RESUMO
A randomized treatment trial of travelers' diarrhea was carried out among U.S. military personnel participating in routine exercises in several port cities in South America and West Africa. A 5-day, twice daily course of either norfloxacin (400 mg) or trimethoprim/sulfamethoxazole (TMP/SMX, 160/800 mg) was given to 142 volunteers. At the end of 5 days of treatment, diarrhea had resolved in 100% of 73 patients receiving norfloxacin and 97.1% (67/69) receiving TMP/SMX. A probable bacterial pathogen was determined in 44% of 142 subjects: 49% of the norfloxacin group and 39% of the TMP/SMX group. The most common pathogens detected were enterotoxigenic Escherichia coli in 20% of cases and rotavirus in 15%. Resistance to TMP/SMX was present in 20 (27%) bacterial isolates, while no resistance to norfloxacin was found. Eight of 10 patients in the TMP/SMX treatment group who had TMP/SMX-resistant bacterial enteropathogens improved clinically. Both norfloxacin and TMP/SMX were clinically effective in the treatment of travelers' diarrhea in this military population.
Assuntos
Diarreia/tratamento farmacológico , Militares , Norfloxacino/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Doença Aguda , Adolescente , Adulto , África Ocidental , Infecções Bacterianas/tratamento farmacológico , Infecções por Escherichia coli/tratamento farmacológico , Fezes/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , América do Sul , Inquéritos e Questionários , Viagem , Estados Unidos , Viroses/tratamento farmacológicoRESUMO
One hundred fifteen acute cases of gonorrhea were documented in U.S. military personnel during a five-month cruise in which 22 port cities of Latin America were visited in 1985. Penicillinase-producing Neisseria gonorrhoeae (PPNG) was isolated from 23 (20%) of the 115 cases. No penicillin-resistant, beta-lactamase-negative gonococci were encountered. None of the ten cases of gonorrhea acquired in the Caribbean region was due to PPNG. In South America, the PPNG infection rate was 35% (19/54) in ports along the Pacific Ocean and 8% (4/51) in those along the Atlantic. Infections incurred in four cities of three countries on the Pacific coast of the South American continent accounted for 78% of all PPNG isolates. Although the study did not deal directly with infections in the local populations, the data suggest that PPNG are common in coastal South America and that hyperendemic foci exist in some cities of the continent's western coast.
Assuntos
Gonorreia/microbiologia , Militares , Neisseria gonorrhoeae/enzimologia , Resistência às Penicilinas , Penicilinase/metabolismo , Antibacterianos/uso terapêutico , América Central , Gonorreia/tratamento farmacológico , Humanos , Masculino , América do SulRESUMO
A serologic survey in 1983-1984 evaluated the presence of hepatitis A antibody (anti-HAV) and hepatitis A immunoglobulin M antibody (anti-HAV IgM) in 3,251 adults and 811 children in the jungle and coastal areas of Peru. All subjects were asymptomatic. Adults had a 98% positive anti-HAV rate except for naval cadets, who had a 76% rate. Children had an 82% positive anti-HAV rate, increasing from 30% at one year of age to 100% at eight years of age. Anti-HAV IgM was present in 27% of children one to four years of age who had antibody and was not present in those older than 12. The vast majority of Peruvian adults are immune to hepatitis A, and children with asymptomatic infection play a significant role in the transmission of this disease.