Real-time PCR for diagnosis and follow-up of Toxoplasma reactivation after allogeneic stem cell transplantation using fluorescence resonance energy transfer hybridization probes

Toxoplasma reactivation is a life-threatening complication of allogeneic stem cell transplantation. A poor prognosis is probably linked to a difficult diagnosis, based on the detection of evidence of parasites in tissue. We developed a real-time PCR test using fluorescence resonance energy transfer hybridization probes to detect and quantify Toxoplasma gondii DNA in serum. This PCR test gave reproducible quantitative results over a dynamic range of from 0.75 x 10(6) to 0.75 parasites per PCR mixture. Serial samples from four patients with toxoplasma reactivation were evaluated. Three patients had several consecutive PCR-positive samples which corresponded to </=0.75 parasites. These three patients became PCR negative during trimethoprim-sulfamethoxazole therapy but never developed clinically apparent toxoplasmosis. In contrast, one patient had an increasing PCR signal, from 1 to 396 parasites in 12 days, and developed cerebral symptoms. The parasite count decreased to 5 parasites in 3 days after pyrimethamine-clindamycin treatment. Real-time quantitative PCR is useful for diagnosis and follow-up of toxoplasma reactivation.

Three year seroepidemiological study of varicella-zoster virus in São Paulo, Brazil

A serosurvey of varicella has been carried out in children attending the public school network of São Paulo city, Brazil, from 1992 to 1994. This study was performed in order to establish the age related prevalence of antibodies against varicella-zoster virus (VZV) and its age specific transmission dynamics pattern in these children. Among 2500 schools in the city of São Paulo public network, 304 were randomly selected; 7 children of a given age (ranging from 1 to 15 years) were randomly selected in each school, and blood samples were obtained by fingerprick into filter paper. Blood eluates were analyzed for the presence of antibodies to VZV by ELISA. Proportion of seropositivity were calculated for each age group. Samples consisted of 1768 individuals in 1992, 1758 in 1993, and 1817 in 1994, resulting in 5343 eluates. A high proportion of seropositive children from 1 to 3 years of age was observed, ascending until 10 years of age and reaching a plateau around 90% afterwards. VZV transmission in this community was similar along the three years of the study. In children attending public schools in the city of São Paulo, contact with VZV occurs in early childhood. If immunization against VZV is considered it should be introduced as soon as possible.

Fast and efficient mutation detection method using multiplex PCR and cycle sequencing--application to haemophilia B

A method using multiplex PCR followed by cycle-sequencing has been developed to detect mutations in the FIX gene. The procedure was evaluated in 45 severe or mild haemophilia B patients from 45 unrelated families. At least one deleterious mutation was identified in every haemophiliac demonstrating the efficiency of the method. Furthermore the described procedure offers many advantages compared to other screening detection methods: it is fast (less than 48 h), simple (partly automated) and of relatively low cost (it requires only one PCR).

[Phlebotominae (Diptera: Psychodidae) of Lagoas, a city of Buriticupu, Amazonia of Maranhão. I. The richness and relative abundance of the species in an area of recent colonization]

In this study the diversity of the species and relative abundance of the sand flies in the Amazonian community of Lagoas, in Buriticupu, Maranhão State, was determined. The study consisted of adult sandflies captured with CD light-traps, Shannon-trap and manual aspiration tube, between 18 PM and 6 AM, once a month, from December/95 to January/97, in a forest fragment and in the domestic environment (peri and intra). In all, 9,393 specimens were captured (4,302 males and 5,140 females) distributed among 38 species (1 Brumptomyia and 37 Lutzomyia). The diversity and abundance of species was higher in the forest, followed by the peri and intra. The predominance in the wild ambient is a consequence of the potentialities found in the remaining fragments of the forest which have survived the lumber yard exploitation and agricultural activities. In the forest environment Lutzomyia whitmani (64.9%), L. migonei (27%) and L. serrana (3.6%) were the most frequent species. In the peri and intra domicile L. evandroi predominated (55.4% and 97.9%). The species, L. whitmani (33.4%) and L. migonei (6.4%), were important in the peri domicile. The peridomestic habit of 7.7% of the sand flies showed the greatest epidemiologic importance, due to the existence of patients with leishmaniasis ulcers, who believe they were infected near their habitations.

