RESUMO

1. Salmonella Gallinarum (SG) infections cause fowl typhoid, which leads to important economic losses. Multidrug resistance (MDR) and the capacity for bacteria to form biofilms could play an important role in the persistence of SG in poultry flocks resulting in intermittent disease outbreaks. The aim of the following study was to assess the lytic activity of two new bacteriophages (Salmonella phages UPF_BP1 and UPF_BP2) against MDR and biofilm-forming SG. 2. Forty-six strains of SG, isolated in 2015, were characterised by antimicrobial resistance, biofilm formation profiles and susceptibility to two new bacteriophages. 3. Of these strains, 24% were multidrug resistant and more than 80% formed biofilm, with no statistical difference between incubation temperatures (42°C or 22°C). With regard to the lytic activity of the phages, 85% of strains were susceptible to at least one phage. Of these, 74% were lysed by both phages, including MDR and biofilm producing strains. 4. The use of salmonella phages UPF_BP1 and UPF_BP2 were shown to be promising alternatives for the biological control of fowl typhoid.

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The oral agent miltefosine has demonstrated a >95% cure rate in Indian visceral leishmaniasis. We performed a large, placebo-controlled study of miltefosine therapy (2.5 mg/kg per day orally for 28 days) against cutaneous leishmaniasis in Colombia and Guatemala. In regions in Colombia where Leishmania vianna panamensis is common, the per-protocol cure rates for miltefosine and placebo were 91% (40 of 44 patients) and 38% (9 of 24). These values are similar to historic values for the antimony standard of care and placebo. In regions in Guatemala where L. v. braziliensis and L. mexicana mexicana are common, the per-protocol cure rates were 53% (20 of 38) for miltefosine and 21% (4 of 19) for placebo. The miltefosine rate was lower than historic antimony cure rates of >90%. Miltefosine was well tolerated. Miltefosine is a useful oral agent against cutaneous leishmaniasis due to L. v. panamensis in Colombia but not against leishmaniasis due to L. v. braziliensis in Guatemala.

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A double-blind, randomized trial was undertaken in Guatemala to determine the therapeutic efficacy of an ointment for the treatment of cutaneous leishmaniasis that contained 15% paromomycin and 12% methylbenzethonium chloride and that was applied twice a day for 20 days. The treatment group included 35 patients, and the placebo group included 33 patients. The initial clinical response rate (13 weeks after completing the treatment) was 91.4% in the treatment group and 39.4% in the placebo group. The final clinical response rate at the 12-month follow-up examination was 85.7% (31 of 35) in the treatment group and 39.4% (13 of 33) in the placebo group (P < or = 0.001). In general, the treatment was well tolerated and was never interrupted because of adverse effects. The number of adverse effects reported in the placebo group was lower than in the treatment group (16 events versus 30 events). All adverse effects reported by patients disappeared within 1 week of completing the treatment. Our findings show that the combination of paromomycin with methylbenzethonium chloride for 20 days is a good alternative for antimonial treatments of cutaneous leishmaniasis in Guatemala.

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RESUMO

A study of urban pharmacies in Guatemala and in Chiapas, southern Mexico, was undertaken to analyse the scale of the inadequate drug advice provided, and to identify the contributing factors. The estimate of the scale of the problem was based on the results of 969 approaches to 191 pharmacies by 'magic clients' (i.e. researchers pretending to be looking for treatment for relatives who had one of three 'tracer' diseases), interviews with 4469 pharmacy users as they left the same 191 pharmacies, and a comparison of the quality of advice offered by public and private pharmacies in Guatemala (based on exit interviews with 150 users). The contributing factors were explored using a provider survey (interviews with 166 pharmacy supervisors and 371 drug vendors), an in-depth study analysing large-chain and independent Mexican pharmacies, and a review of the national drug policies in both countries. Although only about 11% of all drug treatments were recommended in pharmacies (the rest being prescribed by physicians or recommended by kin-groups), this still represents large numbers of treatments. Overall, 501 individuals who visited the 191 study pharmacies over 2 days of observation received drugs recommended by pharmacy staff. Much of the pharmacy advice was revealed to be poor: > 80% of the treatments recommended to the 'magic clients' for diarrhoeal disease or acute respiratory infection included unnecessary or dangerous drugs. Few of those who worked in the pharmacies based their advice on careful case histories. Drug advice in pharmacies was much more likely to be of poor quality than that from physicians or even kin-groups. The factors behind this poor advice were identified as a lack of knowledge about standard treatments and legal regulations, incompetence among pharmacy staff, commercial pressures (particularly in the large-chain pharmacies of Mexico), and a failure to implement the existing regulations covering the drug market and its retail practices. It is recommended that: (1) pharmacy owners and drug vendors be made more aware that the selling of drugs should involve provision of healthcare (as well as reasonable profit-making); (2) existing drug-related legislation be reinforced (through consensus-building rather than coercion); and (3) mass training of pharmacy supervisors and drug vendors, in the standard treatment of common diseases, be undertaken. This process will be challenging and slow.

