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1.
Pesqui. vet. bras ; 43: e07187, 2023. tab, ilus
Artigo em Inglês | VETINDEX | ID: biblio-1431060

Resumo

Bovine paratuberculosis causes chronic, incurable diarrhea and weight loss, resulting in decreased cattle production. The disease is caused by Mycobacterium avium subsp. paratuberculosis (MAP), an obligate intracellular mycobactin-dependent mycobacterium that replicates slowly in the host and has heightened environmental resistance. In countries where the disease is found and the damage has been quantified, direct and indirect economic losses are extremely high. Local epidemiological data is of paramount importance for the implementation of control programs. Our objective was to verify whether paratuberculosis is present in commercial dairy herds in different mesoregions of RS. Therefore, a prospective, cross-sectional and observational study was performed on dairy cattle from five mesoregions of the RS state, Brazil. Milk samples taken from individual cows on commercial farms were tested using indirect ELISA tests and classified as negative, suspicious, or positive. In herds containing at least one positive cow, we conducted convenience sampling of feces directly from the rectal ampulla to identify MAP through PCR. Of the 362 cows tested, 20 were seroreactive for paratuberculosis from two mesoregions. The PCR tests were all positive; cows with a negative ELISA and positive PCR results probably indicate that the MAP was ingested and eliminated without causing infection. We found that paratuberculosis is likely endemic in the northwest and northeast mesoregions.


A paratuberculose bovina causa diarreia crônica e incurável, perda de peso e resulta em diminuição da produção. A doença é causada pelo Mycobacterium avium subsp. paratuberculosis (MAP), micobactéria intracelular obrigatória, dependente de micobactina, que se replica lentamente no hospedeiro e possui elevada resistência ambiental. Nos países onde a doença é encontrada e os danos foram quantificados, as perdas econômicas diretas e indiretas são extremamente altas. Os dados epidemiológicos locais são de suma importância para a implementação de programas de controle. Nosso objetivo foi verificar se a paratuberculose está presente em rebanhos leiteiros comerciais em diferentes mesorregiões do RS. Para tanto, foi realizado um estudo prospectivo, transversal e observacional em bovinos leiteiros de cinco mesorregiões do estado do RS, Brasil. Amostras de leite individuais, provenientes de vacas leiteiras de fazendas comerciais foram testadas com ELISA indireto e classificadas como negativas, suspeitas ou positivas. Em rebanhos contendo pelo menos uma vaca positiva, realizamos amostragem por conveniência, em que foram coletadas fezes diretamente da ampola retal, para identificar MAP por meio da PCR. Das 362 vacas testadas, 20 foram sororreativas para paratuberculose, oriundas de duas mesorregiões. Os testes de PCR foram todos positivos. Vacas com resultado negativo no teste ELISA e PCR positivo provavelmente indicam que o MAP foi ingerido e eliminado sem causar infecção. Sugere-se que a paratuberculose é provavelmente endêmica nas mesorregiões noroeste e nordeste.


Assuntos
Animais , Feminino , Bovinos , Paratuberculose/diagnóstico , Paratuberculose/epidemiologia , Doenças dos Bovinos/microbiologia , Brasil/epidemiologia , Ensaio de Imunoadsorção Enzimática/veterinária , Reação em Cadeia da Polimerase/veterinária , Mycobacterium avium subsp. paratuberculosis/isolamento & purificação , Leite/microbiologia
2.
Acta sci. vet. (Impr.) ; 50: Pub. 1889, 2022. ilus, mapas, tab
Artigo em Inglês | VETINDEX | ID: biblio-1401063

