La plupart des études sur l’hybride naturel entre Schistosoma haematobium (S.) et S. guineensis sont réalisées sur les vers adultes et contrairement aux études expérimentales sur l’hybridation, on ne retrouve pas de vers adultes hybrides après analyse de leur ADN. Avec cette étude, nous souhaitons mettre en évidence la présence d’hybride naturel entre ces deux espèces au Gabon à partir du premier élément suspect : l’œuf. Nous avons suivi l’œuf de son observation morphologique, à sa coloration par la technique de Ziehl-Neelsen jusqu’à l’amplification par PCR de son ADN et on a pu montrer qu’un œuf de morphologie suspecte observé dans les urines est capable d’amplifier à la fois une région spécifique de S. haematobium et de S. guineensis. / Most studies on the natural hybrid between Schistosoma haematobium (S.) and S.guineensis are performed on adult worms and contrary to experimental studies of hybridization, we do not find an adult hybrid worm after analysis of their DNA. With this study, we wish to highlight the presence of a natural hybrid between these two species in Gabon from the first suspect element: the egg. We followed the egg from its morphological observation to its staining using Ziehl-Neelsen technique until PCR amplification of its DNA and it has been shown that a suspected egg morphology seen in the urine is able to amplify both a specific region of S. haematobium and S. guineensis.

Introdução: Vários genes, particularmente os envolvidos na via de transcrição Transforming Growth Factor beta, estão claramente associados ao risco de desenvolvimento de hipertensão arterial pulmonar. Entretanto, pouco ou quase nada se sabe sobre a existência de fatores genéticos que possam estar associados a uma das formas mais prevalentes de hipertensão arterial pulmonar no mundo, a hipertensão arterial pulmonar associada a esquistossomose (HAP-Sch). O objetivo deste estudo foi avaliar a associação dos genes já descritos na hipertensão arterial pulmonar idiopática (HAPI) com a HAP-Sch. Método: Estudo transversal, comparando amostras de pacientes seguidos no ambulatório de Circulação Pulmonar no Instituto do Coração do HCFMUSP, com diagnóstico de HAP-Sch ou HAPI. Foram avaliadas as características genéticas nestes grupos quanto à presença de variantes patogênicas dos genes:BMPR2, ACVRL1, KCNK3, KCNK5, CAV-1, CBLN2, ENG, andSMAD9. Resultados: Foram incluídos 69 pacientes com HAP-Sch e 74 pacientes com HAPI. O grupo HAP-Sch apresentou idade mais avançada (52.1 ± 11.8 vs 41.5 ± 15.0; p = < 0,001) e débito cardíaco mais preservado ao diagnóstico (4.7 ± 1.9 vs 4.0 ± 1.4 p = 0.019). Cerca de 24% dos pacientes com HAPI apresentaram resposta aguda durante o teste de vasorreatividade, enquanto nenhum paciente com HAP-Sch apresentou resposta (p =< 0.001). Pacientes com HAP-Sch apresentaram 7% de variantes patogênicas, comparado com11% dos HAPI(p=0,782). Em ambos os grupos, pacientes portadores de variantes patogênicas possuíam características clínicas e hemodinâmicas semelhantes aos demais pacientes. No grupo HAP-Sch, a sobrevida dos portadores de variantes patogênicas foi significativamente menor (p=0.035). Conclusão: A prevalência de variantes patogênicas na HAP-Sch é semelhante à encontrada na HAPI e, da mesma forma, sua presença está associada a pior prognóstico / Background: Several genes, mainly those involved with the Transforming Growth Factor ? transcription pathway, are well-defined as risk factors for developing pulmonary arterial hypertension. Nevertheless, little is known about the existence of a genetic background associated with one of the most prevalent forms of pulmonary arterial hypertension worldwide, which is schistosomiasis associated pulmonary arterial hypertension (Sch-PAH). The aim of this study was to evaluate the association of genes already described in idiopathic pulmonary arterial hypertension (IPAH) with Sch-PAH. Method: A cross-sectional study comparing samples from patients followed at the Pulmonary Circulation clinic at the Heart Institute of HCFMUSP, diagnosed as Sch-PAH or IPAH. Genetic characteristics in these groups were evaluated for the presence of pathogenic variants of the genes: BMPR2, ACVRL1, KCNK3, KCNK5, CAV-1, CBLN2, ENG, and SMAD9.Results: A total of 69 patients with Sch-PAH and 74 patients with IPAH were included. The Sch-PAH group presented older age (52.1 ± 11.8 vs 41.5 ± 15.0, p =< 0.001) and higher cardiac output at diagnosis (4.7 ± 1.9 vs 4.0 ± 1.4 p = 0.019). About 24% of patients with IPAH presented acute response during the vasoreactivity test, whereas no Sch-PAH patient presented response (p = < 0.001). Patients with PAH-Sch had 7% prevalence of pathogenic variants, compared to 11% in IPAH (p = 0.782). In both groups, patients with pathogenic variants had clinical and hemodynamic characteristics similar to the other patients. In the Sch-PAH group, the survival of patients with pathogenic variants was significantly lower (p = 0.035). Conclusion: The prevalence of pathogenic variants in Sch-PAH is similar to that found in IPAH and, likewise, its presence is associated with worse prognosis

