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Alzheimer's disease (AD) is characterized by cognitive and memory impairments and neuropathological abnormalities. AD has no cure, inadequate treatment options, and a limited understanding of possible prevention measures. Previous studies have demonstrated that AD model mice that received a diet high in the essential nutrient choline had reduced amyloidosis, cholinergic deficits, and gliosis, and increased neurogenesis. In this study, we investigated the lifelong effects of perinatal choline supplementation on behavior, cognitive function, and amyloidosis in AppNL-G-F AD model mice. Pregnant and lactating mice were given a diet containing either 1.1 g/kg (control) or 5 g/kg (supplemented) of choline chloride until weaning and subsequently, all offspring received the control diet throughout their life. At 3, 6, 9, and 12 months of age, animals were behaviorally tested in the Open Field Test, Elevated Plus Maze, Barnes Maze, and in a contextual fear conditioning paradigm. Immunohistochemical analysis of Aβ42 was also conducted on the brains of these mice. AppNL-G-F mice displayed hippocampal-dependent spatial learning deficits starting at 3-months-old that persisted until 12-months-old. These spatial learning deficits were fully prevented by perinatal choline supplementation at young ages (3 and 6 months) but not in older mice (12 months). AppNL-G-F mice also had impaired fearful learning and memory at 9- and 12-months-old that were diminished by choline supplementation. Perinatal choline supplementation reduced Aβ42 deposition in the amygdala, cortex, and hippocampus of AppNL-G-F mice. Together, these results demonstrate that perinatal choline supplementation is capable of preventing cognitive deficits and dampening amyloidosis in AppNL-G-F mice and suggest that ensuring adequate choline consumption during early life may be a valuable method to prevent or reduce AD dementia and neuropathology.

BackgroundDengue is one of the most aggressively expanding mosquito-transmitted viruses. The human burden approaches 400 million infections annually. Complex transmission dynamics pose challenges for predicting location, timing, and magnitude of risk; thus, models are needed to guide prevention strategies and policy development locally and globally. Weather regulates transmission-potential via its effects on vector dynamics. An important gap in understanding risk and roadblock in model development is an empirical perspective clarifying how weather impacts transmission in diverse ecological settings. We sought to determine if location, timing, and potential-intensity of transmission are systematically defined by weather.Methodology/principal findingsWe developed a high-resolution empirical profile of the local weather-disease connection across Peru, a country with considerable ecological diversity. Applying 2-dimensional weather-space that pairs temperature versus humidity, we mapped local transmission-potential in weather-space by week during 1994-2012. A binary classification-tree was developed to test whether weather data could classify 1828 Peruvian districts as positive/negative for transmission and into ranks of transmission-potential with respect to observed disease. We show that transmission-potential is regulated by temperature-humidity coupling, enabling epidemics in a limited area of weather-space. Duration within a specific temperature range defines transmission-potential that is amplified exponentially in higher humidity. Dengue-positive districts were identified by mean temperature >22°C for 7+ weeks and minimum temperature >14°C for 33+ weeks annually with 95% sensitivity and specificity. In elevated-risk locations, seasonal peak-incidence occurred when mean temperature was 26-29°C, coincident with humidity at its local maximum; highest incidence when humidity >80%. We profile transmission-potential in weather-space for temperature-humidity ranging 0-38°C and 5-100% at 1°C x 2% resolution.Conclusions/significanceLocal duration in limited areas of temperature-humidity weather-space identifies potential locations, timing, and magnitude of transmission. The weather-space profile of transmission-potential provides needed data that define a systematic and highly-sensitive weather-disease connection, demonstrating separate but coupled roles of temperature and humidity. New insights regarding natural regulation of human-mosquito transmission across diverse ecological settings advance our understanding of risk locally and globally for dengue and other mosquito-borne diseases and support advances in public health policy/operations, providing an evidence-base for modeling, predicting risk, and surveillance-prevention planning.

