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BACKGROUND Trypanosoma cruzi shows an exuberant genetic diversity. Currently, seven phylogenetic lineages, called discrete typing units (DTUs), are recognised: TcI-TcVI and Tcbat. Despite advances in studies on T. cruzi and its populations, there is no consensus regarding its heterogeneity. OBJECTIVES This study aimed to perform molecular characterisation of T. cruzi strains, isolated in the state of São Paulo, to identify the DTUs involved and evaluate their genetic diversity. METHODS T. cruzi strains were isolated from biological samples of chronic chagasic patients, marsupials and triatomines through culture techniques and subjected to molecular characterisation using the fluorescent fragment length barcoding (FFLB) technique. Subsequently, the results were correlated with complementary information to enable better discrimination between the identified DTUs. FINDINGS It was possible to identify TcI in two humans and two triatomines; TcII/VI in 19 humans, two marsupials and one triatomine; and TcIII in one human host, an individual that also presented a result for TcI, which indicated the possibility of a mixed infection. Regarding the strains characterised by the TcII/VI profile, the correlation with complementary information allowed to suggest that, in general, these parasite populations indeed correspond to the TcII genotype. MAIN CONCLUSIONS The TcII/VI profile, associated with domestic cycles and patients with chronic Chagas disease, was the most prevalent among the identified DTUs. Furthermore, the correlation of the study results with complementary information made it possible to suggest that TcII is the predominant lineage of this work.

Visceral leishmaniasis (VL) is a public health problem in Brazilian municipalities. As much as there is a planning of public policies regards VL in São Paulo State, new cases have been reported and spread. This paper aims to discuss how the Center for Zoonoses Control conducts its actions spatially in endemic city of Presidente Prudente, São Paulo State. Data are from the Municipal Health Department of Presidente Prudente, Adolfo Lutz Institute, and Brazilian Institute of Geography and Statistics. We spatially estimated the dog population per census tract and used geoprocessing tools to perform choropleth maps, spatial trends, and spatial autocorrelation. We found a spatial pattern of higher prevalence in the city’s outskirt and a positive statistically significant spatial autocorrelation (I = 0.2, p-value < 0.000) with clusters of high-high relationships in the Northwest part of the city. Moreover, we identified a different direction in the path of the conducted serosurveys versus the canine VL trend, which stresses the fragility of the Center for Zoonoses Control actions to control the disease. The Center for Zoonoses Control always seems to chase the disease. The spatial analysis may be useful for rethinking how the service works and helps in public policies. A leishmaniose visceral (LV) é um problema de saúde pública nas cidades brasileiras. Por mais que haja um planejamento de políticas públicas para LV no Estado de São Paulo, Brasil, novos casos têm sido notificados e se disseminado. O artigo objetiva discutir como o Centro de Controle de Zoonoses realiza suas atividades espacialmente em uma cidade endêmica, Presidente Prudente, no Estado de São Paulo. Os dados são da Secretaria Municipal de Saúde de Presidente Prudente, Instituto Adolfo Lutz e Instituto Brasileiro de Geografia e Estatística. Estimamos espacialmente a população canina por setor censitário e utilizamos ferramentas de geoprocessamento para produzir mapas coropléticos, tendências espaciais e autocorrelação espacial. Encontramos um padrão espacial de maior prevalência na periferia da cidade e uma autocorrelação espacial positiva estatisticamente significativa (I = 0,2; p < 0,000) com clusters de relação alta-alta no noroeste da cidade. Além disso, identificamos uma direção diferente no caminho dos inquéritos sorológicos realizados versus a tendência na LV canina, o que enfatiza a fragilidade das medidas de controle do Centro de Controle de Zoonoses para controlar casos da doença. O Centro de Controle de Zoonoses parece estar sempre correndo atrás da doença. A análise espacial pode ser útil para repensar o funcionamento do serviço e auxiliar as políticas públicas. La leishmaniasis visceral (LV) es un problema de salud pública en las ciudades brasileñas. Aunque hay políticas públicas de planificación relacionadas con la LV en el estado de São Paulo, Brasil, se han informado de nuevos casos, además de su propagación. El objetivo de este trabajo es discutir cómo el Centro de Control de Zoonosis dirige sus acciones espacialmente en una ciudad endémica del estado de São Paulo, Presidente Prudente. Los datos proceden de la Secretaría Municipal de Salud de Presidente Prudente, del Instituto Adolfo Lutz, y del Instituto Brasileño de Geografía y Estadística. Estimamos espacialmente la población de perros por sector censal y utilizamos herramientas de geoprocesamiento para elaborar mapas de coropletas, tendencias espaciales, y autocorrelación espacial. Encontramos un patrón espacial de más alta prevalencia en la periferia de la ciudad, además de una autocorrelación espacial positiva y estadísticamente significativa (I = 0,2; valor de p < 0,000) con clústeres de relaciones alto-alto en la parte noroccidental de la ciudad. Además, identificamos una dirección diferente en la trayectoria de las encuestas serológicas llevadas a cabo, frente a la tendencia de LV canina, que enfatiza la debilidad de acciones del Centro de Control de Zoonosis para controlar casos de la enfermedad. El Centro de Control de Zoonosis parece siempre estar tras la enfermedad. El análisis espacial podría ser útil para repensar cómo está funcionando el servicio, además de ayudar a políticas públicas.

Previous studies demonstrated that insecticide collars are highly effective in reducing canine visceral leishmaniasis (CVL); however, it is unclear if the efficacy differs by socioeconomic conditions across diverse communities. This study aimed fourfold: (i) to evaluate the protection of 4% impregnated deltamethrin collared (DMC) dogs in different areas of an endemic city for visceral leishmaniasis (VL); (ii) to analyze socioeconomic variables with the seroconversion rates; (iii) to analyze the indirect effect of DMC on untreated dogs in areas of intervention; and, (iv) to evaluate the potential transmission to other dogs in the same household when one positive dog is present. The study employed the municipality of Bauru, São Paulo, Brazil, as the area of interest and used Geographic Information System tools to fit binary logistic regression models. Dogs were divided into three cohort studies: intervention with DMC (I), indirect effect of DMC (IE), and control (C). Pre-intervention, lower mean income was associated with higher rates of CVL and a 142% increase in the odds of transmission (OR = 1.42, p-value = 0.001, CI 1.14,1.77). Post-intervention, lower-income areas depicted greater efficacy (76%) than higher-income areas (45%). The overall efficacy of DMC in preventing CVL was 63%; however, seroconversion rates were higher for IE (6.02%) than C (3.78%), revealing the failure of the indirect protection of DMC to manage the spread of the disease among the general non-wearing DMC canine population living in the same area. The protected dogs may repel the vectors, and non-protected dogs attract them, creating a higher transmission rate for non-protected dogs. Greater seroconversion was observed for living with an infected dog (10.20% in IE and 8.75% in C) than for the indirect effect of DMC, demonstrating the social burden of CVL. Overall, uncollared dogs have three times higher odds of being infected with CVL than DMC dogs (p 0.005), and uncollared dogs living with (an) infected dog(s) in the same household can reach 3.5 times higher odds than those living with negative ones (p 0.005). The results may assist in enhancing public policies and minimizing inequality in low and middle-income countries that suffer from neglected diseases such as VL.