Resumo

Background: Goat farming has been on the rise in Brazil in recent years. Overall, 93% of the national herd is concentrated in the Northeast, with the state of Paraíba being the largest goat milk producer in the country. Considering Mycobacterium avium subsp. paratuberculosis (MAP) as a sanitary issue for the development of animal farming with risks for human health and that is a notifiable disease, this research was structured with the objective of confirming the presence and performing a molecular characterization of MAP in goat milk destined for processing plants in the semiarid region of the Brazilian Northeast. Materials, Methods & Results: Samples from 179 production units and 5 collective bulk tanks and 4 samples of pasteurized goat milk were analyzed through Real-time polymerase chain reaction (qPCR). Genetic material (DNA) for MAP was found in the goat milk sample from 1 production unit (1/179). From this positive sample, 9 lactating goats were identified in the original property, 7 of which showed MAP DNA in milk samples (77.77%). The characterization of the nucleotide sequence detected in the positive sample has 99% identity with KJ173784. Discussion: One sample (1/179), from the production units, had MAP genetic material (DNA) detected using the molecular test. Samples from these production units represent the milk from all lactating goats from each producer. Therefore, it was possible to identify from which farm the samples originated, allowing individual animals to then be tested, with milk samples collected from 9 goats and MAP DNA detected in 7 of them (77.77%) via PCR. Control and/or prevention programs need this type of surveillance in reason that it allows the tracking of possible foci from milk samples collected from dairy products or cooling stations. The use of PCR to detect MAP foci via goat milk is thus advantageous because samples are obtained in a non-invasive manner, with faster results when compared to the culture technique. The low detection via PCR in goat milk may be related to factors such as the small amount of MAP eliminated and the intermittent excretion in asymptomatic animals, as also false-positive samples. Samples from the collective bulk tanks was negative. It is possible that the combination of milk from all the properties diluted the amount of MAP. This suggests that the sensitivity of the PCR can be improved if the samples are obtained from the pooled milk from the same property. In some regions of Brazil, for example, showed the frequency of Zona da Mata region of the state of Minas Gerais, Brazil, found 1.94% of positive samples (9/464) and 9.76% (4/41) of properties with at least 1 positive sample for MAP. Different results to what were found in the semiarid region of Paraíba, where climate and production characteristics are different. Goats are susceptible to 3 strains: type "S" (Sheep), "Bison type" and type "C" (Cattle). Previous contact with this species may explain the similarity between the strain found in goat milk and those detected from bovine samples. This must also be taken into consideration during diagnosis and upon implementation of control measures for paratuberculosis in goats. Mycobacterium avium subsp. paratuberculosis was recorded for the first time in goat milk in the semiarid region, which may reveal a potential biological risk to humans and suggests the need for active surveillance of the agent.


Assuntos
Animais , Paratuberculose/diagnóstico , Mycobacterium avium subsp. paratuberculosis/isolamento & purificação , Leite/microbiologia , Cabras , Reação em Cadeia da Polimerase/veterinária
3.
Arq. bras. med. vet. zootec. (Online) ; 73(2): 508-512, Mar.-Apr. 2021. tab
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1248944

Resumo

Mycobacterium avium subesp. paratuberculosis (MAP) e o vírus da leucemia bovina (BLV) são agentes que causam grandes perdas econômicas nos rebanhos. O objetivo deste estudo foi avaliar a situação epidemiológica da paratuberculose bovina (PTB) e leucose enzoótica bovina (EBL) em rebanhos leiteiros de Lagoa Formosa, Minas Gerais, Brasil. Foram coletadas 236 amostras de sangue de vacas, as quais foram submetidas aos testes ELISA e imunodifusão em gel de ágar para detecção de anticorpos contra MAP e BLV. A soroprevalência de anticorpos contra MAP e BVL foi de 20% para os rebanhos e 6% para os animais e de 85% para os rebanhos e 50,42% para os animais, respectivamente. A presença dessas enfermidades deve servir como um alerta para os produtores e veterinários, para que concentrem maior atenção na implementação de medidas higiênico-sanitárias, incorporando elementos de vigilância com base nos riscos identificados no estudo.(AU)


Assuntos
Animais , Bovinos , Paratuberculose/epidemiologia , Fatores de Risco , Mycobacterium avium subsp. paratuberculosis/isolamento & purificação , Leucose Enzoótica Bovina/epidemiologia , Vírus da Leucemia Bovina/isolamento & purificação , Brasil , Ensaio de Imunoadsorção Enzimática/veterinária , Imunodifusão/veterinária
4.
Acta sci. vet. (Impr.) ; 48: Pub.1767-Jan. 30, 2020. ilus
Artigo em Inglês | VETINDEX | ID: biblio-1458290

