Revista Cubana de Medicina Tropical最新文献

Introduction: infections caused by protozoa of the genus Leishmania are a global health problem with a high prevalence in underdeveloped countries. There is no vaccine against this disease at present and the treatment used is poor, so the search for more effective and safe medicines is an urgent need.

Objective: to assess the in vitro antileishmanial activity of six aqueous and hydroalcohol extracts from marine organisms.

Methods: the activity of six extracts against Leishmania amazonensis promastigots and amastigots as well as their toxicity against peritoneal macrophages in BALB/c mice.

Results: in the promastigot assay, the extracts from Bryothamnion Iriquetrum, Bunodosoma granulifera, Halimeda opuntia and Physalia physalis showed growth inhibition at concentrations lower than 100 microg/mL whereas in amastigots, these last two extracts were the most active and least toxic with a selectivity index of 6 and 8 respectively.

Conclusions: taking these results into account, it was considered that the H. opuntia and P. physalis extracts showed a promising activity, so it is suggested that further studies on its in vivo activity be conducted.

Introduction: the intestinal parasitic infections are still endemic in Cuba, with a higher frequency in rural and mountain regions. Twenty five years after the last national survey, it deemed necessary to carry out a new national survey in order to know the prevalence of intestinal parasitic infections and to compare the obtained results between both studies. That knowledge would be valuable to work out strategies of health and to design a control program for intestinal parasitic infections in Cuba.

Objective: to determine the current prevalence of intestinal parasitic infections in Cuba and to compare these results with those obtained from the previous survey after a 25 year-period.

Methods: a cross sectional study was conducted from May to August of 2009 in a sample of Cuban population. A stool sample was collected from each individual, which was analyzed by direct examination, Willis' brine flotation method and the Kato-Katz thick smear technique. Additionally, a questionnaire was administered.

Results: the comparison between 1984 and 2009 surveys showed a general decrease of frequencies of intestinal parasitic infections caused by both helminths and pathogenic protozoa; however, the percentage of infections with commensal protozoa increased in 2009. In this last survey, there was observed decline of frequencies of infections with soil transmitted species, Trichuris trichiura, Ascaris lumbricoides, hookworm, and Strongyloides stercoralis and the pathogenic protozoa: Giardiau lamblia, Entamoeba histolytica/E. dispar, and the commensals: Endolimax nana and Entamoeba coli. The intestinal parasite Enterobius vermicularis was the only parasitic species that increased the frequency of infections with respect to the 1984 survey. The frequencies of parasitic and commensal infections in both studies were higher in the 5-14 y age group (school age).

Conclusions: the comparison between the intestinal parasitic infections surveys of 1984 and 2009 showed a reduction in the frequencies of intestinal parasitic infections in the last survey. The finding in both studies of a higher frequency of pathogenic parasitic infections and commensal infections in the 5-14 y age group (school age) supports the recommendation of making emphasis on the control programs for intestinal parasitic infections in this age group.

Cuba reported the first dengue hemorrhagic fever epidemic in the American region in 1981. More than 344 203 cases with 10 312 severe and very severe cases and 158 fatalities were reported. Thirty years after this epidemic, the established surveillance, the control actions and the performed research studies have allowed the country to keep free of dengue, although some epidemics and waves of transmission have occurred, which have finally been eliminated. This paper summarized some interesting aspects related with this epidemic as well as with the laboratory surveillance and results of some of the main research works.

Introduction: tuberculosis is traditionally considered as a professional disease in health care workers.

Objective: to evaluate the individual and collective tuberculosis infection risk by areas or departments in the National University Pneumologiic Hospital of Havana, Cuba.

Methods: the individual risk was assessed during 2008-2009 by means of a survey administered to the staff that includes personal data, labor location and exposition to M. tuberculosis, and a Tuberculin Skin Test (TST) was applied to 112 of them. A > or = 10 mm cut-off point was used for positivity. The collective risk was measured in each area or department by the prevalence of TB infection, the tuberculin conversion rate and the number of tuberculosis cases hospitalized per year.

Results: of the 183 surveyed workers, 60.7% had workers for more than 5 years in the institution. Of the 64 negative workers in the previous survey, 34.4% became positive in this survey. The latent TB infection prevalence was 50.8% (CI 95%: 43.36-58.23); higher prevalence found in nurses (64.7%-CI 95%: 38.6-84.7) and lower in health non-related technicians(30%-CI 95%: 8.1-64.6). Half of the departments or areas (17/34) were evaluated as high risk, 23.5% as intermediate risk, 11.8% as low risk and 14.7% as very low risk.

Conclusions: the National Pneumologic Hospital, as it was expected, is a high risk facility for Micobacterium tuberculosis infection that may affect its workers, and most of its areas pose a potential risk potential for the staff working there.

Introduction: dengue is a viral disease with endemic behavior. At the beginning of the illness it is not possible to know which patients will have an unfavorable evolution and develop a severe form of dengue. However, some warning symptoms and signs may be present.

Objective: to apply decision tree techniques to the exploration of signs of severity in the early phase of the illness.

Methods: the study sample was made up of 230 patients admitted with dengue to "Pedro Kouri" Institute of Tropical Medicine in 2001. The variables considered for the classification were the signs, symptoms and laboratory exams on the third day of evolution of the illness. The algorithm of classification and regression trees using the Gini's index was applied. Different loss matrices to improve the sensitivity were considered.

