associated with any disease. Diagnosis is established using screening (enzymatic assays, agglutination) and confirmatory (Western blot, PCR) tests. The viruses are transmitted by blood and contaminated needles, by sexual relations and from mother to child, especially by breast feeding. Prevention efforts should focus on education of positive blood donors, infected mothers and IV drug users.

Glue solvent inhalation impairs host resistance to Mycobacterium bovis-induced infection in hamsters

Industrial organic solvents present in glue are among the common used psychotropic drugs in Brazil and perhaps worldwide; but few data are available concerning the toxic effects of glue sniffing, with almost no information about immunotoxicity. This seems interesting because several drugs and environmental chemicals are recognized as potential immunotoxicants. The present study investigated the effects of forced inhalation of a toluene/n-hexane 1:1 mixture on hamster resistance to Mycobacterium bovis. Adult hamsters were divided at random into 3 equal groups. Animals of Groups E and E inhaled the mixture of toluene/n-hexane twice daily for 37 d. Group C was placed for the same period of time in identical chambers free of solvents. Two days after the beginning of the experiment, Groups E and C were injected ip with 0.5 ml of an activated suspension of M. bovis; Group E received the same volume of a control solution. Hamsters inhaling the toluene/n-hexane mixture (E) exhibited increased weight loss, increased scores of M. bovis colony forming units isolated from liver, lung and spleen, increased granulomatous areas in the liver, lung and spleen. Inhalation of the toluene/n-hexane mixture for 37 d also increased serum cortisol compared to control hamsters. Tuberculosis is an infection with an intracellular bacterium in which sensitivity is determined mainly by host response. The present data demonstrated impaired defense against M. bovis in hamsters inhaling a toluene/n-hexane mixture for 37 d. Since macrophages are the architectural and functional units of the granulomas in tuberculosis, and no data were found about glue solvent effects on cellular immunity, the present data suggest an indirect effect of glue solvents on macrophage/lymphocyte activity via stress induction and central nervous system stimulation of hormonal (ACTH/cortisol) secretion and/or autonomic nervous system activity.

Effects of treatment with amphetamine and diazepam on Mycobacterium bovis-induced infection in hamsters

Tuberculosis is an example of an infection with an intracellular bacterium in which sensitivity is determined mainly by the host response. Macrophages are the architectural and functional units of the granulomas described in tuberculosis. Treatment with amphetamine (AMPH) and diazepam has been reported to decrease macrophage activity. The present experiment was undertaken to investigate the effects of AMPH and/or diazepam given alone or in combination on hamster resistance to Mycobacterium bovis. The effects of these treatments on serum cortisol levels were also studied. Adult hamsters were treated i.p. with AMPH (group E1 = 1.0 or 2.0 mg/kg/day), with AMPH (group E2 = 1.0 or 2.0 mg/kg/day) plus diazepam (2.0 mg/kg/day), with diazepam (group E3 = 2.0 mg/kg/day), or with control vehicles (1.0 ml/kg/day) for 40 days. Six days after the beginning of the treatments, the animals received identical inoculum concentrations of M. bovis. Hamsters treated with AMPH plus diazepam exhibited: 1) increased weight loss; 2) increased mortality; 3) increased scores of M. bovis colony forming units (CFU) isolated from liver, lung and spleen; 4) increased granuloma areas measured in the liver, lung and spleen. These effects were not induced by AMPH (1.0 or 2.0 mg/kg/day) given alone and were produced by diazepam (2.0 mg/kg/day) treatment per se. Furthermore, AMPH (2.0 mg/kg/day) and diazepam (2.0 mg/kg/day) given alone or in combination for 20 days increased the serum levels of cortisol in relation to control hamsters, with the effect being higher in the animals treated with both drugs. The present data, which demonstrate an impaired defense against M. bovis in hamsters treated with AMPH plus diazepam or with diazepam alone, were tentatively explained on the basis of a direct and/or indirect action of the drugs on macrophage/lymphocyte activity. In the former case, the effects may be related to stimulation of peripheral benzodiazepine receptor sites (PBR) present on macrophages/lymphocytes and/or to a direct effect of ACTH on immune cells, while in the latter they may be mediated by cortisol via PBR and ACTH stimulation of the adrenals.