Background The Global Influenza Hospital Surveillance Network (GIHSN) has since 2012 provided patient-level data on severe influenza-like-illnesses from >100 participating clinical sites worldwide based on a core protocol and consistent case definitions. Methods We used multivariable logistic regression to assess the risk of intensive care unit admission, mechanical ventilation, and in-hospital death among hospitalized patients with influenza and explored the role of patient-level covariates and country income level. Results The data set included 73 121 patients hospitalized with respiratory illness in 22 countries, including 15 660 with laboratory-confirmed influenza. After adjusting for patient-level covariates we found a 7-fold increase in the risk of influenza-related intensive care unit admission in lower middle-income countries (LMICs), compared with high-income countries (P =.01). The risk of mechanical ventilation and in-hospital death also increased by 4-fold in LMICs, though these differences were not statistically significant. We also find that influenza mortality increased significantly with older age and number of comorbid conditions. Across all severity outcomes studied and after controlling for patient characteristics, infection with influenza A/H1N1pdm09 was more severe than with A/H3N2. Conclusions Our study provides new information on influenza severity in underresourced populations, particularly those in LMICs. [ABSTRACT FROM AUTHOR]

La importancia de la vigilancia de la circulación del virus de influenza y la vacunación oportuna a las diferentes poblaciones del Perú, fue analizada en tres sesiones por un grupo de clínicos expertos de diferentes especialidades. En Perú, en los últimos años, el sistema nacional de vigilancia de influenza tiene muchos establecimientos seleccionados que son ineficaces en la notificación oportuna. La mayoría de las muestras provienen de Lima. La distribución viral es inadecuadamente analizada. El norte y la selva tienen estaciones climáticas diferentes a Lima y la sierra sur. Esta descoordinación se acentúa con la oportunidad de la llegada de la vacuna de influenza al país. El Ministerio de Salud utiliza una vacuna trivalente pero la posibilidad de una vacuna tetravalente con los dos linajes de tipo B, debe ser analizada desde el punto de vista de costo-beneficio. Se debería evaluar la pertinencia de vacunar en dos momentos anuales, regionalmente.

BackgroundData addressing the incidence and epidemiology of influenza and influenza-like illness (ILI) in tropical regions of the world is scarce, particularly for the neotropics of South America.MethodsWe conducted active, population-based surveillance for ILI across 45 city blocks within the Amazon Basin city of Iquitos, Peru. Demographic data and household characteristics were collected for all participants, and participating households were visited three times weekly to inquire about ILI (fever plus cough or sore throat) among household residents. Nasal and oropharyngeal swabs were collected from participants with ILI and tested for influenza virus infection.ResultsBetween May 1, 2008 and July 8, 2009, we monitored 10,341 participants for ILI for a total of 11,569.5 person-years. We detected 459 ILI episodes, with 252 (54.9%) of the participants providing specimens. Age-adjusted incidence of ILI was estimated to be 46.7 episodes/1000 person-years. Influenza A and B viruses were detected in 25 (9.9%) and 62 (24.6%) specimens of ILI patients, respectively, for an estimated age-adjusted incidence rate of 16.5 symptomatic influenza virus infections/1000 person-years. Risk factors for ILI included age, household crowding, and use of wood as cooking fuel. For influenza virus infection specifically, age and use of wood as a cooking fuel were also identified as risk factors, but no effect of household crowding was observed.ConclusionsOur results represent the initial population-based description of the epidemiology of ILI in the Amazon region of Peru, which will be useful for developing region-specific strategies for reducing the burden of respiratory disease.

