Epidemiologia da raiva humana no estado do Ceará, 1970 a 2019 / Epidemiología de la rabia humana en el estado de Ceará, Brasil, 1970 a 2019 / Epidemiology of human rabies in the state of Ceará, Brazil, 1970 to 2019

Objetivo: Descrever os casos de raiva humana no estado do Ceará, Brasil, no período 1970-2019. Métodos: Estudo descritivo, sobre dados secundários da Secretaria da Saúde e do hospital de referência do Ceará. Resultados: Dos 171 casos, 75,7% ocorreram em homens, 60,0% nas idades até 19 anos e 56,0% em áreas urbanas. O cão foi agente transmissor em 74,0% dos casos; sagui em, 16,7%; e morcego, em 7,3%. Entre 1970 e 1978, houve crescimento do número de casos (pelo Joinpoint Regression Program, percentual da mudança anual [APC] = 13,7 - IC95% 4,6;41,5); e entre 1978 e 2019, redução (APC = -6,7 - IC95% -8,8;-5,9). Houve redução da transmissão por cães (71 casos; último caso em 2010) e aumento relativo por mamíferos silvestres (5 casos a partir de 2005). Conclusão: O estudo evidencia mudança na dinâmica da transmissão da raiva no período observado, com redução da transmissão por cão e incremento de casos por animais silvestres.

Objetivo: Describir los casos de la rabia humana en Ceará, Brasil, 1970-2019. Métodos: Estudio descriptivo con datos secundarios de la Secretaría de Salud y del hospital de referencia de Ceará. Resultados: De los 171 casos, 75,7% ocurrió en hombres, el 60,0% en los 19 años y el 56,0% en áreas urbanas. El perro fue transmisor en 74,0%, el mono tití en 16,7% y el murciélago el 7,3%. Entre 1970 y 1978, hubo un aumento de casos (por el Joinpoint Regression Program, cambio porcentual anual [APC] = 13,7 - IC95% 4,6; 41,5), entre 1978 y 2019 una disminución (APC= -6,7 - IC95% -8,8; -5,9). Hubo una reducción de la transmisión por perros (71 casos, el último en 2010) y un aumento por mamíferos salvajes (5 casos, desde 2005). Conclusión: El estudio muestra un cambio en la dinámica de la transmisión de la rabia en los últimos años, con reducción de la transmisión por perros y aumento de casos por animales salvajes.

Objective: To describe cases of human rabies in Ceará State, Brazil between 1970 and 2019. Methods: This was a descriptive study using secondary data from the Ceará State Department of Health and the state reference hospital. Results: Of 171 cases, 75.7% occurred in males, 60.0% in <19-year-olds, and 56.0% in urban areas. Rabies was transmitted by dogs in 74.0% of cases, marmosets in 16.7% and bats in 7.3%. Between 1970 and 1978, there was an increase of cases (using the Joinpoint Regression Program, annual percentage change [APC] = 13.7 - 95%CI 4.6;41.5), while between 1978 and 2019 there was a decrease (APC = -6.7 - 95%CI -8.8;-5.9). There was a reduction in transmission by dogs (71 cases, last case in 2010) and an increase by sylvatic animals (5 cases since 2005). Conclusion: This study demonstrates changes in rabies transmission dynamics during the period studied, with a reduction in transmission by dogs and an increase of transmission by sylvatic animals.

Fatal disseminaeed cryptococcosis with renal involvement in an HIV-infected patient / Criptococose disseminada fatal com envolvimento renal em paciente infectado pelo HIV