Die genitale Bilharziose ist eine Manifestation der Bilharziose, über deren Bedeutung für die reproduktive Gesundheit der Frau bisher wenig bekannt ist. Das klinische Bild der genitalen Bilharziose ist heterogen, da alle Genitalorgane betroffen sein können. Durch die Bilharziose verursachte gynäkologische Probleme wie z.B. Infertilität können für die betroffenen Frauen erhebliche Auswirkungen auf ihr soziales Leben haben (Scheidung wegen Kinderlosigkeit, verringerte Heiratsaussichten). In der vorliegenden Arbeit werden epidemiologische, parasitologische und klinische Untersuchungsergebnisse von Feldforschungsarbeiten zur genitalen Bilharziose der Zervix, die in Tansania durchgeführt wurden, vorgestellt. In den Studiendörfern war die Häufigkeit der genitalen Bilharziose der Zervix (38 %) bei Frauen im Alter zwischen 15 und 45 Jahren nahezu zahlengleich mit der Häufigkeit der Blasenbilharziose (42 %). Die genitale Bilharziose der Zervix ging einher mit "sandy patches", die als pathognomisch angesehen werden, Leukoplakien und Epithelläsionen. In den Biopsien von Frauen mit genitaler Bilharziose wurde im Vergleich zu nichtinfizierten Frauen eine erhöhte Anzahl von Entzündungszellen gesehen. Nach Therapie mit Praziquantel sank die Häufigkeit der genitalen Bilharziose um 70 %. Die Diagnose der genitalen Bilharziose der Zervix durch den direkten Nachweis mittels eines Quetschpräparats des Zervixgewebes ist der histologischen Untersuchung der Zervixbiopsie und der zytologischen Untersuchung des Zervixabstriches überlegen. Die diagnostische Wertigkeit indirekter Krankheitsmarker wurde untersucht. Frauen mit genitaler Bilharziose wiesen höhere Spiegel von eosinophilem kathodischen Protein (ECP) in der vaginalen Lavage auf als nichtinfizierte Frauen. Dies war aber auch bei Frauen mit sexuell übertragbaren Infektionen der Fall war. Es wurden bei Frauen mit genitaler Bilharziose - im Verhältnis zur Eiausscheidung im Urin - höhere Schistosomenantigenspiegel (CAA) festgestellt als bei Frauen mit ausschließlicher Blasenbilharziose. Dies kann durch die "ektopische" Lokalisation der adulten Würmer im Zervixgewebe erklärt werden. Die Forschungsergebnisse geben Hinweise, die die Hypothese einer möglichen Interaktion zwischen der genitalen Bilharziose und Infektionen mit HIV bzw. HPV unterstützen. Dazu gehören z.B. die Störung der Barrierefunktion des Zervixepithels bereits im jungen Alter und die Anwesenheit von HIV-empfänglichen Zellen im Zervixgewebe, die das Risiko einer Infektion mit HIV erhöhen könnten. / Female genital schistosomiasis is a neglected manifestation of schistosomiasis and its public health importance is yet to be determined. Symptoms and signs induced by genital schistosomiasis are unspecific and depending on the localisation of the infection the clinical picture is heterogenous. Pathological consequences of female genital schistosomiasis such as infertility may have a considerable impact on the social life of the diseased woman resulting in divorce or reduced chances to marry. In this paper the results of epidemiological, parasitological and clinical investigations of female genital schistosomiasis, which have been carried out in two study villages in Northern Tanzania, are described. The frequency of schistosomiasis of the cervix in women aged 15 to 45 years (38%) was similar to the frequency of urinary schistosomiasis (42%). The main pathological lesions seen were sandy patches, which seem to be pathognomic, leucoplakia and epithelial lesions. In cervical biopsies of women with genital schistosomiasis a higher absolute number of inflammatory cells were seen compared to women without the infection. The standard therapy reduced the frequency of genital schistosomiasis by 70%. The diagnostic performance of the direct parasitological examination of cervical tissue was better compared to the histopathological examination of the biopsy or the cytological examination of the cervical smear. The diagnostic value of indirect disease markers were investigated. Women with diagnosed genital schistosomiasis and sexually transmitted diseases showed higher levels of eosinophil cationic protein (ECP) in the vaginal lavage compared to women without infections. In women with genital schistosomiasis higher levels of schistosome antigens (CAA) were detected compared to women with urinary schistosomiasis only. This might be explained by the "ectopic" localisation of adult schistosomes in the genital tract. The research results support the hypothesis of a possible interaction of genital schistosomiasis with sexually transmitted infections such as HIV and HPV, e.g. the disruption of the cervical epithelial barrier in young age and the presence of HIV-sensible cells due to genital schistosomiasis might increase the risk of HIV transmission.

