Leprosy in children under 15 years of age in a municipality in northeastern Brazil: evolutionary aspects from 2003 to 2015.

INTRODUCTION: The Integrated Program of Leprosy Control was initiated in 2003 in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy. Here, we present the evolution of the indicators of leprosy within the established period in children aged <15 years. METHODS: This is a descriptive study based on an active search for cases and spontaneous healthcare demand for leprosy, with an evolutionary analysis of the detection coefficient of new cases. We considered individuals aged <15 years diagnosed with leprosy from January 2003 to December 2015. To evaluate the factors associated with clinical and operational forms, Chi-square, Fisher's exact, or Fisher-Freeman-Halton tests were performed. RESULTS: A total of 61 new cases were detected (6.9% of the total leprosy cases diagnosed in the municipality during the study period), and the majority was found in males (62.3%). The most frequent operational classification was paucibacillary (67.2%), and this association increased with age. The tuberculoid clinical form was the most prevalent in both sexes and in the age range of 10 to <15 years. There was a reduction in the detection coefficient from 21.84/100,000 inhabitants in 2003 to 2.79/100,000 in 2015. CONCLUSIONS: Despite the progress in the control of leprosy, this historical series shows that it is necessary to strengthen educational measures and implement control actions, so that the disease ceases to be a public health problem in the population aged <15 years.

Leprosy in children under 15 years of age in a municipality in northeastern Brazil: evolutionary aspects from 2003 to 2015

Abstract INTRODUCTION The Integrated Program of Leprosy Control was initiated in 2003 in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy. Here, we present the evolution of the indicators of leprosy within the established period in children aged <15 years. METHODS: This is a descriptive study based on an active search for cases and spontaneous healthcare demand for leprosy, with an evolutionary analysis of the detection coefficient of new cases. We considered individuals aged <15 years diagnosed with leprosy from January 2003 to December 2015. To evaluate the factors associated with clinical and operational forms, Chi-square, Fisher's exact, or Fisher-Freeman-Halton tests were performed. RESULTS A total of 61 new cases were detected (6.9% of the total leprosy cases diagnosed in the municipality during the study period), and the majority was found in males (62.3%). The most frequent operational classification was paucibacillary (67.2%), and this association increased with age. The tuberculoid clinical form was the most prevalent in both sexes and in the age range of 10 to <15 years. There was a reduction in the detection coefficient from 21.84/100,000 inhabitants in 2003 to 2.79/100,000 in 2015. CONCLUSIONS Despite the progress in the control of leprosy, this historical series shows that it is necessary to strengthen educational measures and implement control actions, so that the disease ceases to be a public health problem in the population aged <15 years.

Factors associated with leprosy in a municipality of the Pre-Amazon region, state of Maranhão, Brazil.

INTRODUCTION: The Integrated Program of Leprosy Control was initiated in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy in 2003. It aims at assessing the clinical and epidemiological characteristics of the disease to reduce the detection rate of new cases until 2015. Here, we present the evolution of the indicators of leprosy within the period from 2003 to 2015. METHODS: We conducted a descriptive analytical study based on the active search for and voluntary referral of cases of leprosy. The detection rate of new cases was analyzed over time. We included individuals diagnosed with leprosy between January 2003 and December 2015. The association between categorical variables was assessed using the chi-square test of independence, considering a level of significance of 5%. When the association was significant, the detection rate (with a confidence interval of 95%) was calculated. RESULTS: Overall, 879 new leprosy cases were detected; the majority of the affected individuals were men (65.9%). Multibacillary leprosy was the most common type of the disease, according to the operational classification (55.5%); it showed the strongest association with an age ≥60 years. We also detected an association between the male sex and both, lepromatous and multibacillary leprosy. The detection rate reduced from 211.09/100,000 population in 2003 to 50.26/100,000 population in 2015. CONCLUSIONS: We found an improvement in leprosy control, with a reduction in the detection rate and the absolute number of cases. Strengthening of disease control measures should be prioritized to eliminate leprosy as a public health concern in this municipality.