[Sandflies (Diptera, Psychodidae) from an endemic leishmaniasis area in the cerrado region of the State of Maranhão, Brazil]

This article presents a list of ten sandfly species from the genus Lutzomyia França, 1924 found in the counties of Aldeias Altas, Capinzal do Norte, Caxias, Codó, Coelho Neto, Timbiras, Timon and Tuntum in northeastern Maranhão, Brazil. Presence of sandflies was associated with cases of visceral and cutaneous leishmaniasis. Some 377 specimens were captured indoors with CDC light traps and 1491 specimens in the peridomicile. The species were: Lutzomyia cortelezii, Lutzomyia evandroi, Lutzomyia goiana, Lutzomyia intermedia, Lutzomyia lenti, Lutzomyia longipalpis, Lutzomyia longipennis, Lutzomyia squamiventris, Lutzomyia termitophila and Lutzomyia whitmani. The most abundant species was L. longipalpis (67. 4% and 70.2%) followed by L. whitmani (31.0% and 24.7%). L. longipalpis was captured both indoors and outdoors in all the months studied.

[Distribution of Aedes aegypti and dengue in the State of Maranhão, Brazil]

Dengue and Aedes aegypti are widespread in the State of Maranhão. During 1995, 87 of the 136 of the State's counties, including 176 towns and 480,687 households, were studied, of which 30 counties (34. 4%), 118 towns (67.0%) and 10,357 households (2.1%) were positive for Aedes aegypti. The positive counties are distributed as follow: 3 on São Luís Island, 7 in the Amazonia of Maranhão, 12 in the southern zone of the cerrados or savannas, and 5 in the mixed forest/savanna/palm grove zone. One positive county for Ae. aegypti was located in each of the following: alluvial fields, forest/palm grove, and sand dune/shoals areas. The Ae. aegypti-positive household rates were higher in the Amazonia of Maranhão (3.5%) and on São Luís Island (2.5%), because they are the most heavily traveled migratory and trade routes between Maranhão and neighboring states and are also the State's main economic centers. Household infestation rates for Ae. aegypti and reported dengue case rates were higher during the rainy season, showing the importance of rain in forming prime breeding sites for Aedes and spreading dengue.

An unusual presentation of paracoccidioidomycosis in an AIDS patient: a case report

A case of paracoccidioidomycosis presenting as a solitary pulmonary nodular lesion in a patient with acquired immunodeficiency syndrome (AIDS) is presented. This case illustrates that restricted lung lesions can also be found and diagnosed in immunodeficient patients.

Neuroradiological practices in Europe: Working ESNR Committee on Neuroradiological Practices in Neuroradiology. European Society of Neuroradiology

In order to achieve an overview of neuroradiology in Europe a questionnaire was sent to all ESNR National Delegates. The answers received were submitted to a data-based analysis, leading to the conclusion that neuroradiology is an expanding discipline among neurological sciences.

Comparison of serum galactomannan antigen detection and competitive polymerase chain reaction for diagnosing invasive aspergillosis

To improve the diagnosis of invasive aspergillosis (IA), we retrospectively compared competitive polymerase chain reaction (PCR) and sandwich ELISA for detection of serum galactomannan (GM) antigen. We studied 281 serum samples collected weekly during the period at risk for IA from 41 selected hematology patients. Twenty-two patients had confirmed, probable, or suspected IA, according to clinical and mycologic data. Fifteen of them had positive GM titers (87 samples) and 12 had positive PCRs (20 samples). Nineteen of the 20 PCR-positive samples were also GM-positive. Of the 19 patients without IA (83 samples), one had 3 GM-false-positive samples. Neither test anticipated the initiation of antifungal therapy on the basis of clinical suspicion. Both tests were more likely to be positive before death. This study suggests that PCR on serum samples is not more sensitive than GM detection. However, PCR can improve the specificity of the GM test. Together, these noninvasive tests should improve the diagnosis of IA.

[Comparative study of American tegumentary leishmaniasis between childhood and teenagers from the endemic areas Buriticupu, Maranhao and Corte de Pedra, Bahia, Brazil]

A comparative study on children aged 0-15 years, with American tegumentary leishmaniasis (ATL), in the endemic regions of Buriticupu (MA) and Corte de Pedra (BA), whereby 214 cases were detected between 1982 and 1993, 78 (36.4%) of them originated from Corte de Pedra and 136 (63.6%) from Buriticupu. In Corte de Pedra, most cases were observed in patients aged between 0-5 years. Twenty nine (37.2%) cases; 62% of those were male. In the Buriticupu region, 88 (64.7%) cases occurred in patients of 11-15 years of age, where in 73.8% consisted of male. In both researched regions, brunetts were predominant, with a ratio of 65.4% in Corte de Pedra and 75% in Buriticupu. Twenty six (33.3%) children in the village of Corte de Pedra were farmers, predominantly male (57.7%), generating statistical significance (chi 2 = 11.21). Twenty one (80.8%) farmers were aged 11-15 years. Thirty seven and a half per cent of the children from Buriticupu were students, however, 41 (30.2%) were farmers, representing 39 (44.3%) cases; all of them male. Both in Buriticupu and Corte de Pedra, the unique wound was predominant, corresponding to 57.7% and 53.7%, respectively. The wounding time stood out from one to three months, with 45 (69.2%) cases in Corte de Pedra and 73 (61%) in Buriticupu (chi 2 = 11.82). As to the wound locations, it has been observed that they were most constantly present on the lower limbs, with 77.2% in Corte de Pedra and 58.9% in Buriticupu (chi 2 = 27.9). The cutaneous case mostly found in Corte de Pedra was the ulcerous one (91%). IDRM was positive in 61 (78.2%) children originated from Corte de Pedra, wherein no statistical difference was detected between age ratio and positivity of the test (chi 2 = 0.0669).

