RESUMO
Because concurrent infections with geohelminth parasites might impair the immune response to oral vaccines, we studied the vibriocidal antibody response to the oral cholera vaccine CVD 103-HgR in children infected with Ascaris lumbricoides and investigated the effect of albendazole pretreatment on the postvaccination response. Children with ascariasis were randomized to receive either 2 sequential doses of 400 mg of albendazole or placebo. After the second dose, CVD 103-HgR was given, and serum vibriocidal antibody levels were measured before and 10 days after vaccination. Postvaccination rates of seroconversion were greater in the treatment group that received albendazole (P=.06). Significantly greater rates of seroconversion and geometric mean titer were observed in the albendazole group in subjects with non-O ABO blood groups. A significant association was observed between vibriocidal seroconversion rates and treatment group, suggesting that A. lumbricoides infections impair the immune response to oral cholera vaccine, particularly in subjects of non-O blood groups.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Anticorpos Antibacterianos/sangue , Ascaríase/tratamento farmacológico , Ascaríase/imunologia , Ascaris lumbricoides , Vacinas Bacterianas/imunologia , Vacinas contra Cólera/imunologia , Vacinas Atenuadas/imunologia , Adolescente , Animais , Formação de Anticorpos , Ascaris lumbricoides/efeitos dos fármacos , Antígenos de Grupos Sanguíneos/imunologia , Criança , Interações Medicamentosas , Equador , Feminino , Humanos , Masculino , Trichuris/efeitos dos fármacosRESUMO
The roles of eotaxin, RANTES, and MCP-3 expression in eosinophil recruitment to the site of parasite killing that occurs following ivermectin treatment of onchocerciasis were assessed in the skin of 13 Onchocerca volvulus-infected subjects and two noninfected controls before and after ivermectin treatment. Adverse reactions in infected subjects were associated with the appearance of eosinophils in the dermis as part of a perivascular inflammatory infiltrate. Although no expression of RANTES and eotaxin was seen in dermal vascular endothelial cells in biopsies taken before treatment (nor at any time in the skin of uninfected controls), endothelial expression of both eotaxin and RANTES was noted by 24 h following treatment. While RANTES expression was transient, eotaxin expression increased in parallel with increasing eosinophil recruitment up to 60 h posttreatment. These observations indicate that endothelial expression of eotaxin and RANTES may have an important role in eosinophil recruitment into the skin during helminth-killing reactions.
Assuntos
Quimiocinas CC , Quimiocinas/biossíntese , Derme/imunologia , Endotélio Vascular/imunologia , Eosinofilia/imunologia , Ivermectina/uso terapêutico , Onchocerca volvulus/imunologia , Oncocercose/imunologia , Adulto , Animais , Biópsia , Quimiocina CCL11 , Quimiocina CCL5/biossíntese , Quimiotaxia de Leucócito , Citocinas/biossíntese , Procedimentos Cirúrgicos Dermatológicos , Derme/irrigação sanguínea , Equador , Feminino , Humanos , Ivermectina/efeitos adversos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Oncocercose/tratamento farmacológicoRESUMO
An open clinical trial to determine the efficacy and tolerability of postprandial doses of triclabendazole against Paragonimus mexicanus in 62 patients with pulmonary paragonimiasis from the Ecuadorian Amazon region was performed. Praziquantel was used as therapeutic control. Patients were allocated at random to the following 4 therapeutic regimens: triclabendazole, 5 mg/kg once daily for 3 d (16 patients), 10 mg/kg twice on one day (15 patients), and 10 mg/kg in a single dose (16 patients), and praziquantel, 25 mg/kg thrice daily for 3 d (15 patients). Clinical tolerance, based on the frequency and severity of adverse reactions, was superior in all 3 triclabendazole regimens to that of praziquantel. No alteration was observed in hepato-renal functions or haematological values. The clinical symptoms resolved at a comparable rate in all 4 treatment groups. A more rapid parasitological response to treatment, as determined by the reduction in the average number of parasite eggs found in sputum, was seen in patients treated with triclabendazole than with praziquantel. By day 90, 60 patients had no egg detected in their sputum; 2 patients, treated with a single dose of 10 mg/kg, had a few and were re-treated with triclabendazole (5 mg daily for 3 d). On day 365, none of the patients had eggs in their sputum. Triclabendazole can be recommended as an alternative drug of choice for the treatment of pulmonary paragonimiasis; it is as effective as praziquantel in clearing infections and better tolerated.
Assuntos
Anti-Helmínticos/uso terapêutico , Benzimidazóis/uso terapêutico , Pneumopatias Parasitárias/tratamento farmacológico , Paragonimíase/tratamento farmacológico , Adolescente , Adulto , Anticestoides/uso terapêutico , Criança , Equador/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Ovos de Parasitas/métodos , Contagem de Ovos de Parasitas/estatística & dados numéricos , Praziquantel/uso terapêutico , Resultado do Tratamento , TriclabendazolRESUMO
To assess the current epidemiologic status of onchocerciasis in Colombia two surveys were undertaken in 1995 in a suspected new focus on the border between Colombia and Ecuador and in the known focus located on the Micay River. No new focus was found along the Colombia-Ecuador border. In the known focus, communities along the upper Micay River and its tributaries were surveyed; 655 adults underwent physical examinations and skin biopsies. Infected individuals were found almost exclusively in the community of Naiciona, where prevalence of infection was 40% (36 of 91). Polymerase chain reaction detection of onchocercal DNA in skin snips correlated with the skin-snip biopsy results. The prevalence of punctate keratitis, the only ocular manifestation found, was 33%. A rapid entomologic assessment demonstrated Simulium exiguum infected with Onchocerca volvulus. This is the first finding in Colombia of naturally infected black flies and confirms S. exiguum as a vector species. These data will be used for implementing a control program using periodic ivermectin distribution.
