摘要
The present study recorded the consumption of paca and agouti meat and revealed the presence of hydatid cysts in the livers of these rodents in extractivist communities in Brazilian Amazonia. A total of 42 families (with a median four of members per household) were interviewed, of which 98% (n=41) reported the consumption of paca and 86% (n=36) the consumption of agouti. Structures consistent with hydatid cysts were detected more frequently in the liver tissue of the pacas (74% 31 of 42 samples) than the agoutis (26% 11/42). The parasitological analysis of a paca liver confirmed the presence of E. vogeli. The consumption of the meat of these rodents and the confirmation of infection by E. vogeli represent preoccupying risk factors for the inhabitants of these forest communities, given that the uncooked viscera of both rodents are often fed to domestic dogs.
O presente estudo registrou o consumo de carne de paca e cutia e revelou a presença de cistos hidáticos nos fígados desses roedores em comunidades extrativistas da Amazônia brasileira. Foram entrevistadas 42 famílias (mediana quatro membros/família), destas 98% (n=41) informaram o consumo de paca e 86% (n=36) o consumo de cutia. Estruturas compatíveis com cistos hidáticos foram relatadas com maior frequência em fígados de pacas 74% (31/42) do que em cutias 26% (11/42). A análise parasitológica de um fígado de paca confirmou a presença de E. vogeli. O consumo da carne desses roedores e a confirmação da infecção por E. vogeli representam fatores de risco preocupantes para os moradores dessas comunidades florestais, uma vez que as vísceras cruas de ambos os roedores são utilizadas na alimentação de cães domésticos.
Subject(s)
Animals , Zoonoses/parasitology , Echinococcosis/veterinary , Cuniculidae/parasitology , Dasyproctidae/parasitology , Hunting , Liver/parasitology , Animals, Wild/parasitology , Meat/analysis摘要
ABSTRACT Objectives: to assess Popular Health Education practices on intestinal parasites, carried out by telephone contact with men living in urban communities in Rio de Janeiro, Brazil, during the COVID-19 syndemic. Method: a quasi-experimental, quantitative and descriptive study, carried out with men aged 20 to 59 years. Pre-test was applied, and participants were divided into two groups: control and experimental. Popular Education in Health practices were carried out with an experimental group, and post-test was applied for both. Results: health education practices were significant in the experimental group, with a reduction in incorrect answers. There was an increase in incorrect answers in the control group's post-test. Conclusions: the Brazilian National Policy for Popular Education in Health contributed to qualify men's health literacy on intestinal parasites. Practice by telephone contact proved to be a powerful strategy for nursing and public policies to access this group and promote health in Primary Health Care.
RESUMEN Objetivos: evaluar las prácticas de Educación Popular en Salud sobre parásitos intestinales, realizadas por contacto telefónico con hombres residentes en comunidades urbanas de Río de Janeiro, Brasil, durante la sindemia de la COVID-19. Métodos: estudio cuasiexperimental, cuantitativo y descriptivo, realizado con hombres de 20 a 59 años. Se aplicó la preprueba y se dividió a los participantes en dos grupos: control y experimental. Se realizaron prácticas de Educación Popular en Salud con un grupo experimental y a ambos se les aplicó la posprueba. Resultados: las prácticas de educación en salud fueron significativas en el grupo experimental, con reducción de respuestas incorrectas. Hubo un aumento de respuestas incorrectas en la posprueba del grupo control. Conclusiones: la Política Nacional de Educación Popular en Salud contribuyó a cualificar la alfabetización en salud de los hombres sobre parásitos intestinales. La práctica por contacto telefónico demostró ser una poderosa estrategia de enfermería y de políticas públicas para acceder a ese grupo y promover la salud en la Atención Primaria de Salud.
RESUMO Objetivos: avaliar práticas de Educação Popular em Saúde sobre parasitoses intestinais, realizadas por contato telefônico com homens residentes em comunidades urbanas do Rio de Janeiro, Brasil, durante a sindemia de COVID-19. Métodos: estudo quase-experimental, quantitativo e descritivo, realizado com homens de 20 a 59 anos. Foi aplicado o pré-teste, e os participantes, distribuídos em dois grupos: controle e experimental. Foram realizadas práticas de Educação Popular em Saúde com grupo experimental e aplicado o pós-teste para ambos. Resultados: práticas de educação em saúde foram significativas no grupo experimental, com redução das respostas incorretas. Houve aumento de respostas incorretas no pós-teste do grupo controle. Conclusões: a Política Nacional de Educação Popular em Saúde contribuiu para qualificar a literacia em saúde de homens sobre parasitoses intestinais. A prática por contato telefônico mostrou-se uma potente estratégia para a enfermagem e as políticas públicas acessarem este grupo e promoverem saúde na Atenção Primária à Saúde.