Factors associated with leprosy in a municipality of the Pre-Amazon region, state of Maranhão, Brazil

Abstract INTRODUCTION: The Integrated Program of Leprosy Control was initiated in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy in 2003. It aims at assessing the clinical and epidemiological characteristics of the disease to reduce the detection rate of new cases until 2015. Here, we present the evolution of the indicators of leprosy within the period from 2003 to 2015. METHODS: We conducted a descriptive analytical study based on the active search for and voluntary referral of cases of leprosy. The detection rate of new cases was analyzed over time. We included individuals diagnosed with leprosy between January 2003 and December 2015. The association between categorical variables was assessed using the chi-square test of independence, considering a level of significance of 5%. When the association was significant, the detection rate (with a confidence interval of 95%) was calculated. RESULTS: Overall, 879 new leprosy cases were detected; the majority of the affected individuals were men (65.9%). Multibacillary leprosy was the most common type of the disease, according to the operational classification (55.5%); it showed the strongest association with an age ≥60 years. We also detected an association between the male sex and both, lepromatous and multibacillary leprosy. The detection rate reduced from 211.09/100,000 population in 2003 to 50.26/100,000 population in 2015. CONCLUSIONS: We found an improvement in leprosy control, with a reduction in the detection rate and the absolute number of cases. Strengthening of disease control measures should be prioritized to eliminate leprosy as a public health concern in this municipality.

Evolução da malária no estado do Maranhão: série histórica de 2009 a 2013 / Malaria evolution in the State of Maranhão: Historical series from 2009 to 2013

O estudo foi desenvolvido com o objetivo de avaliar a evolução da malária no estado do Maranhão no período de 2009 a 2013. Números absolutos de casos e incidência parasitária anual (IPA) das cinco regiões geográficas do estado, nas 19 Unidades Regionais de Saúde (URS) e nos 10 municípios com maior registro da doença, foram avaliados com base nos registros do Departamento de Endemias da Secretaria de Estado da Saúde. Foram notificados 16.847 casos no período do estudo. No ano de 2009, a Incidência Parasitária Anual era de 0,86/1.000 habitantes, já em 2013 este indicador chegou a 0,08/1.000 habitantes no estado, o que corresponde a um percentual de redução de 90,6%. Houve aumento moderado do número de casos na região norte no ano de 2011 e na região centro nos anos de 2010 e 2011. No ano de 2010, verificou-se aumento desses valores em sete unidades regionais de saúde; em 2011, em seis e, em 2012, em duas. No ano de 2013, houve maior registro de casos, em relação a 2012, na unidade regional de Codó. Entre os municípios que registraram a doença, destacam-se Centro Novo do Maranhão, Cândido Mendes, Alcântara, Amapá do Maranhão, Presidente Sarney e Guimarães, os quais apresentaram indicador de médio risco em diferentes momentos no período de estudo. Houve redução da incidência de casos, com a incidência parasitária anual menor que 10 casos /1.000 habitantes (baixo risco), no ano de 2013, em todas as áreas estudadas.

Severe visceral leishmaniasis in children: the relationship between cytokine patterns and clinical features

Introduction The relationship between severe clinical manifestations of visceral leishmaniasis (VL) and immune response profiles has not yet been clarified, despite numerous studies on the subject. This study aimed to investigate the relationship between cytokine profiles and the presence of immunological markers associated with clinical manifestations and, particularly, signs of severity, as defined in a protocol drafted by the Ministry of Health (Brazil). Methods We conducted a prospective, descriptive study between May 2008 and December 2009. This study was based on an assessment of all pediatric patients with VL who were observed in a reference hospital in Maranhão. Results Among 27 children, 55.5% presented with more than one sign of severity or warning sign. Patients without signs of severity or warning signs and patients with only one warning sign had the highest interferon-gamma (IFN-γ) levels, although their interleukin 10 (IL-10) levels were also elevated. In contrast, patients with the features of severe disease had the lowest IFN-γ levels. Three patients who presented with more than two signs of severe disease died; these patients had undetectable interleukin 2 (IL-2) and IFN-γ levels and low IL-10 levels, which varied between 0 and 36.8pg/mL. Conclusions Our results showed that disease severity was associated with low IFN-γ levels and elevated IL-10 levels. However, further studies with larger samples are needed to better characterize the relationship between disease severity and cytokine levels, with the aim of identifying immunological markers of active-disease severity. .

