During 45 days without electrical power, 57 individuals (8.7% of the population) from the village of Antônio Dino (municipality of Turiaçu, Northeastern Brazil) were attacked by bats and 16 died from human rabies. The aim of the study was to analyze the factors associated with bat attacks and the development of human rabies. Of the 46 individuals, who suffered bat attacks, 36 (78.3%) were under 17 years of age. The risk factors associated with bat attacks were age under 17 years, having observed bats inside the bedroom and having been without electrical power in the house. Age under 17 years and having been without electrical power in the house were factors associated with human rabies. The objective of this study was to analyze factors associated with bat attacks and human rabies in an outbreak of bat-transmitted human rabies. DESCRIPTORS: METHODSThe village of Antônio Dino has 685 inhabitants and is 320 km away from the capital of the state of Maranhão, in the Northeast of Brazil. It is located in the municipality of Turiaçu, in a well-preserved area of the Amazon forest. The population, which has low purchasing power and no fi xed source of income, survives by growing cassava and rice. There are no health care services available in the village, and the residents travel 32 km, when they need medical care. In September, 2005, the transformer that distributed power to the village failed, leaving 223 (87.1%) of 256 homes without electricity. In due course, bats attacked 57 (8.3%) residents, of which 16 (28.1%) developed HR and died.In 13 cases, antigenic typing of the virus with a panel of monoclonal antibodies was carried out at the Pasteur Institute in São Paulo and variant three of the rabies virus was identifi ed. This variant is usually isolated from samples taken from the bat species Desmodus rotundus. In three other cases, confi rmation was made by means of clinical and epidemiological criteria. Interventions to curb the epidemic were put in place, during which 73 bat captures were made, yielding a total of 263 animals, of which 251 (95%) belonged to the species Desmodus rotundus. The bats were not tested for antibodies against rabies virus.A convenience sample of 148 individuals (21.6%) of the village population was selected from the most affected areas. They were enrolled and divided into two groups: group 1-comprised of 102 individuals, who were not attacked by bats; and group 2 -made up of 46 (80.7%) of the 57 individuals attacked by bats, including 16 who developed HR and died. In the cases of death, disease was diagnosed by interview with a member of the family and review of medical notes.

The space occupation and the expansion of American visceral leishmaniasis (AVL) were described in the municipality of São Luis, Maranhão, Northeast Brazil. AVL medical notes from the Fundação Nacional de Saúde as well as official documents about the space occupation were analyzed from September 1982 to December 1996. AVL cases were more likely to occur in recently settled suburbs and tended to follow the same spatial pattern observed for land occupations secondary to migratory fluxes.

RESUMOIntrodução: A transmissão vertical constitui a principal via de infecção infantil pelo vírus HIV-1 (vírus da imunodeficiência humana). A presente pesquisa tem como objetivo estudar a evolução clínica e laboratorial de crianças vivendo com HIV/AIDS decorrente da transmissão vertical. Métodos: trata-se de um estudo descritivo, retrospectivo, realizado a partir da coleta de dados em prontuário médico de todas as crianças atendidas em um Serviço de Assistência Especializada, no período de janeiro de 1998 a junho de 2006. Resultados: foram avaliadas 80 crianças que preencheram critérios de inclusão. Observou-se que em 56 (70%) crianças, o diagnóstico da infecção pelo HIV na mãe deu-se após o parto e que em 44 (55%) o parto foi via vaginal. Amamentação ao seio materno foi documentada em 56 (70%) crianças e esta variou de um mês até mais de 12 meses. A não utilização ou uso incompleto do Protocolo ACtG 076 foi documentado em 63 (78,5%) casos. Conclusões: Os dados observados em nosso estudo são bastante preocupantes e revelam falha na assistência materno-infantil, especialmente voltada para prevenção da transmissão.Palavras-chaves: HIV. AIDS. transmissão vertical. Crianças. ABSTRACTIntroduction: Vertical transmission constitutes the main route for child infection by the HIV-1 virus (human immune deficiency virus). This study aimed to investigate the clinical and laboratory evolution of children with vertically transmitted HIV/AIDS. Methods: This was a retrospective descriptive study based on data gathered from the medical records of all the children who were seen at a specialized care unit between January 1998 and June 2006. Results: Eighty children who met the inclusion criteria were evaluated. In the cases 56 (70%) of the children, their mothers were diagnosed as HIV-positive after childbirth. The delivery was vaginal for 44 (55%) of the children. fifty-six children (70%) were breastfed by their mothers for periods ranging from one to more than 12 months. failure to use or incomplete use of the ACtG 076 protocol was documented in 63 (78.5%) of the cases. Conclusions: The findings from our study are a cause for considerable concern and show failures of medical care for mothers and children, particularly with regard to prevention of transmission.

Hantavirus pulmonary syndrome (HPS) was described for the first time in Brazil in 1993 and has occurred endemically throughout the country. This study analysed clinical and laboratory aspects as well as death-related factors for HPS cases in Brazil from 1993 to 2006. The investigation comprised a descriptive and exploratory study of the history of cases as well as an analytical retrospective cohort survey to identify prognostic factors for death due to HPS. A total of 855 Brazilian HPS cases were assessed. The majority of cases occurred during spring (33.5%) and winter (27.6%), mainly among young male adults working in rural areas. The global case fatality rate was 39.3%. The mean interval between the onset of symptoms and hospitalisation was 4 days and that between hospitalisation and death was 1 day. In the multiple regression analysis, adult respiratory distress syndrome and mechanical respiratory support were associated with risk of death; when these two variables were excluded from the model, dyspnoea and haemoconcentration were associated with a higher risk of death.

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A person diagnosed with acquired immunodeficiency syndrome in 2000 and who received highly active antiretroviral therapy developed co-infection with dengue virus in 2003. In the course of the co-infection, he developed fever, thrombocytopenia (13,700 cells/mm3), petechia, and hypoalbuminemia, which are compatible with the World Health Organization criteria for a case of dengue hemorrhagic fever. Human immunodeficiency virus was not detected 30 days before co-infection and 10 days afterwards. His CD4 cell count did not show significant alterations in the two periods evaluated. He continued his course of treatment without arterial hypotension, serious hemorrhage, or other life-threatening complications.