Evidences of gentamicin resistance amplification in Klebsiella pneumoniae isolated from faeces of hospitalized newborns

The intestinal microbiota, a barrier to the establishment of pathogenic bacteria, is also an important reservoir of opportunistic pathogens. It plays a key role in the process of resistance-genes dissemination, commonly carried by specialized genetic elements, like plasmids, phages, and conjugative transposons. We obtained from strains of enterobacteria, isolated from faeces of newborns in a university hospital nursery, indication of phenotypical gentamicin resistance amplification (frequencies of 10(-3) to 10(-5), compatible with transposition frequencies). Southern blotting assays showed strong hybridization signals for both plasmidial and chromosomal regions in DNA extracted from variants selected at high gentamicin concentrations, using as a probe a labeled cloned insert containing aminoglycoside modifying enzyme (AME) gene sequence originated from a plasmid of a Klebsiella pneumoniae strain previously isolated in the same hospital. Further, we found indications of inactivation to other resistance genes in variants selected under similar conditions, as well as, indications of co-amplification of other AME markers (amikacin). Since the intestinal environment is a scenario of selective processes due to the therapeutic and prophylactic use of antimicrobial agents, the processes of amplification of low level antimicrobial resistance (not usually detected or sought by common methods used for antibiotic resistance surveillance) might compromise the effectiveness of antibiotic chemotherapy.

Effects of diazepam on Mycobacterium bovis-induced infection in hamsters

The in utero exposure of hamsters to low doses of diazepam results in impaired host defense against Mycobacterium bovis during adulthood. Delayed developmental immunotoxicity, however, represents a specific situation that might not be general. The present experiment was undertaken to investigate the effects of diazepam on hamster resistance to M. bovis using adult animals. The effects of diazepam treatment on serum cortisol levels were also studied. Adult hamsters (N = 10 for each group) were treated with diazepam (E1 = 1. 0, E2 = 2.0 or E3 = 3.0 mg kg-1 day-1 subcutaneously) or with control solution (C) for 30 days. Seven days after the beginning of the treatment, the animals received identical inoculum concentrations of M. bovis. Hamsters treated with the higher (2.0 and 3.0 mg kg-1 day-1) doses of diazepam exhibited: 1) increased granuloma areas in the liver (C = 1.81 +/- 1.39, E2 = 10.29 +/- 4.64 and E3 = 15.80 +/- 4.82) and lung (C = 0.54 +/- 0.55, E2 = 6.28 +/- 3.85 and E3 = 6.31 +/- 3.56) and 2) increased scores of M. bovis colony-forming units isolated from liver (C = 2.0, E2 = 3.0 and E3 = 3.5), lung (C = 1.0, E2 = 3.0 and E3 = 3.5) and spleen (C = 1.0, E2 = 2.5 and E3 = 4.0). These effects were dose dependent, and were not detected or were less severe in animals treated with the lowest (1.0 mg/kg) dose of diazepam as well as in those of the control group. Furthermore, diazepam treatment (3.0 mg kg-1 day-1 for 30 days) increased (E3 = 71.32 +/- 2.99; N = 10) the serum levels of cortisol compared to control hamsters (C = 22.61 +/- 2.75; N = 10). The present data, that demonstrate an impaired defense against M. bovis in adult hamsters treated with diazepam, were tentatively explained on the basis of a direct and/or indirect action of diazepam on the cytokine network. The effects may be related to stimulation of peripheral benzodiazepine receptor binding sites (PBR) by macrophages and/or lymphocytes, or they may be mediated by PBR stimulation of the adrenals.

