[Longitudinal radiologic study of the esophagus, in an endemic area of Chagas disease, in a period of 13 years]

A radiological study of the oesophagus of a cohort of patients was carried during a 13 year period in the municipality of Mambaí Goiás. Barium swallow findings were recorded on 70mm film using a portable machine. Of 731 patients examined 382 (52.3%) were seropositive for T. cruzi. The sexes were equally divided. The incidence of detectable megaoesophagus was 7.9% among the cohort and 14.2% in the seropositive individuals. Progression of the disease was noted during this longitudinal study in 21.7% of males and 16.6% of females.

Chagas' disease

Chagas' disease is one of the most important public health problems in South America and Mexico. Migrations from rural areas into urban zones have contributed to the spread of the disease. The main targets of the disease within the body are the heart, the alimentary tract, and the nervous system. In the acute phase of the disease, the parasite responsible for the disease can be identified in the blood by direct examination. This article identifies the parasite responsible for transmission of the disease and discusses symptoms, means of identification in the patient, and treatment.

Doença de chagas aguda em mulher de 80 anos no México. Relato anatomopatológico

Mulher de 80 anos de idade, com doença de Chagas aguda diagnosticada à necrópsia, adquirida, provavelmente, através de triatomíneos no município de Zacoelo de Torres, no Estado de Jalisco, México. Assinala-se a raridade do encontro de casos de doença de Chagas agudo, na faixa etária da paciente. O exame anatomopatológico mostrou comprometimento do coração, esôfago e intestino grosso. Encontrou-se lesões no sistema nervoso autônomo intramural do esôfago e do intestino grosso, sendo estes achados de interesse, por ocorrer em área geográfica onde os megas tem sido pouco relatados.

[Acute Chagas' disease in an 80-year-old woman in Mexico. An anatomicopathological report]

A case of acute Chagas' disease, diagnosed by necropsy, in a 80-year-old woman, is reported. It is assumed that infection was acquired through triatomine bite in Zacoelo de Torres, Jalisco State, Mexico. There were lesions due to Aoffican trypanosomiasis in the heart, esophagus and bowel. Autonomic nervous lesions were detected in the esophagus and bowel. It is emphasized the importance of these findings in an area where few cases of megas were reported.

[Mefloquine chemoprophylaxis of malaria in the Brazilian Amazonia]

In a randomised double-blind study 122 volunteers living in an endemic malarious area in Amazonian Rondônia state were divided into 4 groups to study malaria suppression. . The first group received 500 mg of mefloquine every month, group II 250 mg every two weeks, group III a tablet of Fansidar (500 mg sulphadoxine + 25mg pyrimethamine) a week and group IV placebo. Acute attacks of malaria occurred in one individual in group I, 2 subject in group II, and 6 individuals in groups III and IV. Protection with mefloquine was significant compared with the placebo group. Both treatment regimens with mefloquine were effective suppressants in an area of high prevalence of drug multiresistant Plasmodium falciparum transmission.

[A longitudinal radiologic study of the esophagus in an endemic area of Chagas' disease over a 6-year period]

A longitudinal study over six years was undertaken of 494 residents of the municipality of Mambaí, Goiás. Two hundred and twelve (43%) were seropositive in 1975/76 and 199 of 464 of the same patients group, positive in 1980/82 (42.8%). At both examination single radiographs of the oesophagus were obtained immediately after ingestion of 75 ml of barium sulphate solution and a second X-ray taken one minute later. Among the 201 seropositive patients without megaesophagus in the first study 4 (2%) evolved megaesophagus during the six years of observation. During this time, using Rezende's classification, patients with established megaesophagus, changed their group in the following manner. Only one Group I patient changed to group II. Only one group II patient progressed to group IV. Progress of megaesophagus in the affected patients occurred in 2.8% of 212 patients. Also four patients with grade I megaesophagus initially had a normal oesophagogram on the follow up examination. Ten patients had doubtful oesophagogram initially and six on follow up, 75% of these patients were seropositive. This study could indicate that a doubtful oesophagogram is an early sign of megaoesophagus.