Made available in DSpace on 2019-10-04T12:31:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-10-18 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Leishmaniasis is a vector-borne parasitic protozoan infection that affects mammals and involves a complex epidemiology. Although dogs are considered the main reservoir in zoonotic visceral leishmaniasis (VL), the possible presence of other mammalian species acting as reservoirs has been associated as a possible cause of lack of success in the control of human VL in many endemic areas. The knowledge about natural infections of some species is still scarce, such as nonhuman primates (NHP), especially from the genus Callithrix (marmosets). We investigated the infection by Leishmania (Leishmania) infantum, the agent of VL in the Americas, in 26 marmosets captured monthly, from April 2014 to March 2015, in an environmentally protected area (EPA) in Southeastern Brazil. The EPA has undergone significant environmental changes and has a transmission focus of canine VL since 2009. Serology was performed through the direct agglutination test, which detected low antibody titers in seven marmosets (7/26; 26.9%, 95% confidence interval 9.9-44.0), being five Callithrix penicillata (black-tufted-ear marmoset) and two Callithrix jacchus (white-tufted-ear marmoset). The presence of the DNA of Leishmania was investigated in blood and skin samples by PCR and genetic sequencing. This is the first report of the detection of L. (L.) infantum in the skin of a marmoset, which was verified in a sample from one C. penicillata. The results demonstrate the natural infection of marmosets by L. (L.) infantum and may suggest the participation of these animals as hosts in the parasite's transmission cycle in the EPA. However, more comprehensive studies are needed to elucidate their role on the VL epidemiology in this area and also in different endemic areas, especially because these NHP are increasingly in contact with humans and domestic animals, particularly due to environmental changes. Univ Estadual Campinas, Dept Publ Hlth, Fac Med Sci, Campinas, SP, Brazil Adolfo Lutz Inst, Ctr Syst Parasit Dis, Sao Paulo, Brazil Adolfo Lutz Inst, Bauru Ctr Reg Labs 2, Bauru, Brazil Sao Paulo State Univ, Sch Vet Med & Anim Sci, Dept Vet Hyg & Publ Hlth, Botucatu, SP, Brazil Sao Paulo State Univ, Sch Vet Med & Anim Sci, Dept Vet Hyg & Publ Hlth, Botucatu, SP, Brazil FAPESP: 2014/27212-0 FAPESP: 2014/13049-0 FAPESP: 2016/02572-0

When it comes to visceral leishmaniasis (VL) in Brazil, one of the main targets of public health policies of surveillance is the control of domestic canine reservoirs ofLeishmania infantum. This paper aims to evaluate the effect of the household environment risk in the maintenance of natural foci and in the transmission to human and animal hosts in an endemic city for VL, Bauru, in Brazil. We collected 6,578 blood samples of dogs living in 3,916 households from Nov.2019 to Mar.2020 and applied geospatial models to predict the disease risk based on the canine population. We used Kernel density estimation, cluster analysis, geostatistics and Generalized Additive Models (GAM). To validate our models, we used cross-validation and created a ROC graph. We found an overall canine VL (CVL) prevalence of 5.6%. Odds ratios (OR) for CVL increased progressively according to the number of canines for >2 dogs (OR 2.70); households that already had CVL in the past increased the chances for CVL currently (OR 2.73); and the cases of CVL increase the chances for human VL cases (OR 1.16). Our models were statistically significant and demonstrated an association between the canine and human disease, mainly in VL foci that remain endemic. Although the Kernel ratio map had the best performance (AUC=82), all the models showed high risk in the city’s northwest area. Canine population dynamics must be considered in public policies and geospatial methods may help target priority areas and planning VL surveillance in low and middle-income countries.HighlightsTwo or more dogs in a household increase the chances for canine visceral leishmaniasis.Canine visceral leishmaniasis or households with positive dogs increase the chances for human visceral leishmaniasis.Households that already had an infected dog increase the chances for canine visceral leishmaniasis, and it can work as silent endemic areas.More than 40 dogs in an area of influence of household (100m buffer) increase the chances for canine and human visceral leishmaniasis.Canine population dynamics must be considered in public policies regarding visceral leishmaniasis control in low and middle-income countries.Spatial analysis tools can bring new insights into decision-making and public policies regarding visceral leishmaniasis.

Made available in DSpace on 2021-06-25T12:32:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-11 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Leishmaniasis is a public health problem worldwide. We aimed to predict ecological niche models (ENMs) for visceral (VL) and cutaneous (CL) leishmaniasis and the sand flies involved in the transmission of leishmaniasis in Sao Paulo, Brazil. Phlebotomine sand flies were collected between 1985 and 2015. ENMs were created for each sand fly species using Maximum Entropy Species Distribution Modeling software, and 20 climatic variables were determined. Nyssomyia intermedia (Lutz & Neiva, 1912) and Lutzomyia longipalpis (Lutz & Neiva, 1912), the primary vectors involved in CL and VL, displayed the highest suitability across the various regions, climates, and topographies. L. longipalpis was found in the border of Parana an area currently free of VL. The variables with the greatest impact were temperature seasonality, precipitation, and altitude. Co-presence of multiple sand fly species was observed in the cuestas and coastal areas along the border of Parana and in the western basalt areas along the border of Mato Grosso do Sul. Human CL and VL were found in 475 of 546 (86.7%) and 106 of 645 (16.4%) of municipalities, respectively. Niche overlap between N. intermedia and L. longipalpis was found with 9208 human cases of CL and 2952 cases of VL. ENMs demonstrated that each phlebotomine sand fly species has a unique geographic distribution pattern, and the occurrence of the primary vectors of CL and VL overlapped. These data can be used by public authorities to monitor the dispersion and expansion of CL and VL vectors in Sao Paulo state. Sch Vet Med, Dept Pathobiol Sci, Baton Rouge, LA USA Paulista State Univ Julio De Mesquita Filho, Geog Dept, Fac Sci & Technol, Presidente Prudente, SP, Brazil Oeste Paulista Univ, Dept Emergency, Fac Med, Presidente Prudente, SP, Brazil Adolfo Lutz Inst, Ctr Parasitol & Mycol, Syst Parasit Nucleus, Sao Paulo, SP, Brazil Paulista State Univ Julio De Mesquita Filho, Geog Dept, Fac Sci & Technol, Presidente Prudente, SP, Brazil FAPESP: 2014/12494-0

BACKGROUND Dogs are the main peridomiciliary reservoir of Leishmania infantum thus the correct diagnosis of infection is essential for the control of the transmission and treatment as well. However, the diagnosis is based on serological assays that are not fully effective. OBJECTIVE We aimed to establish an effective serological assay for the diagnosis of L. infantum infected dogs using Leishmania-derived recombinant antigens. METHODS Leishmania derived rK39-, rK28-, rKR95-based enzyme-linked immunosorbent assay (ELISA) was standardized using symptomatic and asymptomatic L. infantum-infected dogs. Then 2,530 samples from inquiry in endemic areas for VL were evaluated and the results compared with recommended assays by the Brazilian Ministry of Health (MH algorithm). Further samples from a cohort of 30 dogs were searched. FINDINGS For rK39-, rK28- and rKR95-ELISA the sensitivity was around 97% and specificity 100%. The positivity of these three ELISA in the inquiry samples was 27-28%, around 10% higher than the assays currently in use. When cohort samples were searched, we observed likely false-negative results (> 65%) with supposedly negative samples that turned positive six months later with the assays in use (MH algorithm). MAIN CONCLUSIONS For the diagnosis of L. infantum-infected dogs, rK39-based ELISA showed better diagnostic performance than other assays in use in Brazil and worldwide.