Effects of prenatal diazepam treatment on Mycobacterium bovis-induced infection in hamsters

In utero exposure of rats to low dosages of diazepam has been found to result in depression of cellular and humoral immune responses during adulthood, with marked changes in macrophage spreading and phagocytosis. The present experiment was undertaken to investigate the resistance of adult hamsters to Mycobacterium bovis after prenatal exposure to diazepam. Time-pregnant hamsters were exposed to diazepam (1.0 or 1.5 mg kg(-1) day(-1) subcutaneously) or vehicle from gestational day 9 to 15. A total of 36 different litters (12 of them control and 12 for each experimental group) born after a 16/17-day gestation were used. One male from each litter was infected twice with identical inoculum concentrations of M. bovis at 75 and 107 days of age. This infection model involves the participation of macrophages and T and B cell populations. The animals prenatally exposed to the higher (1.5 mg/kg) dose of diazepam exhibited: (1) increased weight loss, (2) increased mortality, (3) increased granuloma areas measured in the liver, lung and spleen, (4) increased spleen weight, and (5) increased scores of M. bovis colony forming units (CFU) isolated from liver, lung and spleen. These effects were dose-dependent, and were not detected or were less severe in animals treated with the lower (1.0 mg/kg) dose of diazepam as well as in those of the control group. The present data demonstrate an impaired defence against M. bovis in adult hamsters after in utero exposure to a dosage of 1.5 mg/kg of diazepam.

[Newborn intestinal colonization by multidrug resistant enterobacteria in a neonatal unit]

OBJECTIVE: To evaluate the occurrence of intestinal colonization in newborns by multidrug-resistant enterobacteria strains (MDRES) during hospital stay after birth. We used selective media in an attempt to determine the relationship between isolation of these strains and some of the presumed colonization risk factors. METHOD: A sequencial inclusion study of 30 newborns was carried out in the neonatal unit of the HUPE, State University Hospital, a general 600-bed tertiary care hospital. We obtained clinical and epidemiological information from medical records and collected a fecal sample from each newborn, which was plated in gentamicin (8mg/ml) medium and potassium tellurite (25mg/ml) medium. The isolated strains were biochemically identified and also submitted to tests of antimicrobial susceptibility. Nine MDRES were submitted to an assay for plasmid conjugational transfer. RESULTS: We isolated 56 distinct MDRES from 14 among 30 newborns (46.7%). Klebsiella pneumoniae was the most common bacterial species (38/56 (68%). We found statistical association between individual MDRES isolation and presence of 3 or 4 of the following colonization risk factors considered: antimicrobial use, low weight (<2.500g), more than 6 days of hospitalization and artificial milk feeding (p< 0.02). We could detect plasmid resistance transfer by bacterial conjugation for 8 among 9 MDRES. CONCLUSION: The seletive cultura media were useful to detect the high frequence of newborns colonized by MDRES in association with well established infection risk factors. We emphasize the importance of reinforcing control rules aiming at preventing intestinal colonization viewed as a risk of nosocomial infection.

Presence of human immunodeficiency virus (HIV) and T-lymphotropic virus type I and II (HTLV-I/II) in a haemophiliac population in Belo Horizonte, Brazil, and correlation with additional serological results

The aim of this study was to determine the prevalence of human immunodeficiency virus type 1 (HIV-1) and human T lymphotropic virus types I and II (HTLV-I/II) infections in 226 haemophiliac patients treated at Fundação Hemominas in Belo Horizonte, Minas Gerais State, Brazil, and to verify association with other serological results. Patients positive for HTLV-I/II had also a neurological, haematological and ophthalmological evaluation. Fundação Hemominas offers comprehensive care for all haemophiliac patients in Minas Gerais. Thirty-six (15.9%) of the 226 patients showed reactive results to HIV-1 [ELISA, Abbott, USA, confirmed by Western blot (WB), Cambridge Biotech, USA, and/or immunofluorescence, Fiocruz, Brazil] and 16 (7.1%) had reactive sera to HTLV-I/II (ELISA, Ortho). Eleven of these 16 (4.9%) were positive, 3/16 (1.3%) were indeterminate and 2/16 (0.9%) were negative in the HTLV WB (Cambridge Biotech). Neurological, haematological and ophthalmological examination of 9/16 patients revealed no abnormality suggestive of HTLV disease. Of the 16 patients reactive to HTLV-I/II ELISA test, six (37.5%) were also positive to HIV-1 (chi 2 = 5.92; P = 0.01). Seropositivity for HTLV-I/II and HIV-1 was associated with advancing age and positive results for hepatitis C virus (HCV), Chagas' disease (T. cruzi infection) and syphilis. No association between the presence of HTLV with type and severity of haemophilia and hepatitis B results was detected. The prevalence of antibodies against HIV-1 is approximately three times that of HTLV-I/II and a patient positive for HTLV-I/II had a significantly increased risk of being positive for HIV-1, HCV and T. cruzi.