Alzheimer's disease (AD) is characterized by cognitive and memory impairments and neuropathological abnormalities. AD has no cure, inadequate treatment options, and a limited understanding of possible prevention measures. Previous studies have demonstrated that AD model mice that received a diet high in the essential nutrient choline had reduced amyloidosis, cholinergic deficits, and gliosis, and increased neurogenesis. In this study, we investigated the lifelong effects of perinatal choline supplementation on behavior, cognitive function, and amyloidosis in AppNL-G-F AD model mice. Pregnant and lactating mice were given a diet containing either 1.1 g/kg (control) or 5 g/kg (supplemented) of choline chloride until weaning and subsequently, all offspring received the control diet throughout their life. At 3, 6, 9, and 12 months of age, animals were behaviorally tested in the Open Field Test, Elevated Plus Maze, Barnes Maze, and in a contextual fear conditioning paradigm. Immunohistochemical analysis of Aβ42 was also conducted on the brains of these mice. AppNL-G-F mice displayed hippocampal-dependent spatial learning deficits starting at 3-months-old that persisted until 12-months-old. These spatial learning deficits were fully prevented by perinatal choline supplementation at young ages (3 and 6 months) but not in older mice (12 months). AppNL-G-F mice also had impaired fearful learning and memory at 9- and 12-months-old that were diminished by choline supplementation. Perinatal choline supplementation reduced Aβ42 deposition in the amygdala, cortex, and hippocampus of AppNL-G-F mice. Together, these results demonstrate that perinatal choline supplementation is capable of preventing cognitive deficits and dampening amyloidosis in AppNL-G-F mice and suggest that ensuring adequate choline consumption during early life may be a valuable method to prevent or reduce AD dementia and neuropathology. [ABSTRACT FROM AUTHOR]

El metaneumovirus humano es un nuevo patógeno asociado a infecciones respiratorias, principalmente en niños, que produce cuadros clínicos que van desde leves hasta graves, los cuales pueden incluso requerir tratamiento en unidades de cuidados intensivos. Hasta el momento, la reacción en cadena de la polimerasa con transcripción inversa y el cultivo celular son los métodos más usados para su diagnóstico. Se presentan los seis primeros casos de metapneumovirus humano en niños de Medellín, Colombia. doi: http//dx.doi.org/10.7705/biomedica.v32i2.644

To better describe the genetic diversity of hantaviruses associated with human illness in South America, we screened blood samples from febrile patients in Chapare Province in central Bolivia during 2008–2009 for recent hantavirus infection. Hantavirus RNA was detected in 3 patients, including 1 who died. Partial RNA sequences of small and medium segments from the 3 patients were most closely related to Andes virus lineages but distinct (1 hantaviruses; the highest prevalence was among agricultural workers. Because of the high level of human exposure to hantavirus strains and the severity of resulting disease, additional studies are warranted to determine the reservoirs, ecologic range, and public health effect of this novel strain of hantavirus.

Se describe un brote de infección respiratoria febril aguda en una unidad militar de Trujillo, Perú. Se usó la definición de caso de síndrome gripal del Ministerio de Salud, se tomó hisopado nasal para prueba rápida de influenza (PRI) e hisopado faríngeo para aislamiento viral en cultivo celular. La genotipificación de influenza A fue por secuenciamiento genético de una región del gen de hemaglutinina teniendo como base la cepa vacunal de 2008. Se presentaron 59 casos entre el 01 y 08 de abril de 2008, la tasa de ataque fue de 82,9%. La PRI identificó a 40 casos positivos de influenza A y 43 casos fueron confirmados mediante cultivo celular. Los aislamientos fueron genéticamente similares con la cepa A H1N1 Brisbane. La detección precoz de un brote en lugares cerrados como las bases militares permite actuar de manera inmediata para prevenir su diseminación.We describe an acute febrile respiratory infection outbreak in a military unit in Trujillo, Peru. Cases were identified using the influenza like illness (ILI) definition of the Ministry of Health. Nasal swab samples used for a rapid influenza test (RIT) and pharyngeal swab samples for viral isolation were taken. For influenza A, genotyping of a partial sequence of the hemagglutinin region was performed. The rate attack was 82.9%. Fifty-nine cases appeared between April 1 and 8, 2008; 58 came from the military unit (MU) #1 and one from the MU #2. The RIT identified 40 cases of influenza A and 43 cases were confirmed through cell culture. Isolations were genetically similar to the A H1N1 Brisbane strain. Early detection of outbreaks in confined locations such as military bases permits immediate action in preventing disease propagation.

