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Objective: To evaluate clinical, epidemiological and laboratorial aspects for the understanding of the disease characteristics and its relationship with diagnostic tests., Methods: A retrospective, descriptive and analytical study involving 2,660 American cutaneous leishmaniasis (ACL) suspected patients from southern Brazil was undertaken between April 1986 and December 2005. Data on population characteristics and laboratory tests were obtained. Diagnostic laboratory tests used were direct search for Leishmania spp. (DS), Montenegro skin test (MST) and indirect immunofluorescent assay (IFA)., Results: 62.3% of patients were positive for at least one laboratory test. DS test was positive in 65.1%; MST in 92.3% and IFA in 70.0%. Although Cohen's Kappa test did not reveal any agreement with laboratory diagnosis for ACL, the association between MST and IFA tests increased positiveness to 98.9%; MST and DS to 97.2%; and IFA and DS to 85%. IFA and MST positiveness were higher among patients with < 2-month lesion-evolution time. Most ACL patients were male (72.6%) in the age range of 15-49 years, featuring lesions during two months or less (53.9%) and a cutaneous form of the disease (88.0%)., Conclusion: Findings suggest that for the adequate identification of ACL cases a combination of laboratory tests that involves the association of MST with at least another test should be used.

American cutaneous leishmaniasis, an endemic disease in the northwestern region of Paraná, Brazil, is transmitted by phlebotomines to man and animals like dogs, armadillos, opossums and wild rodents. This disease has been occurring in places where forests have been felled and on the banks of rivers and lakes with arboreal vegetation, where man comes into contact with infected insects. This disease is a public health problem because of the occurrence of epidemic outbreaks throughout Paraná. Because of the importance of finding out about endemic areas, this study used epidemiological file data on patients attended between 1999 and 2004. These data were correlated with areas of forest felling that were identified by means of satellite remote sensing techniques and products. The results showed that the occurrences of cases in the municipalities of this region coincided with the presumed likely areas for patient infection.

American cutaneous leishmaniasis (ACL) has a wide geographical distribution, including all the states of Brazil. Parasitological and immunological tests are the most commonly used methods for the laboratorial diagnosis of ACL. The objective of this study was to find a specific and sensitive antigen to the diagnosis of ACL. To this end, promastigotes of Leishmania (Viannia) braziliensis were submitted to gel-filtration chromatography (Sephadex G100) and to ionic-change chromatography (DEAE-Sepharose Fast-Flow), and the antigen reactivity was evaluated by enzyme immunoassay (EIA-IgG). The results showed that the peak II of fraction 8 distinguished ACL patient sera from those of healthy individuals and individuals with other diseases (P<0.0001), presenting 85.41% sensitivity and 91.22% specificity. False-positive results were found for sera from Chagas disease patients (16.67%) and healthy individuals (10.42%). False-positive results were not detected for sera from patients with toxoplasmosis or paracoccidioidomycosis. The fraction obtained shows good sensitivity and specificity for ACL diagnosis and opens up new possibilities for the use of serology in laboratorial diagnosis, seroepidemiological studies and in the follow up of ACL treatment.

Subclinical cases of cutaneous leishmaniasis were investigated in a district of Maringá, State of Paraná, by means of the indirect immunofluorescence reaction and enzyme immunoassay. Among the 130 samples analyzed, one presented titer 40 and three presented titer 20 in the indirect immunofluorescence reaction, while 11 samples were positive in the enzyme immunoassay reaction. These data suggest that subclinical cases exist at this locality.

The deregulation of inflammatory response during sepsis seems to reflect the overproduction of mediators, which suppress leukocyte functions. We investigated the intracellular mechanisms underlying the inability of neutrophils from severe septic patients to migrate toward chemoattractants. Patients with sepsis (52) and 15 volunteers were prospectively enrolled. Patients presented increased circulating levels of tumor necrosis factor-alpha, interferon-gamma, interleukin (IL)-8, and IL-10. Patients showed reduced neutrophil chemotaxis to formyl-methionyl-leucyl-phenylalanine (FMLP), leukotriene B4 (LTB4) or IL-8. No difference in the transcription or expression of the IL-8 receptor, CXCR1, was detected in neutrophils from controls and patients. However, septic neutrophils failed to increase tyrosine phosphorylation and actin polymerization in response to IL-8 or LTB4. In contrast, septic neutrophils, similar to controls, showed phagocytic activity that induced actin polymerization and augmented phosphotyrosine content. Treatment of control neutrophils with cytokines and lipopolysaccharide (LPS) to mimic endogenous septic environment inhibited actin polymerization and tyrosine phosphorylation in response to IL-8 or LTB4. High expression of G protein-coupled receptor kinase 2 (GRK2) and GRK5 was detected in septic neutrophils and control cells treated with cytokines plus LPS. Data suggest that endogenous mediators produced during sepsis might continually activate circulating neutrophils, leading to GRK activation, which may induce neutrophil desensitization to chemoattractants.