[Tumor form of encephalic schistosomiasis: presentation of a case surgically treated]

The involvement of the central nervous system in the Schistosomiasis mansoni is uncommon and in the literature exist few reports in relation this occurrence in the brain, in that the schistosoma eggs, usually promote a granulomatous reaction that remember an expansive tumour. A patient, male sex, from São Vicente de Ferrer (MA), 27 years old, had a tumour in the cerebellum, that had surgical therapy. Later histological studies of the cerebellar material of the patient, demonstrated an extensive granulomatous reaction around schistosoma eggs. The granulomatous reaction present different stages of evolution, since degenerative necrosis to organization granulomatous reaction. This is the first report from Maranhão (Brazil). The evolution of the patient was characterized for incoordination of members and trembling.

Myotonic dystrophy protein kinase gene expression in skeletal muscle from congenitally affected infants

Myotonic dystrophy (DM) is an autosomal dominant neuromuscular disorder characterized by marked variability of its clinical manifestations. The mutational basis of DM is an unstable (CTG)n trinucleotide repeat in the 3' untranslated region of the myotonic dystrophy protein kinase gene (DMPK). We used quantitative RT-PCR to determine DMPK mRNA levels in muscular biopsies from three congenitally affected (CDM) and two control infants. The CDM infants had increased DMPK mRNA levels, which were not correlated to increased expression of the mutant allele. This increase may be the consequence of a maturational muscular arrest, which may maintain an elevated level of DMPK mRNA until birth.

EcbI and EcbR: homologs of LuxI and LuxR affecting antibiotic and exoenzyme production by Erwinia carotovora subsp. betavasculorum

Erwinia carotovora subsp. betavasculorum Ecb168 causes vascular necrosis and root rot of sugar beet and produces an antibiotic(s) that is antagonistic against other Erwinia spp. EcbI- mutants of Ecb168, each containing a single transposon insertion in the ecbI gene (for Erwinia carotovora subsp. betavasculorum inducer), do not produce detectable levels of extracellular protease or antibiotic(s), and express less pectate lyase activity and virulence than the wild-type strain. A plasmid containing the cloned ecbI gene complemented the EcbI- mutants for these phenotypes. Protease production by EcbI- mutants grown on agar surfaces was restored by neighboring cells of Escherichia coli containing ecbI. Production of a diffusible N-acylhomoserine lactone autoinducer by wild-type Ecb168 was detected with indicator strains of E. coli and Agrobacterium tumefaciens. EcbI- mutant strains did not produce an autoinducer detected by the indicator strains. Antibiotic production by EcbI- mutants was restored by cell-free culture supernatants of Ecb168 or E. coli containing a cloned ecbI gene. The predicted amino acid sequence of EcbI is similar to those of CarI, ExpI, and HsII, three LuxI homologs required for production of a diffusible N-acylhomoserine lactone autoinducer in Erwinia carotovora subsp. carotovora. A luxR homolog, termed ecbR (for Erwinia carotovora subsp. betavasculorum regulator), is convergently transcribed and overlaps with ecbI by 17 bp at their 3' ends. These results are consistent with the hypothesis that a quorum-sensing system related to the prototypic luxI-luxR gene pair controls antibiotic and exoenzyme production in Erwinia carotovora subsp. betavasculorum.

Development of secondary resistance to fluconazole in Cryptococcus neoformans isolated from a patient with AIDS

Cryptococcus neoformans is the fifth most common opportunistic agent of infection in patients with AIDS in the USA, exceeded only by Candida species, Pneumocystis carinii, cytomegalovirus and Mycobacterium avium1, 2, 6, 10, 11. In Brazil is the sixth, exceeded by Candida species, P. carinii, Mycobacterium species, Toxoplasma gondii, and herpes simplex virus (AIDS, Boletim Epidemiológico, set/nov 96, Ministério da Saúde, Brasil). During 30 years, the treatment of C. neoformans meningitis was based on the use of amphotericin B with or without flucytosine13. Nowadays, with the immunodepression caused by human immunodeficiency virus (HIV) infection and the availability of new antifungal drugs as the triazoles, the concept related to cure and relapses of cryptococcosis has been altered7, 20. Patients are treated with amphotericin B with or without flucytosine as initial therapy, but maintenance therapy is always necessary in AIDS patients with C. neoformans infections

