RESUMO
The reservoir capacity of domestic cats and dogs for Trypanosoma cruzi infection and the host-feeding patterns of domestic Triatoma infestans were assessed longitudinally in 2 infested rural villages in north-western Argentina. A total of 86 dogs and 38 cats was repeatedly examined for T. cruzi infection by serology and/or xenodiagnosis. The composite prevalence of infection in dogs (60%), but not in cats, increased significantly with age and with the domiciliary density of infected T. infestans. Dogs and cats had similarly high forces of infection, prevalence of infectious hosts (41-42%), and infectiousness to bugs at a wide range of infected bug densities. The infectiousness to bugs of seropositive dogs declined significantly with increasing dog age and was highly aggregated. Individual dog infectiousness to bugs was significantly autocorrelated over time. Domestic T. infestans fed on dogs showed higher infection prevalence (49%) than those fed on cats (39%), humans (38%) or chickens (29%) among 1085 bugs examined. The basic reproduction number of T. cruzi in dogs was at least 8.2. Both cats and dogs are epidemiologically important sources of infection for bugs and householders, dogs nearly 3 times more than cats.
Assuntos
Doenças do Gato/epidemiologia , Doença de Chagas/epidemiologia , Reservatórios de Doenças , Doenças do Cão/epidemiologia , Insetos Vetores/parasitologia , Triatoma/parasitologia , Trypanosoma cruzi , Fatores Etários , Animais , Argentina/epidemiologia , Doenças do Gato/diagnóstico , Doenças do Gato/imunologia , Doenças do Gato/parasitologia , Gatos , Doença de Chagas/diagnóstico , Doença de Chagas/imunologia , Doença de Chagas/parasitologia , Doença de Chagas/veterinária , Criança , Doenças do Cão/diagnóstico , Doenças do Cão/imunologia , Doenças do Cão/parasitologia , Cães , Feminino , Humanos , Estudos Longitudinais , Masculino , Prevalência , População Rural , Inquéritos e Questionários , XenodiagnósticoRESUMO
The long-term effects on domiciliary reinfestation by Triatoma infestans of smoothing the plaster of indoor walls prior to insecticide application (in Amamá village) relative to only insecticide application (in Trinidad-Mercedes villages) were evaluated in rural northwestern Argentina from 1992 to 1997. All domestic and peridomestic areas of each house were sprayed with 2.5% suspension concentrate deltamethrin at 25 mg/m(2) in October 1992, and infestations were assessed by various methods every 6 months. Domiciliary infestation decreased from 72-88% in 1992 to 6-17% in late 1995, to increase moderately thereafter without returning to baseline rates. Peridomestic sites were the first in becoming reinfested, and reached more abundant T. infestans populations than domiciliary areas. Domiciliary infestation rates and bug abundances were not significantly different between communities during surveillance. Domiciliary infestation rates in well-plastered houses were very low (5-9%) and approximately stable until 1996, but in houses with regular or bad plaster they consistently increased from 5 to 19-21% in both communities. Logistic multiple regression analysis showed that the likelihood of domestic infestation assessed through householders' collections was significantly and positively associated with the occurrence of an infested peridomestic site in the respective house, the occurrence of high-density domestic infestations before interventions, and well-plastered walls in 1996. Combining insecticide spraying and partial improvement of walls controlled domestic infestations and transmission of Trypanosoma cruzi effectively, but was not sufficient to eliminate T. infestans from the study area or increase the effectiveness of careful chemical control.
Assuntos
Doença de Chagas/prevenção & controle , Habitação , Controle de Insetos/métodos , Piretrinas/uso terapêutico , Triatoma , Animais , Argentina , Ectoparasitoses/epidemiologia , Ectoparasitoses/prevenção & controle , Humanos , Inseticidas , Nitrilas , Vigilância da População , PrevalênciaRESUMO
American trypanosomiasis, or Chagas disease, caused by the protozoan parasite Trypanosoma cruzi and transmitted by blood-feeding triatomine bugs, is a chronic, frequently fatal infection that is common in Latin America. Neither adequate drugs nor a vaccine is available. A mathematical model calibrated to detailed household data from three villages in northwest Argentina shows that householders could greatly reduce the risk of human infection by excluding domestic animals, especially infected dogs, from bedrooms; removing potential refuges for bugs from walls and ceilings; and using domestically applied insecticides. Low-cost, locally practicable environmental management combined with intermittent use of insecticides can sustainably control transmission of T. cruzi to humans in rural Argentina and probably elsewhere.