SUMMARYIntroduction: We present a fatal case of disseminated cryptococcosis in a young man whose diagnosis of HIV infection was made at the time of admission to the emergency room.Case report: The patient was a twenty-three-year-old man, with a history of daily fever during one month associated with diarrhea, weight loss, headache, vomiting and generalized seizures. He also had a history of diabetes mellitus, alcoholism and drug addiction. Upon physical examination the patient was pale, disoriented and had periods of agitation. White blood cells count was 3,440/mm3 (5% lymphocytes), hemoglobin was 10g/dL, platelets were 83,000/ mm3. Creatinine was 0.7 mg/dL; urea 19 mg/dL; Na, K, and liver enzymes were within normal limits. Lactic dehydrogenase was 494 IU/L. Cerebrospinal fluid (CSF) analysis revealed 10 white blood cells/mm3 (58% neutrophils, 31% lymphocytes, 11% monocytes) and 2 red blood cells/mm3. India ink test revealed six Cryptococcusyeasts/mm3. CSF glucose was 122 mg/dL and protein was 36 mg/ dL. VDRL test was negative and anti-HIV test was positive. Intravenous hydration, insulin, phenytoin, fluconazole, pyrimethamine, sulfadiazine, folinic acid, and amphotericin B were started. The patient did not improve and became obtunded and hypotensive. He was intubated and put on mechanical respiration. He received vasoactive drugs and died less than 24 hours after admission. A postmortem examination was performed and revealed disseminated cryptococcosis, with severe involvement of the kidneys.Conclusion:Cryptococcosis, as a rule, is a systemic disease that affects mostly immunocompromised individuals, especially patients with AIDS. When diagnosed late in its course it has a very high mortality.

RESUMOIntrodução: Apresentamos um caso fatal de criptococose disseminada em homem jovem cujo diagnóstico de HIV foi feito no momento da admissão na emergência.Relato de caso: O paciente, de 23 anos, sexo masculino, tinha história de febre diária de um mês de duração, associada à diarreia, perda de peso, cefaleia, vômitos e convulsões generalizadas. Tinha ainda história de diabetes mellitus, alcoolismo e drogadição. Ao exame físico havia palidez, desorientação e períodos de agitação. Os exames laboratoriais mostraram 3.440 leucócitos/mm3(5% linfócitos), hemoglobina de 10 g/dL, 83,000 plaquetas/mm3, creatinina de 0,7mg/dL, ureia de 19 mg/dL, Na, K e enzimas hepáticas dentro dos limites da normalidade. A lactato desidrogenase era 494 UI/L. Análise do líquor revelou 10 leucócitos/mm3 (58% neutrófilos, 31% linfócitos, 11% monócitos) e 2 hemácias/mm3, glicose de 122 mg/dL e proteína de 36 mg/dL. A análise com tinta da Índia revelou seis blastoconídeos de Cryptococcus/mm³. O VDRL foi negativo e o anti-HIV positivo. Foi iniciado tratamento com hidratação venosa, insulina, fenitoína, fluconazol, pirimetamina, sulfadiazina, ácido folínico e anfotericina B. O paciente não apresentou melhora e evoluiu com obnubilação e hipotensão, sendo intubado e iniciada ventilação mecânica. Foram administradas drogas vasoativas, e o paciente evoluiu a óbito menos de 24h após a admissão. A autópsia revelou criptococose disseminada, com grave envolvimento renal.Conclusão:A criptococose é via-de-regra, doença sistêmica que afeta principalmente indivíduos imunocomprometidos, especialmente com AIDS, e quando diagnosticada tardiamente apresenta alta mortalidade.

Microepidemia de doença de Chagas aguda por transmissão oral no Ceará. / Microepidemics of acute Chagas' disease by oral transmission in Ceará.