A desconexão ázigo-portal e esplenectomia (DAPE) é a operação mais aceita e realizada em nosso meio para a profilaxia da recidiva hemorrágica por ruptura de varizes esofágicas ou gástricas em pacientes portadores de esquistossomose hepato-esplênica. Menores índices de ressangramento são obtidos através da associação da DAPE com escleroterapia ou ligadura elástica endoscópica das varizes esofágicas realizada no pós-operatório. Faltam trabalhos mostrando a evolução, a longo prazo, dos doentes esquistossomóticos submetidos a este tratamento. Este estudo retrospectivo tem como objetivo avaliar a evolução destes pacientes com tempo mínimo de seguimento de 5 anos. Foram analisados os prontuários dos pacientes operados no Serviço de Cirurgia de Fígado e Hipertensão Portal da Disciplina de Cirurgia do Aparelho Digestivo do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período compreendido entre março de 1989 a março de 2001 e que foram acompanhados prospectivamente. Avaliamos dados clínicos, laboratoriais, endoscópicos e ultra-sonográficos de 97 pacientes com seguimento de 116,4 ± 46,7 meses. Nenhum paciente cursou com insuficiência hepática clínica ou laboratorial. Ocorreu, no pós-operatório tardio, correção da anemia, leucopenia e plaquetopenia, diminuição dos níveis de bilirrubinas total e indireta séricas e aumento do tempo de atividade da protrombina. Houve significativa redução do número e calibre das varizes esofágicas, assim como da presença de sinais de manchas vermelhas e de varizes gástricas. Houve aumento na freqüência de gastropatia congestiva, entretanto, sem repercussão clínica significativa. A recidiva hemorrágica xviii ocorreu em 24,7% dos pacientes, sendo em 14,6% quando considerada apenas por varizes esofágicas, gástricas ou duodenais. A probabilidade estimada de não ocorrer ressangramento em 20 anos é de 67,1%, sendo de 82,5% quando considerada recidiva por varizes. Em quatro pacientes a recidiva hemorrágica ocorreu por varizes, mesmo após o relato, em exame endoscópico prévio, de erradicação das varizes esofágicas. À avaliação ultrassonográfica observou-se redução do calibre da veia porta no pósoperatório tardio, em comparação ao pré-operatório. Concluímos que a desconexão ázigo-portal com esplenectomia, associada ao tratamento endoscópico de varizes esofágicas no pós-operatório, propicia bons resultados do ponto de vista clínico com baixa morbidade e mortalidade; permite melhora laboratorial da função hepática e correção do hiperesplenismo; determina a redução da incidência dos sinais endoscópicos preditivos de sangramento digestivo por hipertensão portal (varizes esofágicas de grosso calibre, sinais de manchas vermelhas e varizes de fundo gástrico), porém, a gastropatia congestiva é mais freqüente; permite adequada profilaxia da recidiva hemorrágica em 67% dos pacientes ao longo de 20 anos. A recidiva hemorrágica por varizes pode ocorrer mesmo após a erradicação das varizes esofágicas, tanto por recidiva de varizes como por varizes de outro sítio (gástrica ou duodenal). Ocorre redução do calibre da veia porta no pós-operatório tardio, observado em exame ultrassonográfico em comparação ao pré-operatório. / Esophagogastric devascularization and splenectomy (EGDS) is nowadays the most performed operation for esophageal varices bleeding recurrence prophylaxis in hepatosplenic schistosomiasis. Lower rebleeding rates are obtained through the association of EGDS with postoperative endoscopic sclerotherapy or elastic bandage of esophageal varices, however, there is a lack of studies showing long term results. The objectives of this study were to evaluate retrospectively EGDS results in patients with at least five years of follow-up. Clinical, laboratorial, endoscopic and ultrasonographic data of 97 patients submitted to EGDS from March 1989 to March 2001 were analyzed. The mean follow-up was 116.4 months. There was no postoperative clinical or laboratorial hepatic insufficiency. In the late follow-up we observed normalization of preexisting anemia, leucopenia, thrombocytopenia, hyperbilirubinemia, and a prothrombin activity time increase. There was a significant esophageal varices caliber and number reduction, cherry red spots signs and gastric varices decrease. Congestive gastropathy was observed more frequently but without clinical importance. Bleeding recurrence occurred in 24.7% of the patients, however, in 14.6% when esophageal varices hemorrhage was considered. Estimated probability of rebleeding prophylaxis over 20 years is 67.1% and 82.5% when variceal recurrence was considered. Bleeding recurrence occurred in four patients even after endoscopic evaluation showing esophageal varices eradication. There was a significant portal vein caliber reduction on late ultrasound assessment, compared to preoperative. We concluded that the EGDS with postoperative endoscopic treatment leads to good clinical results with low morbidity and mortality; provides laboratorial liver function improve and xx hypersplenism correction; determines endoscopic predictive signs of portal hypertension digestive bleeding decrease (large esophageal varices, cherry red spots signs and gastric varices), however congestive gastropathy is more frequent; allows appropriate bleeding prophylaxis in 67% of the patients over 20 years. Variceal hemorrhagic recurrence may occur even when esophageal varices eradication is reached suggesting the need of an endoscopic surveillance even in this group of patients.