Assuntos
Doença de Chagas/transmissão , Doenças do Cão/epidemiologia , Habitação , Insetos Vetores/fisiologia , Modelos Biológicos , Triatoma/fisiologia , Animais , Argentina , Sangue , Doença de Chagas/epidemiologia , Doença de Chagas/prevenção & controle , Doença de Chagas/veterinária , Galinhas , Cães , Comportamento Alimentar , Humanos , Insetos Vetores/parasitologia , Inseticidas , Matemática , Estações do Ano , Triatoma/parasitologia , Trypanosoma cruzi/fisiologiaRESUMO
OBJECT: With the recent development and refinement of endovascular stents, the significant potential for these devices in the treatment of wide-necked dissecting and fusiform aneurysms has become apparent. In this article the authors report on the use of stents and coils to treat dissecting and fusiform vertebral artery (VA) aneurysms. METHODS: Eight consecutive patients harboring eight dissecting aneurysms and one fusiform aneurysm of the VA were succesfully treated using a procedure in which the authors inserted an intravascular stent and secondary endosaccular coils when needed. In all but one patient complete aneurysm occlusion was achieved, and in all cases there was no neurological complication. Follow-up angiography examinations were performed in all patients (mean duration of follow-up angiography review 13.1 months, range 3-42 months). The patients remained stable throughout the clinical follow-up period (mean 14.1 months, range 4-42 months). No rebleeding was recorded. CONCLUSIONS: At present this combined approach represents a reliable and safe alternative for the treatment of VA dissecting aneurysms, especially in patients who cannot tolerate occlusion tests.
Assuntos
Embolização Terapêutica , Stents , Dissecação da Artéria Vertebral/terapia , Adulto , Angiografia Digital , Angiografia Cerebral , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Complicações Pós-Operatórias/mortalidade , Resultado do Tratamento , Dissecação da Artéria Vertebral/diagnóstico , Dissecação da Artéria Vertebral/mortalidadeRESUMO
BACKGROUND: Gas-containing brain abscesses are very rare, and the majority are caused by Clostridium perfringens. We report a case of gas-containing brain abscess that required urgent surgery after a craniotomy for a brain tumor. METHODS AND RESULTS: The patient was a 53-year-old male who presented with a cerebral neoplasm. A temporal lobectomy was performed and the diagnosis of low grade glioma was confirmed. Although the surgery was uneventful the postoperative course was complicated; the patient became agitated and febrile and deteriorated to a deep coma. A computed tomography scan demonstrated gas in the temporal fossa at the lobectomy site, producing mass effect. Urgent surgical debridement and drainage was performed and C. perfringens and mixed flora were found. Antibiotics were started and the patient's condition markedly improved. He was awake and alert, followed commands adequately and was extubated; however, after a week he suffered massive gastrointestinal bleeding and died. CONCLUSIONS: Early recognition of a gas-containing brain abscess is of great interest to immediately start the appropriate treatment. Urgent surgical debridement and broad spectrum chemotherapy are major components in the management of this entity.
Assuntos
Abscesso Encefálico/etiologia , Abscesso Encefálico/cirurgia , Infecções por Clostridium/etiologia , Clostridium perfringens , Craniotomia/efeitos adversos , Tratamento de Emergência , Procedimentos Neurocirúrgicos , Abscesso Encefálico/microbiologia , Infecções por Clostridium/microbiologia , Clostridium perfringens/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Domestic reinfestations by triatomine bugs were monitored after application of deltamethrin and apparent elimination of Triatoma infestans in Amama and other nearby rural villages, north-west Argentina, from 1992 to 1996. The five methods used were sensor boxes, sheets of pink typing-paper, timed manual catches by a skilled three-person team aided by a flushing-out agent, collections by house-dwellers, and knockdown using insecticide fumigant canisters. In bedrooms, house-dwellers collected T. infestans significantly more frequently than the flushing-out method, but the reverse occurred in peridomestic sites. Both methods and sensor boxes revealed the frequent invasion of adult Triatoma guasayana and T. infestans, but neither T. guasayana nor Triatoma sordida colonized bedroom areas in spite of their rising abundance in nearby peridomestic sites. Sensor boxes were significantly more sensitive than the matched paper-sheets in three of five cross-sectional surveys. On average, each box recorded 2.0-3.2 times more triatomine fecal smears than each paper sheet. The frequency of dejecta in sensor boxes correlated positively with the proportion of houses where T. infestans, T. guasayana or T. sordida were captured by any method in bedroom areas. Triatomine fecal smears in sensor boxes were the earliest and most frequent sign of domiciliary infestation, followed by dwellers' collections of adult bugs. Analyzing the data prospectively, we provide a quantitative, predictive understanding of detection methods and review the validity and interpretation of the different signs of infestation obtained. The most sensitive and cost-effective combination of detection methods for vector surveillance in domestic areas was the use of sensor boxes and house-dwellers collections.