Fulminant hepatitis with microvesicular steatosis (a histologic comparison of cases occurring in Brazil--Labrea hepatitis--and in central Africa--Bangui hepatitis)

A similar histopathologic picture of fatal hepatitis associated with widespread acute fatty changes in hepatocytes and single-cell necrosis was seen in epidemic cases occurring in two distinct equatorial areas having high prevalences of HBV and HDV infections. The cases were previously considered to be two different entities; Labrea hepatitis in Brazil, and Bangui hepatitis in the Central African Republic. However, the histopathologic findings suggest that they are pathogenetically and etiologically related to HBV and HDV infections, probably modified by some as yet unknown factor(s) present in equatorial forest zones.

Phagocytic and bactericidal function of mouse macrophages to Salmonella typhimurium in schistosomiasis mansoni

Patients infected with schistosomes may develop a clinical picture of chronic salmonellosis. We have investigated the altered function of macrophages capable of playing a role in the development of chronic salmonellosis associated with Schistosoma mansoni in an experimental model. The capacity of mouse peritoneal macrophages to ingest and kill Salmonella was assessed in mice infected with S. mansoni with or without concurrent Salmonella typhimurium infection. Schistosomiasis was associated with a significant decrease in the phagocytic index of macrophages, due to the reduced number of cells engaged in phagocytosis. However, the number of bacteria ingested by these cells was comparable to that of the control group. The bactericidal capacity of macrophages from S. mansoni-infected mice was also significantly lower than that of cells from normal mice. Macrophages from animals infected only with Salmonella typhimurium showed an increased phagocytic capacity. It was concluded that S. mansoni infection alters phagocytosis and intracellular destruction of salmonellae. This demonstration of a novel mechanism of survival of salmonellae represents a step forward in understanding the pathogenesis and management of chronic septicemic salmonellosis.

Influence of the host related factors in the development of the hepatosplenic form of schistosomiasis mansoni

The frequency of hepatosplenomegaly in endemic areas is not proportional to the fecal ova count. This may be explained by epidemiological genetic. The occurrence of two or more cases of schistosomal hepatosplenomegaly in nuclear family is much higher than expected. The concentration is higher among siblings than it is among mothers and children of father and children. It is not significant between father and mother. If the mother, instead of the father, has hepatosplenic schistosomiasis the relative risk for the child to acquire hepatosplenomegaly is at least five times (the maternal affect). The inbreeding is higher in the hepatosplenic than in the hepato-intestinal patients. In some areas in Brazil the hepatosplenic form of the schistosomiasis mansoni occurs with much higher frequency in whites than in blacks. After treatment, reversion of hepatosplenic schistosomiasis occurs more frequently in non-whites. It seems that the resistance of blacks to the hepatosplenic form of schistosomiasis may be related to the glyoxalase system, perhaps associated to another genetic marker. The hepatosplenic schistosomiasis is less frequent in longilineal individuals. In some areas the hepatosplenic form of schistosomiasis is more frequent in A blood group of ABO system. The family heredograms do not suggest a single mendelian inheritance, but probably a multifactorial and possibly polygenic one.

Evidence for an association between human resistance to Schistosoma mansoni and high anti-larval IgE levels

The anti-larval IgE antibody response of adolescents with high or low resistance to infection by Schistosoma mansoni was evaluated before parasitological cure with oxamniquine and over an extended post-treatment period during which the least resistant subjects regained high infections. IgE from most sera, taken at several bleeding times before and after treatment, reacted, on immunoblots, with a large number of antigens (Ag) in schistosomular tegument extract. A family of 120-165-kDa cross-reacting molecules and a 85-kDa Ag were the most prominent Ag. Some of these determinants were shown to be located on the outer tegumental membrane and to be accessible to IgE on living larvae. The comparison of IgE between the two study groups showed that IgE levels were on average six-to eightfold higher (p less than 0.01) in the sera of the most resistant adolescents whereas there was no difference in patterns of Ag recognition between study groups. In contrast to IgE, anti-larval IgG and IgM levels were either similar in both groups or higher in the least resistant subjects when these exhibited high reinfection levels. IgG that competed for the binding of IgE to larval Ag were detected in most sera and their levels were higher in the least resistant group after reinfection. Finally, the treatment had no observable long-lasting effects on the levels and on the specificity of the anti-larval IgE. Altogether, these observations can be taken as evidence supporting a role of IgE in human resistance to infection by S. mansoni.

