Chez la souris, Six6 et Lhx2 sont exprimés dans l'œil et la glande pituitaire en développement. Par une approche "gènes candidats", les ADN de patients avec un phénotype proche de celui de souris invalidées pour ces gènes ont été séquencés. Aucune mutation a été mise en évidence pour SIX6. Deux variations hétérozygotes faux-sens de LHX2 ont été identifiées mais n'ont pas d'effet (tests in vitro). LHX2 a un rôle régulateur transcriptionnel in vitro sur deux gènes pituitaires (PRL, POU1F1), et en action synergique avec POU1F1. Deux mutations hétérozygotes composites de LHX3 chez un patient non consanguin ont permis d'assigner à ce gène un syndrome décrit uniquement chez des patients consanguins. Une de ces mutations a un effet dominant négatif. POU1F1, impliqué dans la différenciation pituitaire terminale, est associé en pathologie humaine à un déficit en hormone de croissance (GH), PRL et TSHβ. L'expression de GH est régulée par la fixation de POU1F1 sur son promoteur et sur un " Locus Control Region " mais ses cofacteurs ne sont pas connus. Deux mutations faux-sens identifiées dans le domaine de transactivation (TAD) de POU1F1 sont associées à un déficit isolé en GH. La résonnance plasmonique de surface a permis de définir les interactions de POU1F1 (normal et mutés) sur ses séquences cibles ; des extraits nucléaires sont passés avec POU1F1 (normal et mutés) afin d'identifier (par spectrométrie de masse) ses partenaires au locus GH. Une cristallographie du TAD a débuté pour analyser sa structure tridimensionnelle qui est probablement altéré par les mutations identifiées

There has been tremendous variation in the development trajectories of Latin America's leftist parties. Whereas some have successfully entrenched roots in society, built their party organization, and become relevant national parties, other leftist parties have languished organizationally, suffered debilitating internecine rivalries, and witnessed a mass defection of followers, at times despite substantial initial electoral success. For instance, Brazil's Workers' Party (PT) abandoned socialism, moderated its program, and built itself up into one of Brazil's two main parties. Venezuela's Radical Cause (LCR) and Peru's United Left (IU), however, did not. While they had similar origins to the PT, both failed to adapt: LCR and IU fractured and became electorally irrelevant, having been unable to adapt to external challenges. What accounts for this puzzling empirical variation in otherwise similar parties in relatively similar contexts? More broadly, this dissertation seeks to answer under what conditions do leftist parties in Latin American democracies transform from undemocratic, radical, weakly institutionalized parties into democratic, moderate, professional parties? Conversely, under what conditions do they fail to adapt, experience organizational stagnation, and succumb to irrelevance? It argues that the political context in which each of these leftist parties emerged had an indelible effect on the parties' later ability to adapt institutionally and ideologically to future endogenous and exogenous shocks. First, where authoritarian repression dismantled preexisting leftist parties, a political vacuum on the left emerged that created the incentive for the rise of a new type of leftist party that intrinsically valued democracy. Second, the implementation of legal requirements by outgoing authoritarian regimes during a party's formative years encouraged parties to institutionalize, ensuring the development of a disciplined, majoritarian party organization. Finally, obstinance on the part of the military's move to extricate itself from politics encouraged leftist parties to participate in democratization and, thus, widen their electoral appeals. Those leftist parties that were formed under such regimes were induced to take certain actions and adopt certain institutions that made them adaptable in the long run. Those that formed afterwards or never experienced life under authoritarian rule had little incentive to change and, thus, proved unable to respond to external challenges down the line that demanded institutional professionalization and ideological moderation. / text

Le génotypage d'une famille jordanienne consanguine constituée de 5 frères globozoospermiques et de 3 frères fertiles sur puce Affymetrix, a permis d'identifier un nouveau gène responsable de la globozoospermie situé dans un intervalle de 6.4Mb en 12q14.2. Au regard de son expression prédominante dans le testicule et l'implication de son orthologue, chez C. elegans, dans la polarisation cellulaire, le gène DPY19L2 est un gène candidat parfait. Le gène, codant pour une protéine transmembranaire, est flanqué par deux séquences répétées (LCRs) qui partagent 96,5% d'identité. Dans une première étude, une délétion de 200Kb englobant l'ensemble du gène a été mise en évidence chez les 4 frères infertiles de cette famille jordanienne ainsi que chez 3 autres patients non apparentés. Nous avons ensuite recruté une plus grande cohorte de 54 patients. Parmi ces patients, 20 sont homozygotes pour la délétion de DPY19L2 et 7 sont hétérozygotes composites associant la délétion hétérozygote et une mutation ponctuelle. En outre, nous avons identifié, 4 patients avec des mutations ponctuelles homozygotes. Par conséquent, la fréquence d'implication de DPY19L2 s'élève à 66.7%. En tout, 9 points de cassures, regroupés en deux hotspots au sein des LCRs, ont pu être mis en évidence. Ceci confirme que le mécanisme sous-jacent de la délétion est une recombinaison homologue non allélique (NAHR) entre les LCRs. En conclusion, nous confirmons que DPY19L2 est le principal gène de la globozoospermie et nous élargissons le spectre des mutations possible dans ce gène.