[Tuberculosis lymphadenitis in slaughtered swine from the State of São Paulo, Brazil: microscopic histopathology and demonstration of mycobacteria]

INTRODUCTION

As the occurrence of tuberculosis lymphadenitis in swine constitutes a public health risk, especially in immunosuppressed individuals, the distribution of tuberculoid lesions and the presence of microbacteria in lymph nodes and hepatic and muscular tissue in swine for slaughter, in the State of S. Paulo, SP (Brazil), in the period from 1993 to 1994, were studied. MATERIAL E METHOD: Tuberculous lesions in 60 carcasses of swine, slaughtered at abattoirs during the period 1993-1994, were studied. When macroscopic lesions were observed, a representative sampling of lymph nodes, hepatic and muscular tissues (masseter and diaphragm) were examined using histopathological and microbacterial isolation techniques.

RESULTS

The macroscopic lesions were found predominantly in mesenteric lymph nodes. The MAI Complex (M.avium-intracellulare) was isolated mainly in the carcass group that showed lesions and was not found in the control group. Microorganisms of the MAI Complex were not isolated from hepatic and muscular tissues.

CONCLUSION

No clear relationship between the type of mycobacteria isolated and the macroscopic lesions observed during the carcass inspection was found.

HTLV-I associated uveitis, myelopathy, rheumatoid arthritis and Sjögren's syndrome

A 62 year-old white female presented with a 10-year-history of slowly progressive spastic paraparesis, pain and dysesthesia in the lower limbs and sphincter disturbance. A few years after the onset of the neurologic symptoms she developped migratory arthritis with swelling of the knees and pain on palpation of knees and fingers, dry eyes, mouth and skin. Two months before admission she presented bilateral nongranulomatous anterior uveitis. Examination revealed spastic paraparesis with bilateral Babinski sign, a decreased sensation level below L3, decreased vibration sense in the lower extremities, and a postural tremor of the upper limbs. Laboratory work-up disclosed HTLV-I positive tests in the blood and cerebrospinal fluid (CSF), and a mild pleocytosis in the CSF with a normal protein content. Nerve conduction velocity studies were normal. The present case shows the association of uveitis, arthritis and Sjögren's syndrome in a patient with tropical spastic paraparesis/human T-cell lymphotropic virus type I (HTLV-I) associated myelopathy (TSP/HAM), and illustrates the wide spectrum of clinical manifestations which may accompany this infection with this virus.

[Canine tuberculosis and its importance in public health]

The present paper describes tuberculosis in a family whose dog also presented the disease. The importance of animal epidemiological investigation in cases of tuberculosis in man is discussed.

Isolation of Leishmania sp. from aqueous humor of a patient with cutaneous disseminated leishmaniasis and bilateral iridocyclitis (preliminary report)

The authors report an uncommon case of leishmaniasis with disseminated cutaneous lesions, systemic manifestations and ocular involvement, the latter being characterized by bilateral nongranulomatous iridocyclitis. The severity of the ophthalmologic lesions and its unresponsiveness to therapy (in spite of satisfactory regression of both systemic and cutaneous manifestations) lead to a needle aspiration of the anterior eye chamber content. From this material Leishmania sp was isolated. To our knowledge this is the first time that Leishmania has been shown into the ocular globe.