Assuntos
Doença de Chagas/prevenção & controle , Habitação , Controle de Insetos/métodos , Insetos Vetores/crescimento & desenvolvimento , Triatoma/crescimento & desenvolvimento , Animais , Argentina , Inseticidas , Nitrilas , Estudos Prospectivos , Piretrinas , População Rural , Fatores de TempoRESUMO
Environmental, demographic, and entomologic variables were analyzed by logistic multiple regression analysis for their association with the likelihood of being seropositive for Trypanosoma cruzi in three highly infested rural villages of northwest Argentina. The prevalence of seropositivity for T. cruzi, as determined by the composite results of three serologic tests, was 34% among 338 persons in 1992. The strongest positive predictors of the adjusted odds of being infected were the household number of dogs, the density of T. cruzi-infected Triatoma infestans in bedroom areas, and each person's age. Dwellers from houses with roofs made completely or partly with a grass called simbol, or which used insecticides rudimentarily and nonsystematically, had a significantly lower odds of being seropositive for T. cruzi than residents from other types of dwellings. The adjusted odds of infection also increased with the number of T. cruzi-infected dogs or cats and the presence of chickens in bedroom areas. No significant effects on the adjusted odds of infection of a community-wide deltamethrin spraying carried out in one of the villages seven years before were detected. Socioeconomic indicators, such as domiciliary area, and numbers of corrals and livestock, were inversely related to being infected. Our study identified several manageable variables suitable for control actions, most of them not examined before in univariate or multivariate analyses. Environmental management based on low-cost housing with appropriate local materials and removal of domestic animals from domiciliary areas have a crucial role to play in the control of Chagas' disease in rural areas.
Assuntos
Anticorpos Antiprotozoários/sangue , Doença de Chagas/epidemiologia , Trypanosoma cruzi/imunologia , Adolescente , Adulto , Animais , Animais Domésticos/parasitologia , Argentina/epidemiologia , Gatos , Doença de Chagas/prevenção & controle , Doença de Chagas/transmissão , Criança , Cães , Feminino , Habitação , Humanos , Insetos Vetores/parasitologia , Masculino , Fatores de Risco , Saúde da População Rural , População Rural , Estudos Soroepidemiológicos , Triatoma/parasitologiaRESUMO
Reported are the environmental and demographic risk factors associated with the domestic infestation and density of Triatoma infestans in three heavily infested rural villages in Santiago del Estero Province, Argentina. In a one-factor unadjusted analysis, the number of T. infestans captured per person-hour was associated significantly and negatively with the use of domestic insecticides by householders, type of thatch used in the roofs and the age of the house; and positively with the following: degree of cracking of the indoor walls and presence of hens nesting indoors. In one model, using multiple linear regression and a backward stepwise elimination procedure, most of the variation in the overall abundance of T. infestans was explained by insecticide use and the presence of hens nesting indoors; in another model using the same procedure it was explained by insecticide use, bug density in 1988 and previous spraying with deltamethrin in 1985. Variations in bug density per capture stratum (household goods, beds, walls and roof) were explained by the bug density in other strata and by one or two of the following risk factors: hens nesting indoors, type of roof, presence of cracks in the walls and number of people living in the house. Bug density might be locally controlled by the availability of refuges in the roofs and walls, by the presence of hens nesting indoors and by the use of domestic insecticides. Certain local materials, such as a grass known as simbol, could be successfully used in rural housing improvement programmes aimed at reducing the availability of refuges for insects in the roof.