Evidence for the segregation of a major gene in human susceptibility/resistance to infection by Schistosoma mansoni

Severe clinical disease caused by the major human parasite Schistosoma mansoni is the consequence of high and prolonged infections. Epidemiological studies indicate that, for individuals having frequent contacts with cercaria-infested waters, both infection intensities and reinfection after treatment depend, in large part, on their intrinsic susceptibility/resistance to infection, suggesting the role of genetic factors in human resistance to S. mansoni. To investigate whether a major gene controls human susceptibility/resistance to infection by S. mansoni, segregation analysis of infection intensities, adjusted for the factors relevant in schistosomiasis (water contact, age, sex), was performed on 20 Brazilian pedigrees (269 individuals), using both the unified mixed model and the regressive model of analysis. The results are consistent with the hypothesis that there is a codominant major gene controlling human susceptibility/resistance to infection by S. mansoni. Parameter estimates indicate a frequency of .20-.25 for the deleterious allele; thus, about 5% of the population is predisposed to high infections, 60% is resistant, and 35% has an intermediate, although fairly good, level of resistance. These findings provide a genetic basis for earlier observations on the lower resistance and the predisposition to reinfection of certain individuals. In addition to the detection of a major gene effect, the data suggest that immunity to S. mansoni develops progressively during childhood to reach a maximum around the age of puberty. The implications of these results for the strategy to be used in endemic areas to reduce morbidity and to control parasite transmission are discussed.

Specific treatment of hepatosplenic schistosomiasis can increase T-lymphocyte reactivity

It has been recognized that Schistosoma mansoni infection causes depression of T-cell responsiveness. In this study we have evaluated whether immunodepression associated to schistosomiasis could be reverted by specific treatment. T-cell immune response was assessed by means of intradermal tests using recall antigens in a group of 22 patients with hepatosplenic schistosomiasis, one year after treatment with oxamniquine and compared with a group of untreated hepatosplenic patients. Only 27% of treated patients presented complete anergy to all tested antigens, in marked contrast to 80% unresponsiveness showed by hepatosplenic patients without treatment. Although most of the treated individuals showed some response to the tested antigens, in some individuals this unresponsiveness still persisted after treatment. Anergy was not found in any normal individual of the control group. It was concluded that Schistosoma mansoni infected patients may recover their normal immune responsiveness after the elimination of the worm by treatment.

[Schistosomiasis--infection and race of carriers]

The geometric average (parasitical charge) of the eggs of Schistosoma mansoni quantified by Kato-Katz method in five parasitological fecal exams of 868 individuals, was correlated to sex, age and racial groups. The higher averages were observed in females from 6 to 15 years old and in black individuals--the analysis of variation showed, however, more significant effect of age and of sex. However, when the average results were translated, qualitatively into positives and negatives no sexual differences were observed and only the individuals under 5 years old were significantly more negative than those over 6 years old. Nevertheless, in these age brackets the white individuals were mostly negative, and in the sample group they reach statistic significance (X2(2) = 20.76 p 0.0001)--with the following percentage of negatives: whites--26.8%; mulatos--16.3% and negroes--9.1%. These results reinforce the hypothesis, among other predisponent factors of Schistosomiasis--infection, of the effect of the social-economical level in the Brazilian black population.