Resumo

Background: Bovine tuberculosis control programs are based on a standard diagnostic method, the intradermal test with purified protein derivatives, which is used to identify and eliminate diseased animals. Currently none of the tests available allow complete differentiation between infected and uninfected animals. The main limitations of the tests available are related to diagnostic sensitivity and specificity, which results in false positive reactions due to the existence of cross infections, and also false negative, inherent to the state of energy of some animals. The aim of this work was to study the intercurrence of paratuberculosis in tuberculosis reactive cattle by the comparative cervical test. Materials, Methods & Results: Three hundred and thirty four cattle were evaluated using the comparative cervical test (CCT) and serology for tuberculosis (TB) and paratuberculosis (PTB) ELISA IDEXX®. All of the animals testing positive by CCT were euthanized and necropsied. Fragments of lymph node, lung and intestine were collected and analyzed using histopathological techniques, with staining by Hematoxylin-Eosin (HE). Samples of lung and lymph nodes (retropharyngeal, submandibular, cervical and mediastinal) of the animals testing positive by CCT were evaluated using qPRC for M. bovis, and intestinal and mesenteric lymph nodes using PCR for PTB. Of the 334 cattle evaluated using the comparative cervical test, 16 were considered positive. No lesions suggestive of tuberculosis were found in the macroscopic inspection of the carcasses. The most evident anatomical and pathological finding was a thickening of intestinal mucosa, found in 12 of the 16 cattle submitted to necropsy. No microscopic lesions suggestive of TB were identified nor was the presence of M. bovis detected by qPCR. The main histopathological findings were observed in the small intestine and mesenteric lymph nodes and identified as enteritis, lymphangitis...


Assuntos
Animais , Bovinos , Paratuberculose/diagnóstico , Paratuberculose/epidemiologia , Teste Tuberculínico/métodos , Teste Tuberculínico/veterinária , Mycobacterium avium subsp. paratuberculosis , Mycobacterium bovis
5.
Braz. J. Vet. Res. Anim. Sci. (Online) ; 57(1): e161653, 2020. ilus
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1122163

Resumo

A pregnant heifer with an advanced clinical stage of paratuberculosis was reported in a herd in Argentina. Thus, the animal was euthanized and samples of organs of the cow and its fetus was taken and cultured for bacteriology in specific medium. Tissues were analyzed by histopathology (hematoxylin-eosin and Ziehl-Neelsen staining). Histopathological analysis of the cow's samples revealed the presence of lesions consistent with paratuberculosis, and Ziehl-Neelsen staining revealed the presence of acid-fast bacilli, whereas the fetal tissues showed absence of lesions but the presence of acid-fast bacilli by Ziehl-Neelsen staining. After growing in specific medium, colonies in tissues from both cow and fetus were positive for IS900-PCR, confirming the presence of Mycobacterium avium subsp. paratuberculosis (MAP). Finally, the isolates were typed by Multiple-Locus Variable-number tandem-repeat Analysis (MLVA), which confirmed the epidemiological link between them. This study is the first in Argentina to report the detection of MAP that shares an identical MLVA type in a pregnant cow and its fetus. The results of this study are consistent with previous reports and highlight the intra-uterine transmission of MAP as an important source of infection within herds.(AU)


Uma novilha prenha em estado clínico avançado de paratuberculose foi observada em um rebanho bovino na Argentina. O animal foi eutanasiado e foram colhidas amostras dos seus órgãos e dos órgãos feto as quais foram cultivadas para bacteriologia em meio específico. Os tecidos foram examinados por histopatologia (coloração de hematoxilina-eosina e Ziehl-Neelsen). Na histopatologia das amostras colhidas da novilha foram observadas lesões compatíveis com paratuberculose e a coloração de Ziehl-Neelsen revelou a presença de bacilos álcool-ácido resistentes, nos tecidos fetais não foram observadas lesões, porém a coloração de Ziehl-Neelsen revelou a presença de bacilos álcool-ácido resistentes. Após o crescimento em meio específico, as colônias foram positivas para o teste IS900-PCR nos tecidos de ambos, vaca e feto, confirmando a presença de Mycobacterium avium subsp. paratuberculosis. Por fim, os isolados foram tipados por Multiple-Locus Variable-number tandem-repeat Analysis, confirmando a relação epidemiológica entre eles. Este estudo relata a primeira detecção de Mycobacterium avium subsp. paratuberculosis na Argentina em que houve o compartilhamento de um tipo idêntico de MLVA em uma vaca prenhe e no seu feto. Os resultados deste estudo são consistentes com relatos anteriores e destacam a transmissão intra-uterina de Mycobacterium avium subsp. paratuberculosis como importante fonte de infecção nos rebanhos de bovinos.(AU)