Assuntos
Controle de Insetos , Triatoma , Adulto , Animais , Argentina , Criança , Cães , Características da Família , Habitação , Humanos , Inseticidas/administração & dosagem , Modelos Lineares , Estudos Longitudinais , Nitrilas , Densidade Demográfica , Piretrinas/administração & dosagemRESUMO
BACKGROUND: The natural history of a traumatic acute subdural hematoma is usually interrupted by its prompt surgical removal. Rapid spontaneous resolution within 48 hours, although infrequently reported, may be, underestimated and demonstrates a benign course of this condition. To our knowledge, this is the first case of rapid spontaneous resolution of an acute subdural hematoma in a patient with HIV encephalopathy and cerebral atrophy. METHODS AND RESULTS: This 27-year-old man, an intravenous drug user with AIDS-related complex and HIV encephalopathy, suffered an acute subdural hematoma due to head injury in a car accident. The hematoma spontaneously resolved within 12 hours, resulting in a favorable outcome with nonoperative treatment. CONCLUSIONS: AIDS related cerebral atrophy may not only have predisposed the patient to the development of an extracerebral collection, but may have also favorably influenced the spontaneous resolution of the hematoma. The mechanism of the hematoma resolution and the influence of HIV related cerebral atrophy is discussed.
Assuntos
Complexo AIDS Demência/complicações , Complexo Relacionado com a AIDS/complicações , Encéfalo/patologia , Hematoma Subdural/complicações , Complexo AIDS Demência/diagnóstico por imagem , Complexo AIDS Demência/patologia , Complexo Relacionado com a AIDS/diagnóstico por imagem , Complexo Relacionado com a AIDS/patologia , Doença Aguda , Adulto , Atrofia , Encéfalo/diagnóstico por imagem , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/patologia , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
In three rural villages of northwest Argentina, the overall proportion of domiciliary Triatoma infestans infected with Trypanosoma cruzi was 49% among 1,316 bugs individually examined for infection in March and October 1992). Most of the variation among individual households in the proportion of infected triatomines was explained by variations among houses in the proportion of bugs that fed on dogs or cats, the prevalence of infected dogs or cats, and the proportion of bugs that fed on humans, according to a logistic multiple regression analysis. The effects of human infection rates on bug infection rates were not statistically significant. After adjusting for the effects of other predictors, the presence of chickens in bedroom areas had negative and significant effects on the proportion of infected Triatoma infestans, and positive and significant effects on the number of T. cruzi-infected triatomines collected per person-hr per house. Dog or cat infection rates and the proportion of bugs that fed on dogs or cats and on chickens explained 80% of the total variance of infected-bug numbers in a linear multiple regression model. This is the first study to use detailed field data to show that variations in triatomine infection rates depend on bug host feeding patterns and dog or cat infection rates, while the presence of chickens in bedroom areas exerts opposite effects on the proportion and number of infected triatomines. Domestic animals play a crucial role in the domiciliary transmission of T. cruzi.
Assuntos
Insetos Vetores/parasitologia , Triatoma/parasitologia , Trypanosoma cruzi/isolamento & purificação , Animais , Argentina , Doenças do Gato/epidemiologia , Gatos , Doença de Chagas/epidemiologia , Galinhas , Doenças do Cão/epidemiologia , Cães , Comportamento Alimentar , Habitação , Humanos , Mordeduras e Picadas de Insetos/epidemiologia , Insetos Vetores/fisiologia , Modelos Lineares , Parasitemia/epidemiologia , Prevalência , Saúde da População Rural , Triatoma/fisiologiaRESUMO
BACKGROUND: This is the first communication of a fatal spontaneous spinal epidural hematoma following thrombolysis. CLINICAL PRESENTATION: Spine pain may precede neurologic deterioration by many hours. The diagnosis can be accurately made with axial computed tomography (CT) of the involved spinal segment. TREATMENT: Emergency surgery is the treatment for this condition, but conditions such as the acute stage of a myocardial infarction or intraoperative bleeding difficulties due to iatrogenic coagulopathy, the degree of preoperative neurologic deficit, and the timing of surgery must be cautiously considered. CONCLUSIONS: Neurosurgeons will be faced with another devastating complication of thrombolytic therapy, as long as the available drugs are being used. Early clinical suspicion and availability of CT or magnetic resonance imaging for prompt diagnosis are essential to initiate appropriate medical therapy and timely surgery. New strategies must include the development of completely fibrin-specific thrombolytics and drugs that may rapidly reverse the systemic and local clotting disorder.