Studies have suggested that enzootic strains of Venezuelan equine encephalitis (VEE) subtype ID in the Amazon region, Peru, may be less pathogenic to humans than are epizootic variants. Deaths of 2 persons with evidence of acute VEE virus infection indicate that fatal VEEV infection in Peru is likely. Cases may remain underreported.

After a human rabies outbreak in southeastern Peru, we collected bats to estimate the prevalence of rabies in various species. Among 165 bats from 6 genera and 10 species, 10.3% were antibody positive; antibody prevalence was similar in vampire and nonvampire bats. Thus, nonvampire bats may also be a source for human rabies in Peru.

An HIV seroprevalence and molecular study was conducted among 935 subjects: 723 female commercial sex workers, 92 men who have sex with men and 120 HIV-positive volunteers. The reported injection drug use rates were 0.7% in female commercial sex workers and 3% in men who have sex with men. Sexually transmitted infections were reported in 265 (37%) of the female commercial sex workers and 38 (41%) of the men who have sex with men. A total of 20 (2.8%) female commercial sex workers and 12 (13%) men who have sex with men became HIV infected during the study period. A history of sexually transmitted infection increased the risk of subsequent HIV infection twofold (adjusted odds ratio of 2.5) among the female commercial sex workers, while cocaine use had an adjusted odds ratios of 6.61 among men who have sex with men. From 130 samples, and based on heteroduplex mobility assaying for the env gene, with sequencing of part of pol and/or full genomes, subtype B was the predominant subtype identified (66%); followed by subtype F (22%) and subtype C (4%). Recombinant CRF12-BF strains were identified in 6% and CRF17_BF was identified in 2%.Um estudo de soroprevalência e de avaliação molecular do HIV foi realizado com 935 indivíduos: 723 mulheres que trabalhavam no comércio do sexo, 92 homens que mantinham relações sexuais com outros homens e com 120 voluntários HIV-positivos. O relato de uso de drogas injetáveis foi de 0,7% nas mulheres que trabalhavam no comércio do sexo e de 3% nos homens que mantinham relações sexuais com outros homens. Infecções sexualmente transmitidas foram relatadas por 265 (37%) das mulheres que trabalhavam no comércio do sexo e em 38 (41%) dos homens que mantinham relações sexuais com homens. Um total de 20 (2,8%) mulheres que trabalhavam no comércio do sexo e 12 (13%) homens que mantinham relações sexuais com homens se infectou com HIV durante o período do estudo. História prévia de infecção sexualmente transmitida aumentou em duas vezes o risco de infecção subseqüente por HIV (odds ratio ajustado de 2,5) entre as mulheres que trabalhavam no comércio do sexo, enquanto cocaína apresentou odds ratio ajustado de 6,61 entre os homens que mantinham relações sexuais com outros homens. De 130 amostras, com base no ensaio da mobilidade heteroduplex para o gene env, com sequenciamento de parte do pol e/ou genomas completos, o subtipo B foi o subtipo mais identificado (66%); seguido pelo subtipo F (22%) e subtipo C (4%). Cepas recombinantes CRF12-BF foram identificadas em 6% e CRF17_BF foi identificada em 2%.