Introdução: Vários genes, particularmente os envolvidos na via de transcrição Transforming Growth Factor beta, estão claramente associados ao risco de desenvolvimento de hipertensão arterial pulmonar. Entretanto, pouco ou quase nada se sabe sobre a existência de fatores genéticos que possam estar associados a uma das formas mais prevalentes de hipertensão arterial pulmonar no mundo, a hipertensão arterial pulmonar associada a esquistossomose (HAP-Sch). O objetivo deste estudo foi avaliar a associação dos genes já descritos na hipertensão arterial pulmonar idiopática (HAPI) com a HAP-Sch. Método: Estudo transversal, comparando amostras de pacientes seguidos no ambulatório de Circulação Pulmonar no Instituto do Coração do HCFMUSP, com diagnóstico de HAP-Sch ou HAPI. Foram avaliadas as características genéticas nestes grupos quanto à presença de variantes patogênicas dos genes:BMPR2, ACVRL1, KCNK3, KCNK5, CAV-1, CBLN2, ENG, andSMAD9. Resultados: Foram incluídos 69 pacientes com HAP-Sch e 74 pacientes com HAPI. O grupo HAP-Sch apresentou idade mais avançada (52.1 ± 11.8 vs 41.5 ± 15.0; p = < 0,001) e débito cardíaco mais preservado ao diagnóstico (4.7 ± 1.9 vs 4.0 ± 1.4 p = 0.019). Cerca de 24% dos pacientes com HAPI apresentaram resposta aguda durante o teste de vasorreatividade, enquanto nenhum paciente com HAP-Sch apresentou resposta (p =< 0.001). Pacientes com HAP-Sch apresentaram 7% de variantes patogênicas, comparado com11% dos HAPI(p=0,782). Em ambos os grupos, pacientes portadores de variantes patogênicas possuíam características clínicas e hemodinâmicas semelhantes aos demais pacientes. No grupo HAP-Sch, a sobrevida dos portadores de variantes patogênicas foi significativamente menor (p=0.035). Conclusão: A prevalência de variantes patogênicas na HAP-Sch é semelhante à encontrada na HAPI e, da mesma forma, sua presença está associada a pior prognóstico / Background: Several genes, mainly those involved with the Transforming Growth Factor ? transcription pathway, are well-defined as risk factors for developing pulmonary arterial hypertension. Nevertheless, little is known about the existence of a genetic background associated with one of the most prevalent forms of pulmonary arterial hypertension worldwide, which is schistosomiasis associated pulmonary arterial hypertension (Sch-PAH). The aim of this study was to evaluate the association of genes already described in idiopathic pulmonary arterial hypertension (IPAH) with Sch-PAH. Method: A cross-sectional study comparing samples from patients followed at the Pulmonary Circulation clinic at the Heart Institute of HCFMUSP, diagnosed as Sch-PAH or IPAH. Genetic characteristics in these groups were evaluated for the presence of pathogenic variants of the genes: BMPR2, ACVRL1, KCNK3, KCNK5, CAV-1, CBLN2, ENG, and SMAD9.Results: A total of 69 patients with Sch-PAH and 74 patients with IPAH were included. The Sch-PAH group presented older age (52.1 ± 11.8 vs 41.5 ± 15.0, p =< 0.001) and higher cardiac output at diagnosis (4.7 ± 1.9 vs 4.0 ± 1.4 p = 0.019). About 24% of patients with IPAH presented acute response during the vasoreactivity test, whereas no Sch-PAH patient presented response (p = < 0.001). Patients with PAH-Sch had 7% prevalence of pathogenic variants, compared to 11% in IPAH (p = 0.782). In both groups, patients with pathogenic variants had clinical and hemodynamic characteristics similar to the other patients. In the Sch-PAH group, the survival of patients with pathogenic variants was significantly lower (p = 0.035). Conclusion: The prevalence of pathogenic variants in Sch-PAH is similar to that found in IPAH and, likewise, its presence is associated with worse prognosis

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Apesar de significativos avanços obtidos no estudo da esquistossomose mansônica, as relações existentes entre esquistossomose e má-nutrição ainda não se acham completamente esclarecidas. Sendo a fase de lactação um período de vida de extrema importância para o indivíduo, alterações metabólicas na gestante podem afetar diretamente o desenvolvimento do feto sugerindo uma programação (imprinting) no metabolismo deste indivíduo em resposta adaptativa aos fatores ambientais encontrados em períodos iniciais de desenvolvimento. Este trabalho teve como objetivo avaliar as características do baço na fase aguda da infecção esquistossomótica de camundongos programados metabolicamente por restrição calórica e restrição protéica. Os baços dos animais eutanasiados na 9 semana de infecção foram submetidos a cortes histológicos (5m) e corados com hematoxilina-eosina. Foi realizada avaliação histopatológica, análise morfométrica e estereologia. A análise estatística foi realizada utilizando-se o programa Graph Pad Instat. Foi observada desorganização estrutural da polpa branca e da polpa vermelha nos grupos programados, independente da presença de infecção. Animais infectados apresentaram hiperplasia e hipertrofia da polpa branca e maior quantidade de pigmentos dispersos no tecido esplênico, bem como a presença de eosinófilos no interior de estruturas vasculares. A polpa branca dos grupos infectados tanto de restrição calórica quanto de restrição protéica apresentaram medidas morfométricas maiores quando comparados aos grupos não infectados. Os resultados estereológicos mostraram que o grupo de restrição calórica infectado apresentou menor densidade de volume de polpa vermelha, enquanto não houve diferenças significativas na densidade de volume