Plasmodium vivax malaria: related factors to severity in the State of Maranhão, Brazil.

INTRODUCTION: Malaria caused by Plasmodium vivax species has shown signs of severity, recorded with increasing frequency in the medical literature. This study aimed to characterize the signs of severe malaria by Plasmodium vivax in the State of Maranhão, Brazil. METHODS: A descriptive cohort study of patients assisted in the field and a historical and concurrent study of a series of cases among hospitalized patients were undertaken to identify the clinical and laboratory signs of severity. RESULTS: A total of 153 patients were included in the study, 13 of whom were hospitalized. Males made up the majority, numbering 103 (67.3%). The age of the patients ranged from 10 to 70 years, 92.2% were natives of the State of Maranhão, and 65% of the patients had had malaria before. The average time elapsed between symptom onset and diagnosis among outpatients was three days, while among hospitalized patients this average reached 15.5 days, a statistically significant difference (p=0.001). The parasitemia ranged from 500 to 10,000 parasites/µl in 92.8% of cases. The clinical and laboratory manifestations of severity were vomiting and diarrhea, jaundice, drowsiness, mental confusion, seizures, loss of consciousness, agitation, bleeding, pale skin, coughing and dyspnea, thrombocytopenia, anemia, elevation of nitrogenous compounds, and elevated transaminases and bilirubin. CONCLUSIONS: The monitoring of malaria patients with Plasmodium vivax showed the possibility of aggravation, the intensity of which varied in different circumstances, especially the interval time between falling ill and diagnostic confirmation.

Plasmodium vivax malaria: related factors to severity in the State of Maranhão, Brazil

INTRODUCTION: Malaria caused by Plasmodium vivax species has shown signs of severity, recorded with increasing frequency in the medical literature. This study aimed to characterize the signs of severe malaria by Plasmodium vivax in the State of Maranhão, Brazil. METHODS: A descriptive cohort study of patients assisted in the field and a historical and concurrent study of a series of cases among hospitalized patients were undertaken to identify the clinical and laboratory signs of severity. RESULTS: A total of 153 patients were included in the study, 13 of whom were hospitalized. Males made up the majority, numbering 103 (67.3%). The age of the patients ranged from 10 to 70 years, 92.2% were natives of the State of Maranhão, and 65% of the patients had had malaria before. The average time elapsed between symptom onset and diagnosis among outpatients was three days, while among hospitalized patients this average reached 15.5 days, a statistically significant difference (p=0.001). The parasitemia ranged from 500 to 10,000 parasites/µl in 92.8% of cases. The clinical and laboratory manifestations of severity were vomiting and diarrhea, jaundice, drowsiness, mental confusion, seizures, loss of consciousness, agitation, bleeding, pale skin, coughing and dyspnea, thrombocytopenia, anemia, elevation of nitrogenous compounds, and elevated transaminases and bilirubin. CONCLUSIONS: The monitoring of malaria patients with Plasmodium vivax showed the possibility of aggravation, the intensity of which varied in different circumstances, especially the interval time between falling ill and diagnostic confirmation.

Severe visceral leishmaniasis in children: the relationship between cytokine patterns and clinical features.

INTRODUCTION: The relationship between severe clinical manifestations of visceral leishmaniasis (VL) and immune response profiles has not yet been clarified, despite numerous studies on the subject. This study aimed to investigate the relationship between cytokine profiles and the presence of immunological markers associated with clinical manifestations and, particularly, signs of severity, as defined in a protocol drafted by the Ministry of Health (Brazil). METHODS: We conducted a prospective, descriptive study between May 2008 and December 2009. This study was based on an assessment of all pediatric patients with VL who were observed in a reference hospital in Maranhão. RESULTS: Among 27 children, 55.5% presented with more than one sign of severity or warning sign. Patients without signs of severity or warning signs and patients with only one warning sign had the highest interferon-gamma (IFN-γ) levels, although their interleukin 10 (IL-10) levels were also elevated. In contrast, patients with the features of severe disease had the lowest IFN-γ levels. Three patients who presented with more than two signs of severe disease died; these patients had undetectable interleukin 2 (IL-2) and IFN-γ levels and low IL-10 levels, which varied between 0 and 36.8pg/mL. CONCLUSIONS: Our results showed that disease severity was associated with low IFN-γ levels and elevated IL-10 levels. However, further studies with larger samples are needed to better characterize the relationship between disease severity and cytokine levels, with the aim of identifying immunological markers of active-disease severity.