Objetivo. Describir un brote de Influenza en dos bases militares en Tumbes, Perú. Material y métodos. Se utilizó la definición de caso de síndrome gripal del Ministerio de Salud en casos con menos de cinco días de inicio de síntomas. Se tomó hisopado nasal para la prueba rápida de Influenza (PRI) e hisopado faríngeo para aislamiento viral en tres líneas celulares (MDCK, VERO, LLCMK2). Para la genotipificación de Influenza B se usó un secuenciamiento parcial de la región de hemaglutinina de 898 pares de bases teniendo como base la cepa de la vacuna del 2007 (B/Florida/4/2006) y para el tipo A se analizó 958 pares de bases teniendo como referencia la cepa vacunal del 2007 (A/Brisbane/10/2007 (H3N2). Resultados. Se tomó 124 hisopados, 20 de la base militar (BM) # 1 y 104 de la BM # 2. La PRI identificó a 41 casos positivos: Flu B: 27, Flu A: 02, Flu: 12, con 62% de sensibilidad y 100% de especificidad. Finalmente, 66 casos fueron confirmados por cultivo celular, 54 Flu B y 12 Flu A. Los aislamientos de Tumbes fueron genéticamente similares con la cepa B/Texas/4/ 2006 (n=34) y A/Texas/91/2007 (H3N2)/ (n=7). Los síntomas más comunes fueron fiebre, cefalea, malestar general, tos, dolor de garganta, mialgias y rinorrea. Las medidas de control consistieron en el aislamiento de los casos identificados y el uso de mascarillas. Conclusiones. Se confirmó 66 casos de Influenza por cultivo celular. Los aislamientos tuvieron la mayor similitud genética con las cepas denominadas B/Texas/4/2006 y A/Texas/91/2007 (H3N2).

BackgroundDiagnosing tuberculosis in children is challenging because specimens are difficult to obtain and contain low tuberculosis concentrations, especially with HIV-coinfection. Few studies included well-controls so test specificities are poorly defined. We studied tuberculosis diagnosis in 525 children with and without HIV-infection.Methods and findings'Cases' were children with suspected pulmonary tuberculosis (n = 209 HIV-negative; n = 81 HIV-positive) and asymptomatic 'well-control' children (n = 200 HIV-negative; n = 35 HIV-positive). Specimens (n = 2422) were gastric aspirates, nasopharyngeal aspirates and stools analyzed by a total of 9688 tests. All specimens were tested with an in-house hemi-nested IS6110 PCR that took 0.2) for HIV-positive versus HIV-negative cases. All specimens were also tested with auramine acid-fast microscopy, microscopic-observation drug-susceptibility (MODS) liquid culture, and Lowenstein-Jensen solid culture that took ≤6 weeks and had 100% specificity (all 2112 tests on 704 specimens from 235 well-controls were negative). Microscopy-positivity was rare (0.21%, 5/2422 specimens) and all microscopy-positive specimens were culture-positive. Culture-positivity was less frequent (P≤0.01) in HIV-infection: 1.2% (1/81) HIV-positive cases versus 11% (22/209) HIV-negative cases; caused by 0.42% (2/481) versus 4.7% (58/1235) of their specimens, respectively.ConclusionsIn HIV-positive children with suspected tuberculosis, diagnostic yield was so low that 1458 microscopy and culture tests were done per case confirmed and even in children with culture-proven tuberculosis most tests and specimens were false-negative; whereas PCR was so prone to false-positives that PCR-positivity was as likely in specimens from well-controls as suspected-tuberculosis cases. This demonstrates the importance of control participants in diagnostic test evaluation and that even extensive laboratory testing only rarely contributed to the care of children with suspected TB.Trial registrationThis study did not meet Peruvian and some other international criteria for a clinical trial but was registered with the ClinicalTrials.gov registry: ClinicalTrials.gov NCT00054769.