Assuntos
Animais , Feminino , Gravidez , Bovinos , Paratuberculose/diagnóstico , Reação em Cadeia da Polimerase , Mycobacterium avium subsp. paratuberculosis , Feto/patologia , Argentina , Coloração e Rotulagem , Repetições Minissatélites
6.
Braz. j. vet. res. anim. sci ; 57(1): e161653, 2020. ilus
Artigo em Inglês | VETINDEX | ID: vti-29249

Resumo

A pregnant heifer with an advanced clinical stage of paratuberculosis was reported in a herd in Argentina. Thus, the animal was euthanized and samples of organs of the cow and its fetus was taken and cultured for bacteriology in specific medium. Tissues were analyzed by histopathology (hematoxylin-eosin and Ziehl-Neelsen staining). Histopathological analysis of the cow's samples revealed the presence of lesions consistent with paratuberculosis, and Ziehl-Neelsen staining revealed the presence of acid-fast bacilli, whereas the fetal tissues showed absence of lesions but the presence of acid-fast bacilli by Ziehl-Neelsen staining. After growing in specific medium, colonies in tissues from both cow and fetus were positive for IS900-PCR, confirming the presence of Mycobacterium avium subsp. paratuberculosis (MAP). Finally, the isolates were typed by Multiple-Locus Variable-number tandem-repeat Analysis (MLVA), which confirmed the epidemiological link between them. This study is the first in Argentina to report the detection of MAP that shares an identical MLVA type in a pregnant cow and its fetus. The results of this study are consistent with previous reports and highlight the intra-uterine transmission of MAP as an important source of infection within herds.(AU)


Uma novilha prenha em estado clínico avançado de paratuberculose foi observada em um rebanho bovino na Argentina. O animal foi eutanasiado e foram colhidas amostras dos seus órgãos e dos órgãos feto as quais foram cultivadas para bacteriologia em meio específico. Os tecidos foram examinados por histopatologia (coloração de hematoxilina-eosina e Ziehl-Neelsen). Na histopatologia das amostras colhidas da novilha foram observadas lesões compatíveis com paratuberculose e a coloração de Ziehl-Neelsen revelou a presença de bacilos álcool-ácido resistentes, nos tecidos fetais não foram observadas lesões, porém a coloração de Ziehl-Neelsen revelou a presença de bacilos álcool-ácido resistentes. Após o crescimento em meio específico, as colônias foram positivas para o teste IS900-PCR nos tecidos de ambos, vaca e feto, confirmando a presença de Mycobacterium avium subsp. paratuberculosis. Por fim, os isolados foram tipados por Multiple-Locus Variable-number tandem-repeat Analysis, confirmando a relação epidemiológica entre eles. Este estudo relata a primeira detecção de Mycobacterium avium subsp. paratuberculosis na Argentina em que houve o compartilhamento de um tipo idêntico de MLVA em uma vaca prenhe e no seu feto. Os resultados deste estudo são consistentes com relatos anteriores e destacam a transmissão intra-uterina de Mycobacterium avium subsp. paratuberculosis como importante fonte de infecção nos rebanhos de bovinos.(AU)


Assuntos
Animais , Feminino , Gravidez , Bovinos , Paratuberculose/diagnóstico , Reação em Cadeia da Polimerase , Mycobacterium avium subsp. paratuberculosis , Feto/patologia , Argentina , Coloração e Rotulagem , Repetições Minissatélites
7.
Artigo em Inglês | LILACS-Express | VETINDEX | ID: biblio-1471195

Resumo

A pregnant heifer with an advanced clinical stage of paratuberculosis was reported in a herd in Argentina. Thus, the animal was euthanized and samples of organs of the cow and its fetus was taken and cultured for bacteriology in specific medium. Tissues were analyzed by histopathology (hematoxylin-eosin and Ziehl-Neelsen staining). Histopathological analysis of the cows samples revealed the presence of lesions consistent with paratuberculosis, and Ziehl-Neelsen staining revealed the presence of acid-fast bacilli, whereas the fetal tissues showed absence of lesions but the presence of acid-fast bacilli by Ziehl-Neelsen staining. After growing in specific medium, colonies in tissues from both cow and fetus were positive for IS900-PCR, confirming the presence of Mycobacterium avium subsp. paratuberculosis (MAP). Finally, the isolates were typed by Multiple-Locus Variable-number tandem-repeat Analysis (MLVA), which confirmedthe epidemiological link between them. This study is the first in Argentina to report the detection of MAP that shares an identical MLVA type in a pregnant cow and its fetus. The results of this study are consistent with previous reports and highlight the intra-uterine transmission of MAP as an important source of infection within herds.