摘要
ABSTRACT Subsistence hunting is the main source of protein for forest reserve dwellers, contributing to the development of spurious infections by Calodium hepaticum, frequently associated with the consumption of the liver from wild mammals. The prevalence of infections by soil-transmitted helminths (STHs) and intestinal protozoa is considered an indicator of the social vulnerability of a country, besides providing information on habits, customs and quality of life of a given population. Intestinal parasites mostly affect poor rural communities with limited access to clean water and adequate sanitation. This study reports the results of a parasitological survey carried out in 2017 and 2019, in two municipalities (Xapuri and Sena Madureira) in Acre State. Stool samples were collected from 276 inhabitants. Upon receipt, each sample was divided into two aliquots. Fresh samples without preservative were processed and examined by the Kato-Katz technique. Samples fixed in 10% formalin were processed by the spontaneous sedimentation and the centrifugal sedimentation techniques. Calodium hepaticum eggs were found in three stool samples. The overall STH prevalence was 44.9%. The hookworm prevalence (19.2%) was higher than that of Ascaris lumbricoides (2.5%) and Trichuris trichiura (0.7%), an unexpected finding for municipalities belonging to the Western Brazilian Amazon. When considering parasites transmitted via the fecal-oral route, Endolimax nana and Entamoeba coli showed the highest positivity rates, of 13% and 10.9%, respectively. This study is the first report of spurious infection by C. hepaticum among forest reserve dwellers that consume undercooked liver of lowland pacas. Additionally, this is the first report of Blastocystis sp. in Acre State.
摘要
Abstract The helminth Echinococcus vogeliRausch & Bernstein, 1972 is a causative agent of Neotropical Echinococcosis, a chronic zoonotic disease which is endemic to the Neotropical region. This parasite is transmitted from bush dogs (Speothos venaticus) to their prey, which include lowland pacas (Cuniculus paca) and agoutis (Dasyprocta spp.). In Brazil, most human cases of Neotropical Echinococcosis have been recorded in the Amazonian states of Acre and Pará, although few data are available on the occurrence of the potential definitive or intermediate hosts of E. vogeli in the Amazon region. In the present study, we surveyed the forests surrounding 46 human communities located within and around of outside six sustainable-use protected areas in the southwestern Amazon basin of Brazil. The forests were surveyed using camera traps to determine the local presence of potential wild hosts of E. vogeli, and the exploitation of these hosts for game meat was evaluated through interviews with 136 subsistence hunters resident in the local communities. We recorded pacas, agoutis, and bush dogs, as well as domestic dogs (Canis familiaris), all potential reservoirs of Neotropical Echinococcosis, using the same habitats. We also confirmed the frequent consumption of paca and agouti meat by subsistence hunters and their families in the study communities. Our data contribute to the understanding of the occurrence of E. vogeli in Brazilian ecosystems.
Resumo O helminto Echinococcus vogeliRausch & Bernstein, 1972 é o agente causador da Equinococose Neotropical, uma doença zoonótica crônica e endêmica da região Neotropical. Este parasito é transmitido entre o cachorro-vinagre (Speothos venaticus) e suas presas, como pacas (Cuniculus paca) e cutias (Dasyprocta spp.). No Brasil, a maioria dos casos humanos de Equinococose Neotropical é registrada nos estados do Acre e Pará, embora existam poucos dados disponíveis sobre a ocorrência de potenciais hospedeiros definitivos e intermediários de E. vogeli na Amazônia. No presente estudo, foram investigadas áreas de floresta ao redor de 46 comunidades humanas localizadas no interior e entorno de seis unidades de conservação de uso sustentável no sudoeste da bacia amazônica brasileira e, por meio de armadilhas fotográficas, foram avaliadas as presenças de potenciais hospedeiros silvestres de E. vogeli. Adicionalmente, foram avaliados o padrão de consumo da carne dos hospedeiros silvestres por meio de entrevistas com 136 moradores dessas comunidades. Foram registradas pacas, cutias e cachorros-vinagre, bem como cães domésticos (Canis familiaris) utilizando os mesmos habitats, todos potenciais reservatórios da Equinococose Neotropical. Além disto, confirmamos a alto consumo de paca e cutia nas comunidades. Os dados do presente trabalho contribuem para pesquisas em andamento sobre a presença dos potenciais reservatórios de E. vogeli em ambientes brasileiros.