O diagnóstico de neurosífilis é freqüentemente dependente dos resultados dos testes serológicos e alterações no líquido cefalorraquidiano, mas a confiabilidade desses resultados em pacientes com infecção pelo HIV-1 tem sido questionada especialmente em pacientes assintomáticos com sífilis latente. O estudo se propõe avaliar a presença de DNA do T. pallidum no LCR de pacientes assintomáticos infectados pelo HIV, com o diagnóstico de sífilis. Amostras de LCR foram coletadas de 12 pacientes infectados pelo HIV atendidos em um terciário localizado no sul do Brasil , durante o período de 2012 a 2013. A presença de DNA do T. pallidum foram analisadas nas amostras de LCR pelo método de PCR “seminested”. Dados demográficos dos pacientes, parâmetros bioquímicos, celularidade e VDRL do LCR e linfócitos T-CD4 também foram analisados. Nas amostras de LCR de cinco dos 12 pacientes (40%) foram detectados o DNA do T. pallidum . Inesperadamente, nestes doentes, os níveis de contagem de células, proteína e glicose no LCR foram normais. Além disso , nenhuma destas cinco amostras de CSF apresentou uma reacção positiva VDRL. Os títulos de VDRL no soro foram semelhantes entre pacientes positivos e negativos para a presença T. pallidum DNA no LCR. A maioria dos pacientes com DNA de T. pallidum detectável apresentaram baixos títulos de VDRL no soro. O VDRL sérico elevado com título de 1:64 foi observada em apenas um paciente. Nossos resultados demostraram que os pacientes assintomáticos infectados pelo HIV com evidência de sífilis latente e LCR normais podem apresentar DNA de T. pallidum detectável no LCR. A detecção do DNA do T. pallidum pelo nosso seminested PCR pode fornecer informações adicionais além da análise convencional do LCR para o diagnóstico de neurossífilis. presença do DNA de T. pallidum no LCR em pacientes infectados pelo HIV com sífilis latente e resultados de LCR normais pode determinar uma mudança terapêutica do uso de penicilana benzatina intramuscular para o de penicilina cristalina intravenosa aquosa para o tratamento da sífilis. / Neurosyphilis diagnosis is frequently dependent upon the results of serological tests and cerebrospinal fluid abnormalities, but the reliability of findings in patients with HIV-1 infection has been questioned, especially asymptomatic patients with latent syphilis, We present the data on the presence of T. pallidum DNA in CSF from asymptomatic HIV-infected patients with the diagnosis of syphilis. CSF and serum samples were collected from 12 HIV-infected patients attending a tertiary care located in southern Brazil, during the period 2012 to 2013. In CSF samples from five of 12 patients (40%), we detected T. pallidum DNA. Unexpectedly, in these patients, CSF cell count, protein and glucose levels were normal. In addition, none of these 5 CSF samples presented a positive VDRL reaction. Serum VDRL titers were similar between patients with positive and negative CSF T. pallidum DNA. Most patients with detectable T. pallidum DNA presented low serum VDRL titers. Serum VDRL titer of 1:64 was observed in one patient. Our results have shown that asymptomatic HIV-infected patients with evidence of latent syphilis and normal CSF might present detectable T. pallidum DNA in the CSF. The detection of T. pallidum DNA by our seminested PCR provide additional information beyond conventional CSF analysis for diagnosis of neurosyphilis. The detection of T. pallidum DNA in the CSF despite normal CSF findings in HIV-infected patients could also provide a different therapeutic approach including the use of intravenous aqueous crystalline penicillin.