Made available in DSpace on 2022-04-29T08:32:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-08-01 When it comes to visceral leishmaniasis (VL) in Brazil, one of the main targets of public health policies of surveillance is the control of domestic canine reservoirs of Leishmania infantum. This paper aims to evaluate the effect of the dog population and household environment for the maintenance of natural foci in the transmission to human and animal hosts in an endemic city for VL, Bauru, in Brazil. We collected 6, 578 blood samples of dogs living in 3, 916 households from Nov.2019 to Mar.2020 and applied geospatial models to predict the disease risk based on the canine population. We used Kernel density estimation, cluster analysis, geostatistics, and Generalized Additive Models (GAM). To validate our models, we used cross-validation and created a receiver operating characteristic (ROC) curve. We found an overall canine VL (CVL) seroprevalence of 5.6% for the sampled dogs, while for the households, the positivity rate was 8.7%. Odds ratios (OR) for CVL increased progressively according to the number of canines for >2 dogs (OR 2.70); households that already had CVL in the past increased the chances for CVL currently (OR 2.73); and the cases of CVL increase the chances for human VL cases (OR 1.16). Our models were statistically significant and demonstrated a spatial association between canine and human disease cases, mainly in VL foci that remain endemic. Although the Kernel density ratio map had the best performance (AUC = 82), all the models showed high risk in the city's northwest area. Canine population dynamics must be considered in public policies, and geospatial methods may help target priority areas and planning VL surveillance in low and middle-income countries. Parasitology and Mycology Center Adolfo Lutz Institute (IAL) Sao Paulo Adolfo Lutz Institute Regional Laboratories Center II Bauru, Bauru Center for Zoonoses Control of Bauru Health Secretariat of Bauru Bioterium Nucleos Adolfo Lutz Institute (IAL) Sao Paulo Institute of Geography Federal University of Uberlándia, Uberlándia Department of Geography Sao Paulo State University Faculty of Sciences and Technology (FCT/UNESP) Presidente Prudente Department of Geography Sao Paulo State University Faculty of Sciences and Technology (FCT/UNESP) Presidente Prudente

Visceral leishmaniasis (VL) is an important zoonotic vector-borne disease and domestic dogs are considered the main domiciliary and peri-domiciliary reservoir of Leishmania (Leishmania) infantum in South America. Distinct eco-epidemiological scenarios associated to the prevalence of the disease, clusters of parasite genotypes and chemotypes of vectors population are described in Brazil, especially in the state of Sao Paulo (SP). In this context, the purpose of the present study is to evaluate the clinical signs, histopathological lesions, parasite load and cytokine profile by immunohistochemistry (IHC) in popliteal lymph nodes of canines naturally infected with L. infantum, from different municipalities of the state of SP. Eighty-three dogs with VL, 61 from northwest SP (NWSP) and 22 from southeast SP (SESP), were clinically classified in stage II, with no babesiosis and ehrlichiosis. Subcapsular inflammatory infiltration and histiocytosis were significantly higher in the SESP group (p = 0.0128; 0.0077, respectively). On the other hand, dogs from NWSP revealed 4.6-fold significantly higher parasite burden (p = 0.0004) and higher IHC scores of IL-1β (p = 0.0275) and IL-4 (p = 0.0327) in the popliteal lymph node tissues, which may be associated with the susceptibility and progression of the disease in these dogs. Differences in immune response profile associated with higher parasite load in dogs can also contribute to explain the distinct eco-epidemiological patterns of VL in specific geographic regions.

Made available in DSpace on 2020-12-12T02:43:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-06-05 Background: Visceral leishmaniasis is an important but neglected disease that is spreading and is highly lethal when left untreated. This study sought to measure the Leishmania infantum seroprevalence in dogs, the coverage of its control activities (identification of the canine reservoir by serological survey, dog culling and insecticide spraying) and to evaluate its relationship with the occurrence of the disease in humans in the municipalities of Araçatuba and Birigui, state of São Paulo, Brazil. Methods: Information from 2006 to 2015 was georeferenced for each municipality and modeling was performed for the two municipalities together. To do this, latent Gaussian Bayesian models with the incorporation of a spatio-temporal structure and Poisson distribution were used. The Besag-York-Mollie models were applied for random spatial effects, as also were autoregressive models of order 1 for random temporal effects. The modeling was performed using the INLA (Integrated Nested Laplace Approximations) deterministic approach, considering both the numbers of cases as well as the coverage paired year by year and lagged at one and two years. Results: Control activity coverage was observed to be generally low. The behavior of the temporal tendency in the human disease presented distinct patterns in the two municipalities, however, in both the tendency was to decline. The canine serological survey presented as a protective factor only in the two-year lag model. Conclusions: The canine serological coverage, even at low intensity, carried out jointly with the culling of the positive dogs, suggested a decreasing effect on the occurrence of the disease in humans, whose effects would be seen two years after it was carried out. Department of Epidemiology School of Public Health Universidade de São Paulo (USP), Avenida Doutor Arnaldo 715 Department of Animal Health and Production School of Veterinary Medicine Unesp Center for Parasitology and Mycology Instituto Adolfo Lutz Regional Service 9 Superintendência de Controle de Endemias Zoonosis Control Center MRC-PHE Centre for Environment and Health Department of Epidemiology and Biostatistics Imperial College, Norfolk Place Department of Animal Health and Production School of Veterinary Medicine Unesp