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A wide variety of treatment modalities have been employed for cutaneous leishmaniasis (CL); however, none has been demonstrated to be good enough to be used as the first-line drug to treat patients in all the CL epidemiological scenarios. Although pentavalent antimonials remain a drug widely used in the treatment of all forms of leishmaniasis, they are far from being satisfactory. A great variety of topical treatments have been used to treat CL. However, the majority of these modalities have been tested in non-controlled studies, with only few subjects and the interpretation of results is usually difficult due to the lack of a standard and well-accepted cure definition. Several oral drugs, such as ketoconazole and itraconazole, have also been tested for CL, but results obtained were not completely satisfactory. As of today, miltefosine, originally developed as an oral antineoplastic agent, seems, from the preliminary results obtained in different phase II clinical studies, to be the most promising oral drug developed during the last decade.

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Ten rural communities in the northern area of Guatemala where cutaneous leishmaniasis (CL) is endemic were investigated to determine the residents' knowledge of the disease, their related concepts and practices, and their treatment preferences, and to identify the communication channels they use to acquire information. Of 425 heads of household interviewed, 96.7% could accurately describe a typical CL lesion. CL was found to be the fourth most frequently mentioned disease (in studies based on a free list format) and to be considered the sixth most serious (in studies based on paired comparisons). A series of three-way comparisons, used to analyse the subjects' concepts about the similarities of various discases, indicated that CL was considered to be most closely related to skin problems and to be different from any other group of diseases. All interviewees believed that it was necessary to receive treatment for CL, because without treatment the disease would progress, reach the bone, and take years to heal. More than half (55%) of the respondents knew about meglumine antimonate (Glucantime), the most commonly prescribed drug for treating CL in Guatemala. Only a few communication channels that were used by respondents to receive information were identified; the use of radio broadcasts and direct communication via the community leaders appeared to be the most effective.

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Before recommending the skin-test use at national level in Guatemala of an antigen prepared from Leishmania major (a Leishmania species not found in the New World), we conducted a study in 100 Guatemalans to determine its sensitivity and specificity. The antigen consisted of 0.1 mL of a solution that contained 5 x 10(6) promastigotes of L. major (MRHO/IR/75/VAX). Positive leishmanin skin test (LST) reactions at 48 h were observed in 16 (80%) of 20 patients with proven active cutaneous leishmaniasis (CL), 18 (90%) of 20 with previously treated proven CL, and in 18 (90%) of 20 with a history and compatible scan of previously suspected but unconfirmed CL. None of 20 healthy controls or 20 patients with skin lesions due to causes other than CL had positive reactions to the LST, giving a sensitivity of 85% and specificity of 100%. There were no statistically significant differences in ethnic group, age, duration of the lesion, lesion size or Leishmania species between the 34 persons with true positive reactions. Even though it will be necessary to test this antigen on a larger number of patients, these preliminary results show that this antigen is specific and reasonably sensitive in identifying current or past CL and that it is a reasonable choice for epidemiological studies on CL in Guatemala.