de polpa branca. Megacariócitos foram vistos em maior quantidade nos grupos infectados, com ênfase no grupo de restrição protéica. Estes dados sugerem que a programação pela desnutrição materna na lactação e a infecção esquistossomótica provocam desorganização do tecido esplênico. / Despite significant advances in the study of schistosomiasis, the relationship between schistosomiasis and malnutrition are still not completely understood. As lactation stage is a extreme important lifetime for the individual, metabolic abnormalities during pregnancy can directly affect fetal development suggesting a metabolic imprinting of this individual in adaptive response to environmental factors found in earlier periods of development. This study aimed to evaluate the spleen characteristics in the acute phase of mice schistosomiasis metabolically programmed by caloric restriction and protein restriction. The spleens of animals euthanized at the 9th week of infection were subjected to histological sections (5&#956;m) and stained with hematoxylin-eosin. It was performed histopathological evaluation, morphometric and stereological analysis. Statistical analysis was performed using Graph Pad Instat. It was observed structural disorganization of the white pulp and the red pulp on programmed groups, regardless of the presence of infection. Infected animals showed hyperplasia and hypertrophy of the white pulp and a larger amount of pigments dispersed in the spleen tissue, as well as the presence of eosinophils within vascular structures. The white pulp of both infected groups of caloric restriction and protein restriction showed higher morphometric measurements when compared to uninfected groups. The stereological results showed that the infected caloric restriction group had lower volume density of red pulp, while there were no significant differences in the volume density of white pulp. Megakaryocytes were seen in higher quantities in the infected groups, with emphasis on the protein restriction group. These data suggest that imprinting by maternal undernutrition during lactation and schistosome infection causes disorganization on the splenic tissue.

A esquistossomose à uma doenÃa parasitÃria, provocada por vermes trematÃdeos do gÃnero Schistosoma. à uma endemia mundial, ocorrendo em 74 paÃses e territÃrios, principalmente na AmÃrica do Sul, Caribe, Ãfrica e Leste do MediterrÃneo, onde atinge as regiÃes do Delta do Nilo, alÃm de paÃses como Egito e SudÃo. Entre as parasitoses humanas mais disseminadas no mundo, a esquistossomose ocupa o segundo lugar (perdendo apenas para a malÃria), constituindo, no Brasil, um de seus mais graves problemas de saÃde pÃblica. A transmissÃo do Schistosoma mansoni depende do inter-relacionamento entre o ecossistema, as pessoas e suas condiÃÃes sociais. Grandes projetos de engenharia que causam alteraÃÃes no meio ambiente costumam criar condiÃÃes satisfatÃrias para o aparecimento de fatores de risco de introduÃÃo e disseminaÃÃo de doenÃas nas comunidades afetadas. O objetivo deste trabalho foi construir uma linha de base dos municÃpios atingidos por dois grandes projetos de infra-estrutura hÃdrica: A integraÃÃo de Bacias do Rio SÃo Francisco nos limites do estado do Cearà e o EixÃo das Ãguas do CearÃ, e as implicaÃÃes sobre a transmissÃo de Esquistossomose MansÃnica. Os municÃpios pertencentes a Ãrea de InfluÃncia Direta dos projetos envolvidos foram: Alto Santo, Baixio, Barro, Brejo Santo, Cascavel, Caucaia, Chorozinho, Horizonte, IcÃ, Itaitinga, Jaguaribara, Jaguaribe, Jati, Lavras da Mangabeira, MaracanaÃ, Mauriti, MissÃo Velha, Morada Nova, Ocara, Pacajus, Pacatuba, Pena Forte, Russas, SÃo GonÃalo do Amarante e Umari. Foram utilizados indicadores sÃcio-demogrÃficos, sÃcio-econÃmicos, educacionais, ambientais e de saÃde. A anÃlise dos dados sÃcio-demogrÃficos e sÃcio-econÃmicos revelou que os municÃpios prÃximos a RegiÃo Metropolitana de Fortaleza apresentaram os melhores indicadores. O hospedeiro intermediÃrio B. straminea encontra-se disseminado em todos os 25 municÃpios dos quais 6 apresentaram casos de esquistossomose mansÃnica no perÃodo de 2001 a 2006. Somente 8 municÃpios sÃo trabalhados pelo Programa Estadual de Controle da Esquistossomose com prevalÃncia variando de 0,1 a 0,8 % com o municÃpio de Maracanaà apresentando a maior prevalÃncia (0,8%). Cinco municÃpios da AID apresentaram Ãbito por esquistossomose no perÃodo de 2001 a 2009, destes 3 nÃo sÃo trabalhados pelo PCE. A produÃÃo de espaÃos potenciais para a transmissÃo da esquistossomose na AID decorrentes da implementaÃÃo do referidos projetos de transposiÃÃo de bacias necessita ser mensurado. / Schistosomiasis is a parasitic disease caused by trematode worms of the genus Schistosoma. It is a worldwide endemic disease, occurring in 74 countries and territories, mainly in South America, the Caribbean, Africa and Eastern Mediterranean, where it reaches the regions of the Nile Delta, along with countries like Egypt and Sudan Among the most widespread parasitic infections in human world, schistosomiasis ranks second (second only to malaria), constituting, in Brazil, one of its most serious public health problems. The transmission of Schistosoma mansoni depends on the inter-relationship between the ecosystem, people and their social conditions. Large engineering projects that cause environmental changes often create good conditions for the emergence of risk factors for introduction and spread of diseases in the affected communities. The