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Epidemiologic aspects of the relationship between infection with Leishmania chagasi and development of clinical visceral leishmaniasis (VL) were studied in all children < 11 years old in a defined, endemic, rural area of the state of Ceará in northeast Brazil. Antileishmanial antibodies were measured in the same subjects by ELISA on six occasions between May 1987 and August 1989. Seroconversion was documented during this period in 108 children, with a cumulative annual incidence of 4.6%. Twelve (11.1%) of these children developed VL. Age < 4 years, hematocrit < 33%, and living in the mountains predicted the development of clinically apparent VL after seroconversion. Despite a high percentage of dogs serologically positive in the region (38%), there was no increased risk of infection for children living in the same household with dogs. Since children in households with a prior case of VL had a threefold increased risk of infection, human-sandfly-human transmission might have been important.

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Melioidosis was first recognized in northeastern Brazil in 2003. Confirmation of additional cases from the 2003 cluster in Ceará, more recent cases in other districts, environmental isolation of Burkholderia pseudomallei, molecular confirmation and typing results, and positive serosurveillance specimens indicate that melioidosis is more widespread in northeastern Brazil than previously thought.

Melioidosis is a potentially severe bacterial infection caused by Burkholderia pseudomallei. There has been growing awareness of the disease in the Americas, particularly since the Vietnam conflict when it was diagnosed in returning service personnel. Accidental laboratory exposure indicates the difficulty making a culture-based diagnosis when melioidosis has not been considered in the differential diagnosis. Melioidosis is most likely underdiagnosed in tropical Central and South America where conditions are more suited to persistence of B. pseudomallei in the environment. Recent melioidosis case clusters in northeastern Brazil highlight the threat posed to rural populations located far from specialist services. Increased clinical awareness of the disease and improvements in laboratory diagnostic methods are likely to bring wider recognition of melioidosis in the Americas.

The extracellular promastigote stage of Leishmania donovani is inoculated by a phlebotomine sandfly into the skin of a susceptible host, after which visceral dissemination and clinical disease may ensue. Using a hamster model we examined the histopathology of early infection with L. donovani after intradermal inoculation of cultured promastigotes. The initial response was a mixed polymorphonuclear (PMN)-mononuclear phagocyte infiltrate, noted between 1 and 24 hr after inoculation, which became primarily mononuclear by 48 hr. Parasites were initially found intracellularly in both PMN's and mononuclear phagocytes, but by 48 hr they had assumed amastigote-like morphology and were found exclusively in macrophages. The number of parasites per infected macrophage increased during the first week after inoculation, suggesting that intracellular replication of the organism was taking place. This was followed by the formation of granulomas between 4 and 6 wk. By 8 wk intracellular parasites were largely gone. The histologic response was consistent with early destruction of parasites in PMN's, and survival and replication of L. donovani in macrophages. Cutaneous infection with the parasite was eventually controlled locally, coincident with granuloma formation. Despite these local responses, the organism was able to disseminate and eventually produce typical visceral leishmaniasis.

Population-based data on sexually transmitted infections (STI), bacterial vaginosis (BV), Laboratory testing included polymerase chain reaction (PCR) for human papillomavirus (HPV), ligase chain reaction (LCR) for Chlamydia trachomatis and Neisseria gonorrhoeae, ELISA for human immunodeficiency virus (HIV), venereal disease research laboratory (VDRL) and fluorescent treponema antibody absorption test (FTA-ABS) for syphilis, and analysis of wet mounts, gram stains and Pap smears for trichomoniasis, candidiasis, and BV. Only women who had initiated sexual life were included in the analysis (n = 592). The prevalences of STI were , chlamydia 4. 5% (3.0-6.6), trichomoniasis 4.1% (2.7-6.1), gonorrhoea 1. 2% (0.5-2.6), syphilis 0. 2% (0.0-1.1), and HIV 0%. The prevalence of ) and 12. 5% (10.0-15.5 ), respectively. The most common gynaecological complaint was lower abdominal pain. STI are common in women in rural Brazil and represent an important health threat in view of the HIV pandemic.Key words: sexually transmitted infections -reproductive tract infections -prevalence -epidemiology -Brazil Sexually transmitted infections (STI) are a major cause of morbidity throughout the world, particularly in developing countries (Gerbase et al. 1998). In women, STI are often chronic and present with little or no symptoms, but eventually may lead to severe sequels, such as chronic pelvic inflammatory disease, ectopic pregnancy, and infertility (WHO 2000). The impact of STI on the health of women tends to be more severe in resourcepoor settings where diagnostic and treatment facilities are inappropriate. Here, women often are not aware of STI as health problems, and health care seeking behaviour is poor (Giffin & Lowndes 1999). Relatively high prevalences of STI have been documented in such settings e.g. from Brazil, Papua New Guinea, and The Gambia (Walraven et al. 2001, Mgone et al. 2002, Soares et al. 2003. STI, as well as bacterial vaginosis (BV), are considered to increase the risk of acquiring human immunodefiency virus (HIV) (Sewankambo et al. 1997, Rottingen et al. 2001.In Brazil, the HIV epidemic is characterized by changing dynamics, currently reaching new population groups, namely women, underprivileged individuals, and communities outside the great urban centres (Fonseca et al. 2000, Brazilian Ministry of Health 2006. Reliable epidemiological data from Brazilian women on STI and other reproductive tract infections (RTI), such as BV and candidiasis, are scanty. Syphilis and HIV in pregnant women, AIDS, and congenital syphilis are notifiable infections, but the epidemiologic situation of other RTI is rather enigmatic. Studies have addressed the issue of STI in certain specific groups, such as patients attending STI clinics, gynaecology and obstetric outpatient departments, female prisoners or commercial sex workers (Miranda et al. 2000, Benzaken et al. 2002, Codes et al. 2002, Cook et al. 2004. However, these studies do not allow to conclude on the burden of disease on the community level.To increase further the knowledge...

We report for the first time the successful use of fluconazole to treat cutaneous leishmaniasis due to Leishmania braziliensis. We used escalating doses from 5 to 8 mg/kg per day. At a dose of 5 mg/kg per day, 75% patients were cured, and at 8 mg/kg per day, the cure rate was 100%. Fluconazole was well tolerated.