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An initial evaluation of insecticide barrier spraying directed against sand fly vectors of cutaneous leishmaniasis was done in a nonclimax forested area with heavy undergrowth in Peten, Guatemala. A 100 m-wide swath of vegetation was sprayed once with a 1:3 mixture of cyfluthrin insecticide and a palm oil carrier using back-pack sprayers to simulate a central cantonment area in one site while another site remained as an untreated control. Prior to spraying and throughout 87 days post-treatment, sand fly populations were monitored at both sites with light traps set at ground and canopy levels at 50-m intervals radiating out from the centers of the cantonments, 150-m in the four cardinal directions. A total of 2,876 female sand flies were captured, representing 16 species. Three species, Brumptomyia galindoi, Lutzomyia panamensis, and Lu, ovallesi, comprised 70% of the total collection. The single insecticide barrier significantly reduced sand flies from reaching the cantonment area for more than 80 days, while sand fly populations outside the treated cantonment and in the untreated (control) cantonment remained high (52 sand flies in the treated cantonment versus 235 sand flies in the untreated cantonment).

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Leishmania braziliensis is endemic in Guatemala and Belize in Central America. To help identify the vector(s) of this parasite in Guatemala, phlebotomine sand flies that were aspirated from the clothing of collectors at Tikal National Park in the Department of the Peten were examined for flagellates. Lutzomyia ovallesi was found infected with flagellates that were identified as L. braziliensis by isoenzyme electrophoresis. The isoenzyme profile of this isolate matched those from humans from the same area.

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The polyphenols are part of the composition of many foods, it is known the inhibitory effect of tea and coffee through the tannins on iron intestinal absorption; the "yerba mate" (Ilex Paraguarensis) is a beverage widely used in South America, that has a high content of a polyphenol named chlorogenic acid. The present work shows the effect of this substance in nonhem iron absorption. An intestinal loop, was made in rats, to form a closed cavity in a small section of intestine tieing it from the pilorous to a distance of six cm. In this closed cavity a solution of 59Fe was injected with different doses of chlorogenic acid; it was living 20, 40 and 120 minutes into the loop, and after this different times, the blood, spleen, liver, femur and intestine were removed to measure the 59Fe uptake to be compared with the control group. The results gave an intense inhibitory effect on the intestinal iron absorption with doses of 0.58 and 1.7 mM per rat of chlorogenic acid at the different times studied.

Assuntos

RESUMO

The polyphenols are part of the composition of many foods, it is known the inhibitory effect of tea and coffee through the tannins on iron intestinal absorption; the [quot ]yerba mate[quot ] (Ilex Paraguarensis) is a beverage widely used in South America, that has a high content of a polyphenol named chlorogenic acid. The present work shows the effect of this substance in nonhem iron absorption. An intestinal loop, was made in rats, to form a closed cavity in a small section of intestine tieing it from the pilorous to a distance of six cm. In this closed cavity a solution of 59Fe was injected with different doses of chlorogenic acid; it was living 20, 40 and 120 minutes into the loop, and after this different times, the blood, spleen, liver, femur and intestine were removed to measure the 59Fe uptake to be compared with the control group. The results gave an intense inhibitory effect on the intestinal iron absorption with doses of 0.58 and 1.7 mM per rat of chlorogenic acid at the different times studied.

RESUMO

The polyphenols are part of the composition of many foods, it is known the inhibitory effect of tea and coffee through the tannins on iron intestinal absorption; the [quot ]yerba mate[quot ] (Ilex Paraguarensis) is a beverage widely used in South America, that has a high content of a polyphenol named chlorogenic acid. The present work shows the effect of this substance in nonhem iron absorption. An intestinal loop, was made in rats, to form a closed cavity in a small section of intestine tieing it from the pilorous to a distance of six cm. In this closed cavity a solution of 59Fe was injected with different doses of chlorogenic acid; it was living 20, 40 and 120 minutes into the loop, and after this different times, the blood, spleen, liver, femur and intestine were removed to measure the 59Fe uptake to be compared with the control group. The results gave an intense inhibitory effect on the intestinal iron absorption with doses of 0.58 and 1.7 mM per rat of chlorogenic acid at the different times studied.

RESUMO

During a 1-year study, 13 species of sand fly were collected in bite-landing collections on human attractants in Tikal, Guatemala. Using isoenzyme analysis, Leishmania braziliensis was identified among isolates from Lutzomyia ovallesi, Lu. panamensis, and Lu. ylephiletor. Lutzomyia ovallesi, Lu. shannoni, and Lu. cruciata were found with flagellates whose isoenzyme patterns matched unidentified flagellates isolated from a patient with mucosal lesions.

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