Microsatellite in the beta-tubulin gene of Toxoplasma gondii as a new genetic marker for use in direct screening of amniotic fluids

To examine the correlation between Toxoplasma gondii genotype and congenital human toxoplasmosis, the polymorphism of the microsatellite consisting of a dinucleotide (TG) repeat in the intron of the beta-tubulin gene was investigated by PCR. Thirty-four reference strains were studied, including 7 strains virulent in mice and 27 strains avirulent in mice. The seven virulent strains had a (TG)8 microsatellite, and the avirulent strains had a (TG)7 microsatellite. This confirms the dichotomy already observed for virulent and avirulent strains. Additionally, 37 samples of amniotic fluid from infected fetuses were tested. All of them had the (TG)7 microsatellite marker. This result confirms that most of the human cases of congenital toxoplasmosis are due to strains avirulent in mice. Nevertheless, their virulence in human fetuses was obvious, as numerous abnormalities were observed on ultrasonic examination. The new genetic marker is the first one directly used for typing T. gondii isolates without any bias due to cultivation of the parasite. This microsatellite marker is not sufficient to type the strains which are avirulent in mice; however, seeking more polymorphic microsatellites should be worthwhile to obtain new genetic markers for direct screening of biological samples.

[Cryptococcosis not related to AIDS in Rio Grande do Sul: a report of 8 cases and a review of the literature]

We report eight cases of cryptococcosis in non-AIDS patients diagnosed in Santa Maria, RS, during 1961-1995. A review of the literature is performed and the prevalence of the infection caused by var neoformans in patients without underlying disease in subtropical regions is commented.

[Visceral leishmaniasis (kala-azar) on Ilha de São Luís, Maranhão. Brazil: its evolution and outlook]

Visceral leishmaniasis (kala-azar) was definitively an important disease of the state of Maranhão, Brasil since 1982. Since of then, many authors have been working with this topic in spite of reports. Nevertheless, the aspects of diagnosis, treatment an control of cure went through still hard worried the authors have been studying the disease, that came at São Luís Island since of the destabilization of the ecotopes of Lutzomya longipalpis, most important sandflies bites. After 1993 the constatation of cases with bad response to pentavalent antimonial (Glucantime) comes to add the other worries. This actual trial accost the disease and conclude about an existence of failures to Glucantime being important to have much vigilance in the diagnosis, treatment and control of cure of the patients.

Congenital hemangiopericytoma: two cases of familiar presentation

We report two cases of congenital hemangiopericytoma localized in the abdominal wall in the first patient and scalp in the second. The treatment of both cases consisted in the complete resection of the tumor mass. Four and two years later the patients remain asymptomatic. The special interest in this case report lies in the extremely low incidence of congenital hemangiopericytoma and that this is the first reference to affected siblings.

Microsatellite polymorphism in the promoter sequence of the elongation factor 3 gene of Candida albicans as the basis for a typing system

The polymorphism of a TTC/TTTC microsatellite in the promoter sequence of the elongation factor 3 gene of Candida albicans was investigated by PCR. One primer was fluorescein labeled, and PCR signals were read with an automatic sequencer. Twenty-nine reference strains and 31 independent clinical isolates were studied. Eleven different alleles were identified, giving 16 different profiles among the 60 strains tested, with a discriminatory power of 0.88. This marker is stable upon subculture, and reproducibility was achieved by automated procedures. When several microsatellite markers are available, many isolates can be rapidly and reproducibly tested for epidemiological questions, such as the prevalence of a given strain in a hospital setting and transmission between patients.

Choroid plexus papillomas of the III ventricle in infants. Report of three cases

The III ventricle is an uncommon location for choroid plexus papilloma at any age. We describe three new cases of choroid plexus papillomas of the III ventricle (CPPs). All children were boys under 4 months of age and all presented with increased intracranial pressure, hydrocephalus and macrocephaly. The three were examined by preoperative computed tomography (CT) and ultrasonography. Two of them were investigated with magnetic resonance imaging (MRI). The first case was treated with a right corticofrontal transventricular approach and subtotal resection, so that he required a second operation through a transcallosal approach. In the other two cases a transcallosal approach was used. Two children needed permanent ventriculo-peritoneal shunts. The average follow-up of 4.3 years has revealed no neurological deficits in any case. The timing of and the need for shunting are major considerations. Clinical and imaging follow-up (CT and/or ultrasonography) are very helpful in controlling postoperative hydrocephalus and subdural effusion, avoiding unnecessary shunting in many cases. The operative approaches, transcortical and transcallosal, are discussed.