摘要
ABSTRACT Intestinal parasitic infections (IPIs) are neglected diseases caused by helminths and protozoa, with the relationships between parasite, host and environment having the potential to produce high morbidity and incapacity to work and mortality in vulnerable areas. This study assessed the prevalence of IPIs concerning socio-environmental conditions and analyzed the knowledge, attitudes and practices related to these diseases among men living in the slums of Rio de Janeiro city, Rio de Janeiro State, Brazil. A cross-sectional study was conducted in an agglomeration of urban slums between 2018 and 2019, with men aged between 20 and 59 years. A socioeconomic status questionnaire and an IPIs knowledge, attitudes and practices questionnaire (KAPQ) were applied. Coproparasitological diagnoses (n=454) were performed using four methods and samples of water for household consumption (n=392) were subjected to microbiological and physicochemical analysis. A total of 624 participants were enrolled. About 40% of the households had "water unsuitable for consumption". Only one Major Area, MA 3 was not statistically significant for IPIs (AOR=0.75; 95% CI: 0.30-1.88; p=0.55). The overall prevalence of IPIs was 23.8%. Endolimax nana (n=65, 14.3%) and hookworm (n=8, 1.7%) were the most frequently identified parasites. The analysis of the frequency of responses to the KAPQ has shown that men reported to seeking medical care if they were suspicious of IPIs, and around 35% would self-medicate. The results have shown the need to adopt integrated health education practices targeting male residents in urban slums to qualify the care with water for human consumption and promote self-care about IPIs. The household can be considered strategic for Primary Health Care activities for men.
摘要
The intestinal parasitic diseases directly affect the quality of life of indigenous populations, because of vulnerabilities they experience. This study aimed to understand the prevalence of intestinal parasites among the Haliti-Paresí and relate with sanitation and ethno-development. It is a quantitative and cross-sectional study on indigenous Utiaritiland where reside the Haliti-Paresí, in the middle region northern Mato Grosso, Brazil. Data collection occurred in 2015, from interview with application of semi-structured form and collection of feces for coprological survey.Forty-three indigenous people participated in the study, of an average age of 30.9 years old, mostly women, and a predominance of basic education. The prevalence of enteroparasitosis was 46.6%, predominantly among men, reaching all adolescents, followed by children, without the influence of schooling in the rate of infection. Nine species were detected, being six pathogenic, Giardia duodenalis, Entamoebahistolytica, Ancilostomídeo, Blastocystishominis, Hymenolepis nana and Rodentolepis nana, in addition to three non-pathogenic, Iodamoebabutschlii, Entamoeba coli and Endolimax nana.The sanitation conditions, associated with cultural habits, point to the need for improvement in sanitation, since we detected a high prevalence of intestinal parasitoses in this study. The ethno-development may be crucial as strategies for the maintenance of culture in balance with health and sanitary development.
As doenças parasitárias intestinais impactam diretamente na qualidade de vida das populações indígenas, em decorrência das vulnerabilidades que vivenciam. Objetivou-se conhecer a prevalência das parasitoses intestinais entre os Haliti-Paresí e relacionar com o saneamento e etnodesenvolvimento. Trata-se de um estudo quantitativo e transversal na terra indígena Utiariti onde residem os Haliti-Paresí, na região médio Norte de Mato Grosso, Brasil. A coleta de dados ocorreu em 2015, a partir de entrevista com aplicação de formulário semiestruturado e coleta de fezes para inquérito coprológico. Participaram do estudo 43 indígenas, com idade média de 30,9 anos, maioria mulheres e predomínio do ensino fundamental. A prevalência de enteroparasitoses foi de 46,6%, predominando entre os homens, atingindo todos os adolescentes, seguido pelas crianças, sem influência da escolaridade na taxa de infecção. Nove espécies foram detectadas, sendo seis patogênicos, Giardiaduodenalis, Entamoebahistolytica, Ancilostomídeo, Blastocystishominis, Hymenolepis nana e Rodentolepis nana, além de três não patogênicas, Iodamoebabutschlii, Entamoeba coli e Endolimax nana. As condições de saneamento associadas aos hábitos culturais apontam para necessidade de melhoria no saneamento, uma vez que detectamos alta prevalência de parasitoses intestinais neste estudo. O etnodesenvolvimento poderá ser fundamental como estratégias de manutenção da cultura em equilíbrio com a saúde e desenvolvimento sanitário.