objective of this study was to build a baseline of the municipalities affected by two major projects of water infrastructure: The integration of the SÃo Francisco River Basin within the limits of the state of Ceara and EixÃo Waters of CearÃ, and the implications on the transmission Schistosomiasis mansoni. The municipalities in the Area of Direct Influence of the projects involved were: Alto Santo, Baixio, Barro, Brejo Santo, Cascavel, Caucaia, Chorozinho, Horizonte, IcÃ, Itaitinga, Jaguaribara, Jaguaribe, Jati, Lavras da Mangabeira, MaracanaÃ, Mauriti, MissÃo Velha, Morada Nova, Ocara, Pacajus, Pacatuba, Pena Forte, Russas, SÃo GonÃalo do Amarante e Umari. Indicators were used socio-demographic, socioeconomic, educational, and environmental health. The socio-demographic and socioeconomic analysis revealed that the municipalities close to the Metropolitan Region of Fortaleza were the best indicators. The intermediate host Biomphalaria straminea is widespread in all 25 municipalities of which 6 were cases of schistosomiasis in the period 2001 to 2006.Only eight counties are handled by the State Program for the Control of Schistosomiasis with prevalence ranging from 0.1 to 0.8% with the town of Maracanaà presenting the highest prevalence (0.8%). Five municipalities ADI (area of direct influence) had died of schistosomiasis in the period 2001 to 2009, these three are not operated by the State Program for the Control of Schistosomiasis. The production potential spaces for the transmission of schistosomiasis in the ADI following the implementation of these projects watershed transposition needs to be measured.

A natureza e diversidade das estruturas químicas com atividade farmacológica que se tem encontrado nos organismos marinhos justificam a busca por novos compostos que são de interesse nas mais diversas áreas de aplicação. As espécies de macroalgas vermelhas, em especial Laurencia spp., merecem destaque pela enorme variedade de terpenos e acetogeninas que produzem, sendo consideradas de grande potencial na produção de novos fármacos. O estudo de seus constituintes pode fornecer importantes subsídios para a quimiotaxonomia, ecologia química, caracterização das espécies e avaliação do potencial biotecnológico. Baseado nisso, Laurencia aldingensis, L. dendroidea e Laurenciella sp. foram selecionadas para o presente estudo para isolamento, caracterização e teste de atividades biológicas dos seus compostos. A técnica do DNA barcoding foi utilizada como ferramenta de diagnóstico para garantir a similaridade entre as amostras de cada espécie, que foram coletadas em época e locais diferentes. Do extrato orgânico de Laurencia aldingensis, nove substâncias foram isoladas, sendo quatro esfingosinas (1-4), três terpenos (5-7) e duas novas substâncias halogenadas (8 e 9). Do extrato orgânico de Laurencia dendroidea formam isolados dois terpenos halogenados conhecidos (10, 11) e, do extrato de Laurenciella sp. três novas substâncias halogenadas alifáticas insaturadas (12-14), assim como um ácido graxo (15) e um esterol (16) conhecidos. Dentre elas, a 8 apresentou atividade citotóxica, mas não se mostrou seletivo, e as substâncias 4 e 11 apresentaram atividade esquistossomicida, bastante promissora. No entanto, nenhum deles apresentou atividade antioxidante. Diante desta investigação, podemos dizer que as informações geradas com os estudos de Laurencia aldingensis, L. dendroidea e Laurenciella sp. expandiram significantemente o conhecimento no que tange a diversidade química no gênero e o potencial biológico-farmacêutico dos mesmos. / The nature and diversity of chemical structures with pharmacological activity that have been found in marine organisms justifies the search for new compounds that may have applications in various areas of interest. Species of red seaweeds, especially Laurencia spp., are special because of the unprecedented variety of terpenes and acetogenins they produce that are considered potentially useful for the production of new drugs. Study of their constituents can also provide important insights relating to their chemotaxonomy, chemical ecology, characterization of species and biotechnological potential. On this basis Laurencia aldingensis, L. dendroidea and Laurenciella sp., were selected for study and isolation, characterization, and biological activity assessment of isolatable quantities of their compounds. The technique of DNA barcoding was used as a diagnostic tool to ensure similarity between samples of each species collected at different times and places. From the organic extract of Laurencia aldingensis nine compounds were isolated; four sphingosines (1-4), three terpenes (5-7) and other two new halogenated compound (8, 9). From the organic extract of Laurencia dendroidea two known halogenated terpenes (10, 11) were isolated while from a similar extract of Laurenciella sp., three new halogenated aliphatic compounds (12-14) were isolated together with known fatty acid (15) and sterol (16). Among all isolates, 8 demonstrated unspecific cytotoxic activity and compounds 4 and 11 showed promising schistosomicidal activity. In applied antioxidant assays none of the isolates we noted to have activity. From the overall investigation it is also clear that the information gleaned from the studies of Laurencia aldingensis, L. dendroidea and Laurenciella sp., significantly expanded our knowledge base concerning chemical diversity in the genus Laurencia and their biological-pharmaceutical potential.