Paracoccidioidomycosis in the state of Maranhão, Brazil: geographical and clinical aspects.

INTRODUCTION: The study aimed to show the situation of paracoccidioidomycosis in the state of Maranhão, Brazil. METHODS: This study is a descriptive case series developed in two stages. First, a survey of cases originating from the state of Maranhão at the Instituto de Doenças Tropicais Natan Portela, Piauí (IDTNP) from 1997 to 2007, and second, the clinical description of 29 cases diagnosed in the Centro de Referências em Doenças Infecciosas e Parasitárias, Maranhão (CREDIP) from 2004 to 2010. RESULTS: Two hundred and sixteen cases have been cataloged at the IDTNP. West, east, and central regions of the state of Maranhão recorded 90.3% of cases proving to be important areas for study. The western region, with a prevalence of 10.8/100,000 inhabitants, has a significantly higher proportion of cases than the northern, southern, and eastern regions (p < 0.05). The occurrence was higher in men with 89.3% of cases, and the male-to-female ratio was 8.4:1. The majority of patients were older than 20 years, lived in rural areas, and had farming or soil management as main occupation (73.8%). At CREDIP, 29 cases were diagnosed, of which 26 (89.6%) had multifocal manifestations. Mucous tissues were involved more (75.8%) frequently, followed by lymph nodes, skin, and lungs with 65.5%, 39% and 37.9 %, respectively. The diagnosis was made by combining direct examination, culture, and histopathology. CONCLUSIONS: The study shows the geographical distribution and the epidemiological and clinical aspects of paracoccidioidomycosis, revealing the significance of the disease to the state of Maranhão.

Paracoccidioidomycosis in the state of Maranhão, Brazil: geographical and clinical aspects / Paracoccidioidomicose no Estado do Maranhão, Brasil: aspectos geográficos e clínicos

INTRODUCTION: The study aimed to show the situation of paracoccidioidomycosis in the state of Maranhão, Brazil. METHODS: This study is a descriptive case series developed in two stages. First, a survey of cases originating from the state of Maranhão at the Instituto de Doenças Tropicais Natan Portela, Piauí (IDTNP) from 1997 to 2007, and second, the clinical description of 29 cases diagnosed in the Centro de Referências em Doenças Infecciosas e Parasitárias, Maranhão (CREDIP) from 2004 to 2010. RESULTS: Two hundred and sixteen cases have been cataloged at the IDTNP. West, east, and central regions of the state of Maranhão recorded 90.3% of cases proving to be important areas for study. The western region, with a prevalence of 10.8/100,000 inhabitants, has a significantly higher proportion of cases than the northern, southern, and eastern regions (p < 0.05). The occurrence was higher in men with 89.3% of cases, and the male-to-female ratio was 8.4:1. The majority of patients were older than 20 years, lived in rural areas, and had farming or soil management as main occupation (73.8%). At CREDIP, 29 cases were diagnosed, of which 26 (89.6%) had multifocal manifestations. Mucous tissues were involved more (75.8%) frequently, followed by lymph nodes, skin, and lungs with 65.5%, 39% and 37.9 %, respectively. The diagnosis was made by combining direct examination, culture, and histopathology. CONCLUSIONS: The study shows the geographical distribution and the epidemiological and clinical aspects of paracoccidioidomycosis, revealing the significance of the disease to the state of Maranhão.