No Brasil, em virtude das ações de controle, a transmissão vetorial da doença de Chagas foi reduzida. Por outro lado, vêm se destacando casos de transmissão por via oral. Esse trabalho relata a investigação de um surto de doença de Chagas aguda ocorrido no interior do Ceará no ano de 2006, cuja transmissão se deu provavelmente por via oral. O estudo foi realizado através de revisão de prontuários; entrevistas com pacientes, familiares e profissionais de saúde; achados laboratoriais e da investigação ambiental e entomológica. A microepidemia acometeu 8 integrantes de uma família que estiveram juntos nas férias do mês de janeiro de 2006. Duas mulheres e seis crianças, com idade variando entre 2 e 35 anos. Todos apresentaram quadro inicial de febre, cefaleia, náuseas, vômitos, mialgia e diarreia. Três semanas após o início dos sintomas apresentaram quadro de edema de membros inferiores e de face. Ao exame físico, além de edema, todos apresentaram hepatoesplenomegalia e linfoadenomegalia. O diagnóstico foi confirmado através da demonstração direta de amastigota em linfonodo, tecido muscular e medula. Anticorpos IgM contra Trypanosoma cruzi foram detectados em soro pelo método de hemaglutinação indireta. Todas as culturas para Trypanosoma cruzi foram positivas. A possível fonte de contaminação foi uma sopa à qual tinham sido adicionados coentro e cebolinha liquidificados, provenientes de uma horta domiciliar.

In Brazil, due to control actions, vectorial transmission of Chagas? disease has been largely reduced. On the other hand, oral transmission cases are showing up. This work reports the investigation of an outbreak of acute Chagas? disease in the inland of Ceará state in the year 2006 in which transmission occurred probably by oral route. This research was done through analysis of medical records, interviews with patients, their relatives and health professionals, laboratory data and environmental and entomological investigation. The microepidemics hit eight members of a family that were together on vacations in January 2006: two women and six children, ages ranging from 2 to 35 years. All of them shown initial clinical manifestations of headache, nausea, vomit, myalgia and diarrhea. Three weeks after these initial symptoms they shown edema of the lower limbs and face. Under clinical examination, besides edema, all of them shown hepatosplenomegaly and lymphadenomegaly. Diagnostic was confirmed by direct visualization of amastigota forms in lymph nodes, muscular tissue and bone marrow. IgM antibodies against Trypanosoma cruzi were detected on the serum by indirect hemagglutination assay. All cultures for Trypanosoma cruzi were positive. The probable contamination source was a stew into which liquid coriander and scallion from an orchard were added.

Sexually transmitted infections, bacterial vaginosis, and candidiasis in women of reproductive age in rural Northeast Brazil: a population-based study

Population-based data on sexually transmitted infections (STI), bacterial vaginosis (BV), and candidiasis reflect the epidemiological situation more accurately than studies performed in specific populations, but such data are scarce. To determine the prevalence of STI, BV, and candidiasis among women of reproductive age from a resource-poor community in Northeast Brazil, a population-based cross sectional study was undertaken. All women from seven hamlets and the centre of Pacoti municipality in the state of Ceará, aged 12 to 49 years, were invited to participate. The women were asked about socio-demographic characteristics and genital symptoms, and thereafter examined gynaecologically. Laboratory testing included polymerase chain reaction (PCR) for human papillomavirus (HPV), ligase chain reaction (LCR) for Chlamydia trachomatis and Neisseria gonorrhoeae, ELISA for human immunodeficiency virus (HIV), venereal disease research laboratory (VDRL) and fluorescent treponema antibody absorption test (FTA-ABS) for syphilis, and analysis of wet mounts, gram stains and Pap smears for trichomoniasis, candidiasis, and BV. Only women who had initiated sexual life were included in the analysis (n = 592). The prevalences of STI were: HPV 11.7 percent (95 percent confidence interval: 9.3-14.7), chlamydia 4.5 percent (3.0-6.6), trichomoniasis 4.1 percent (2.7-6.1), gonorrhoea 1.2 percent (0.5-2.6), syphilis 0.2 percent (0.0-1.1), and HIV 0 percent. The prevalence of BV and candidiasis was 20 percent (16.9-23.6) and 12.5 percent (10.0-15.5), respectively. The most common gynaecological complaint was lower abdominal pain. STI are common in women in rural Brazil and represent an important health threat in view of the HIV pandemic.

Progresso em saúde no Ceará / Health development in Ceará State

Relata o processo de transformaçäo no cenário da saúde no Ceará ao longo dos últimos dez anos, inspirado nos ideais da Reforma Sanitária e princípios da Lei Orgânica da Saúde (MMSC)