A leishmaniose visceral é uma doença emergente e negligenciada em processo de expansão para áreas urbanas. A incidência da doença humana está relacionada com a infecção canina. Araçatuba e Birigui são municípios do Estado de São Paulo, Brasil, com soroprevalência da infecção canina de 8 a 10%, que empregam estratégias de controle voltadas ao reservatório canino baseado em inquérito sorológico e eutanásia dos cães soropositivos. Usando dados desses programas de controle para parametrizar modelos matemáticos, este estudo avaliou a eficácia dessas atividades. Estimamos que o controle atualmente empregado é capaz de reduzir em cerca de 20% a incidência de casos de leishmaniose visceral canina (LVC). Considerando-se um controle contínuo e um esforço das atividades de inquérito sorológico igual ao triplo da média do observado em Araçatuba e Birigui, a atividade de eutanásia de cães com diagnóstico positivo seria efetiva para o controle da infecção canina. Embora teoricamente possível, na prática, o controle da LVC com as estratégias preconizadas atualmente é insuficiente, pois exigiria superpor dificuldades enfrentadas por estas atividades como falta de recursos materiais, humanos e financeiros, além das questões éticas e jurídicas associadas. Visceral leishmaniasis is an emerging and neglected disease that is currently expanding to urban areas. The incidence of human disease is related to canine infection. Araçatuba and Birigui are municipalities (counties) in the state of São Paulo, Brazil, with 8-10% seroprevalence of canine infection and that employ control strategies targeting the canine reservoir, based on serological survey and culling of seropositive dogs. Using data from these control programs to parameterize mathematical models, this study assessed the efficacy of these activities. We estimated that current control is capable of reducing the incidence of canine visceral leishmaniasis (CVL) by approximately 20%. Assuming continuous control and three times the current serological survey activities in Araçatuba and Birigui, culling dogs with a positive CVL diagnosis would be effective for the control of canine infection. Although theoretically possible, in practice the control of CVL with the currently recommended strategies is insufficient, since it would require overcoming the difficulties in these activities, such as lack of material, human, and financial resources, besides associated ethical and legal issues. La leishmaniasis visceral es una enfermedad emergente y pasada por alto en proceso de expansión hacia áreas urbanas. La incidencia de la enfermedad humana está relacionada con la infección canina. Araçatuba y Birigui son municipios del estado de São Paulo, Brasil, con una seroprevalencia de infección canina de un 8 a un 10% que emplean estrategias de control dirigidas al reservorio canino, basado en una encuesta serológica y eutanasia de los perros seropositivos. Usando datos de esos programas de control para proporcionar parámetros en modelos matemáticos, este estudio evaluó la eficacia de esas actividades. Estimamos que el control actualmente empleado es capaz de reducir cerca de un 20% la incidencia de casos de leishmaniasis visceral canina (LVC). Si se considera un control continuo y un esfuerzo de las actividades de encuesta serológica igual al triple de la media de lo observado en Araçatuba y Birigui, la actividad de eutanasia de perros con diagnóstico positivo sería efectiva para el control de la infección canina. A pesar de que teóricamente es posible, en la práctica el control de la LVC con las estrategias preconizadas actualmente es insuficiente, puesto que exigiría superar dificultades a las que se enfrentan estas actividades como la falta de recursos materiales, humanos y financieros, además de las cuestiones éticas y jurídicas asociadas.

Summary The identification of the parasite in cytological smears of lymph node aspirates is a widely applied technique for the direct diagnosis of Leishmania spp. infection, especially in endemic areas. Although very specific, this method has limited sensitivity, and improving the technique would be highly desirable. This study aimed to evaluate the efficacy of conventional smear cytology (SC), liquid-based cytology (LBC), cell block (CB) stained with haematoxylin and eosin (HE) and immunocytochemistry (ICC), and formalin-fixed paraffin wax-embedded tissue immunohistochemistry (FFPE–IHC) compared with serology and polymerase chain reaction for the diagnosis of canine visceral leishmaniosis (CVL) in lymphoid tissue. The use of a preservative medium and centrifugation for cytological samples reduced the number of unsatisfactory artefacts/background. Moreover, LBC allowed excellent cellular preservation and the application of ancillary techniques, such as CB and ICC. SC was the most accurate morphological diagnostic method (45.0%). CB–ICC alone or associated with SC demonstrated significantly higher sensitivity (70.0% and 72.0%, respectively) when compared with SC alone (34.00%). CB–ICC was found to be more effective in the detection of infected animals with mild clinical signs, similar to FFPE–IHC. The specificity and positive predictive value were similar between all methods. Finally, the detection limit for CB–ICC and SC + CB–ICC was identical (18.46 amastigotes/mm2). Our study suggests that CB–ICC is a promising tool for improvement of the cytopathological diagnosis of CVL and may be applied in routine epidemiological screening.

Visceral leishmaniasis is an emerging and neglected disease that is currently expanding to urban areas. The incidence of human disease is related to canine infection. Araçatuba and Birigui are municipalities (counties) in the state of São Paulo, Brazil, with 8-10% seroprevalence of canine infection and that employ control strategies targeting the canine reservoir, based on serological survey and culling of seropositive dogs. Using data from these control programs to parameterize mathematical models, this study assessed the efficacy of these activities. We estimated that current control is capable of reducing the incidence of canine visceral leishmaniasis (CVL) by approximately 20%. Assuming continuous control and three times the current serological survey activities in Araçatuba and Birigui, culling dogs with a positive CVL diagnosis would be effective for the control of canine infection. Although theoretically possible, in practice the control of CVL with the currently recommended strategies is insufficient, since it would require overcoming the difficulties in these activities, such as lack of material, human, and financial resources, besides associated ethical and legal issues.A leishmaniose visceral é uma doença emergente e negligenciada em processo de expansão para áreas urbanas. A incidência da doença humana está relacionada com a infecção canina. Araçatuba e Birigui são municípios do Estado de São Paulo, Brasil, com soroprevalência da infecção canina de 8 a 10%, que empregam estratégias de controle voltadas ao reservatório canino baseado em inquérito sorológico e eutanásia dos cães soropositivos. Usando dados desses programas de controle para parametrizar modelos matemáticos, este estudo avaliou a eficácia dessas atividades. Estimamos que o controle atualmente empregado é capaz de reduzir em cerca de 20% a incidência de casos de leishmaniose visceral canina (LVC). Considerando-se um controle contínuo e um esforço das atividades de inquérito sorológico igual ao triplo da média do observado em Araçatuba e Birigui, a atividade de eutanásia de cães com diagnóstico positivo seria efetiva para o controle da infecção canina. Embora teoricamente possível, na prática, o controle da LVC com as estratégias preconizadas atualmente é insuficiente, pois exigiria superpor dificuldades enfrentadas por estas atividades como falta de recursos materiais, humanos e financeiros, além das questões éticas e jurídicas associadas.La leishmaniasis visceral es una enfermedad emergente y pasada por alto en proceso de expansión hacia áreas urbanas. La incidencia de la enfermedad humana está relacionada con la infección canina. Araçatuba y Birigui son municipios del estado de São Paulo, Brasil, con una seroprevalencia de infección canina de un 8 a un 10% que emplean estrategias de control dirigidas al reservorio canino, basado en una encuesta serológica y eutanasia de los perros seropositivos. Usando datos de esos programas de control para proporcionar parámetros en modelos matemáticos, este estudio evaluó la eficacia de esas actividades. Estimamos que el control actualmente empleado es capaz de reducir cerca de un 20% la incidencia de casos de leishmaniasis visceral canina (LVC). Si se considera un control continuo y un esfuerzo de las actividades de encuesta serológica igual al triple de la media de lo observado en Araçatuba y Birigui, la actividad de eutanasia de perros con diagnóstico positivo sería efectiva para el control de la infección canina. A pesar de que teóricamente es posible, en la práctica el control de la LVC con las estrategias preconizadas actualmente es insuficiente, puesto que exigiría superar dificultades a las que se enfrentan estas actividades como la falta de recursos materiales, humanos y financieros, además de las cuestiones éticas y jurídicas asociadas.