INTRODUÇÃO: O estudo teve o objetivo de mostrar a situação da paracoccidioidomicose no Estado do Maranhão, Brasil. MÉTODOS: Trata-se de um estudo descritivo do tipo série de casos, desenvolvido em duas etapas: na primeira, levantamento de casos originários do Maranhão, atendidos no Instituto de Doenças Tropicais Natan Portela, Piauí (IDTNP), de 1997 a 2007; na segunda, descrição clínica de 29 casos diagnosticados no Centro de Referência em Doenças Infecciosas e Parasitárias, Maranhão (CREDIP), no período de 2004 a 2010. RESULTADOS: Foram catalogados 216 casos no IDTNP. As regiões Oeste, Leste e Centro do Maranhão registraram 90,3% destes casos, demonstrando serem áreas importantes para estudo. A região oeste, com prevalência de 10,8/100.000 habitantes, apresenta proporção de casos significativamente maior que as regiões Norte, Sul e Leste (p<0,05). A ocorrência foi maior em indivíduos do sexo masculino (89,3% dos casos), sendo a proporção entre homens e mulheres de 8,4:1. A maioria dos acometidos possuía mais de 20 anos, residia na zona rural e tinha como principal ocupação a lavoura ou o manejo do solo (73,8%). Foram diagnosticados 29 casos no CREDIP, dos quais 26 (89,6) tinham manifestações multifocais. O acometimento mais comum foi de mucosas (75,8%), seguindo-se gânglios, pele e pulmões com 62%, 39% e 34,7%, respectivamente. A confirmação do diagnóstico foi feita pela combinação de exame micológico direto, cultura e histopatológico. CONCLUSÕES: O estudo mostra a distribuição geográfica, os aspectos epidemiológicos e clínicos da paracoccidioidomicose, revelando a importância da doença no Estado do Maranhão.

Leprosy in Buriticupu, state of Maranhão: active search in the general population.

INTRODUCTION: This study was developed to evaluate the situation of leprosy in the general population of the municipality of Buriticupu, State of Maranhão, Brazil. METHODS: We used the method of active search to identify new cases from 2008 to 2010. Bacilloscopy of intradermal scrapings was performed in all patients with skin lesions compatible with leprosy, and histopathological examination in those who had doubts on the definition of the clinical form. RESULTS: The study included 19,104 individuals, with 42 patients diagnosed with leprosy after clinical examination, representing a detection rate of 219.84 per 100,000 inhabitants. The predominant clinical presentation was tuberculoid with 24 (57.1%) cases, followed by borderline with 11, indeterminate with four, and lepromatous with three cases. The study also allowed the identification of 81 patients with a history of leprosy and other skin diseases, such as pityriasis versicolor, dermatophytosis, scabies, vitiligo, and skin carcinoma. The binomial test showed that the proportion of cases in the headquarters was significantly higher than that in the villages (p = 0.04), and the generalized exact test showed that there was no association between age and clinical form (p = 0.438) and between age and gender (p = 0.083). CONCLUSIONS: The elevated detection rate defines the city as hyperendemic for leprosy; the active search for cases, as well as the organization of health services, is an important method for disease control.

Leprosy in Buriticupu, state of Maranhão: active search in the general population / Hanseníase no município de Buriticupu, estado do Maranhão: busca ativa na população geral

INTRODUCTION: This study was developed to evaluate the situation of leprosy in the general population of the municipality of Buriticupu, State of Maranhão, Brazil. METHODS: We used the method of active search to identify new cases from 2008 to 2010. Bacilloscopy of intradermal scrapings was performed in all patients with skin lesions compatible with leprosy, and histopathological examination in those who had doubts on the definition of the clinical form. RESULTS: The study included 19,104 individuals, with 42 patients diagnosed with leprosy after clinical examination, representing a detection rate of 219.84 per 100,000 inhabitants. The predominant clinical presentation was tuberculoid with 24 (57.1%) cases, followed by borderline with 11, indeterminate with four, and lepromatous with three cases. The study also allowed the identification of 81 patients with a history of leprosy and other skin diseases, such as pityriasis versicolor, dermatophytosis, scabies, vitiligo, and skin carcinoma. The binomial test showed that the proportion of cases in the headquarters was significantly higher than that in the villages (p = 0.04), and the generalized exact test showed that there was no association between age and clinical form (p = 0.438) and between age and gender (p = 0.083). CONCLUSIONS: The elevated detection rate defines the city as hyperendemic for leprosy; the active search for cases, as well as the organization of health services, is an important method for disease control.