Assuntos
Hematoma Epidural Craniano/induzido quimicamente , Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Idoso , Vértebras Cervicais , Evolução Fatal , Hematoma Epidural Craniano/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Patients with AIDS frequently show secondary involvement of the brain by different infectious agents, and Chagas' disease is now recognized as a potential opportunistic infection. To our knowledge, pseudotumoral chagasic meningoencephalitis has not been previously reported as the first manifestation of AIDS. METHODS AND RESULTS: A 30-year-old Argentinian man without any risk factor for HIV infection was admitted to the hospital with an acute onset of drowsiness. A computed tomography scan showed a hypodense parietal tumor-like lesion. Open brain biopsy revealed hemorrhagic necrosis and numerous amastigotes of Trypanosoma cruzi. Nifurtimox was started, but the patient died. CONCLUSIONS: Chagas' disease can reactivate in patients with AIDS and present as a brain mass that is indistinguishable from other infectious or neoplasic processes. Our report demonstrates this entity as the first manifestation of AIDS.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Doença de Chagas , Meningoencefalite/parasitologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico por imagem , Adulto , Doença de Chagas/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Masculino , Meningoencefalite/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
The objective of this study was to assess the levels of prolactin (PRL) in cerebrospinal fluid (CSF) of HIV-infected patients with regard to nonHIV-infected patients, and to assess the levels of prolactin in the CSF of HIV-infected patients with and without neurological HIV-involvement. Seventeen HIV-infected patients with different degrees of immunological and neurological involvement were studied. A second group of six HIV-seronegative patients with varying clinical conditions requiring lumbar punctures were included as controls. CSF was collected from patients and controls. Patients were studied neurologically and neuropsychologically, and computed tomography of the brain were performed. They were staged according to CDC clinical classification for HIV infection, and on the basis of tomographic findings into one of five stages. An additional classification for neurological involvement in AIDS was used. CD4+ cell counts, CSF studies, serum-prolactin levels and CSF-prolactin levels were performed as principal laboratory tests. CSF PRL concentrations were significantly higher in the HIV-infected group (n = 17) than the nonHIV infected control group (n = 6) (mean +/- s.d.; 5.77 +/- 2.22 vs. 3.53 +/- 0.69 x 10(-6) g l-1, respectively; p = 0.009, Mann-Whitney U-test). Moreover, even CSF-PRL concentration was higher in HIV-infected patients without cognitive impairment (stage 0 of the clinical classification), (n = 12) in comparison with nonHIV infected controls (n = 6) (mean +/- s.d.; 5.51 +/- 2.31 vs. 3.53 +/- 0.69 x 10(-1) g l-1, respectively; p = 0.028, Mann-Whitney U-test). There was a good correlation between serum and CSF-PRL levels in HIV-infected patients when measured by the Spearman Rank Test (rs = 0.773; p = 0.005). PRL raised serum levels were found in 4 out of 13 patients (30.73%). We conclude that higher levels of CSF-PRL are more frequently found in HIV-infected patients in comparison to uninfected controls. High levels of circulating PRL were also found in HIV-infected patients corroborating results from other work. A good correlation coefficient was found between circulating and CSF-PRL levels in HIV-infected patients, suggesting that disruption of the blood-brain barrier might account for a possible pathogenic mechanism.
Assuntos
Complexo AIDS Demência/líquido cefalorraquidiano , Prolactina/líquido cefalorraquidiano , Infecções Oportunistas Relacionadas com a AIDS/líquido cefalorraquidiano , Feminino , Proteína do Núcleo p24 do HIV/líquido cefalorraquidiano , Humanos , Masculino , Prolactina/sangueRESUMO
This is the first report of the occurrence of a central neurocytoma and a symptomatic paraventricular cyst; this entity may have particular surgical implications. A 37-year-old male was admitted with a four month history of dizziness and gait instability. He subsequently developed increasing weakness of his left arm and leg. An unenhanced computed tomography scan revealed a hyperdense mass in the right lateral ventricle with a paraventricular cystic lesion in the frontoparietal white matter. MR images showed the origin and extent of the lesion more completely. A frontoparietal craniotomy with a transfrontal transcystic approach allowed resection of the tumor. Intraventricular tumors continue to present a major challenge for neurosurgeons because of their depth and the important surrounding structures. We report the use of a well-known neurosurgical strategy, the transcystic approach, for gross removal of a neurocytoma located in the ventricles.