BACKGROUND:Dengue is one of the most aggressively expanding mosquito-transmitted viruses. The human burden approaches 400 million infections annually. Complex transmission dynamics pose challenges for predicting location, timing, and magnitude of risk; thus, models are needed to guide prevention strategies and policy development locally and globally. Weather regulates transmission-potential via its effects on vector dynamics. An important gap in understanding risk and roadblock in model development is an empirical perspective clarifying how weather impacts transmission in diverse ecological settings. We sought to determine if location, timing, and potential-intensity of transmission are systematically defined by weather. METHODOLOGY/PRINCIPAL FINDINGS:We developed a high-resolution empirical profile of the local weather-disease connection across Peru, a country with considerable ecological diversity. Applying 2-dimensional weather-space that pairs temperature versus humidity, we mapped local transmission-potential in weather-space by week during 1994-2012. A binary classification-tree was developed to test whether weather data could classify 1828 Peruvian districts as positive/negative for transmission and into ranks of transmission-potential with respect to observed disease. We show that transmission-potential is regulated by temperature-humidity coupling, enabling epidemics in a limited area of weather-space. Duration within a specific temperature range defines transmission-potential that is amplified exponentially in higher humidity. Dengue-positive districts were identified by mean temperature >22°C for 7+ weeks and minimum temperature >14°C for 33+ weeks annually with 95% sensitivity and specificity. In elevated-risk locations, seasonal peak-incidence occurred when mean temperature was 26-29°C, coincident with humidity at its local maximum; highest incidence when humidity >80%. We profile transmission-potential in weather-space for temperature-humidity ranging 0-38°C and 5-100% at 1°C x 2% resolution. CONCLUSIONS/SIGNIFICANCE:Local duration in limited areas of temperature-humidity weather-space identifies potential locations, timing, and magnitude of transmission. The weather-space profile of transmission-potential provides needed data that define a systematic and highly-sensitive weather-disease connection, demonstrating separate but coupled roles of temperature and humidity. New insights regarding natural regulation of human-mosquito transmission across diverse ecological settings advance our understanding of risk locally and globally for dengue and other mosquito-borne diseases and support advances in public health policy/operations, providing an evidence-base for modeling, predicting risk, and surveillance-prevention planning.

Estudio descriptivo transversal realizado en la provincia de Ayabaca (zona endémica de peste bubónica), departamento de Piura, Perú; con el objetivo de ampliar los conocimientos sobre las especies de pulgas presentes. Fueron colectados 10 152 especimenes de pulgas en 46 localidades pertenecientes a seis distritos de la provincia de Ayabaca (Suyo, Sapillica, Montero, Paimas, Lagunas y Ayabaca), entre los meses de enero a julio de 1999. El muestreo se realizó seleccionando para cada vivienda un mínimo de cinco ropas de cama y cinco cuyes (Cavia porcellus) además de la totalidad de los roedores capturados en las viviendas y en el área silvestre. Ocho especies de pulgas fueron identificadas (Pulex irritans, Tiamastus cavicola, Polygenis litargus, Xenopsylla cheopis, Ctenocephalides felis, Craneopsylla minerva, Leptopsylla segnis y Cediopsylla spillmanni) de éstas, P. irritans se reportó en todos los distritos muestreados, seguida de X. cheopis y P. litargus, encontradas en cinco de los seis distritos.

Objetivo: Determinar la distribución de los subtipos del virus de la inmunodeficiencia humana (VIH-1) y las presencia de cepas recombinantes en Argentina, Bolivia, Colombia, Chile, Ecuador, Paraguay, Perú, Uruguay y Venezuela a través de estudios epidemiológicos y de genotipificación. Materiales y Métodos: Se incluyeron a los participantes de los protocolos realizados en los nueve paises, incluyendo poblaciones de trabajadoras sexuales (TS), hombres que tienen sexo con hombres (HSH), individuos VIH positivos, gestantes y paciente con tuberculosis (TB). Se utilizó la prueba de movilidad heteroduplex de envoltura (env HMA), ProRT, secuenciamiento completo o ambas para determinar los subtipos de VIH 1. Resultados: Se identificaron 3081 individuos positivos al VIH (de un total de 42 290 voluntarios), las prevalencias oscilaban entre menos de 1% a 29% según población estudiada, siendo mayor en los HSH. Un total de 1654 muestras (54%) fueron genotipificadas. Se encontró el subtipo B en 1380 (83%) muestras, el subtipo F en 218 (13%), así como los subtipos A y C en 0,1% y 0,4% respectivamente. Se hallaron subtipos recombinantes BF en 39 muestras (2%) y formas recombinantes CRF01_AE(0,1%), CRF17_BF(0,4%) y CRF02_AG(0,1%). En Venezuela, Colombia, Ecuador, Perú, Bolivia y Chile (paises andinos) predominó el subtipo B, mientras en Argentina, Uruguay y Paraguay hubo un alto porcentaje del subtipo F. Conclusiones: En la mayoría de países andinos la epidemia de VIH-1 se concentró en los HSH con un predominio del subtipo B. El subtipo F es más frecuente en las TS en Argentina y Uruguay. Esta información es útil para implementar planes de prevención y futuros ensayos de vacunas en esta región.