T cell-dependent immunodepression in vivo in Schistosoma mansoni infected patients

T-cell function was evaluated in 29 patients with either hepatointestinal or hepatosplenic schistosomiasis by intradermal tests to recall antigens. Immunodepression was detected in 26% of the subjects with hepatointestinal schistosomiasis and in 50% of those with the hepatosplenic form. Cellular immunodepression was related to worm load and spleen size. This non specific T-cell immunodepression may represent a serious constraint to the elimination of intracellular pathogens both in hepatosplenic or hepatointestinal schistosomiasis.

[Hepatosplenic form of schistosomiasis mansoni, in relation to race and socioeconomic level, in Catolândia-Bahia]

Of 1,125 individuals, residents in an area where mansonic schistosomiasis is hyperendemic, were studied regarding the clinical forms correlated to the racial groups (indian mestizo, white, light mullato, medium mullato, dark mullato and negro) and to their socio-economic level according to a set of 16 variables. The white individuals (10.5%) showed a significantly higher incidence of the hepatosplenic forms; in the other racial groups there were similar frequencies, altogether 3.6%. Those with hepatosplenomegaly had a higher socio-economic level and when they also belonged to the white race the relative risk (2.78) was significantly higher.

Effects of immigration on the prevalence of malaria in rural areas of the Amazon basin of Brazil

Epidemiological studies were conducted on malaria in three rural areas of the Amazon basin in the State of Rondônia: the town of Costa Marques, Forte Principe da Beira (Fort), and an immigrant settlement in the nearby forest. These studies were instituted to document the malaria problem and to describe the role of immigration on its distribution and prevalence. Hospital records in the town show that the number of malaria cases increased five fold from 1983 to 1987 and that the predominant malaria parasite changed from Plasmodium vivax to P. falciparum. Increased malaria followed increased immigration and colonization of the forest. A series of epidemiologic studies suggested the linkage between malaria and immigration as the prevalence of malaria was 1-2% at the Fort, a stable community, 8-9% at Costa Marques, a growing community, and 14-26% in the new settlements in the forest.

Algorithm for computation of Zernike polynomials expansion coefficients

A numerically efficient algorithm for expanding a function in a series of Zernike polynomials is presented. The algorithm evaluates the expansion coefficients through the standard 2-D integration formula derived from the Zernike polynomials' orthogonal properties. Quadratic approximations are used along with the function to be expanded to eliminate the computational problems associated with integrating the oscillatory behavior of the Zernike polynomials. This yields a procedure that is both fast and numerically accurate. Comparisons are made between the proposed scheme and a procedure using a nested 2-D Simpson's integration rule. The results show that typically at least a fourfold improvement in computational speed can be expected in practical use.

[Inbreeding coefficient in carriers of Schistosoma mansoni]

The coefficient of inbreeding (for Wright) was studied in Catolândia, in the state of Bahia, Brazil, an area considered hyperendemic for manson schistosomiasis in a population of 1,130 inhabitants. The coefficient of inbreeding was estimated for 1,123 individuals it was classified as f greater than 0 in 13.2% (n = 148). In the hepatosplenic group the frequency of f greater than 0 was 26.8%, and in the hepatointestinal group the frequency was 12.5%. The frequency of the hepatosplenic diagnosis in whites who were f = 0 did not differ from that which was observed in the negroid group. These verifications were confirmed by the Woolf's test; the relative risk of the whites, f greater than 0 in acquiring hepatosplenic schistosomiasis was 14.1. These observations reinforce the influence of the genetic component in the development of the hepatosplenic form of the mansons schistosomiasis.

Family occurrence of schistosomal hepatosplenomegaly and maternal effect

In this paper we present a study of members of 265 nuclear families, aged six or more. This study is based of family heredograms, and takes into account the clinical form of schistosomiasis observed before treatment with oxamniquine. The probability of occurrence of two or more cases of hepatosplenomegaly is low, notwithstanding the fact that it was observed in 38 families. Even less frequent is the occurrence of three or more cases observed in 17 families (P = 0.002). The concentration of the hepatosplenic form was higher among siblings than it was among mothers and children, or fathers and children. It was found to be not significant between husband (father) and wife (mother). These observations reinforce the evidence for the presence of a genetic component in susceptibility to the hepatosplenic form of the disease. In cases in which the mother was hepatosplenic there was a higher incidence of hepatosplenic children; the relative risk was a least five times higher than in those in which the father was the affected member (the maternal effect). In cases where both members were affected by the hepatointestinal form, the risk to the filial generation was similar to that of the population in general. Thus, in the process towards severe forms of schistosomiasis mansoni, pre and post natal factors might be involved.