INTRODUÇÃO: O estudo foi desenvolvido com o objetivo de avaliar a situação da hanseníase na população geral do município de Buriticupu, Estado do Maranhão, Brasil. MÉTODOS: Foi empregado o método de busca ativa na identificação de casos novos, de 2008 a 2010. Baciloscopia de raspado intradérmico foi feita em todos os pacientes com lesões de pele compatíveis com hanseníase e exame histopatológico, naqueles em que havia dúvidas na definição da forma clínica. RESULTADOS: Participaram do estudo 19.104 indivíduos, sendo que o exame clínico definiu o diagnóstico de hanseníase em 42 pacientes, o que representa um coeficiente de detecção de 219,84/100.000 habitantes. A forma clínica predominante foi a tuberculóide com 24 (57,1%) casos, seguindo-se da dimorfa, com 11, da indeterminada, com 4 e da virchowiana com 3 casos. O estudo permitiu, ainda, a identificação de 81 pacientes com passado de hanseníase, além de outras doenças da pele, tais como pitiríase versicolor, dermatofitose, escabiose, vitiligo e carcinoma de pele. O teste binomial mostrou que a proporção de casos na sede foi significativamente maior que a dos povoados, p= 0,04 e o teste exato generalizado que não há associação entre faixa etária e forma clínica (p=0,438), bem como entre faixa etária e sexo (p=0,083). CONCLUSÕES: O elevado coeficiente de detecção define o município como hiperendêmico para a hanseníase; a busca ativa de casos é um método importante, bem como a organização dos serviços de saúde, para o controle da doença.

Hanseníase no município de Buriticupu, estado do Maranhão, Brasil: estudo de incapacidades em indivíduos no pós-alta / Leprosy in municipality of Buriticupu, State of Maranhão, Brazil: study of disabilities in individuals in post-discharge

O município de Buriticupu apresenta indicadores epidemiológicos que o classificam como hiperendêmico para hanseníase. Levando em conta o potencial da doença em causar incapacidades físicas e limitações de natureza psicossocial foi desenvolvido um estudo como objetivo de caracterizar o grau de limitação funcional,de atividade física e da participação social de indivíduos após alta por cura. O estudo, transversal e descritivo, foi desenvolvido no período de junho a dezembro de 2010 em uma amostra de 69 indivíduos que tinham recebido alta do tratamento entre 2007 e 2009. Foi feita avaliação simplificada da função neural, aplicação da escala SALSA(para caracterizar a limitação de atividade e consciência de risco) e da escala de participação (para caracterizara restrição à participação social do indivíduo), além do cálculo do escore OMP. Foi identificada uma população predominante do sexo masculino, na faixa etária economicamente ativa e com ocupação relacionada a demandas por esforço físico, com destaque para lavrador.O percentual de 76,8% dos pacientes não apresentava incapacidades físicas e 59,4% não apresentava limitação de atividades. Não foi constatada percepção de risco de sofrer lesões traumáticas por 69,6% dos indivíduos, enquanto 72,5% dos indivíduos não apresentaram restrição significativa à participação social. Apesar dos dados favoráveis, o percentual que apresentou alterações reflete a necessidade de melhoria na atenção pós-alta ao indivíduo no município.

The municipality of Buriticupu presents the epidemiologicalindicators are classified as hiperendêmico for leprosy. Taking into account the potential of disease incausing physical disability and limitations of psychosocial nature was developed a study to characterize thedegree of functional impairment, physical activity andsocial participation of individuals after high for cure. The study, transversal and descriptive, was developed during the period from June to December 2010 in a sampleof 69 individuals who had received the treatment between 2007 and 2009. Simplified evaluation was made of neural function, applying the scale SALSA to characterize the limitation of activity and awareness of risk and of the scale of participation to characterize the restriction on the individual’s social participation, in addition to the calculation of the OMP score. It was identified a predominantly male population, economically active age group and occupation related to demands for physical effort,high lighted by a farmer. The percentage of 76.8% of patientshad no physical disabilities, while 59.4% had nolimitation of activity. There was no perception of risk ofsuffering traumatic injuries by 69.6% of individuals, while72.5% of individuals showed no significant constraintto social participation. However, the percentage whichshowed changing reflects the necessity of improving ondischarging attention at the municipality.

[Chagas' disease in the State of Maranhão, Brazil: record of acute cases from 1994 to 2008]. / Doença de Chagas no Estado do Maranhão, Brasil: registro de casos agudos no período de 1994 a 2008.

