RESUMO
In Brazil, only 35 cases of human fascioliasis have been reported. Several drugs have been used to treat Fasciola hepatica in humans, including praziquantel, and, more recently, triclabendazole. After three patients were diagnosed as having human fascioliasis by routine stool parasitological examinations done at Hospital de Clínicas UFPR, a study was done to determine the frequency of the infection in people and cattle from the surrounding area. Stool samples from 185 people and from 20 bovines were examined. Nine bovines' exams were positive for Fasciola hepatica and six new diagnoses of human fascioliasis were made. After taking a medical history, physical examination, routine blood examinations and biliary imaging in the 9 patients, therapy was given with praziquantel 75mg/Kg daily for 5 days. After 30 and 60 days stool examinations were made to evaluate the therapy's efficacy. All patients were asymptomatic. Hematological examinations were normal, and only one patient had an abnormal biliary system on the image study (echography). In the nine patients, praziquantel did not eliminate the fasciola eggs. Triclabendazole (a benzimidazole licensed for veterinary use) was therefore tested, 10mg/Kg one oral dose. Triclabendazole was effective and well tolerated in all patients. We conclude that fascioliasis is more common in some regions of Brazil than previously reported, and that single dose triclabendazole is effective and well tolerated in treating human fascioliasis.
RESUMO
Studies have demonstrated that HIV infection negatively affects the immune response to hepatitis B vaccine. The present study evaluated the seroconversion to the recombinant vaccine against hepatitis B applied in HIV patients. Twenty-two patients were included in the study group all with confirmed HIV infection and with negative serum markers to hepatitis B. The control group was composed of 18 healthy individuals with negative markers for hepatitis B. All subjects were vaccinated with 20µg of ENGERIX B((R)) at 0, 1 and 6 months (3 doses). The antibody response was quantitatively assessed 1 month after the third dose of recombinant vaccine. CD4 T lymphocyte counts were also performed in those beginning vaccination. Of 22 patients in the study group, only 10 (45.5%) responded to vaccination with protective levels (over 10mIU/ml). In the control group, all of the subjects responded (p=0.005). Seventeen patients in the study group had their CD4 lymphocytes measured. The results suggested a direct relationship between the level of CD4 lymphocyte counts and response to the vaccine. The rate of response to hepatitis B recombinant vaccine with 3 doses of 20µg of HBsAg in patients infected by the human immunodeficiency virus was significantly lower than in the control group. Patients with low CD4 T lymphocyte counts are likely to have an inadequate response to the current method of hepatitis B vaccination.