[Treatment of 75 patients with malaria caused by Plasmodium falciparum, in Porto Velho (Rondonia), with mefloquine]

Foi avaliada a resposta terapêutica em 75 doentes com malária pelo P. falciparum, em Porto Velho - Rondônia, tratados com mefloquina nas doses de 1250, 1000 e 750 mg. Não houve diferença significante nos resultados obtidos nos três grupos. Até o terceiro dia de tratamento, a febre desapareceu em 76,0% dos casos. A parasitemia negativou-se em 68,0% dos pacientes nos 3 primeiros dias após o inicio do tratamento, em 24,0% no quarto dia e em 5,3% no quinto.Havia um doente positivo no sexto dia e outro no sétimo. Nenhum paciente apresentou trofozoito no período de seguimento de 7 a 28 dias. Não houve modificações do quadro hematológico, exceto por um incremento da taxa de reticulócitos em 76,0%. As alterações bioquímicas registradas no seguimento dos doentes constaram de elevação da desidrogenase lática (28,0%) e, dafosfatase alcalina (41,3%). As reações colaterais foram discretas e infreqüentes; em 72,0% dos tratados não se constatou nenhum efeito secundário. Não se verificou nenhum caso de recidiva. A mefloquina revelou-se eficaz e bem tolerada no tratamento da malária no Estado de Rondônia.

[Biometric data on adult patients with schistosomiasis, Bahia (Brazil)]

De dezessete indivíduos esquistossomóticos, hepatosplênicos, pareados com outros dezessete controles, hepatointestinais, da mesma região, foram aferidas 17 medidas antropométricas. Todas as pessoas tinham de 21 a 50 anos de idade. Esta e outros critérios foram previamente estabelecidos como fatores de pareamente, de inclusão e exclusão no estudo. Porém, não se observou diferenças estatísticas entre as médias dos dois grupos de pacientes.

[Regression of the hepatosplenic form of schistosomiasis, after specific treatment, associated with race]

A forma hepatosplênica, da esquistossomose mansônica, é reconhecidamente mais freqüente em indivíduos brancos. Essa forma clínica pode sofrer regressão após terapêutica específica. Isso ocorreu em dois indivíduos brancos (8,3%) dos 24 analisados e em dez (47,6%) dos 21 não-brancos; essa diferença foi altamente significante (X²1 = 8,84 p< 0,005).

Human resistance to Schistosoma mansoni is associated with IgG reactivity to a 37-kDa larval surface antigen

The aim of this work was to determine whether human resistance to Schistosoma mansoni was associated with increased antibody reactivity to certain larval surface Ag. To this end, young residents of a hyperendemic area were selected for their low or high susceptibility to reinfection after parasitologic cure, and the reactivity of their sera to individual larval surface Ag was determined at different times before and after treatment. The data showed that six Ag: 202, 165, 90 to 92, 85, 72, and 37 kDa are the principal targets on the larva of IgG in the sera of resistant subjects. The comparative study, by immunoblotting and ELISA on purified Ag, of the sera from high and low susceptibility subjects indicates that IgG reactivity toward the 37-kDa Ag may be associated with resistance. This work and ongoing vaccination trials carried out in mice suggest that the 37-kDa Ag may have vaccinating potentials.