A natureza e diversidade das estruturas químicas com atividade farmacológica que se tem encontrado nos organismos marinhos justificam a busca por novos compostos que são de interesse nas mais diversas áreas de aplicação. As espécies de macroalgas vermelhas, em especial Laurencia spp., merecem destaque pela enorme variedade de terpenos e acetogeninas que produzem, sendo consideradas de grande potencial na produção de novos fármacos. O estudo de seus constituintes pode fornecer importantes subsídios para a quimiotaxonomia, ecologia química, caracterização das espécies e avaliação do potencial biotecnológico. Baseado nisso, Laurencia aldingensis, L. dendroidea e Laurenciella sp. foram selecionadas para o presente estudo para isolamento, caracterização e teste de atividades biológicas dos seus compostos. A técnica do DNA barcoding foi utilizada como ferramenta de diagnóstico para garantir a similaridade entre as amostras de cada espécie, que foram coletadas em época e locais diferentes. Do extrato orgânico de Laurencia aldingensis, nove substâncias foram isoladas, sendo quatro esfingosinas (1-4), três terpenos (5-7) e duas novas substâncias halogenadas (8 e 9). Do extrato orgânico de Laurencia dendroidea formam isolados dois terpenos halogenados conhecidos (10, 11) e, do extrato de Laurenciella sp. três novas substâncias halogenadas alifáticas insaturadas (12-14), assim como um ácido graxo (15) e um esterol (16) conhecidos. Dentre elas, a 8 apresentou atividade citotóxica, mas não se mostrou seletivo, e as substâncias 4 e 11 apresentaram atividade esquistossomicida, bastante promissora. No entanto, nenhum deles apresentou atividade antioxidante. Diante desta investigação, podemos dizer que as informações geradas com os estudos de Laurencia aldingensis, L. dendroidea e Laurenciella sp. expandiram significantemente o conhecimento no que tange a diversidade química no gênero e o potencial biológico-farmacêutico dos mesmos. / The nature and diversity of chemical structures with pharmacological activity that have been found in marine organisms justifies the search for new compounds that may have applications in various areas of interest. Species of red seaweeds, especially Laurencia spp., are special because of the unprecedented variety of terpenes and acetogenins they produce that are considered potentially useful for the production of new drugs. Study of their constituents can also provide important insights relating to their chemotaxonomy, chemical ecology, characterization of species and biotechnological potential. On this basis Laurencia aldingensis, L. dendroidea and Laurenciella sp., were selected for study and isolation, characterization, and biological activity assessment of isolatable quantities of their compounds. The technique of DNA barcoding was used as a diagnostic tool to ensure similarity between samples of each species collected at different times and places. From the organic extract of Laurencia aldingensis nine compounds were isolated; four sphingosines (1-4), three terpenes (5-7) and other two new halogenated compound (8, 9). From the organic extract of Laurencia dendroidea two known halogenated terpenes (10, 11) were isolated while from a similar extract of Laurenciella sp., three new halogenated aliphatic compounds (12-14) were isolated together with known fatty acid (15) and sterol (16). Among all isolates, 8 demonstrated unspecific cytotoxic activity and compounds 4 and 11 showed promising schistosomicidal activity. In applied antioxidant assays none of the isolates we noted to have activity. From the overall investigation it is also clear that the information gleaned from the studies of Laurencia aldingensis, L. dendroidea and Laurenciella sp., significantly expanded our knowledge base concerning chemical diversity in the genus Laurencia and their biological-pharmaceutical potential.