O diagnóstico de neurosífilis é freqüentemente dependente dos resultados dos testes serológicos e alterações no líquido cefalorraquidiano, mas a confiabilidade desses resultados em pacientes com infecção pelo HIV-1 tem sido questionada especialmente em pacientes assintomáticos com sífilis latente. O estudo se propõe avaliar a presença de DNA do T. pallidum no LCR de pacientes assintomáticos infectados pelo HIV, com o diagnóstico de sífilis. Amostras de LCR foram coletadas de 12 pacientes infectados pelo HIV atendidos em um terciário localizado no sul do Brasil , durante o período de 2012 a 2013. A presença de DNA do T. pallidum foram analisadas nas amostras de LCR pelo método de PCR “seminested”. Dados demográficos dos pacientes, parâmetros bioquímicos, celularidade e VDRL do LCR e linfócitos T-CD4 também foram analisados. Nas amostras de LCR de cinco dos 12 pacientes (40%) foram detectados o DNA do T. pallidum . Inesperadamente, nestes doentes, os níveis de contagem de células, proteína e glicose no LCR foram normais. Além disso , nenhuma destas cinco amostras de CSF apresentou uma reacção positiva VDRL. Os títulos de VDRL no soro foram semelhantes entre pacientes positivos e negativos para a presença T. pallidum DNA no LCR. A maioria dos pacientes com DNA de T. pallidum detectável apresentaram baixos títulos de VDRL no soro. O VDRL sérico elevado com título de 1:64 foi observada em apenas um paciente. Nossos resultados demostraram que os pacientes assintomáticos infectados pelo HIV com evidência de sífilis latente e LCR normais podem apresentar DNA de T. pallidum detectável no LCR. A detecção do DNA do T. pallidum pelo nosso seminested PCR pode fornecer informações adicionais além da análise convencional do LCR para o diagnóstico de neurossífilis. presença do DNA de T. pallidum no LCR em pacientes infectados pelo HIV com sífilis latente e resultados de LCR normais pode determinar uma mudança terapêutica do uso de penicilana benzatina intramuscular para o de penicilina cristalina intravenosa aquosa para o tratamento da sífilis. / Neurosyphilis diagnosis is frequently dependent upon the results of serological tests and cerebrospinal fluid abnormalities, but the reliability of findings in patients with HIV-1 infection has been questioned, especially asymptomatic patients with latent syphilis, We present the data on the presence of T. pallidum DNA in CSF from asymptomatic HIV-infected patients with the diagnosis of syphilis. CSF and serum samples were collected from 12 HIV-infected patients attending a tertiary care located in southern Brazil, during the period 2012 to 2013. In CSF samples from five of 12 patients (40%), we detected T. pallidum DNA. Unexpectedly, in these patients, CSF cell count, protein and glucose levels were normal. In addition, none of these 5 CSF samples presented a positive VDRL reaction. Serum VDRL titers were similar between patients with positive and negative CSF T. pallidum DNA. Most patients with detectable T. pallidum DNA presented low serum VDRL titers. Serum VDRL titer of 1:64 was observed in one patient. Our results have shown that asymptomatic HIV-infected patients with evidence of latent syphilis and normal CSF might present detectable T. pallidum DNA in the CSF. The detection of T. pallidum DNA by our seminested PCR provide additional information beyond conventional CSF analysis for diagnosis of neurosyphilis. The detection of T. pallidum DNA in the CSF despite normal CSF findings in HIV-infected patients could also provide a different therapeutic approach including the use of intravenous aqueous crystalline penicillin.

No description available.

Angiotensin-converting enzyme 2 (ACE2) has been identified as the cellular entry receptor for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). High ACE2 tissue expression and low glycine levels were suggested to increase susceptibility for SARS-CoV-2 infection and increasing circulating ACE2 has been proposed as one possible strategy to combat COVID-19. In humans, aerobic physical exercise induces an increase in plasma ACE2 in some individuals. However, it is not clear whether glycine and ACE2 levels depend on intrinsic exercise capacity or on exercise training. We used rats selectively bred for high intrinsic exercise capacity (HCR) or low exercise capacity (LCR) and tested the influence of this genetic predetermination and/or aerobic exercise on metabolites, ACE2 tissue expression and circulating ACE 2. ACE2 expression was measured in different tissues in the sedentary animals and again after 4 weeks of high-intensity aerobic exercise in both LCRs and HCRs. Sedentary HCRs exhibited significantly higher circulating ACE2 concentrations compared to LCRs, but a lower expression of ACE2 in all investigated tissues except for adipose tissue. Body weight was negatively correlated with serum ACE2 and positively correlated with ACE2 expression in the heart. Aerobic exercise caused a significant decrease in ACE2 expression in the lung, heart, muscle, and kidney both in LCRs and HCRs. Our results suggest that ACE2 expression, circulating ACE2 and glycine serum concentration are related to aerobic intrinsic exercise capacity and can be influenced with exercise. These results may support the hypothesis that physically fit individuals have a lower susceptibility for COVID-19 infection.