Human resistance to Schistosoma mansoni is associated with IgG reactivity to a 37-kDa larval surface antigen

The aim of this work was to determine whether human resistance to Schistosoma mansoni was associated with increased antibody reactivity to certain larval surface Ag. To this end, young residents of a hyperendemic area were selected for their low or high susceptibility to reinfection after parasitologic cure, and the reactivity of their sera to individual larval surface Ag was determined at different times before and after treatment. The data showed that six Ag: 202, 165, 90 to 92, 85, 72, and 37 kDa are the principal targets on the larva of IgG in the sera of resistant subjects. The comparative study, by immunoblotting and ELISA on purified Ag, of the sera from high and low susceptibility subjects indicates that IgG reactivity toward the 37-kDa Ag may be associated with resistance. This work and ongoing vaccination trials carried out in mice suggest that the 37-kDa Ag may have vaccinating potentials.

Infrequency of asymptomatic malaria in an endemic area in Amazonas, Brazil

A malaria survey was conducted in an area of high transmission (Costa Marques, Rondonia, Brazil) to determine the prevalence of asymptomatic parasitemia and its clinical significance. Most of the people surveyed were immigrants who had lived in the endemic area < 5 years. The people had easy access to free diagnostic and treatment services at the Malaria Clinic in the town of Costa Marques. The prevalence of plasmodial parasitemia in 344 people was 22%. There were 36 individuals with asymptomatic infections among the 77 parasitemic patients. During the two days following the initial examination, 19 ofthe 36 individuals: with asymptomatic infections developed malaria. Among the 17 patients who remained asymptomatic for > 2 days, 4 had only gametocytes, 1 had taken inadequate anti-malarial treatment, 3 were under treatment and 2 moved. Six asymptomatic patients denied the use of anti-malarial drugs and they developed malaria 3-6 days after the initial parasitological diagnosis. The final patient remained asymptomatic during the 7 day observation period. He had a history of > 40 malaria attacks and denied the use of antimalarial treatment. With the exception of the latter all of the other asymptomatic patients, were either in the incubation period or had been treated It is concluded that asymptomatic malaria is rare in the Costa Marques area and that it is necessary to treat all individuals with plasmodial parasitemia.

[Echocardiography in schistosomal pulmonary hypertension]

Realizou-se estudo ecocardiográfico em 16 pacientes esquistossomóticos, 11 dos quais tinham hipertensão pulmonar comprovada por cateterismo cardíaco. Em sete casos havia hipertensão pulmonar ao ecocardiograma, embora em um deles os níveis de pressão fossem normais.

[Prevalence of Chagas esophagopathy in the municipality of Mambaí, Goiás-Brazil]

Em Mambaí, área endêmica de doença de Chagas, foram realizadas abreugrafias do esôfago com filme de 70mm, em 1.145 indivíduos do sexo masculino e 1.184 dofeminino, de 4 a 87 anos, dos quais 1.006eram soropositivos. Os pacientes foram posicionados em oblíqua anterior direita e tomadas duas abreugrafias: uma imediatamente à ingestão de 75 ml de suspensão baritada e outra 60 segundos após. Setenta e seis (3,2%) indivíduos apresentaram esofagopatia, sendo que 71(7%) entre os 1.006 soropositivos e, 5(0,37%) entre os 1.323 soronegativos. Dos 76 esofagopatas 47(61,8%) eram do sexo masculino e 29(38,1%) do sexo feminino. Segundo a classificação de Rezende e cols 48(63,1%) pertenciam ao grupo I, 18(23,7%) ao grupo II, 5(6,6%) ao grupo III e 5(6,6%) ao grupo IV. Entre os infectados a esofagopatia aumentou progressivamente com a idade, principalmente a partir dos 30 anos, alcançando a prevalência de 21,5% após os 59 anos.