Assuntos
Neoplasias Encefálicas/complicações , Ventrículos Cerebrais/patologia , Cistos/complicações , Neurocitoma/complicações , Adulto , Neoplasias Encefálicas/diagnóstico por imagem , Cistos/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Neurocitoma/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Trypanosoma cruzi is the responsible agent of Chagas disease and is endemic in extended areas of South and Central America. There are many previous reports indicating that T. cruzi frequently involves the central nervous system in AIDS patients. Here, we present two cases illustrating that neurological involvement caused by T. cruzi frequently shows a clinical picture similar to that caused by Toxoplasma gondil. Since in neurological Chagas disease early treatment has been associated with a better outcome and considering that the diagnosis is easily reached by the detection of the agent in the cerebrospinal fluid, we propose a new algorithm for the management of AIDS patients presenting neurological focal lesions in endemic areas for T. cruzi.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Algoritmos , Antiprotozoários/uso terapêutico , Encefalopatias/parasitologia , Doença de Chagas , Pirimetamina/uso terapêutico , Sulfadiazina/uso terapêutico , Toxoplasmose/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Adulto , Doença de Chagas/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Toxoplasmose/diagnósticoAssuntos
Ventrículos Cerebrais/patologia , Cisto Dermoide/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Adulto , Ventriculografia Cerebral , Colesterol/líquido cefalorraquidiano , Cisto Dermoide/líquido cefalorraquidiano , Cisto Dermoide/diagnóstico por imagem , Humanos , Queratinas/líquido cefalorraquidiano , Imageamento por Ressonância Magnética , Masculino , Neoplasias Hipofisárias/líquido cefalorraquidiano , Neoplasias Hipofisárias/diagnóstico por imagem , Ruptura Espontânea , Tomografia Computadorizada por Raios XRESUMO
The purpose of this study was to identify the origin of Triatoma infestans reinfestation and study its dynamics following spraying with deltamethrin inside and around 94 houses in three rural communities in northwestern Argentina. The effectiveness of the spraying was evaluated immediately after the houses were sprayed and two months later. In addition, five residual peridomiciliary foci were found and sprayed, as well as three preexisting ones that had not been sprayed. To monitor reinfestation, biosensors were placed in the houses and each family was also asked to capture triatomines and keep them in plastic bags; in addition, triatomines were searched for in and around houses, using an aerosol that dislodged them from their hiding places. Selective sprayings were carried out only where a colony of T. infestans was found. During the 30 months of follow-up, the percentage of houses in which any T. infestans were captured varied between 3% and 9%. In six houses, T. infestans were captured during more than one evaluation. The number of peridomiciliary areas found to be infested (19) was double the number of infested houses (9). Colonies of T. infestans were found only in the peridomiciliary areas, where the number of T. infestans captured was six times higher than in the houses. Chickens were the host most frequently associated with peridomiciliary foci. This area was the origin and principal source of reinfestation. To reduce the speed of reinfestation and the frequency with which sprayings are needed, the following environmental and chemical control methods must be combined in the peridomiciliary area: reduce the number of hiding places of triatomines; restrict the raising of birds to structures that cannot be colonized by triatomines; apply an insecticide that is less likely to be degraded by exposure to the elements, or perform a second spraying 6 to 12 months after the first; and employ a device for early detection of the presence of T. infestans around houses.
Assuntos
Doença de Chagas/prevenção & controle , Habitação , Controle de Insetos , Insetos Vetores , Triatoma , Trypanosoma cruzi , Aerossóis , Criação de Animais Domésticos/métodos , Animais , Argentina , Doença de Chagas/transmissão , Galinhas/parasitologia , Reservatórios de Doenças , Abrigo para Animais , Controle de Insetos/instrumentação , Controle de Insetos/métodos , Inseticidas , Nitrilas , Avaliação de Programas e Projetos de Saúde , PiretrinasRESUMO
El hematoma subdural agudo se debe habitualmente a un traumatismo de cráneo y ocasionalmente a la rotura de un aneurisma o una malformación vascular en el espacio subdural.Se presenta el caso de un paciente con cefalea súbita intensa que posteriormente deteriora su sensorio.No tuvo historia de traumatismo de cráneo.Se efectuó el diagnóstico tomográfico de hematoma subdural agudo y en el acto quirúrgico se indentificó un sangrado activo arterial sin malformación asociada.La entidad hematoma subdural agudo espontáneo de origen arterial es revisada