Sepsis and septic shock continue to be a major cause of morbidity and mortality in critically ill patients. During the onset of sepsis, several inflammatory mediators, including cytokines, chemokines and nitric oxide are released systemically and mediate most of the pathophysiological events present in sepsis and septic shock, such as cardiovascular dysfunction and target-organ lesions. Polymorphonuclear leukocytes are critical effector cells during the inflammatory process and their migration to the infection focus is extremely important for the local control of bacterial growth and consequently for the prevention of bacterial dissemination. In experimental models and in human sepsis a profound failure of neutrophil migration to the infection focus is observed. It seems that the failure of neutrophil migration is dependent on toll-like receptor 4 (TLR4) and mediated by cytokines and chemokines, which induce the production of nitric oxide that inhibits neutrophil adhesion to venular endothelium and also the neutrophil chemotactic ability.

Between 1986 and 1997 a total of 1418 patients were examined at the Clinical Analysis Teaching and Research Laboratory of Maringá State University (LEPAC/UEM) for cutaneous leishmaniasis by direct examination of stained smears made from the lesions, the Montenegro skin test and the indirect immunofluorescent antibody test. Nine hundred and fifty five patients (67.3%) were positive for at least one of the three tests and of these 804 (84.2%) were considered to have contracted the disease in Paraná State; 665 (69.6%) were between 15 and 49 years old; 658 (68.9%) were males; 523 (54.8%) sought medical advice during the first three months of their infections and 74 (7.7%) had mucosal lesions. Of the 83 counties of Paraná State, where the patients had most probably acquired their infections, 44.7% were from the counties of São Jorge do Ivaí (10.2%), Doutor Camargo (9.8%), Terra Boa (7.3%), Maringá (7.3%), Jussara (6.0%) and Cianorte (4.5%). Seventy seven strains of Leishmania (Viannia) braziliensis were isolated and 63.6% of these strains belong to serodema 1.

Mice pre-treated with Concanavalin-A largely survived an intra-peritoneal inoculum of 2 x 10(7) Serratia marcescens, whereas all control mice died within 15 h of inoculation. A subpopulation of peritoneal macrophages from Con-A pre-treated mice was able to phagocytose the bacteria in vitro (6.7 SEM 1.2% phagocytosing cells) and in vivo (16.9 SEM 2.1%), whereas control phagocytes did not phagocytose S. marcescens. The survival of Con-A pre-treated mice allowed their immunisation with living bacteria, and the antiserum thus produced increased the phagocytosis of S. marcescens in vitro. Control mice largely survived an inoculum of S. marcescens suspended in 50% immune serum, although the bacteria were resistant to the bactericidal activity of that serum. These results suggest that, in contrast to the delayed humoral protection afforded by immunisation, phagocytosis by phagocytes activated by Con-A conferred early protection to mice against experimental infection by S. marcescens.

An epidemiological and serological study was carried out on a sample of 2,180 individuals, in five counties in the north of Paraná State-Brazil, using the indirect immunofluorescence test to detect anti-Cysticercus cellulosae antibodies. These individuals, 69 (3.2%) showed significant titers of antibodies. No single significant difference between the proportion of reactivity in Sarandi (6.6%) and in Marialva (4.7%) was observed (Z = 1,319, P = 0.0936), but it was significantly higher than that observed in Mandaguaçu, Paiçandu and Maringá (P < 0.01). Of these individuals, 47.9% were within 21-49 years old and 79.4% were of female sex. "Headache" (70.6%), "faintness" (57.4%), and "convulsions" (7.4%) were among the most frequent by reported, moreover, cases of Taenia infections (22.1%) and the custom of eating uncooked beef (41.2%) or pork (27.9%) and meat containing cysticerci (25.0%) were also related.

An epidemiological investigation of cutaneous leishmaniasis (CL) was performed in 1992 and 1993 in an endemic area of Jussara and Terra Boa counties, in the Northern Paraná State. The study covered 684 individuals from a population of approximately 1,400 from six agricultural areas (Fazenda Palmital, Cerâmica Andirá, Fazenda Jussara, Fazenda Lagoa, Destilaria Melhoramentos, and Fazenda Mururê) in Northern Paraná, Brazil. The mean frequency of CL history was 19.9%. The highest frequency was at Fazenda Jussara (40.5%). Based on the indirect immunofluorescence test, 58 (8.5%) presented significant titers of anti-Leishmania antibody, 17 (29.3%) of whom had no history of CL. The Montenegro skin test was applied to 97 individuals with a history of CL and was positive in 80 (82.5%). During the survey, seven individuals presented lesions, four of which were positive for Leishmania sp. The strain isolated was identified as Leishmania (Viannia) braziliensis.

Increased reporting of mucocutaneous leishmaniasis in the State of Paraná points to the need for information on both this disease's epidemiology and pertinent control measures. A serological survey was thus performed, with indirect immunofluorescence (IIF) for canine leishmaniasis in farm operations belonging to the Companhia Melhoramentos Norte do Paraná, in Jussara and Terra Boa counties, in northwestern Paraná. IIF was performed on 132 dogs, of which 24 (18.2%) had significant titers (>/=40). Imprints of six dogs with lesions were made and all were negative for Leishmania sp.