Made available in DSpace on 2019-10-04T12:32:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01. Added 1 bitstream(s) on 2019-10-09T18:33:43Z : No. of bitstreams: 1 S0034-89102018000100275.pdf: 1044980 bytes, checksum: bb3c17f918e3d91041429010d5e6adf8 (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) OBJECTIVE: Estimate the coverage of control measures of visceral leishmaniasis and relate them with the occurrence of human visceral leishmaniasis in endemic urban area. METHODS: Cases of human and canine visceral leishmaniasis were considered as study population and evaluated by a serological survey conducted in Aracatuba, state Sao Paulo, from 2007 to 2015. The cases of human visceral leishmaniasis were geocoded by the address of the patients and the canine disease by the address of the dogs' owners. The coverage of serological survey, euthanasia, and insecticide spraying was calculated, as well as the canine seroprevalence and the incidence rates of human visceral leishmaniasis. The relationship between human visceral leishmaniasis and control measures was evaluated, as well as the seroprevalence by comparing maps and by linear regression. The relationship between the canine and the human disease was also evaluated by the Ripley's K function. RESULTS: The incidence rates of human visceral leishmaniasis showed a period of decline (2007 to 2009) and a period of stability (2010 to 2015), a behavior similar to that of canine seroprevalence. In general, the coverage of control measures was low, and the non-association with the incidence of human visceral leishmaniasis can be a result of the period analyzed and of the small number of analyzed units (sectors of the Superintendence for the Control of Endemic Diseases). The distribution of human cases showed spatial dependence with the distribution of seropositive dogs from 2007 to 2009. CONCLUSIONS: This study reaffirmed the relationship between the occurrence of the disease in humans and dogs, it verified a decrease in the rates of visceral leishmaniasis in Aracatuba over time, even at low coverage of control activities. However, further studies are needed to determine if factors beyond monitoring and control measures are involved in the reduction of incidences. Univ Sao Paulo, Fac Saude Publ, Programa Posgrad Saude Publ, Sao Paulo, SP, Brazil Superintendencia Controle Endemias, Serv Reg 9, Aracatuba, SP, Brazil Univ Estadual Paulista, Fac Med Vet Aracatuba, Dept Apoio Prod & Saude Anim, Lab Bioquim & Biol Mol, Aracatuba, SP, Brazil Adolfo Lutz Inst, Nucleo Parasitoses Sistem, Sao Paulo, SP, Brazil Prefeitura Municipal Aracatuba, Secretaria Municipal Saude, Ctr Controle Zoonoses, Aracatuba, SP, Brazil Fundacao Oswaldo Cruz, Programa Comp Cient, Rio De Janeiro, RJ, Brazil Univ Sao Paulo, Fac Saude Publ, Dept Epidemiol, Ave Doutor Arnaldo 715, BR-01246904 Sao Paulo, SP, Brazil Univ Estadual Paulista, Fac Med Vet Aracatuba, Dept Apoio Prod & Saude Anim, Lab Bioquim & Biol Mol, Aracatuba, SP, Brazil FAPESP: 2014/06518-4 FAPESP: 2014/177646

Made available in DSpace on 2018-12-11T17:22:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-07-31 Background: The incidence of visceral leishmaniasis (VL), one of the most important neglected diseases worldwide, is increasing in Brazil. The objectives of this study were to determine the canine VL (CanL) seroprevalence in an urban area of Araçatuba municipality and to evaluate its relationship with the characteristics of dogs and their owners. Results: The CanL seroprevalence in the study area was 0.081 (95% credible interval [CI]: 0.068-0.096). The following covariates/categories were positively associated with the occurrence of a seropositive dog: more than 10 dogs that had lived in the house (odds ratio [OR]=2.36; 95% CI: 1.03-5.43) (baseline: 0-10 dogs); house with dogs that previously died of VL (OR=4.85; 95% CI: 2.65-8.86) or died of causes other than old age (OR=2.26; 95% CI: 1.12-4.46) (baseline: natural or no deaths); dogs that spent the day in a sheltered backyard (OR=2.14; 95% CI: 1.05-4.40); dogs that spent the day in an unsheltered backyard or the street (OR=2.67; 95% CI: 1.28-5.57) (baseline: inside home). Spatial dependence among observations occurred within about 45.7m. Conclusions: The number of dogs that had lived in the house, previous deaths by VL or other cause, and the place the dog stayed during the day were associated with the occurrence of a VL seropositive dog. The short-distance spatial dependence could be related to the vector characteristics, producing a local neighbourhood VL transmission pattern. The geostatistical approach in a Bayesian context using integrated nested Laplace approximation (INLA) allowed to identify the covariates associated with VL, including its spatially dependent transmission pattern. USP Programa de Pós-graduação em Saúde Pública Faculdade de Saúde Pública, Avenida Doutor Arnaldo 715 Imperial College MRC-PHE Centre for Environment and Health Department of Epidemiology and Biostatistics, St. Mary's Campus, Norfolk Place Serviço Regional 9 Superintendência de Controle de Endemias, Rua Minas Gerais, 135 Unesp Laboratório de Bioquimica e Biologia Molecular Departamento de Apoio Producao e Saude Animal Faculdade de Medicina Veterinária de Araçatuba, Rua Clóvis Pestana 793 Núcleo de Parasitoses Sistêmicas Instituto Adolfo Lutz, Av. Doutor Arnaldo 355, 8o. Andar Cento de Laboratório Regional I Araçatuba Instituto Adolfo Lutz, R. Minas Gerais 135 Centro de Controle de Zoonozes, Rua Doutor Luiz de Almeida 145 Fundação Oswaldo Cruz Programa de Computação Científica, Avenida Brasil 4365, Antiga Residência Oficial Universidade de São Paulo (USP) Departamento de Epidemiologia Faculdade de Saúde Pública, Avenida Doutor Arnaldo 715 Unesp Laboratório de Bioquimica e Biologia Molecular Departamento de Apoio Producao e Saude Animal Faculdade de Medicina Veterinária de Araçatuba, Rua Clóvis Pestana 793

There is a growing concern about the participation of wild hosts and reservoirs in the epidemiology of leishmaniasis, particularly within the context of increasingly frequent environmental changes and the expansion of the One Health concept. This work is a molecular research of infection by Leishmania spp. among the wildlife of an environmentally protected area located in the municipality of Campinas, São Paulo, Brazil. The studied area has a history of intense environmental changes, with notifications of human cases of cutaneous leishmaniasis in the 1990s, and a focus of canine visceral leishmaniasis since 2009. Eighty-two wild mammals were sampled by monthly captures in this region over a 1-year period. Blood samples were collected from each animal and subjected to DNA extraction and PCR using primers for the region of the internal transcribed spacer-1. The results of gene sequencing for the first time revealed the infection of opossums (Didelphis albiventris) by Leishmania spp., subgenera Leishmania and Viannia, in Campinas. These findings, in addition to environmental and historical characteristics of the studied area, indicate a possible role of wildlife in the introduction and/or maintenance of natural foci of leishmaniasis transmission.