Desenvolveram-se métodos bioanalíticos para determinação de anfotericina B e fluconazol em apenas 200 L de plasma e líquor (LCR) através da cromatografia líquida de alta eficiência (CLAE UV-VIS). A anfotericina B foi determinada através de CLAE-VIS utilizando p-nitrofenol como padrão interno, após purificação das matrizes biológicas com acetonitrila, seguida da análise em coluna Nova Pak C18 (150 x 3,9mm, 4 micron) e fase móvel constituída por tampão acetato 0,1M pH 5,0 e acetonitrila (50:50,v/v) 0,5mL/min em 385nm; o tempo de corrida foi 15 min. Através da validação o método mostrou-se robusto com 0,2-25,0 µg/mL(linearidade, r2 0,9999), LD 0,1 µg/mL, precisão (5,4% e 6,9%), exatidão expressa através do erro sistemático (3,3% e 2,2%): intra e interdias). Os estudos de estabilidade evidenciaram 1,0% para o erro sistemático e 3% de precisão na bandeja (tempo e condição de análise por 24 h), e os ciclos de congelamento evidenciaram boa estabilidade uma vez que todos os ensaios foram realizados em Laboratório de luz amarela. O fluconazol foi determinado através de CLAE-UV utilizando carbamazepina como padrão interno, após purificação das matrizes biológicas pela extração líquido-líquido com diclorometano em meio alcalino, seguido da análise em coluna Nova Pak C18 (150 x 3,9mm, 4 micron) e fase móvel constituída por água UP e acetonitrila (70:30,v/v) 0,5mL/min em 210nm; o tempo de corrida foi 15 min. O método mostrou-se robusto com 0,2-250 µg/mL(linearidade, r2 0,9998), LD 0,1µg/mL, com boa recuperação absoluta (98%) e relativa (100%), precisão 0,5%/1,3%, exatidão expressa através do erro sistemático (1,2%). Evidenciou-se ótima estabilidade para os extratos em bandeja (tempo e condição de análise por 24 h), na longa duração (20° C, 9 meses) e através dos ciclos de congelamento. Investigaram-se 21 pacientes adultos de ambos os sexos portadores de meningite criptocócica com AIDS após internação emergencial em terapia de alta dose com anfotericina B (1mg/Kg) e fluonazol (400 mg, 12/12 horas) durante 12 semanas. O monitoramento das concentrações de anfotericina B e fluconazol no plasma e no LCR forneceram as razões que permitiram estimar a penetração dos antifúngicos no SNC. Obtiveram-se concentrações de anfotericina B, médias (IC95%): 2,30 (0,02-5,08) µg/mL no plasma e 0,30 (0,19-0,36) µg/mL no LCR. As concentrações do fluconazol, médias (IC95%) foram: 31,7 (20,1-43,3) µg/mL no plasma e 19,4 (11,1-27,7) µg/mL no LCR. Com base nos resultados obtidos conclui-se que a penetração da anfotericina B foi insuficiente (10-27%), enquanto que a do fluconazol mostrou-se adequada com valores médios (IC95%) de 67 (47-87) %. / Analytical methods were developed to determine amphotericin B and fluconazole in only 200 L of plasma and in cerebrospinal fluid (CSF) by liquid chromatography (HPLC UVVIS). Amphotericin B was determined by HPLC - VIS using p-nitrophenol as internal standard, after the purification of biological matrices using acetonitrile, followed by chromatographic analysis in a Nova Pak C18 column (150 x 3.9mm, 4 micron) and mobile phase consisting of acetate buffer 0.1M pH 5.0 plus acetonitrile (50:50,v/v) 0.5mL/min at 385nm; the run time required was 15 min. Bioanalytical method validated showed robustness, 0.2-25,0µg/mL (linearity, r2 0.9999), DL 0.1µg/mL, precision (5.4%/6.0%), accuracy expressed as systematic error (3.3%/2.2%). The stability was investigated, error systematic was 1% for the vials on the rack (time and conditions of drug analysis, 24h). Thawing cycles showed good stability after three freezing-thawing cycles. All procedures were performed under yellow light at room temperature. Fluconazole was determined by HPLC - UV using carbamazepine as internal standard, after the purification of biological matrices using liquid-liquid extraction in alkaline medium, followed by chromatographic analysis in a Nova Pak C18 column (150 x 3.9mm, 4 micron) and mobile phase consisting of purified water plus acetonitrile (70:30,v/v) 0.5mL/min at 210nm; the run time required was 15 min. Bioanalytical method validated showed robustness, 0.2-250 µg/mL(linearity, r2 0.9998), DL 0.1µg/mL. Absolute recovery was 98% and relative recovery was 