SummaryTungiasis is caused by penetration of the female sand flea Tunga penetrans into the epidermis of its host. It is endemic in many countries in Latin America, the Caribbean and sub-Saharan Africa. Although superinfection is a common clinical observation, the frequency and the pattern of bacterial pathogens associated with tungiasis have never been investigated systematically. We conducted a prospective clinico-bacteriological study with patients living in a shantytown in Fortaleza, capital of Ceará State (Northeast Brazil), where tungiasis is hyperendemic. Swabs were taken from 78 patients with multiple lesions after surgical extraction of the parasite, and the specimens were cultured for aerobic and anaerobic microorganisms. Ninety-nine specimens were investigated for aerobic bacteria, from which 146 pathogens were identified. The most common species were Staphyloccous aureus (35.5%) and various enterobacteriaceae (29.5%). Bacillus sp., Enteroccous faecalis, Streptococcus pyogenes and Pseudomonas sp. were also isolated. Eighty-four anaerobic cultures yielded 20 pathogens: in eight cases we detected Peptostreptococcus sp., in seven cases Clostridium sp., and in five cases non-identifiable gram-negative bacilli. These results show that secondary infection is very common in tungiasis, and caused by a variety of highly pathogenic microorganisms. It is proposed that T. penetrans acts as a foreign body facilitating biofilm formation within the epidermis. To prevent spreading of pathogens to the surrounding tissue and/or the systemic circulation, sand fleas should be surgically extracted immediately after penetration.keywords tungiasis, clinico-bacteriological study, superinfection, aerobic pathogens, anaerobic pathogens, biofilm formation correspondence Prof.

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.

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.

Postmortem examination of 7 neonates with congenital Zika virus infection in Brazil revealed microcephaly, ventriculomegaly, dystrophic calcifications, and severe cortical neuronal depletion in all and arthrogryposis in 6. Other findings were leptomeningeal and brain parenchymal inflammation and pulmonary hypoplasia and lymphocytic infiltration in liver and lungs. Findings confirmed virus neurotropism and multiple organ infection.

Melioidosis, which is caused by the bacterium Burkholderia pseudomallei, is a potentially fatal tropical infection, little known outside its main endemic zone of Southeast Asia and northern Australia. Though it has received more attention in recent years on account of its claimed suitability as a biological weapon agent, the principal threat from melioidosis is a result of naturally occurring events. Occasional case clusters, sporadic cases outside the known endemic zone and infections in unusual demographic groups highlight a changing epidemiology. As melioidosis is the result of an environmental encounter and not person-to-person transmission, subtle changes in its epidemiology indicate a role environmental factors, such as man-made disturbances of soil and surface water. These have implications for travel, occupational and tropical medicine and in particular for risk assessment and prevention. Practical problems with definitive laboratory diagnosis, antibiotic treatment and the current lack of a vaccine underline the need for prevention through exposure avoidance and other environmental health measures. It is likely that the increasing population burden of the tropical zone and extraction of resources from the humid tropics will increase the prevalence of melioidosis. Climate change-driven extreme weather events will both increase the prevalence of infection and gradually extend its main endemic zone.

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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.