Uma novilha prenha em estado clínico avançado de paratuberculose foi observada em um rebanho bovino na Argentina. O animal foi eutanasiado e foram colhidas amostras dos seus órgãos e dos órgãos feto as quais foram cultivadas para bacteriologia em meio específico. Os tecidos foram examinados por histopatologia (coloração de hematoxilina-eosina e Ziehl-Neelsen). Na histopatologia das amostras colhidas da novilha foram observadas lesões compatíveis com paratuberculose e a coloração de Ziehl-Neelsen revelou a presença de bacilos álcool-ácido resistentes, nos tecidos fetais não foram observadas lesões, porém a coloração de Ziehl-Neelsen revelou a presença de bacilos álcool-ácido resistentes. Após o crescimento em meio específico, as colônias foram positivas para o teste IS900-PCR nos tecidos de ambos, vaca e feto, confirmando a presença de Mycobacterium avium subsp. paratuberculosis. Por fim, os isolados foram tipados por Multiple-Locus Variable-number tandem-repeat Analysis, confirmando a relação epidemiológicaentre eles. Este estudo relata a primeira detecção de Mycobacterium avium subsp. paratuberculosis na Argentina em que houve o compartilhamento de um tipo idêntico de MLVA em uma vaca prenhe e no seu feto. Os resultados deste estudo são consistentes com relatos anteriores e destacam a tra

8.
Acta sci. vet. (Impr.) ; 47: Pub.1693-2019. tab
Artigo em Português | VETINDEX | ID: biblio-1458091

Resumo

Background: The occurrence of economic losses in buffaloes may be related to reproductive problems such as chlamydiosiscaused by the bacteria Chlamydia abortus considered as a zoonotic agent; and digestive problems highlighting the infectionby Mycobacterium avium subsp. paratuberculosis (Map), responsible for paratuberculosis. There is a little information aboutthese diseases in buffaloes, therefore the aim of this study was to determine the occurrence of anti-Chlamydia abortus andanti- Mycobacterium avium subsp. paratuberculosis (Map) antibodies in water buffaloes in the state of Pernambuco, Brazil.Materials, Methods & Results: Two hundred and sixty-two bubaline sera belonging to the serum bank of the InfectiousDiseases Laboratory (LIDIC) of the Federal Rural University of Pernambuco (UFRPE) were analyzed. The samples werefrom nine properties distributed in the municipalities of Agreste and Zona da Mata of the state of Pernambuco. For thedetection of anti-Chlamydia abortus and anti-Map antibodies was used a technique of Enzyme Immunoabsorption Assay (ELISA) of the IDEXX® by following the manufacturer’s instructions. Regarding the detection of anti-Chlamydiaabortus antibodies, it was observed that 47.70% (125/262) of the samples were positive. All properties showed at least onepositive animal for the investigation of anti-Chlamydia abortus antibodies. It was also verified the occurrence of 7.25%of suspected animals for the investigation of anti-C. abortus antibodies. No positives animals were observed for Map inthe bubaline analyzed.Discussion: The occurrence of anti-C. abortus antibodies in buffaloes in the region can be explained by the fact that properties with buffalo breeding has sanitary management that allows the contact between animals, thus increasing the risk oftransmission of the agent. In addition, the variation found...