INTRODUCTION: Chagas' disease is not considered an endemic disease in the State of Maranhão. However, entomological surveys showed high natural vector infection indices and acute cases have been identified in the last few decades. This study aimed to analyze the social, demographic and environmental conditions involved in transmission. METHODS: The study describes acute Chagas' disease identified from 1994 to 2008. Information regarding the cases was obtained from the Information System for Notifiable Diseases (Sinan), National Health Foundation (Funasa) database and medical records. Entomological surveys were conducted from 2002. RESULTS: Data analysis identified 32 cases from 17 municipal districts, with 84.4% of patients from rural areas. The disease was more frequent in men (67%). The most frequent occupation was student, 38.9% of cases, followed by farmer and hunter, 27.8%. CONCLUSIONS: The study suggests that transmission was vectorial and occurred in the wild or peridomicile.

[Leprosy in Buriticupu, State of Maranhão: active search for cases in the adult population]. / Hanseníase no Município de Buriticupu, Estado do Maranhão: busca ativa de casos na população adulta.

INTRODUCTION: This study aimed to analyze the leprosy situation, focusing on the adult population of the town of Buriticupu, State of Maranhão. METHODS: An active search was conducted to identify new cases from 2005 to 2007. All patients with injuries suggestive of leprosy were submitted to cutaneous bacilloscopy and biopsies were performed when defining the clinical presentation was difficulty. RESULTS: 15,409 individuals participated in the study and 62 were diagnosed with leprosy which represents a detection coefficient of 40.23/10,000. Bacilloscopy showed positive results in six patients. The predominant clinical form was tuberculoid, 31 cases, followed by the indeterminate form (20 cases), the dimorphous form (10 cases) and the lepromatous form (1 case). The study also identified other skin diseases, including pityriasis versicolor, scabies, mycosis, vitiligo and carcinoma. CONCLUSIONS: The high detection coefficient defines the town of Buriticupu, MA, as hyperendemic for leprosy. Active cases search is an important method for disease control.

Hanseníase no Município de Buriticupu, Estado do Maranhão: busca ativa de casos na população adulta / Leprosy in Buriticupu, State of Maranhão: active search for cases in the adult population

INTRODUÇÃO: O estudo foi desenvolvido com o objetivo de avaliar a situação da hanseníase na população adulta do Município de Buriticupu, MA. MÉTODOS: Foi empregado o método de busca ativa na identificação de casos novos, no período de 2005 a 2007. Baciloscopia de raspado intradérmico foi feita em todos os pacientes com lesões de pele compatíveis com hanseníase, enquanto exame histopatológico foi feito naqueles em que havia dúvidas na definição da forma clínica. RESULTADOS: Participaram do estudo 15.409 indivíduos, tendo o exame clínico definido o diagnóstico de hanseníase em 62 pacientes, o que representa um coeficiente de detecção de 40,23/10.000. A baciloscopia foi positiva em seis pacientes, sendo predominante a forma clínica tuberculóide, em 31 casos, seguida da forma indeterminada em 20, dimorfa em 10 e virchowiana em um. O estudo permitiu, ainda, a identificação de outras doenças da pele, tais como pitiríase versicolor, dermatofitose, escabiose, vitiligo e carcinoma de pele. CONCLUSÕES: O elevado coeficiente de detecção define o município como hiperendêmico para a hanseníase. A busca ativa de casos é um método importante para o controle da doença.

INTRODUCTION: This study aimed to analyze the leprosy situation, focusing on the adult population of the town of Buriticupu, State of Maranhão. METHODS: An active search was conducted to identify new cases from 2005 to 2007. All patients with injuries suggestive of leprosy were submitted to cutaneous bacilloscopy and biopsies were performed when defining the clinical presentation was difficulty. RESULTS: 15,409 individuals participated in the study and 62 were diagnosed with leprosy which represents a detection coefficient of 40.23/10,000. Bacilloscopy showed positive results in six patients. The predominant clinical form was tuberculoid, 31 cases, followed by the indeterminate form (20 cases), the dimorphous form (10 cases) and the lepromatous form (1 case). The study also identified other skin diseases, including pityriasis versicolor, scabies, mycosis, vitiligo and carcinoma. CONCLUSIONS: The high detection coefficient defines the town of Buriticupu, MA, as hyperendemic for leprosy. Active cases search is an important method for disease control.

