RESUMO
BACKGROUND: Traditional methods of diagnosing mucosal leishmaniasis (ML), such as biopsy with histopathology, are insensitive and require collection of an invasive diagnostic specimen. METHODS: We compared standard invasive procedures including biopsy histopathology, biopsy PCR, and leishmanin skin test (LST) to a novel, non-invasive, cytology-brush based PCR for the diagnosis of ML in Lima, Peru. Consensus reference standard was 2/4 tests positive, and outcome measures were sensitivity and specificity. Leishmania species identification was performed by PCR-based assays of positive specimens. RESULTS: Twenty-eight patients were enrolled, 23 of whom fulfilled criteria for a diagnosis of ML. Sensitivity and specificity of biopsy with histopathology were 21.7% [95% CI 4.9-38.5%] and 100%; 69.6% [95% CI 50.8-88.4%] and 100% for LST; 95.7% [95% CI 87.4-100%] and 100% for biopsy PCR; and 95.7% [95% CI 87.4-100%] and 90% [95% CI 71.4-100%] for cytology brush PCR using both Cervisoft® and Histobrush® cervical cytology brushes. Represented species identified by PCR-RFLP included: L. (V). braziliensis (n = 4), and L. (V). peruviana (n = 3). CONCLUSIONS: Use of commercial grade cytology brush PCR for diagnosis of ML is sensitive, rapid, well tolerated, and carries none of the risks of invasive diagnostic procedures such as biopsy. Further optimization is required for adequate species identification. Further evaluation of this method in field and other settings is warranted.
Assuntos
Leishmaniose Mucocutânea/diagnóstico , Reação em Cadeia da Polimerase/métodos , Biópsia , Humanos , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/normas , Peru , Reação em Cadeia da Polimerase/instrumentação , Reação em Cadeia da Polimerase/normas , Sensibilidade e Especificidade , Testes CutâneosRESUMO
We hypothesized that Leishmania kDNA may be present in urine of patients with cutaneous leishmaniasis (CL). Urine samples and standard diagnostic specimens were collected from patients with skin lesions. kDNA polymerase chain reaction (PCR) was performed on samples from patients and 10 healthy volunteers from non-endemic areas. Eighty-six of 108 patients were diagnosed with CL and 18 (21%) had detectable Leishmania Viannia kDNA in the urine. Sensitivity and specificity were 20.9% (95% confidence interval [CI] 12.3-29.5%) and 100%. Six of 8 patients with mucocutaneous involvement had detectable kDNA in urine versus 12 of 78 patients with isolated cutaneous disease (P < 0.001). L. (V.) braziliensis (N = 3), L. (V.) guyanensis (N = 6), and L. (V.) peruviana (N = 3) were identified from urine. No healthy volunteer or patient with an alternate diagnosis had detectable kDNA in urine. Sensitivity of urine PCR is sub-optimal for diagnosis. On the basis of these preliminary data in a small number of patients, detectable kDNA in urine may identify less localized forms of infection and inform treatment decisions.
Assuntos
DNA de Cinetoplasto/isolamento & purificação , DNA de Cinetoplasto/urina , Leishmania/genética , Leishmaniose Cutânea/urina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , DNA de Cinetoplasto/genética , Feminino , Humanos , Leishmania/isolamento & purificação , Leishmaniose Cutânea/epidemiologia , Leishmaniose Cutânea/parasitologia , Leishmaniose Mucocutânea/epidemiologia , Leishmaniose Mucocutânea/parasitologia , Leishmaniose Mucocutânea/urina , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Adulto JovemRESUMO
Fascioliasis is a foodborne trematode infection that affects patients worldwide causing both liver inflammation and biliary obstruction. In developed countries, the disease is rare but a number of focal outbreaks have been reported. Here, we report a case of human fascioliasis in which acute and chronic manifestations coexisted and discuss the newest evidence regarding pathogenesis, diagnostic approach, and treatment, with emphasis on strategies to control the incidence of this emergent disease.
Assuntos
Fasciola hepatica/isolamento & purificação , Fasciolíase/diagnóstico , Contaminação de Alimentos/análise , Idoso , Animais , Anti-Helmínticos/uso terapêutico , Benzimidazóis/uso terapêutico , Fasciola hepatica/efeitos dos fármacos , Fasciolíase/tratamento farmacológico , Fasciolíase/epidemiologia , Feminino , Humanos , Prevalência , Resultado do Tratamento , TriclabendazolRESUMO
Para el estudio de las actitudes se hace necesario reconocer su importancia dentro del comportamiento social del ser humano el cual puede ser fisiologico o de intereses o motivos, que se interrelacionan con elementos basicos como la herencia, la maduracion y la socializacion. El estudiante y el profesional de enfermeria deben reconocer la importancia de la relacion enfermera-paciente, dado que ambos son capaces de generar actitudes positivas o negativas, activas o pasivas, que segun Hollender estan incluidas en tres niveles. Siendo esta la clave para la practica de la enfermera y favorecen la continua empatia dada por las actitudes propias o individuales de la enfermera. Para este estudio se escogieron:las actitudes de rechazo, sobreproteccion e indiferencia, por parte de la enfermera; igualmente se tuvieron en cuenta las respuestas del paciente frente a su enfermedad como agresion, no colaboracion y dependencia siendo estas las mas evidentes en la escala de Likert por el impacto que causa en la relacion enfermera-paciente. Es asi como a traves del analisis estadistico se logro establecer que la formacion profesional no ejerce influencia sobre las actitudes de las estudiantes de I-IV_VII semestre de la facultad, que estan dadas por sus convicciones, creencias y educacion. Se observo tambien que el cambio de las actitudes es poco significativo entre las estudiantes que ingresan a primer semestre y las que estan cursando su ultimo ano, indicando que aun cuando se adquiran conocimientos cientificos y practicos el cambio de comportamiento se..