100%, intra/interday precision were 0,5/-1,3%; accuracy expressed as systematic error were 1.2%/1.2%.and relative recovery was 100%. Good stability for the vials on the rack (time and conditions of drug analysis, 24h) and long term stability (at 20o C for 9 months) were demonstrated. Also thawing cycles showed good stability after three freezing-thawing cycles. Twenty one adult patients of both sex were investigated. Inpatients with meningitis by Cryptococcus neoformans with AIDS were under high dose therapy with amphotericin B 1mg/Kg plus fluonazole 400 mg, every 12h during 12 weeks. Therapeutic monitoring of amphotericin B and fluconazole in plasma and in CSF showed ratios that indicate the penetration of antifungal drugs into CNS. Mean (CI95%) data were for amphotericin B 2.30 (0.02-5.08 ) µg/mL in plasma and 0.30 (0.19-0.36) µg/mL in CSF. Fluconazole showed 31.7 (20.1-43.3) µg/mL in plasma and 19.4 (11.1-27.7) µg/mL in CSF. Based on data obtained we conclude that the penetration of amphotericin B was poor (10-27%) while fluconazole was adequate 67% (47-87%), mean (CI95%).

L’apparition de la technique CellSearch® a permis d’obtenir la sensibilité et la spécificité suffisantes et de détecter les CTCs en ciblant les marqueurs spécifiques dans le sang périphérique. Elle permet la numération et l’étude morphologique des CTCs qui est largement utilisée et validée. Nous décrivons une adaptation de la méthode CellSearch® pour détecter les cellules tumorale chez les LM (métastases leptoméningées) patients atteints de cancers du sein, du poumon et mélanomes, qui semble atteindre une sensibilité améliorée en comparaison avec la cytologie conventionnelle. Nous présentons également un cas clinique pour la détection de cellules tumorales dans l’ascite et du sang chez un patient avec le cancer de l’oesophage métastatique. De plus, la détection des cellules tumorales dans le redon chez les patients subis une chirurgie de la tête et du cou a été également réalisée. En utilisant cette méthode, les résultats sont non seulement quatitatifs, mais aussi quantitatifs avec des images numériques de chaque cellule, et des résultats séquentiels ont été étudiés chez certains patients atteints de cancer du sein, de cancer du poumon et de mélanome. Les données ont montré des changements dynamiques des nombres de cellules tumorales détectées dans le LCR, mais leurs corrélations avec la réponse au traitement ou la progression de la maladie ont besoin des études supplémentaires plus contrôlées avec une grande cohorte de patients. La mise en évidence de cette application serait importante en clinique pour le diagnostic, le pronostic et le traitement des patients atteints de cancer avec des métastases aux niveaux du SNC, du péritoine / The introduction of CellSearch® technology allows to give sufficient sensitivity and specificity and to detect CTCs targeting specific markers in peripheral blood. The enumeration and morphological study of CTCs are widely used and validated. We described an adaptation of the CellSearch® method to detect tumor cells in LM (leptomeningeal metastases) patients with breast cancer, lung cancer and melanoma, which appeared to achieve an improved sensitivity in comparison with conventional cytology. We also presented a case report for the detection of tumor cells in the ascites and blood of a patient with metastatic oesophageal cancer. Furthermore, the detection of tumor cells in aspirative drains after neck dissectionin from the patients undergoing surgery for head and neck cancer was also performed. Using this method, the results were not only quatitative but also quantitative with digital images of each cell, and sequential results were studied in some patients with breast cancer, lung cancer and melanoma. The data showed dynamic changes of the numbers of tumor cells detected in CSF, but their correlation with the response to treatment or disease progression need additional more controlled studies with a large cohort of patients. The application would be important for the clinical diagnosis, prognosis and treatment of cancer patients with CNS metastases and peritoneal metastases

