Abstract. This study evaluated the cure rate of the standard recommended regimen for Plasmodium vivax malaria in Brazil and assessed risk factors for failures. Fifty patients with vivax malaria given supervised medical treatment (standard dose of chloroquine: total dose ϭ 1.5 g over a three-day period plus primaquine: total dose ϭ 210 mg over a 14-day period) were followed for six months in a non-endemic area. Cox's regression was used to identify predictors of relapses. Among the 289 patient-months of follow-up, seven relapses were identified (2.4 relapses per 100 personmonths) between 33 and 137 days after treatment initiation. Risk factors for relapses (P Յ 0.05) were female sex, higher parasitemia at baseline, shorter number of days with symptoms prior to baseline, and lower mg/kg dose of primaquine. Relapses following supervised vivax treatment is in principle a necessary, but not sufficient, component of in vivo parasite resistance. Results indicate that other factors, principally sub-therapeutic primaquine doses, may explain the occurrence of vivax treatment failures.

Foram avaliados 37 isolados de 10 pacientes HIV negativos e 26 positivos, em Mato Grosso. Exame direto, cultura e quimiotipagem de espécies foram realizados. Cetoconazol, itraconazol, voriconazol, fluconazol e anfotericina B foram avaliados. Foram identificadas 37 leveduras do gênero Cryptococcus spp sendo 26 de pacientes HIV- positivos (25 Cryptococcus neoformans e um Cryptococcus gattii) e 10 de HIV- negativos (cinco Cryptococcus neoformans e cinco Cryptococcus gattii). Considerando isolados clínicos (Cryptococcus neoformans) de HIV positivos observou-se resistência (8% e 8,7%) e susceptibilidade dose-dependência (20% e 17,4%) para fluconazol e itraconazol respectivamente. Para isolados de Cryptococcus neoformans oriundos de pacientes HIV negativos, observou-se susceptibilidade dose-dependência (40%) ao fluconazol. Os isolados de Cryptococcus gattii provenientes de pacientes HIV- negativos mostraram-se susceptíveis a todos os antifúngicos, exceto um isolado de Cryptococcus gattii que foi susceptível dose-dependente ao fluconazol (20%). O isolado proveniente do paciente HIV- positivo demonstrou resistência ao fluconazol (CIM > 256µg/mL) e itraconazol (CIM=3µg/mL).

RESUMOO Strongyloides stercoralis possui dois tipos de ciclo evolutivo: o direto ou homogônico e o indireto ou heterogônico, sendo que no homem ocorre ainda a auto-infecção, que pode ser de forma interna ou externa. Em situações especiais, o ciclo de auto-infecção pode acelerar-se, levando à rápida elevação do número de vermes nos órgãos normalmente envolvidos no ciclo biológico, fenômeno conhecido como hiperinfecção. Pode evoluir para estrongiloidíase disseminada, que se estabelece quando ocorre uma aceleração do curso normal do ciclo biológico do parasita e invasão, pelas larvas filariformes, de órgãos como pele, sistema nervoso central, rins, fígado, com alta mortalidade 6 . Esta complicação ocorre com maior freqüência em indivíduos com depressão da imunidade celular por neoplasias (linfomas, leucemias), transplantados renais, alcoólatras e infecção pelo vírus da imunodeficiência adquirida humana (HIV) 10 .No presente trabalho, é descrito um caso de estrongiloidíase disseminada, com acometimento cutâneo em forma de púrpura, que se desenvolveu em um paciente timectomizado e usuário crônico de corticosteróide devido à miastenia gravis.

Mesmo com a queda progressiva da incidência de infecções oportunistas, após o advento da moderna terapia antirretroviral potente ou high activity antiretroviral therapy (HAART) 17 , estas complicações ainda constituem a principal causa de morbidade e mortalidade para a população portadora do vírus da imunodeficiência humana (Aids) resultando muitas vezes em hospitalização, e requerendo, em algumas situações, tratamentos

Dapsone syndrome is a rare hypersensitivity reaction to dapsone and is characterized by high fever, papular or exfoliative dermatitis, progressing to liver toxicity and generalized lymphadenopathy, resembling a mononucleosis infection. We report a patient who developed acute renal failure, as well as other complications characteristic of dapsone syndrome, during leprosy treatment. Renal involvement had not been previously described as a dapsone syndrome feature.

