SUMMARYThe transmission of malaria in Brazil is heterogeneous throughout endemic areas and the presence of asymptomatic Plasmodium sp. carriers (APCs) in the Brazilian Amazon has already been demonstrated. Malaria screening in blood banks is based on the selection of donors in respect to possible risks associated with travel or residence, clinical evidence and/or inaccurate diagnostic methods thereby increasing the probability of transfusion-transmitted infection. We evaluated the frequency of APCs in four blood services in distinct areas of the Brazilian Amazon region. DNA was obtained from 400 human blood samples for testing using the phenol-chloroform method followed by a nested-PCR protocol with species-specific primers. The positivity rate varied from 1 to 3% of blood donors from the four areas with an average of 2.3%. All positive individuals had mixed infections for Plasmodium vivax and Plasmodium falciparum. No significant differences in the results were detected among these areas; the majority of cases originated from the transfusion centres of Porto Velho, Rondônia State and Macapá, Amapá State. Although it is still unclear whether APC individuals may act as reservoirs of the parasite, efficient screening of APCs and malaria patients in Brazilian blood services from endemic areas needs to be improved.

COMUNICAÇÃO/COMMUNICATIONMalaria is endemic in the Brazilian Amazon region. Of the four known human malaria parasites, Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae and Plasmodium ovale, only the first three species have been detected in Brazil. The immense area of land and water, and the uncontrolled occupation of the Brazilian Amazon region, associated with the lack of personnel to carry out rapid diagnosis, all contribute to the elevated number of malaria cases in this region 2 . Rapid and accurate diagnosis of malaria is essential for reducing morbidity and mortality as well as for control purposes. Laboratory diagnosis of malaria has traditionally relied upon identification of the protozoan in peripheral blood using microscopic examination of thick and thin blood smears 10 . This procedure is labor-intensive, time consuming and dependent on training and expert knowledge, particularly for the interpretation of mixed infections and in cases with low parasitemias 1 4 .During the last few years, alternative immunochromatography tests (ICT) have been developed showing potential for enhancing speed and accuracy in the diagnosis of both falciparum and vivax malaria, particularly where diagnostic tests are not available, such as in rural and remote areas 8 . Newer ICTs make use of a second pan-malarial antibody, which is supposed to detect all four malarial species that infect humans. The OptiMal test (Flow, USA), which is currently marketed by DiaMed, Switzerland, detects a Plasmodium falciparum-specific lactate dehydrogenase (LDH) and a second-generation pLDH common to all human malaria parasites 3 . The purpose of the present study was to evaluate the diagnostic performance of the pLDH for diagnosis under various storage conditions. 195Penhalbel RSR et al A total of 111 positive (75 Plasmodium vivax, 34 Plasmodium falciparum and 2 Plasmodium malariae) and 40 negative samples analyzed by the thick blood smear method were also evaluated using the OptiMal test (according to manufacturer's instructions). The samples from P. vivax malaria patients showed parasite density between 250 and 5,500 infected red blood cells/mm 3 , while in P. falciparum samples the parasitemia ranged from 465 to 7,500 infected red blood cells/ mm 3 . Two samples of P. malariae showed parasite density below 50 infected red blood cells/mm 3 . The OptiMal-IT kits (DiaMed-ID AS) were stored at three different temperatures (25°C, 30°C and 39°C) for 24, 48 and 72 hours before use.The OptiMal-IT kit provided negative results in all 40 samples with no parasites in the microscopy examination (control group). The test could detect the positive samples that were seen in the microscopy examination at all evaluated temperatures and periods of storage. It was observed that the pink-line signals indicating positive results were constant under the same conditions. We could not detect either of the two P. malariae samples at any of the different temperatures and storage periods for the kits.Notable antigens for the diagnosis of malar...

O adenoma hepatocelular é um tumor hepático benigno, raro e geralmente solitário. Sua maior prevalência ocorre em mulheres que fazem uso de anticoncepcionais orais. Pode manifestar-se com dor no hipocôndrio direito, porém, na maioria dos pacientes é assintomático. As complicações mais temíveis são: hemorragia livre em peritônio por ruptura tumoral e degeneração maligna para carcinomahepatocelular (CHC). Descrevemos um caso de paciente com história de uso prolongado de anticoncepcional, que apresentava adenomas múltiplos, tendo indicação de laparotomia para ressecção cirúrgica. Ultrassom intra-operatório mostrou presença de esteatose hepática grau III e inúmeros adenomas que contra-indicaram a ressecção. Após acompanhamento ambulatorial por mais de dois anos, foi indicado transplante de fígado em razão da contra-indicação de ressecção dos adenomas associada a desconforto abdominal e baixa qualidade de vida. Foram encontrados incidentalmente focos de CHC em três adenomas no fígado explantado. Não havia aumento de alfa feto proteína ou evidencias radiológicas que sugerissem CHC. Embora transplante de fígado seja conduta radical e de exceção, pode ser usado em casos selecionados para tratamento de adenomas múltiplos que não permita a cirurgia de ressecção.