A meningite bacteriana continua sendo um problema de saúde pública no Brasil, estudá-la em todos seus aspectos faz com que as chances de intervenções possam ser descobertas a fim de diminuir seus altos índices de mortalidade e sequelas dentre as pessoas acometidas. O presente trabalho teve por finalidade caracterizar o perfil etiológico da meningite bacteriana no estado do Tocantins, no período de 2010 a 2017, através de um estudo retrospectivo, transversal, de natureza quantitativa, realizado a partir de dados provenientes do Laboratório Central de Saúde Pública do Estado do Tocantins (LACEN-TO), em relação à realização de culturas de líquido cefalorraquidiano (LCR) para o diagnóstico laboratorial de meningite bacteriana. Este estudo constatou que foram realizadas 2041 culturas de LCR e um baixo crescimento microbiológico dentre elas. O grupo bacteriano com maior crescimento dentre as culturas positivas foram o Staphylococcus coagulase negativos (SCN), principalmente o S. epidermides. Dentre as bactérias de importância a saúde pública, a de maior incidência foi Streptococcus pneumoniae (sorotipo 3 e 19A), acometendo principalmente indivíduos do sexo masculino e as faixas etárias abaixo de 60 anos, não havendo distinção considerável entre crianças, adolescentes e adultos, seguido de Neisseria meningitides (sorogrupo C) e Haemophilus influenzae (sorotipo b); a maioria dos sorotipos de S. pneumoniae apresentaram susceptibilidade aos antimicrobianos, exceto sorotipo 19A, que apresentou multirresistência. Assim, o principal agente etiológico da meningite bacteriana no estado do Tocantins, de importância a saúde pública, no período estudado foi o Streptococcus pneumoniae, porém devido à baixa positividade de culturas e isolamento desses agentes, é necessário que haja melhorias no diagnóstico laboratorial dessa doença desde o ato da punção, para minimizar o crescimento de bactérias da microbiota, à liberação de resultados, inclusive introdução de novas tecnologias, como a reação em cadeia da polimerase (PCR), que poderá diminuir o tempo de resposta do resultado e aumentar o conhecimento da etiologia deste agravo, devido sofrer menos influência em relação a qualidade de amostra e tempo de processamento. / The bacterial meningitis is still a public health problem in Brazil, studying it in all its aspects causes that the chances of interventions can be discovered in order to reduce their high mortality rates and sequelae among people affected. The present study aimed to characterize the etiological profile of bacterial meningitis in the state of Tocantins, from 2010 to 2017, through a retrospective cross-sectional study of a quantitative nature, based on data from the Central Laboratory of Public Health of the State of Tocantins (LACEN-TO), in relation to cerebrospinal fluid cultures (CSF) for the laboratory diagnosis of bacterial meningitis. This study found that 2041 cultures of CSF and low microbiological growth were performed among them. The bacterial group with the highest growth among the positive cultures were coagulase negative Staphylococcus (SCN), mainly S. epidermides. Among the bacteria of public health importance, Streptococcus pneumoniae (serotype 3 and 19A) was the most prevalent, affecting mainly male individuals and the age groups below 60 years, with no significant distinction among children, adolescents and adults, followed Neisseria meningitides (serogroup C) and Haemophilus influenzae (serotype b); the majority of serotypes of S. pneumoniae showed antimicrobial susceptibility, except for serotype 19A, which presented multiresistance. Thus, the main etiological agent of bacterial meningitis in the State of Tocantins, of importance to public health, during the period studied was Streptococcus pneumoniae, but due to the low positivity of cultures and isolation of these agents, it is necessary to have improvements in the laboratory diagnosis of this disease since the puncture act to minimize the growth of bacteria in the microbiota, the release of results, including introduction of new technologies, such as polymerase chain reaction (PCR), which may decrease the response time of the result and increase knowledge of the etiology of this less influence on sample quality and processing time.