Introduction Schistosomiasis is one of the most important and widespread diseases of rural poverty. Worldwide, approximately 779 million people are at risk of infection, with 207 million already infected. Infections with Ascaris lumbricoides, hookworms and Trichuris trichiura, collectively known as the soil-transmitted helminths (STHs), are also highly endemic throughout the tropics, particularly in resource-poor settings. An estimated 1 billion people worldwide are estimated to be infected with STHs. Schistosomes and STHs often co-exist in the same epidemiological settings and, given the high prevalence of concurrent multiple species infections (multiparasitism), a combined approach to prevention and control could lead to significant improvements, including reducing costs associated with single-species control programmes. In China, rigorous national schistosomiasis control efforts over the past 60 years have decreased the prevalence by over 90%; however, since 2000 the number of infected individuals has been rising, possibly indicative of a re-emergence. Fishermen, migrant communities and poor households in rural areas may be most at risk of single and multiple-species parasitic infections and the associated morbidity. Objectives This Ph.D. thesis is structured according to four main goals and a number of specific objectives: Firstly, to update estimates of S. japonicum prevalence, intensity and associated morbidity levels in Hunan province, China, according to the third national PES carried out in 2004; Secondly, to investigate existing barriers in access to preventive, diagnostic and treatment services for advanced schistosomiasis; Thirdly, to compare and evaluate direct and proxy methods of measuring household socio-economic position, according to data on income, savings and asset-based estimations of wealth; and Finally, to explore and identify behavioural, demographic, economic, environmental and social risk factors associated with the distribution of S. japonicum, STHs and multiple species infections, in two villages of the Dongting Lake region, Hunan province, China. Methods Firstly, we used data from the third national schistosomiasis periodic epidemiological survey (PES) of 2004. In Hunan province, the PES was carried out in 47 villages of the endemic Dongting lake area. A total of 47144 human serological, 7205 stool, and 3893 clinical examinations were performed. For the reservoir hosts, stools from 874 buffaloes and other domestic animals were examined for schistosomiasis by the miracidial hatching test. Secondly, we conducted an in-depth study involving interviews with 66 schistosomiasis control staff and 79 advanced schistosomiasis patient, and six focus group discussions (FGDs), in the Dongting lake region, between August 2002 and February 2003. Using the Health-Access Livelihood framework we examined availability, accessibility, affordability, adequacy and acceptability of schistosomiasis control in the Dongting lake area. Lastly, we carried out two village-wide parasitological, clinical and questionnaire-based investigations between October and December 2006. Parasitological examinations for the prevalence of S. japonicum and the STHs were performed by the Kato-Katz thick smear method, with repeated sampling of each individual. We took fingerprick blood samples to assess haemoglobin levels, using a B-haemoglobin HemoCue photometer. The household-based questionnaire focused on direct and proxy measurements of household wealth, while the individual-based questionnaire focused on demographic and behavioural factors, treatment history and self-perceived symptoms. Results Human sero-prevalence was 11.9% (range: 1.3-34.9% at village level), and the rate of egg-positive stools was 1.9% (0-10.9%) for the same population. The prevalence of infection among buffaloes was 9.5% (0-66.7%). Extrapolating to the entire population of the Dongting Lake region, an estimated 73225 people and 13973 buffaloes were infected. Most frequently reported symptoms were abdominal pain (6.2%) and bloody stools (2.7%). Accessibility and affordability were major barriers in access to schistosomiasis control. Many of staff interviewed indicated that a majority of patients who develop advanced schistosomiasis resided in mildly-endemic or non-endemic settings. None of the patients interviewed had any form of health insurance, and most of their health expenses were out-of-pocket payments. Exploratory factor analysis generated internally robust proxy wealth indices, however these were not complementary to direct measures of household wealth, as indicated by low correlation co-efficients. We found wide disparities in household ownership of durable assets, utility and sanitation, within both settings. Pooled data from the rural and peri-urban settings highlighted structural differences in socioeconomic position (SEP), more likely a result of localised urbanization and modernization. We found higher infection prevalences in rural settings, than in peri-urban settings, for schistosomiasis (6.3% and 6.7% respectively), ascariasis (8.3% and 2.2%, respectively) and trichuriasis (5.1% and 0.5%, respectively), but lower for hookworms (0.1% and 1.5% respectively). Multiple species infections (2.6% and 0.2%, respectively) were less prevalent than single species infections (14.5% and 10.4%). There were significant disparities in the prevalence of parasitic infections between poorest and least poor quintiles of the cohort population. Anaemia and other symptoms, especially headache, stomach ache and swollen stomach, were common in both rural and peri-urban village settings. Conclusion The studies conducted within the framework of this Ph.D. thesis document the current situation pertaining to schistosomiasis and the STHs in Hunan province, China. Our findings highlight the need for increased surveillance, monitoring and health education, with relation to schistosomiasis and STHs, in non-endemic or post-transmission control settings. Based upon these results, we call for improved diagnostic tools, particularly in the case of low intensity infections and for hookworm, and propose an extension of the use of available infrastructure, human resources, knowledge and technology by integrating prevention and control of schistosomiasis with that of other intestinal helminths, particularly STHs. In the future, our studies may form a base from which to further examine local needs and priorities for parasitic disease control in the area.