The objective of this study was to determine the efficacy of a modified Shannon trap to capture adult insects that are involved in cadaveric decomposition processes. The Shannon trap proposed here is composed of a thin fabric tent with a top formed by a transparent bottle containing a compartment filled with alcohol gel on which the captured insects are affixed. The trap was effective both for weather resistance and the quantity, quality and diversity of insects caught.

Made available in DSpace on 2018-12-11T17:23:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-07-30 This study was based on the need to employ a sensitive and specific method with samples that could be easily collected for diagnosing dogs infected with Leishmania infantum. To this end, we used real time-PCR (qPCR) to assess the value of the oral swab (OS) in detecting infected sick dogs (SD; n = 62), including, for the first time, the analysis of apparently healthy infected dogs (AD; n = 30), both from endemic areas for visceral leishmaniasis (VL). For comparison, we also evaluated the performance of the conjunctival swab (CS), blood (BL), lymph node (LN) and serology. We detected the presence of Leishmania DNA in the oral cavity in 62 out of the 92 dogs studied. The OS positivity (67.4%) was equivalent to the CS (68.5%) (p > 0.05), higher than BL (52.2%) (p ≤ 0.05), and lower than LN (84.8%) (p ≤ 0.05). OS and CS performed well in SD dogs (82.3% and 83.9%, respectively) but not in AD dogs (36.7% for both samples). BL showed the lowest positivity (52.2%) and provided equivalent results between AD (60.0%) and SD (48.4%) dogs (p > 0.05). LN yielded the highest positivity (84.8%), and it was also higher in the SD population (93.5%) compared to the AD population (66.7%) (p ≤ 0.05). Parasite load was high in LN, moderate in OS and CS, and low in BL, showing the relationship between the levels of parasitism and the positivity rates found in these samples. Serology was positive in 82.2% of the SD group and in 70% of the AD dogs (p > 0.05). Among the 20 seronegative dogs, seven (35%) were positive in either OS or CS, and 12 (60%) were positive when both noninvasive samples were jointly considered. The OS/CS combination resulted in a significant increase of positivity (p ≤ 0.05) for the AD dogs (from 36.7% to 63.4%), as well as OS/serology (80%) and OS/CS/serology (83.4%). For the SD population, positivity reached up to 95.2% with the same combinations, showing that combination of samples and/or tests is required for the identification of dogs infected with L. infantum and that the OS and CS combination based on qPCR notably improves the detection of both AD and SD dogs.In conclusion, OS proved to be a suitable sample for the molecular diagnosis of infected dogs with clinical signs of VL, but not for dogs with inapparent infection. For these, we recommend the combination of OS results with CS and/or serology in order to reach relevant positivity for L. infantum. Finally, another advantage of using OS or both noninvasive samples is the increased likelihood of diagnosing seronegative dogs. Laboratory of Pathology of Infectious Diseases (LIM50) Medical School University of São Paulo Department of Clinics Veterinary School UNESP Adolfo Lutz Institute Center of Parasitology and Micology Department of Clinics Veterinary School UNESP

Two cases of Leishmania (Leishmania) amazonensis are reported in the domestic dog (Canis familiaris). These are the first records of this parasite in this species. The animals lived in the endemic visceral leishmaniasis area of Araçatuba, São Paulo State, Brazil and were initially diagnosed, on clinical grounds, as having visceral leishmaniasis. Attempted parasite isolation from inguinal lymph node aspirates was unsuccessful and the indirect immunofluorescent test for visceral leishmaniasis was negative in both cases. Parasites were seen in cytological preparations of their lymph nodes and the DNA obtained from these same tissues produced the expected fragment in a Leishmania specific rDNA based PCR assay. The products only hybridized with the L. (L.) amazonensis specific probe S8. No human cases of L. (L.) amazonensis have been reported in this region. These results suggest that L. (L.) amazonensis is being transmitted in the peridomestic habitat and that this parasite is responsible for a clinical condition that is similar to visceral leishmaniasis caused by L. (L.) i. chagasi that is present in the same area.

Made available in DSpace on 2015-12-07T15:39:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-10-26. Added 1 bitstream(s) on 2015-12-07T15:54:27Z : No. of bitstreams: 1 PMC4623279.pdf: 1867186 bytes, checksum: daadf56a08c9c9ff488c19f7e5396c51 (MD5) Visceral leishmaniasis is an emerging zoonosis and its geographic distribution is restricted to tropical and temperate regions. Most of the individuals infected in Latin America are in Brazil. Despite the control measures that have been adopted, the disease is spreading throughout new regions of the country. Domestic dogs are involved in the transmission cycle and are considered to be the main epidemiologic reservoir of Leishmania infantum (syn. L. chagasi). Our aim was to determine the prevalence of canine leishmaniasis (CL) and Ehrlichiosis infection in Presidente Prudente as well as the spatial dispersion of the disease in the western region of São Paulo state. Dogs underwent clinical examination and symptoms related to CL were recorded. Anti- Leishmania antibodies were detected using ELISA, rK39-immunocromatographic tests (DPP), and an indirect fluorescent antibody test (IFAT). Anti-E. canis antibodies were detected by IFAT. A follow-up was conducted in dogs that were positive in the ELISA at the baseline study. Data on the spatial distribution of L. longipalpis and CL in São Paulo state were obtained from Brazilian public health agencies. Serum samples from 4547 dogs were analyzed. The seroprevalence of CL was 11.2 % by ELISA and 4.5 % by IFAT. In the follow-up, seroprevalence was 32.9 % by ELISA, 15.3 % by IFAT, 11.8 % by DPP test, and 66.5 % for E. canis. There was a significant positive association between Leishmania and E. canis infection (P

Cadaverous entomofauna successions vary according to the region, environment, and climate, and such differences may occur within the same country due to seasonal variations. The present study aimed to analyze and compare the dipterofauna that visit or colonize carcasses in the urban and coastal areas of São Paulo, Brazil, during summer and winter seasons. Four swine (Sus scrofaLinné, 1758) carcasses of approximately 12 kg were used. The animals were previously euthanized and then placed in metal cages covered with a flight intercept trap (Shannon, modified). In total, 10,495 flies from 39 families were collected, with 15 species belonging to the Calliphoridae family, 14 species belonging to the Fanniidae family, 43 species belonging to the Muscidae family, and 22 species belonging to the Sarcophagidae family. Flies from these four families visited all carcasses; however, they did not show the highest visitation frequencies in all of the trials. Species variations occurred between the experiments that were performed at different locations and in different seasons. Furthermore, difference in the number of insects attracted to each stage of decomposition was observed. In addition to the four families highlighted above, the families Phoridae, Sepsidae, Otitidae, and Piophilidae were observed in all carcasses.