[Control of transmission of Chagas disease in Mambai-Goias, Brazil (1982-1984)]

A aplicação de inseticidas em Mambaí-GO, desde 1980, está determinando uma diminuição progressiva inicial de Triatoma infestans no intradomicilio, mas não a sua eliminação. A infestação triatominica foi detectada através de diversos métodos de vigilância imediata (transversal) e a longo prazo (longitudinal), com a colaboração dos próprios moradores. No primeiro ano de controle foi observada uma queda signiflcante de 28,6 % a 13,5%, mas devido a uma falha no programa de expurgos, em 1981, esta cifra voltou a elevar-se (23,2%). A continuidade desses expurgos nos anos seguintes resultou em um declínio gradual, atingindo em 1984 o nível de 14,2%. Simultaneamente a percentagem intradomiciliar de T. sórdida tendeu a aumentar, embora a infecção tripanossômica tenha sido sempre mínima. O conjunto destes achados sugerem que o controle do T. infestans com o uso exclusivo de inseticidas (BHC e Deltametrina) é difícil e oneroso. Precisando-se, portanto, o uso de medidas supletivas integradas aos sistemas de controle de doença de Chagas, que encorajam a participação ativa das comunidades afligidas, estimuladas mediante programas educativos.

[Low effectiveness of an oxamniquine and praziquantel combination in the therapy of schistosomiasis mansoni]

Em uma área endêmica onde havia interrupção da transmissão, foram tratados 164 esquistossomóticos com a associação oxamniquine e praziquantel em doses reduzidas. Cada indivíduo tomou de uma só vez uma cápsula de 250mg de oxamniquine e um comprimido de 300mg de praziquantel, ingeridos na nossa presença. As doses de oxamniquine variaram de 3,5 a 16,6mg/kg de peso corporal e as de praziquantel de 4,2 a 20mg. O controle de cura constou de oito exames parasitológicos de fezes de cada paciente, pelo método de Kato-Katz, num período de 6 meses. Os índices de cura variaram de 30% a 56,6%. A percentagem total de cura foi de 39,6%. A tolerância à associação foi boa. Nossos resultados mostraram baixo percentual de cura e aparente ausência de sinergismo da associação oxamniquine epraziquantel em doses reduzidas no tratamento da esquistossomose mansônica no Brasil.

[Persistent schistosomal pulmonary hypertension in a patient after reversion of a hepato-splenic form: presentation of a case]

Os autores relatam o caso de um paciente masculino, de 24 anos, hépato-esplênico e com hipertensão pulmonar esquistossomótica (pressão média na artéria pulmonar de 27,5mm HG). Tratado com oxamniquine. Após 11 anos o exame mostrou reversão à hépato-intestinal, com persistência da hipertensão pulmonar, diagnosticada pelo cateterismo cardíaco (pressão média na artéria pulmonar de 20mm Hg) e ecocardiografia.

Rate of reversion of hepatosplenic schistosomiasis after specific therapy

Seventy patients with hepatosplenic schistosomiasis were treated with oxamniquine. The patients lived iti an endemic area and were evaluated 6, 18 and 24 months after treatment, during which time transmission in the area was interrupted. After treatment, clinical improvement occurred in 49 (70%) of the patients, as seen by reduction in visceromegaly and reversion of liver nodules. Reversion of hepatosplenic disease occurred in 28 (40%) patients and in liver nodularity in 26 (47.3%)patients after 24 months. Reversion of hepatosplenic disease was seen in 12 (21%) patients and liver nodules disappeared in 4 (8.5%) as early as 6 months after treatment. In general, hepatosplenomegaly reverses earlier than liver nodularity. Itis notable that reversion of hepatosplenic disease occurred in many individuals with a history ofprevious treatment and also in some with advanced age. In four cases this clinical form of the disease had existed for 20 years. Therefore, there must exist factors other than age and duration of the condition which determine the reversibility of this clinical form. Ourresults reinforce the concept that, in patients with hepatosplenic disease without esophageal hemorrhages, specific treatment shouldpreceed surgical intervention even in those with a history of previous treatment. At least 18 months should be allowed for the ejfects of treatment to be manifest.