Doença de Chagas no Estado do Maranhão, Brasil: registro de casos agudos no período de 1994 a 2008 / Chagas' disease in the State of Maranhão, Brazil: record of acute cases from 1994 to 2008

INTRODUÇÃO: No Estado do Maranhão, a doença de Chagas não apresenta o padrão clássico de transmissão endêmica. No entanto, inquérito entomológico prévio constata altos índices de infecção natural dos vetores e casos agudos têm sido registrados nas últimas décadas, o que motivou o presente estudo que tem por objetivo avaliar as condições sociodemográficas e ambientais envolvidas na transmissão. MÉTODOS: Foram estudados os casos agudos de doença de Chagas de 1994 a 2008. Os dados relacionados aos pacientes foram obtidos do banco de dados do Sistema de Informação de Agravos de Notificação, dos livros de registros de endemias da Fundação Nacional de Saúde e de prontuários médicos. Investigação entomológica foi realizada a partir de 2002. RESULTADOS: Foram identificados 32 casos, procedentes de 17 municípios, sendo 84,4 por cento, da zona rural. O sexo masculino foi acometido em 67 por cento dos casos. A ocupação mais frequente foi a de estudante (38,9 por cento), seguida pela de lavrador e de caçador (27,8 por cento). CONCLUSÕES: Os dados analisados sugerem que a transmissão foi, predominantemente, vetorial nos ambientes silvestre e peridomiciliar.

INTRODUCTION: Chagas' disease is not considered an endemic disease in the State of Maranhão. However, entomological surveys showed high natural vector infection indices and acute cases have been identified in the last few decades. This study aimed to analyze the social, demographic and environmental conditions involved in transmission. METHODS: The study describes acute Chagas' disease identified from 1994 to 2008. Information regarding the cases was obtained from the Information System for Notifiable Diseases (Sinan), National Health Foundation (Funasa) database and medical records. Entomological surveys were conducted from 2002. RESULTS: Data analysis indentified 32 cases from 17 municipal districts, with 84.4 percent of patients from rural areas. The disease was more frequent in men (67 percent). The most frequent occupation was student, 38.9 percent of cases, followed by farmer and hunter, 27.8 percent. CONCLUSIONS: The study suggests that transmission was vectorial and occurred in the wild or peridomicile.

Shewanella putrefaciens em lesão cutânea traumática / Shewanella putrefaciens in traumatic skin lesions

Os autores descrevem o caso de um paciente do sexo masculino, pescador, de 44 anos de idade, que apresentou úlceras infecciosas na perna direita após trauma sofrido enquanto pescava. Foi isolada e identificada a espécie Shewanella putrefaciens, em associação com Staphylococcus aureus e Escherichia coli em cultivo da secreção da ferida. A identificação dos isolados foi feita por meio de procedimento microbiológico padrão e sistema comercial (NF e Vitek GNI). O teste de sensibilidade mostrou sensibilidade da bactéria à maioria dos antibióticos testados.

The authors describe the case of a 44-year old fisherman who presented with infectious ulcers on his right leg after suffering a trauma while fishing. The species Shewanella putrefaciens, Staphylococcus aureus and Escherichia coli were isolated and identified from a culture of the wound secretion. The isolates were identified by standard microbiological procedures and commercial identification systems (NF and Vitek GNI). Shewanella putrefaciens was sensitive to the majority of antibiotics tested.

[Malaria control in the State of Maranhão]. / Controle da malária no Estado do Maranhão.

This study aimed to show the results from malaria control in the State of Maranhão, based on the state's control plans and on the historical series of malaria records over the period from 1999 to 2007. The evolution of malaria cases was analyzed by comparing the annual incidences of parasitism (total number of cases notified per 1,000 inhabitants) according to geographical area, regional healthcare units and the 46 municipalities included in the plans. Analysis of the results allowed the conclusion that the plans were effective, since the annual incidence went down from 10.1 cases to 1.1 cases per 1,000 inhabitants, i.e. a regression of 89.1%, the largest among all the states in the Amazon region.