Background Leishmaniasis is a rapidly expanding zoonosis that shows increasing urbanization. Concern exists regarding the role of wildlife in visceral leishmaniasis (VL) transmission, due to frequent natural or anthropogenic environmental changes that facilitate contact between wildlife, humans and their pets. The municipality of Campinas, in southeastern Brazil, initially recorded VL in 2009, when the first autochthonous case was confirmed in a dog living in an upscale residential condominium, located inside an environmentally protected area (EPA). Since then, disease transmission remains restricted to dogs inhabiting two geographically contiguous condominiums within the EPA. Methodology/Principal findings We conducted a cross-sectional study of the VL focus to investigate Leishmania spp. infection in domestic dogs, wild mammals and sand flies using molecular tools and recommended serological techniques. Canine seroprevalences of 1.5% and 1.2% were observed in 2013 and 2015, respectively. Six insect species, confirmed or suspected vectors or potential transmitters of Leishmania, were identified. Two specimens of the main L. (L.) infantum vector in Brazil, Lutzomyia longipalpis, were captured in the EPA. Natural infection by L. (L.) infantum was recorded in one Expapillata firmatoi specimen and two Pintomyia monticola. Natural infection by L. (L.) infantum and Leishmania subgenus Viannia was also detected in two white-eared opossums (Didelphis albiventris), a known reservoir of VL. Geographical coordinates of each sampling of infected animals were plotted on a map of the EPA, demonstrating proximity between these animals, human residences, including the dogs positive for VL, and forest areas. Conclusions/Significance The EPA, which is inhabited by humans, has an active VL focus. The risk of establishing and maintaining disease transmission foci in similar scenarios, i.e. wild areas that undergo environmental modifications, is evident. Moreover, different epidemiological profiles of VL must be included to elaborate prevention and control measures that consider the particularities of each transmission area., Author summary Leishmaniasis are neglected tropical diseases that represent a major public health problem in the world. New outbreaks have been recorded in the outskirts of some cities and phlebotomine vectors show geographic expansion, potentially associated with environmental and climate changes. We investigated a recent focus of visceral leishmaniasis (VL) in dogs from two residential condominiums located in an environmentally protected area in the municipality of Campinas, São Paulo, southeastern Brazil. The purpose of the study was to investigate Leishmania (L.) infantum infection, the etiological agent of the disease, in vector insects (phlebotominae), domestic (dog) and wild hosts. Antibody prevalence was determined in 1.5% and 1.2% of dogs examined in 2013 and 2015, respectively. In addition, natural infection by the VL agent was confirmed in two species of sand flies and two white-eared opossums. All positive animals were captured near human residences and in forest areas. Scenarios like these, with changes in ecosystems and the proximity of wild and domestic animals and humans, can promote the occurrence of zoonoses. The participation of wildlife in the transmission cycle of zoonoses has assumed greater importance in recent years as a result of the consolidation of the One Health concept.

Development of vaccines against canine visceral leishmaniasis (CVL) may provide a prophylactic barrier, but antibody response detected by standard diagnostic techniques may not separate vaccinated from naturally infected dogs. Moreover, anti-Leishmania antibody levels in vaccinated dogs may be detectable for months. Accordingly, the aim of the present study was to comparatively evaluate an "in-house" ELISA with three serological tests officially adopted by the Brazilian Ministry of Health for the diagnosis of CVL in dogs vaccinated with Leishmune(®). A total of 18 mongrel dogs were submitted to a complete protocol of the vaccine, monitored and evaluated in 5 times (T0-T4) up to 180 days after T0. Twenty-one days after the first dose (T1), 50% of the dogs were seropositive by the "in-house" ELISA and 5.5% by IFAT, while by the official ELISA and DPP(®) CVL rapid test all dogs tested negative. At time T2, 42 days after of the first dose, 100%, 83.3%, 11.1%, and 5.5% of the dogs were seropositive by the "in-house" ELISA, IFAT, official ELISA kit and the DPP(®) CVL rapid test, respectively. Ninety days after the first dose (T3), 100%, 83.3%, 72.2% and 33.3% of the dogs were seropositive by the "in-house" ELISA, official ELISA kit, IFAT, and the DPP(®) CVL rapid test, respectively. Finally, at time T4, 88.8%, 33.3%, 11.1% and 5.5% of the dogs were seropositive by the "in-house" ELISA, official ELISA kit, DPP(®) CVL rapid test and IFAT, respectively. In conclusion, dogs vaccinated with Leishmune(®) cross-react by an "in-house" ELISA and by the three official Brazilian serological tests for the diagnosis of canine visceral leishmaniasis up to six months after the first vaccine dose, and may be mistakenly diagnosed and removed.

Phlebotomine sand flies are medically important insects, responsible for the transmission of Leishmania parasites between humans and non-human animals, which are found throughout São Paulo state, Brazil. The correct identification of species implicated in the transmission of diseases is paramount to elaborate strategies for vector control. In order to produce an illustrated key to the 67 sand flies male species and 57 female species recorded in São Paulo state we examined and illustrated specimens mounted in microscope slides from entomological collections. Flebotomíneos são insetos de importância médica, responsáveis pela transmissão de parasitas do gênero Leishmania entre humanos e animais não humanos, os quais são encontrados no estado de São Paulo, Brasil. A correta identificação das espécies envolvidas na transmissão de doenças é fundamental para elaboração de estratégias para o controle desses vetores. Para produzir uma chave ilustrada para as 67 espécies de machos e 57 espécies de fêmeas de flebotomíneos registradas no estado de São Paulo, examinamos e ilustramos espécimes montados em lâminas de microscopia obtidos de coleções entomológicas.

Immune reconstitution inflammatory syndromes (IRISs) have been reported in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (AIDS) since the introduction of highly active antiretroviral therapy (HAART). This syndrome is characterized by clinical manifestations of opportunistic infections when signs of immune reconstitution are observed during therapy. We report on leishmaniasis suggestive of HAART-induced IRIS in 2 patients with AIDS. After beginning HAART 1 patient presented with disseminated tegumentary lesions whereas the other patients preexisting lesions worsened and became more extensive; however at the same time their CD4+ T cell counts were recovering and their virus loads were decreasing significantly. The lesions healed with anti-Leishmania therapy. (authors)

Determination of the rate of Trypanosoma cruzi infection in its triatomine vectors is an element in control programmes directed at reducing transmission of the organism to humans. Traditionally, T. cruzi has been detected in these insects by microscopical examination of intestinal contents or excreta. The sensitivity of this laborious process has not been defined because of the lack of a bench-mark method against which microscopical examination could be compared. The purpose of this study was to compare the sensitivity of a polymerase chain reaction (PCR) assay with that of microscopical examination for detecting T. cruzi in Triatoma infestans nymphs that had fed on patients with chronic Chagas disease. To this end, we analysed 54 pairs of samples, each containing 2 groups of 10 insects, obtained by feedings on 19 patients with chronic T. cruzi infection, 17 of whom were fed upon 3 times. One group of insects in each pair was analysed by PCR and the other by microscopical examination of excreta. Overall, the PCR assay gave positive results in 32 of 54 groups of insects examined (59%), whereas only 7 of 54 groups (13%) were positive by microscopical examination (P = 0.038). These results demonstrate that the PCR assay is significantly more sensitive for the detection of T. cruzi in triatomine vectors than is microscopical examination, and suggest that the PCR assay could be a useful tool in epizootiological studies.