Results: the algorithm CART, corresponding to the best loss, had a sensitivity of 98,68% and global error of 0,36. Without considering loss, it obtained its sensitivity reached 74% with an error of 0,25. In both cases, the most important variables were platelets and hemoglobin.

Conclusions: the study submitted rules of decision with high sensitivity and negative predictive value of utility in the clinical practice. The laboratory variables resulted more important from the informational viewpoint than the clinical ones to discriminate clinical forms of dengue.

Introduction: Pediculosis capitis was very frequently reported in Cuba since the end of the 90's, particularly in some groups of school children and their relatives. The latter are involved in a chain of transmission of these insects and may play an important role at present as parasite reservoirs.

Objective: to report on the efficacy of the treatment of one female patient suffering from Pediculus capitis by using 5 % Indigofera suffruticosa Mill (añil cimarrón) tincture.

Methods: a case of persistent infestation with pediculosis capitis was described in which a 55 years-old patient was firstly treated with 1% permethrin solution and later with 5 % Indigofera suffruticosa Mill tincture.

Results: the microscopic identification of adult parasites and pre-adult stages of the parasite confirmed the presence of pediculus capitis. The hair treatment with 1 % permethrin was not effective after two applications. As an alternative, 5 % Indigofera suffruticosa Mill tincture was used and then the population of adult ectoparasites was reduced and the infestation was eliminated after the second application, with the paramedical staff continuously taking the nits out from the patient's hair.

Conclusion: the use of this innocuous method may become a therapeutic alternative to treat this illness.

Introduction: bacterial meningitis is a real concern for physicians and general health systems of any country as well as the international bodies.

Objective: to estimate burdens of disease from morbidity and mortality caused by bacterial meningitis in Cuba during 2006.

Methods: the mortality and the incidence data of the epidemiological survey from the National Surveillance of Bacterial Meningitis of "Pedro Kourí Institute of Tropical Medicine were used. The estimation methods were based on the WHO recommendations by using the DISMOD and the required Excel spreadsheets.

Results: the global burden of bacterial meningitis was estimated at a total of 3527.26 Disability Adjusted Lost Years (DALYs), which accounted for 31.3 years lost per 100 000 inhabitants. Morbidity and mortality burden of bacterial meningitis without sequel weighing was 2056.25 disability adjusted lost years, being the 55.9 % caused by unidentified agent, followed by S. pneumoniae (30.9 %), N. meningitidis (9.5 %) and H influenza type b (3.6 %). The mortality burden was 2 039 years of life lost from premature death, that is, 57.8 % of the global burden. Children under five years of age contributed the biggest global burden of disability adjusted lost years, and S. penumoniae generated the biggest burden.

Conclusion: the burden of bacterial meningitis was high. Burden of disease is an important measure to assess health problems.

Introduction: first infected cases caused by West Nile virus were reported in Cuba in 2004.

Objective: to monitor and learn about the prevalence of the West Nile virus in those areas with confirmed cases.

Methods: the study was conducted in Jatibonico municipality and in the city of sancti Spiritus. A total number of 14 persons, 8 horses and 41 birds were researched to detect antibodies to flavivirus and specific antibodies to West Nile virus.

Results: the presence of specific antibodies to West Nile virus was confirmed in 4 samples of sera from birds and in 4 from horses. One person was confirmed as one case of asymptomatic West Nile virus infection.

Conclusions: the presence of specific antibodies to West Nile virus in birds, horses and persons residing in areas where there are confirmed cases showed that a local amplification cycle had been established in Cuba before this study.

Introduction: visceral leishmaniasis is considered the most severe form of this disease and can be fatal if not properly treated. In Latin America, the infection is caused by Leishmania infantum (syn. Leishmania chagasi). The unequivocal diagnosis and the selection of a suitable experimental model are required to undertake studies on this biologic agent.

Objective: to determine the advantages of immunohistochemistry in identifying Leishmania.

Methods: hamsters were inoculated with Leishmania infantum promastigotes. The body weights of every animal were monitored, and the relative weights of their spleens and livers were estimated. For identification of amastigotes, Giemsa-stained imprints and an immunohistochemistry protocol in paraffin-embedded tissues were developed.

Results: the infection was reproduced in the experimental model. The immunohistochemistry was positive in infected animal sections and non-reactive for the control group. When compared with the Giemsa staining, this methodology facilitated the identification, particularly in organs infected with few parasites.

Conclusions: immunohistochemistry is a specific tool for detection of Leishmania since it facilitates observation and eliminates any confusion in the identification of the parasite, thus improving the quality of diagnosis.

Introduction: Rhodococcus equi is recognized as an emerging pathogen that causes important morbidity and mortality among immunocompromised patients.

Objective: to confirm the presence of R. equi in pleural fluid through the restriction fragment length polymorphism technique.

Methods: the pleural fluid sample from one AIDS patient with respiratory symptoms was used. Microbiologic culture, staining tests, phenotypic and biochemical tests and restriction fragment length polymorphism technique for the diagnosis of microorganism were performed.

Results: the staining technique along with the phenotypic and biochemical tests provided the presumptive diagnosis of R. equi infection, which was further confirmed by the molecular techniques.

Conclusions: this paper reported the molecular detection of R. equi from one HIV/aids patient for the first time in Cuba. The results suggested that the molecular biology techniques could be used in the diagnosis and identification of R. equi.