O fenômeno El Niño, que afetou o Perú em 1998, permitiu o crescimento de abundante vegetação em ambientes tradicionalmente secos. Paederus irritans, coleóptero que produz dermatite ao ser esfregado na pele, encontrou aí um substrato muito favorável ao incremento de sua população. A chegada das chuvas nos meses de fevereiro a abril de 1999 interferiu no hábitat desse inseto, que migrou inclusive para áreas urbanas, condicionando maior exposição da população humana de Piura, no norte do país, ao contato com esse agente. Entre fevereiro e maio de 1999 foram notificados em Piura 1.451 casos da dermatite por Paederus irritans, aí denominada latigazo dado o aspecto característico das lesões, eritematosas, lineares, semelhantes a chicotadas, por ele produzidas na pele por ação da pederina. As áreas do corpo mais afetadas foram a cabeça (56,6%) e o pescoço (30,9%), mas houve casos de conjuntivite e até de lesões genitais devidas à contaminação pelas mãos.

As alterações climáticas produzidas no norte do Perú devidas ao Fenômeno El Niño (ENSO), ocasionaram variações no volume das safras, redistribuição do curso dos rios e provavelmente aumento da população de roedores. Em fevereiro de 1999, em uma comunidade indígena em Jacocha, Huancabamba, na serra de Piura, Perú, surgiu um surto de peste com cinco casos humanos, um dos quais faleceu. O diagnóstico foi confirmado pela sorologia (hemaglutinação passiva). A presença de anticorpos em cães de localidades próximas de Jacocha confirmaram a circulação da Yersinia pestis na área. O surto foi debelado pela rápida atuação das autoridades sanitárias locais. O episódio após silêncio epidemiológico por mais de quatro anos, mostrou a necessidade de reforçar o sistema de vigilância epidemiológica de peste nesta área.

Foram estudadas as alterações renais, tanto clínicas como anatomopatológicas, em 119 indivíduos com a síndrome da imunodeficiência adquirida no Hospital Escola da Faculdade de Medicina do Triângulo Mineiro, Uberaba, MG. A média das idades foi de 33 ± 10,4 anos (variando de 18 a 67 anos). Predominaram a cor branca (59%) e o sexo masculino (80%). Procedência: 90% de Uberaba e região. Havia 59 (50%) heterossexuais, 25 (21%) homossexuais, 17 (14%) bissexuais e 18 (15%) sem dados conhecidos. Havia 43% usuários de drogas intravenosas. Catorze (12,2%) casos apresentavam creatininemia acima de 3mg/dl nos 10 dias antes do óbito, destes encontrou-se necrose tubular aguda em 64%. Em 71 (61%) pacientes encontrou-se hiponatremia e 8 (7%) exibiram hipernatremia. Houve 28 (24%) com hipocalemia e 8 (7%) com hipercalemia. Doze pacientes tinham proteinúria de 24 horas elevada, sendo 7 acima de 1g/24h. Dois pacientes apresentaram glomeruloesclerose segmentar focal, sendo que um deles apresentou proteinúria de 5,5g/24h e creatinemia de 1,5mg/dl, sem edema. Na maioria (56%) dos casos, encontrou-se nefrite túbulo-intersticial. As alterações glomerulares foram relativamente raras em tanto que as lesões túbulo-intersticiais foram muito freqüentes, principalmente a nefrite túbulo intersticial e a necrose tubular aguda. Nem sempre se pode observar uma correlação anatomoclínica pois, muitas vezes, a alteração foi predominantemente funcional, especialmente nas hidroeletrolíticas.