[Changes in parasitemia evaluated using the modified Strout method in patients with acute Chagas disease under treatment].
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Biomedical subjects
Publications and source records attributed to C Castro.
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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.
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.
A grave kala-azar infection in a 14 years old boy is described. The leishmanial infection failed to respond to ten interrupted courses of glucantime of variable duration (14-56 days) at a dose of 20mg Sb5/kg/day. However a favorable response occurred to intramuscular aminosidine sulphate (20mg/kg/day) for 20 days. This same regimen was repeated 20 days later. After the first treatment splenic puncture parasite density fell from 50 amastigotes per oil immersion field to 3 amastigotes in 10 fields. A further splenic puncture 7 months after treatment was negative. The marked hepatoesplenomegaly gradually resolved over 26 months follow up and he gained 13 kilograms in weight. After aminosidine sulphate therapy his Montenegro reaction become positive and his lymphocytes responded to leishmania antigens.
The parasitemia of 202 chronic chagasics was studied for approximately 13 years by repeated conventional xenodiagnoses. Mean patient age was 41.1 years. They lived in an endemic area; 124 were females and 78 were males. It was seen that the level of parasitemia oscillated. It went up in 14 individuals, went down in 42 and stayed at the same level in 146. In general the parasitemia was reduced. The percentage of xenopositive chagasics, which was 37.6%, 48.5%, and 51% in the first, second and third xenodiagnosis, respectively, in 1976/78, changed to 30.2% in 1988/91 (p = 0.00003). The percentage of positive pools, which was 15.2%, 20.9%, 20.8% in the first, second and third xenodiagnosis, respectively, in 1976/78, changed to 10.4% in 1988/91, (p = 0.00000001). There were 62 patients whose xenodiagnoses were all negative and 23 whose exams were all positive. The percentage of chagasics with high, medium and low parasitemia, which in 1976/78 was 9.4%, 20.8% and 69.8%, respectively, changed to 4.4%, 12.9% and 82.7%, respectively, in 1988/91.
Twelve chagasic patients between the ages of seven and twelve, in the indeterminate phase with serology and xenodiagnosis positive, received the specific treatment. Eight of these were evaluated after an eight-year treatment period and four were followed-up during 20 years. Two patients took 7 mg/kg of nifurtimox during sixty and ninety days and ten of these used 5-7 mg/kg of benznidazole during 60 days. The clinical outcome was verified through clinical examination, electrocardiogram and contrasted X-ray of the esophagus. After the treatment, only one patient presented negativity in all the examinations. Seven (58.4%) remained in the indeterminate form and despite the precocious treatment four chagasic patients (33.3%) progressed clinically to second degree cardiopathy and/or megaesophagus.
Xenodiagnoses were performed every 3 hours using 10 Triatoma infestans 3rd instar for 24 to 72 hours, in 18 chronic chagasics with positive serology and/or xenodiagnosis. There was no statistically significant difference in the positivity of assays performed during the day (9:00 to 18:00 h) compared to those performed at night (21:00 to 6:00 h), (chi 2 = 0.1526 p = 0.696). Xenodiagnosis was performed in ten of the patients for 13 successive days but there was no periodicity detected in the positive assays.
A prospective study was performed on the clinical, electrocardiographic (ECG) and radiologic aspects of the esophagus in 190 chagasic patients, for on average follow-up period of 13 years. We found 108 (56.8%) patients who remained in the same clinical state, 72 (37.9%) patients with progressive illness and 10 (5.3%) patients whose previous ECG abnormalities subsided. Thirty nine out of 72 patients with progressive disease developed cardiopathy or aggravation of previous illness, 32 developed into megaesophagus or an existing picture deteriorated and 12 developed or showed worsening of the colopathy. Of 72 patients, 11 presented with associated forms. The development of cardiopathy was greater in males 29.6% (21/71) than in females 15.1% (18/119), p =0.015. There were 19 new cases of cardiopathy, and 20 of aggravated previous disease. The incidence of megaesophagus was 14.9% (23/154), with nine patients whose previous disease worsened. The progression of colopathy was greater in females 9.2% (11/119) than in males 1.4% (1/71), p = 0.026.
Epidemiological surveillance activities were implemented in 1980 in Mambaí and Buritinópolis counties, Goiás State. Twenty years later the authors evaluated the impact of these vector control measures on Chagas' disease transmission, based on entomological indicators. Entomological investigation was conducted using the man-hour technique and covering all domiciles. In order to study vector food sources the stomach contents of triatomines were analyzed using the modified precipitins technique. Triatomines were shown to be present in 48 (71.6%) of the 67 locations. Peridomiciliary infestation rates in Mambaí and Buritinópolis were 8.7% and 12.1%, respectively, while intradomiciliary rates were 0.7% and 1.2%. Triatoma sordida was the species identified in 97.3% of all captured specimens. It was also the only species found to be naturally infected with Trypanosoma cruzi. Birds were the most frequent food source (45%) for Triatoma sordida. The most significant result was the complete absence of Triatoma infestans in the two counties.
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Between June 1988 and February 1993, 520 ultrasound-guided transperitoneal prostate biopsy punctures were performed in patients with prostate disease. Of these, 89 (17.1 %) were positive for malignancy. An analysis is made of the highly uncommon complications observed, which corresponded to 17 cases of haematuria (3.26%) and 3 of fever (0.5%). Likewise, reference is made to perineal neoplastic implantation, since such complication was evident in one of the cases contributed (0.19%). Also, a review of the literature relative to the complications is made, concluding by stating the relevance of this diagnostic technique in spite of said complications.
E. coli strains are the major bacterial cause of diarrhea among children under 2 years of age residing in Mendoza, Argentina. Detection of diarrheogenic E. coli is made after coproculture, by agglutination tests using O-group antisera including most enteropathogenic E. coli (EPEC) serogroups and others often isolated in diarrhea. Although there are many O serogroups and H serotypes of E. coli strongly associated with infantile diarrhea, a number of studies have shown differences in the rate of isolation of EPEC between cases and controls using DNA probes. We compared the diagnosis of EPEC infections by traditional serogrouping tests with other detection methods using cell culture, involving the screening of isolates for adherence patterns to HEp-2 cells. A total of 140 isolates from children less than 24 months old with acute, persistent and chronic diarrhea and 40 isolates from controls were recovered. Three distinct patterns of adherence, termed localised (LA), diffuse (DA) and aggregative (EAgg) adherence were found. The fluorescence actin staining assay was used as indicative of the ability of some EPEC strains that produce attaching-effacing (A/E) lesions. Positive serogrouping strains were strongly associated with adherence (P = 0.0001). LA adherence pattern occurred in 11% of cases with acute diarrhea associated with these serogroups (P = 0.001) and children under 12 months (P = 0.0001). The FAS test was positive in 80% of them. EAgg adherence was found only in patients (20% P = 0.0001) and DA occurred both in cases (29%) and controls (2.5% P = 0.0001). Diagnosis of EPEC infections has traditionally been performed by identifying organisms belonging to a number of serogroups or serotypes epidemiologically linked to diarrhea. Evidence is presented in this paper to show that pathogenicity is not restricted to serogroups. Isolation of many adherent strains not belonging to traditional EPEC O serogroups, shows the need for alternative methods to be used to detect and identify E. coli.