[Characteristics of unexpected sudden death in Chagas disease]

Trinta e cinco indivíduos falecidos subitamente e de modo inesperado foram necropsiados em Serviços Médico-Legais em Uberaba e Uberlândia. A sorologia do líquido pericárdico e os achados anatomopatológicos estabeleceram o diagnóstico de doença de Chagas. Todos, exceto dois, eram do sexo masculino e tinham idade média de 38 anos. Resolvemos fazer uma investigação retrospectiva procurando obter de familiares e amigos e nos registros médicos informações sobre as circunstâncias do óbito e manifestações que pudessem constituir possíveis indícios de doença cardíaca e de comprometimento de outros órgãos. Em 31,2% não havia quaisquer sintomas ou suspeita de cardiopatia. Contudo, em 57,1% dos casos conseguimos detectar história de tonturas (42,8%), dispnéia de esforço (48%), perda de consciência (34,2%) e palpitações (31,4%). A disfagia e ou a obstipação estavam presentes em 38%. Não houve correlação entre a sintomatologia e a intensidade da miocardite. Em 56% o êxito letal surgiu enquanto desenvolviam esforço físico ou tinham emoção. Pelo modo como ocorreu o óbito pode-se concluir que a iminência deste não foi pressentida pelo paciente ou circunstantes em 43,8% dos casos; no restante, o óbito súbito foi precedido de indícios, tais como gestos, pedidos de ajuda, etc. Somente em 5 dos 35 casos o eletrocardiograma havia sido realizado meses ou anos antes do óbito: todos apresentavam alterações.

[Cold lymphocytotoxins in schistosomiasis mansoni]

The serum of 134 patients infected with Schistosoma mansoni, including both acute and chronic forms of the disease, were tested for the presence of cold lymphocytotoxins. These were found in 4.5% of acute forms of the disease, in 88.4% of chronic infections and in only 9.8% of the uninfected control group (blood donors). An analysis of the results suggests a probable role for cold lymphocytotoxins in the immune response of the different phases of human schistosomiasis.

A field study of proteinuria in individuals infected with Schistosoma mansoni

Proteinuria was detected in 24.7% of 89 individuals with hepatosplenic schistosomiasis and in only 4.6% of 86 subjects with mild hepato-intestinal schistosomiasis, all of them living in comparable conditions in two endemic areas in Bahia, Brazil. From nine individuals who hadproteinuria over30 mg/100ml, eight had hepatosplenic schistosomiasis. These findings maybe related to the presence of schistosomal nephropathy and reveal the significance of this condition in thefield in endemic areas of schistosomiasis.

Estudo da coagulação em um caso de hepatite de lábrea

Um caso de hepatite de Lábrea nos possibilitou um estudo do comportamento dos fatores da coagulação nessa doença. O objetivo principal foi estudar a coagulação do sangue, visando: 1. conhecer os níveis dos fatores da coagulação na Febre Negra; 2. contribuir para o melhor conhecimento da doença, principalmente no que se refere às manifestações de hemorragia; 3. tentar correlacionar a gravidade do quadro clínico e prognóstico à intensidade das alterações dos fatores da coagulação. Os resultados evidenciaram uma alteração acentuada da crase sangüínea, sugerindo que, além do quadro infeccioso, o paciente desenvolveu, igualmente, uma síndrome de coagulação intravascular disseminada.

Human antibody response to Schistosoma mansoni surface antigens defined by protective monoclonal antibodies

The antibody response to a 38,000-dalton schistosomular surface antigen, defined by a rat protective monoclonal antibody and specific for Schistosoma species, has been studied in a group of 125 Brazilian patients with schistosomiasis. Antibodies binding this particular antigen were detected in 97% of patient serum samples, a result suggesting that it could represent a potent immunogen. Quantitative studies of the amount of isolated antigens were performed in relation to the age of patients. Results showed a maximal response in the second decade of life and correlated with previous observations on the prevalence and intensity of schistosomiasis. However, in the present study no relationship was shown between the binding capacity of sera and the number of schistosomal eggs in individual patients. These data suggest that the antibody response to the 38,000-dalton schistosomular antigen could be a marker of infection by schistosomes.