Toxoplasmose e uma infeccao zoonotica humana de alta prevalencia, causada por um protozoario Apicomplexa, Toxoplasma gondii. A evolucao da doenca aguda e geralmente leve ou assintomatica, exceto nas infeccoes agudas das gestantes, quando a infeccao fetal causa uma doenca devastadora. Para determinar se haveriam fatores de risco regionais, foi analisada a frequencia de titulos de anticorpos anti-T.gondii em areas na regiao Metropolitana de Sao Paulo, comparando grupos etarios. Esta frequencia de soronegatividade foi determinada retrospectivamente em 1286 gestantes que procuraram os servicos publicos para exames pre-natais da regiao metropolitana de Sao Paulo, usando um teste de imunofluorescencia indireta para IgG anti-T. gondii, em quatro areas selecionadas, com infraestrutura e condicoes sociais semelhantes. A area da cidade de Sao Paulo apresentou a maior frequencia de soronegatividade (41,1%), seguida pelas areas Noroeste (31,5%) e Sudoeste(29,9%), com niveis intermediarios semelhantes, e a area Nordeste (22,5%), com a menor frequencia (p

Alguns pesquisadores demonstraram que o intraconzol, "in vitro" e na infecção aguda de animais, possui atividade antiparasitária referente ao Trypanosoma cruzi. Diante dessas observações, decidimos empreender estudo sobre e etapa crônica da parasitose devida a esse protozoário, considerando que ela é mais proeminente sob o ponto de vista médico-assistencial. A propósito, efetuamos apreciações baseadas em modelo composto por camundongos infectados e, também, relacionadas com indivíduos acometidos de doença de Chagas. Usamos 100 mg/kg/dia, por meio de sonda gástrica, durante três meses, e 100 ou 200 mg/dia, pela via oral, respectivamente, no decurso de igual período, sem evidenciarmos efeitos benéficos, pelo menos conforme a metodologia adotada Other authors have demonstrated that itraconazole has antiparasitic activity against Trypanosoma cruzi both in vitro and in animal acute infection. Because of these observations, we decided to evaluate the chronic phase of this protozoal disease, since it is the most important form under a clinical and assistential point of view. We studied an infected mouse model as well as human cases of Chagas' disease. One hundred mg/ kg/day by gastric tube, and 100 or 200 mg/day orally were given, respectively, during three months, without showing any beneficial effect, at least with the adopted methods

Foi avaliado, comparativamente, o desempenho de fêmeas e machos de Triatoma infestans, em 5º estádio de desenvolvimento, em xenodiagnósticospara a tripanossomiase americana. Estes exames foram realizados em 40 pacientes, em fase crônica da doença de Chagas. Em cada exame utilizou-se 20 ninfas fêmeas e 20 ninfas machos, que foram pesadas imediatamente antes e após o repasto. O exame individual do conteúdo intestinal dos triatomíneos foi efetuado aos 20, 30, 60 e 90 dias após a aplicação dos xenodiagnósticos. As ninfas fêmeas e machos, ingeriram, em média, 230 e210 mg de sangue, respectivamente. Os resultados revelaram 15 (37,5%) xenodiagnósticos positivos; todavia, em nenhum destes exames foi verificada positivação, para T. cruzi, de todas as ninfas utilizadas. As ninfas fêmeas ingeriram significativamente mais sangue que as ninfas machos, isto vem de encontro com as observações de maior positividade, para T. cruzi entre as fêmeas, sugerindo, serem estas ninfas capazes de possibilitar maior incremento à sensibilidade do xenodiagnóstico na fase crônica da doença de Chagas, sendo necessários novos estudos para confirmação desta hipótese.We evaluated, comparatively, the performance of female and male Triatoma infestans in the 5º instar of development, in xenodiagnosis for Chagas 'disease. Xenodiagnosis were done in 40 patients with chronic infectans. For each diagnosis 20 nymphs female and 20 nymphs males were used, which were weighed immediately before and after the meal. Intestinal contents were examined about 20, 30, 60 and 90 days after the xenodiagnosis application. The females and males ingested the mean of 230 and 210 mg of blood, respectively. The results revealed positivity of 15 (37.5%) out 40 xenodiagnosis, but any of the positive tests show 100% of the nymphs, female and/or male infected by T. cruzi. The females ingested significantly more blood than the males; this is coincidental with the higher female positivation to T. cruzi here observed. Our results suggest that the female nymphs seem able to increase the sensibility of the xenodiagnosis for chronic patients with Chagas 'disease being necessary further studies are necessary to confirm this hypothesis.

In October, 1986, 7 to 22 days after a meeting at a farm in Paraíba state, 26 individuals presented with a febrile illness associated with bilateral eyelid and lower limb edema, mild hepatosplenomegaly, lymphadenopathy and, occasionally a skin rash. A 11-year-old boy exhibited atrial premature complexes and a 74-year-old patient developed acute heart failure. In two patients hospitalized in São Paulo city, acute Chagas' disease was diagnosed by the demonstration of circulating Trypanosoma cruzi. At autopsy in a fatal case, acute Chagas' cardiomyopathy was demonstrated. Xenodiagnosis were positive in 9 out of 14 tested patients. A specific IgG immune response was found in all patients and specific IgM antibodies were identified in 20 out of 22 tested patients. A epidemiological survey showed the existence of Triatoma brasiliensis in the outbuildings of this farm, but none in the house where most of the guests stayed. A high rate of infection with Trypanosoma cruzi was found in opossums. These observations together with those related to the food consumed by the patients, lead the authors to suggest that the human infections resulted from oral contamination probably originating from naturally infected marsupials in the area or crushed infected bugs.

Descreve-se uma investigação epidemiológica realizada em zona urbana do município de São Paulo, Brasil, para esclarecer um caso de leishmaniose visceral ocorrido em criança de 2 anos de idade, nascida e sempre residente no local. Afastou-se a possibilidade de transmissão por via transfusional e por vetor biológico, tendo como base os dados levantados da anamnese do doente, os resultados de inquéritos realizados na área em população humana, utilizando testes de imunofluorescência indireta, hemaglutinação passiva e intradermoreação de Montenegro, em população canina com o teste de imunofluorescência indireta, além de pesquisa entomológica em mata residual. An epidemiological investigation was made in the urban zone of S. Paulo, Brazil, to elucidate a case of visceral leishmaniasis that occurred in a two-year old child, born and always resident in that place. The possibility of congenital transmission was eliminated. The transmission by blood transfusion and biological vector was discussed on the basis of the past history of the child and the results of a serological survery in human population with indirect imunofluorescence, passive hemagglutination and leishmanin tests, serological survey on dogs and furthermore entomological research in residual forest situated in the neighbourhood of the patient's house.