Assuntos
Animais , Búfalos/imunologia , Búfalos/virologia , Chlamydia , Mycobacterium avium subsp. paratuberculosis , Paratuberculose/imunologia , Infecções por Chlamydia/imunologia , Infecções por Chlamydia/veterinária
9.
Acta sci. vet. (Online) ; 47: Pub. 1693, Oct. 30, 2019. tab
Artigo em Português | VETINDEX | ID: vti-23819

Resumo

Background: The occurrence of economic losses in buffaloes may be related to reproductive problems such as chlamydiosiscaused by the bacteria Chlamydia abortus considered as a zoonotic agent; and digestive problems highlighting the infectionby Mycobacterium avium subsp. paratuberculosis (Map), responsible for paratuberculosis. There is a little information aboutthese diseases in buffaloes, therefore the aim of this study was to determine the occurrence of anti-Chlamydia abortus andanti- Mycobacterium avium subsp. paratuberculosis (Map) antibodies in water buffaloes in the state of Pernambuco, Brazil.Materials, Methods & Results: Two hundred and sixty-two bubaline sera belonging to the serum bank of the InfectiousDiseases Laboratory (LIDIC) of the Federal Rural University of Pernambuco (UFRPE) were analyzed. The samples werefrom nine properties distributed in the municipalities of Agreste and Zona da Mata of the state of Pernambuco. For thedetection of anti-Chlamydia abortus and anti-Map antibodies was used a technique of Enzyme Immunoabsorption Assay (ELISA) of the IDEXX® by following the manufacturers instructions. Regarding the detection of anti-Chlamydiaabortus antibodies, it was observed that 47.70% (125/262) of the samples were positive. All properties showed at least onepositive animal for the investigation of anti-Chlamydia abortus antibodies. It was also verified the occurrence of 7.25%of suspected animals for the investigation of anti-C. abortus antibodies. No positives animals were observed for Map inthe bubaline analyzed.Discussion: The occurrence of anti-C. abortus antibodies in buffaloes in the region can be explained by the fact that properties with buffalo breeding has sanitary management that allows the contact between animals, thus increasing the risk oftransmission of the agent. In addition, the variation found...(AU)


Assuntos
Animais , Búfalos/virologia , Búfalos/imunologia , Chlamydia , Mycobacterium avium subsp. paratuberculosis , Paratuberculose/imunologia , Infecções por Chlamydia/imunologia , Infecções por Chlamydia/veterinária
10.
Semina Ci. agr. ; 40(1): 485-490, Jan.-Feb. 2019. tab
Artigo em Inglês | VETINDEX | ID: vti-19367

Resumo

Live cattle export is one of the newest commercial sectors available to Brazilian farmers, but to be exported animals must be free of infectious diseases, especially those prohibited by the countries importing them. In this study, 1,800 bovine sera were collected from animals destined for export in the Brazilian states of Goiás (GO), Minas Gerais (MG), and São Paulo (SP). The sera were tested for bovine brucellosis (BB), paratuberculosis (PTB), enzootic bovine leukosis (EBL), and bovine viral diarrhea (BVD). This was the first study in Brazil to conduct a serological survey for bovine PTB in the states of SP, GO, and MG, and the first survey for BVD in GO. The total percentage of animals positive for each disease was 0.33% (2/1,800) for BB, 16.17% (97/1,800) for PTB, 31.50% (189/1,800) for EBL, and 9.67% (58/1,800) for BVD.(AU)


A exportação de bovinos vivos é uma das novas áreas comerciais em que o Brasil está inserido, porém é necessário que os animais sejam livres de doenças infectocontagiosas, principalmente as exigidas pelos países importadores. Os 1800 soros utilizados neste estudo foram de bovinos dos Estados de Goiás (GO), Minas Gerais (MG) e São Paulo (SP), que seriam destinados à exportação. Foram realizados os diagnósticos sorológicos para brucelose bovina (BB), paratuberculose (PTB), leucose enzoótica bovina (EBL) e diarreia viral bovina (BVD), sendo este o primeiro trabalho no Brasil a realizar o levantamento sorológico para PTB em bovinos nos Estados de SP, GO e MG, e de BVD em GO. A porcentagem total de animais positivos para cada uma das patologias foi de 0,33% (2/1800) para BB; 16,17% (97/1800) para PTB; 31,50% (189/ 1800) para EBL e 9,67% (58/1800) para BVD.(AU)


Assuntos
Animais , Masculino , Recém-Nascido , Bovinos , Brucelose Bovina/diagnóstico , Paratuberculose/diagnóstico , Leucose Enzoótica Bovina/diagnóstico , Vírus da Diarreia Viral Bovina , Testes Sorológicos/veterinária , Vigilância Sanitária , Controle de Doenças Transmissíveis
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