Assuntos
Oncocercose/epidemiologia , Adolescente , Adulto , Idoso , Animais , Colômbia/epidemiologia , Humanos , Pessoa de Meia-Idade , Onchocerca volvulus/isolamento & purificação , Reação em Cadeia da Polimerase , Simuliidae/parasitologiaRESUMO
O efeito macrofilaricida da infiltração local, com uma alta concentração de cloroquina, dentro da cápsula do nódulo oncocercótico sobre o verme adulto de Onchocerca volvulus foi determinado. Seis semanas depois da infiltração, estudos histopatológicos de nódulos simple demonstraram todos os vermes adultos mortos. Em conglomerados de nódulos a ação da cloroquina foi só sobre os vermes adultos do nódulo infiltrado, não acontecendo a difusão da droga aos nódulos adjacentes. A infiltração de cloroquina a nódulos novos ou de recente formação reduz a carga de vermes adultos dos indivíduos parasitados e pode ser uma alternativa para os altos custos das nodulectomias.
The macrofilaricidal effects of local infiltration of high concentrations of chloroquine into the capsule of onchocercal nodules on adult worms of Onchocerca volvulus was determined. Six weeks post infiltration, histological examination of single nodules showed all adult worms to be dead. With nodule conglomerates, there was localized action of chloroquine only on the adult worms in the infiltrated nodule, with no diffusion of the drug to adjacent nodules. Chloroquine infiltration of young, recently formed nodules to reduce the adult worm load of infected individuals may be an alternative method to costly nodulectomy.
Assuntos
Adulto , Animais , Humanos , Masculino , Cloroquina/farmacologia , Filaricidas/farmacologia , Oncocercose , Onchocerca volvulus/efeitos dos fármacos , Cloroquina/administração & dosagem , Avaliação de Medicamentos , Equador , Filaricidas/administração & dosagem , Indígenas Sul-Americanos , Injeções Intralesionais , Oncocercose , Pele/parasitologia , Pele/patologia , Fatores de TempoRESUMO
Onchocerciasis is a major blinding disease in equatorial Africa and Central and South America. Ivermectin is a safe and effective drug in the treatment of this disease and now forms the basis of disease control in most endemic areas. We report the findings of long-term control of this infection in the Río Santiago focus in Ecuador, between January 1990 and December 1996, using a strategy of giving ivermectin treatments biannually in hyperendemic communities and annually in meso- and hypoendemic communities. Ivermectin was administered by local health workers from each community. A high level of compliance to ivermectin was achieved, with 81.9% to 98.0% of those eligible receiving the drug at each treatment instance. The impact of ivermectin therapy was monitored using a cohort of 120 randomly selected infected individuals from 8 hyperendemic communities. The geometric mean microfilarial density of this group declined from 19.3 to 0 mf/mg over the 84-month observation period. Ivermectin had a significant impact on anterior segment ocular disease, acute onchodermatitis and sowda. The rate of infection of blackflies declined from 1.1% in 1989-0.08% in 1996, which is below the vectorial capacity of the Simulium vector and, as no new nodules were detected after 1994 and no children under 5 became infected over the observation period, it is likely that the transmission of this infection was interrupted in the study area.
Assuntos
Filaricidas/uso terapêutico , Ivermectina/uso terapêutico , Oncocercose/tratamento farmacológico , Animais , Pré-Escolar , Estudos de Coortes , Serviços de Saúde Comunitária , Equador/epidemiologia , Humanos , Lactente , Oncocercose/epidemiologia , Prevalência , Distribuição Aleatória , SimuliidaeRESUMO
DNA extracted from peripheral blood of two Ecuadorian patients showing severe digestive pathology was amplified by the polymerase chain reaction using a Trypanosoma cruzi specific oligonucleotide primers derived from the primary sequence of a cDNA encoding for a 24 kDa excretory/secretory protein. The positive PCR results together with the clinical findings confirmed that both patients had a digestive pathology due to Chagas' disease. This pathology could be more frequent than previously described in the chagasic endemic regions of Andean countries.
Assuntos
Doença de Chagas/complicações , Doenças do Sistema Digestório/etiologia , Idoso , Animais , Anticorpos Antiprotozoários/sangue , Doença de Chagas/diagnóstico , Doença Crônica , DNA de Protozoário/sangue , Doenças do Sistema Digestório/diagnóstico , Equador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Trypanosoma cruzi/genética , Trypanosoma cruzi/imunologiaRESUMO
DNA extracted from peripheral blood of two Ecuadorian patients showing severe digestive pathology was amplified by the polymerase chain reaction using a Trypanosoma cruzi specific oligonucleotide primers derived from the primary sequence of a cDNA encoding for a 24 kDa excretory/secretory protein. The positive PCR results together with the clinical findings confirmed that both patients had a digestive pathology due to Chagas' disease. This pathology could be more frequent than previously described in the chagasic endemic regions of Andean countries.
DNA obtido do sangue periférico de dois pacientes equatorianos, que apresentavam severa patologia digestiva, foi amplificado pela "polymerase chain reaction" (PCR) utilizando os oligonucleotídoes específicos do Trypanosoma cruzi, derivados de uma seqüência primária de cDNA codificado de 24 kDa proteína excretória/secretória. Os resultados positivos da PCR junto com os achados clínicos confirmam que os dois pacientes tinham uma patologia digestiva de origem chagásica. Esta patologia poderia ser mais freqüente que a descrita previamente nas regiões endêmicas chagásicas das cidades dos Andes.