Five cases of hepatitis B and D superinfection in teenagers from the northernmost region of Mato Grosso State are reported. Hepatitis B is high prevalent there, but not hepatitis D. The proximity to the States of Acre and Amazonas and intense migration may be introducing the virus into the region. Necessity for the surveillance of hepatitis D in northern Mato Grosso is emphasized.

We identified the etiological agents responsible for two fatal cases of rhinocerebral mucormycosis with the classical risk factor for uncontrolled type II diabetes mellitus. Their initial symptoms did not point immediately to the suspicion of mucormycosis. Case 1, caused by Rhizopus microsporus var. oligosporus, was a 52-year-old man who presented with a painful pimple on his nose, which evolved with swelling, erythema, and a central pustule on his right hemiface suspected to be cellulitis. After 7 days of antibiotic treatment, the patient worsened with signs of sepsis and the lesion evolved to necrosis involving all his right face. Case 2, caused by Rhizopus microsporus var. rhizopodiformis, was a 57-year-old woman placed on continuous therapy with azathioprine and corticoids after a renal transplant due to chronic arterial hypertension and uncontrolled type II diabetes mellitus. Because she was suspected to have sepsis, the patient was treated with broad-spectrum antibiotics and mechanical ventilation, yet she deteriorated. Because Candida spp. were isolated from urine and a BAL, she was treated with fluconazole for 10 days, then substituted by caspofungin. Two weeks later, she presented with exophthalmus of the left eye that was surrounded by a large inflammatory and necrotic area. Both patients were the diagnosed with mucormycosis via direct microscopy of necrotic material prior to their death.

To increase blood safety Brazil introduced screening for anti-HBc among blood donors in 1993. There was a decrease in the hepatitis B virus (HBV) transmission, but this measure identified a great number of HBsAg-negative, anti-HBc-positive Studies have shown an increasing chance of finding HBV-positive subjects among household contacts of hepatitis B virus (HBV) carriers as compared with contacts of HBV-negative individuals (Berris et al. 1973, Kashiwagi et al. 1984, Milas et al. 2000. HBV spread inside families can take place by vertical or horizontal route (Dumpis et al. 2001, Ono-Nita et al. 2004. A surveillance approach recommended by the Center for Disease Control and Prevention (US) and the Brazilian Health Ministry is to screen contacts of HBV carriers in order to identify other carriers and susceptible individuals who could benefit from prophylaxis (CDC 1991). One of the most common ways of identifying HBV carriers takes place during blood donation screening (Hadler et al. 1987.In Brazil, HBV blood donors screening was extended to include analysis of antibodies against the core antigen (anti-HBc) in 1993 (Brasil, Ministério da Saúde). While improving safety, the addition of anti-HBc testing has increased the rejection of donated blood and has uncovered a large number of HBsAg-negative, anti-HBc-positive individuals considered to be unsuitable for blood donation. This serologic profile is quite common in en- demic areas and usually indicates a resolved HBV infection, although HBV DNA can be detected in serum from some of these individuals (Hennig et al. 2002).These HBsAg-negative, anti-HBc-positive blood donors require counseling regarding the implications of these results and whether their relatives and sexual contacts are at increased risk for HBV infection. However there is no such policy in Brazil and it has not yet been determined if the contacts of HBsAg-negative, anti-HBc-positive individuals are at increased risk of HBV exposure (Brasil 2000). It is also not know how long these blood donors remained infective in the past or when they stopped carrying HBV. This raises the question: should the surveillance policy for contacts of HBsAg-positive individuals be broadened to include contacts of HBsAg-negative, anti-HBc-positive individuals? The aim of the present study was to clarify whether contacts of HBsAg-negative, anti-HBc-positive blood donor are at increased risk for HBV infection. MATERIALS AND METHODSA cross-sectional study was designed to compare HBV infection prevalence in contacts of subjects with one of two profiles of HBV markers (HBsAg-positive or only antibodies positive: HBsAg-negative, anti-HBc-positive) identified during blood donation. The study was conducted in Cuiabá, (the largest city of the state of Mato Grosso, Central Brazil) at two institutions: the local public blood bank and the main private one. Both collect blood in Cuiabá and also in other cities of the region.