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To compare the clinical characteristics and outcomes of HIV-1-HTLV-1 coinfected patients, in Bahia, Brazil.Retrospective, comparative study.Among a total of 123 consecutive HIV infected patients, 20 men (20.6%) and 6 women (23.1%) had detectable antibodies against HTLV-I/II. The major risk factor associated with coinfection by HTLV was intravenous drug use (57.7% of coinfected patient versus 9.2% of HTLV seronegative patients, p0.0001). Coinfected patients had higher absolute lymphocyte counts (1,921 + 762 versus 1,587 + 951, p = 0.03). Both groups of patients had similar means of CD4+ and CD8+ cell counts. However, among patients with AIDS CD4+ cell counts were significantly higher among those coinfected with HTLV-I/II (292 ± 92 cells/mm³, versus 140 ± 177 cells/mm³, p = 0.36). The frequency and type of opportunistic infections were similar for both groups, but strongyloidiasis and encephalopathy were more frequently diagnosed in coinfected patients (p0.05). On the other hand, patients coinfected with HTLV-I/II received significantly less antiretroviral therapy than singly infected by HIV-1.Coinfection by HTLV-I/II is associated with an increased risk of strongyloidiasis for HIV patients. Higher CD4 count may lead to underestimation of immunodeficiency, and delay to initiate antiretroviral therapy.

To review global tuberculosis case notifications and treatment outcomes, and to assess progress in TB control 1995-1996, especially in the 22 countries that carry 80% of all incident cases.Compilation of case notifications; cohort analysis of treatment outcomes in DOTS and non-DOTS programmes.The 181 of 212 countries (85%) that reported data to WHO in 1997 covered 97% of the global population. They reported 3.81 million cases of tuberculosis, of which 1.29 million were smear-positive, representing case detection rates of approximately 39% and 51%, respectively. DOTS programmes diagnosed 67% of new pulmonary cases to be smear-positive (65% expected), compared with 30% in other control programmes. They evaluated a higher fraction of registered cases (94% vs 55%), achieved higher treatment success rates (78% vs 45%), and a higher fraction of patients was shown to be cured by smear conversion (72% vs 23%). Despite the apparent advantages of DOTS, only 12% of all estimated cases, and only 15% of smear-positive cases, were treated in such programmes.With the exceptions of Vietnam, Peru and Tanzania, none of the 22 highest-incidence countries achieved WHO targets for TB control. The slow progress is of greatest concern in 16 countries, including India, Indonesia, Nigeria and Pakistan.

A five-year prospective study of cutaneous leishmaniasis in an endemic area of Brazil revealed an annual incidence of disease of 8.1 per 1000 inhabitants and a prevalence of 14.9%. The disease fluctuated as a series of mini-epidemics. Most disease occurred in individuals who were 10-30 years of age. Mucosal disease occurred in 2.7% of patients with primary lesions and occurred a median of six years after this lesion. Disease was more common in males, in those with either large or multiple antecedent skin lesions, and in those with incomplete antimony therapy for the primary lesions. An ELISA was positive in 85% of those tested during the first two years after the primary lesion and remained positive for five to 40 years in 27% of patients. Skin testing was positive in 96% of patients with recent lesions and remained positive in 70% of patients. All patients with mucosal disease had positive serological and skin tests.

Eight Bahian patients with cutaneous leishmaniasis who had 20 or more ulcerative lesions of short duration are described. Of five identifications of isolated parasites, four were Leishmania braziliensis braziliensis and one was L. mexicana amazonensis. All but one had positive Montenegro tests initially, and all did after treatment. All had circulating anti-leishmanial antibodies and five responded well to glucantime therapy suggesting a functioning immune response. This is quite different to the anergic hansenoid leishmaniasis seen with L. mexicana amazonensis infections in Brazil. Possible reasons for the occurrence of this type of leishmaniasis are briefly discussed.

Leishmania (Viannia) braziliensis has never been isolated from wild animals although it is apparently capable of inducing infections in man, dogs, and donkeys. An analysis of the standard hamster culture system for analyzing infectivity of Leishmania sp. was undertaken. Results indicate that for L. (V.) braziliensis, routine cultivation of aspirates taken from the inoculation sites of 1-mo-infected hamsters should be undertaken. Moreover, in at least 1 of the 3 strains examined, isolation of the parasite was only achieved after 84 days of cultivation.