Subject(s)
Humans , Male , Female , Adult , Parasitic Diseases , Social Planning , Health of Indigenous Peoples摘要
This study aimed to estimate the frequency, associated factors, and molecular characterisation of Entamoeba histolytica, Entamoeba dispar, Entamoeba moshkovskii, andEntamoeba hartmanni infections. We performed a survey (n = 213 subjects) to obtain parasitological, sanitation, and sociodemographic data. Faecal samples were processed through flotation and centrifugation methods.E. histolytica, E. dispar, E. moshkovskii, and E. hartmanni were identified by nested-polymerase chain reaction (PCR). The overall prevalence of infection was 22/213 (10.3%). The infection rate among subjects who drink rainwater collected from roofs in tanks was higher than the rate in subjects who drink desalinated water pumped from wells; similarly, the infection rate among subjects who practice open defecation was significantly higher than that of subjects with latrines. Out of the 22 samples positive for morphologically indistinguishableEntamoeba species, the differentiation by PCR was successful for 21. The species distribution was as follows: 57.1% to E. dispar, 23.8% to E. histolytica, 14.3% toE. histolytica and E. dispar, and 4.8% E. dispar and E. hartmanni. These data suggest a high prevalence of asymptomatic infection by the group of morphologically indistinguishable Entamoeba histolytica/dispar/moshkovskiicomplex and E. hartmanni species. In this context of water scarcity, the sanitary and socioenvironmental characteristics of the region appear to favour transmission.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Young Adult , DNA, Protozoan/analysis , Drinking Water/parasitology , Entamoeba , Entamoebiasis/epidemiology , Feces/parasitology , Molecular Typing/methods , Brazil/epidemiology , Cross-Sectional Studies , Droughts , Entamoeba/classification , Entamoeba/genetics , Polymerase Chain Reaction , Poverty , Prevalence , Water Wells摘要
INTRODUCTION: Strongyloides stercoralis is a soil-transmitted helminth that produces an infection that can persist for decades. The relationships between certain clinical conditions and strongyloidiasis remains controversial. This study aims to identify the clinical conditions associated with intestinal strongyloidiasis at a reference center for infectious diseases in Rio de Janeiro, Brazil. METHODS: The clinical conditions that were assessed included HIV/AIDS, HTLV infection, cardiovascular diseases, diabetes, obstructive respiratory diseases, viral hepatitis, tuberculosis, cancer, chronic renal disease, nutritional/metabolic disorders, psychiatric conditions, rheumatic diseases and dermatologic diseases. We compared 167 S. stercoralis-positive and 133 S. stercoralis-negative patients. RESULTS: After controlling for sex (male/female OR = 2.29; 95% (CI): (1.42 - 3.70), rheumatic diseases remained significantly associated with intestinal strongyloidiasis (OR: 4.96; 95% CI: 1.34-18.37) in a multiple logistic regression model. With respect to leukocyte counts, patients with strongyloidiasis presented with significantly higher relative eosinophil (10.32% ± 7.2 vs. 4.23% ± 2.92) and monocyte (8.49% ± 7.25 vs. 5.39% ± 4.31) counts and lower segmented neutrophil (52.85% ± 15.31 vs. 61.32% ± 11.4) and lymphocyte counts (28.11% ± 9.72 vs. 30.90% ± 9.51) than S. stercoralis-negative patients. CONCLUSIONS: Strongyloidiasis should be routinely investigated in hospitalized patients with complex conditions facilitate the treatment of patients who will undergo immunosuppressive therapy. Diagnoses should be determined through the use of appropriate parasitological methods, such as the Baermann-Moraes technique. .
Subject(s)
Female , Humans , Male , Immunocompromised Host , Intestinal Diseases, Parasitic/diagnosis , Strongyloidiasis/diagnosis , Brazil , Intestinal Diseases, Parasitic/immunology , Strongyloidiasis/immunology摘要
The seroprevalence of Chagas disease in humans and the presence of triatomines were investigated in a rural locality in the State of Ceará, Brazil, an historically endemic region. Approximately 80% of the surveyed residents agreed to undergo serological tests. Intradomestic and peridomestic environments were searched for triatomines in both the dry and rainy seasons. The prevalence rate of Chagas disease was 1.2% and the majority of individuals confirmed with the disease over 50 years of age. A total of 761 specimens of triatomines were captured, most of which were from colonies composed of nymphs and adult bugs, and the majority of specimens were obtained in the dry season. Triatoma brasiliensis was the predominant species. Analysis using light microscopy revealed that 28.6% of the insects were Trypanosoma cruzi positive. Results suggest that peridomestic man-made structures, such as animal shelters, improper storage of timber and uninhabited dwellings contribute to the high rate of triatomine infestation in the area.
A presença de triatomíneos e a soroprevalência da infecção chagásica humana foram investigadas em uma localidade rural do Estado do Ceará, Brasil, região endêmica histórica da doença de Chagas. Os triatomíneos foram pesquisados nos domicílios, nos períodos de seca e de chuva. A soroprevalência encontrada no período foi de 1,2%, maior entre pessoas com mais de 50 anos de idade, e sem diferença significativa em relação ao sexo. Foram capturados 761 espécimes de triatomíneos, em colônias compostas de ninfas e insetos adultos, com predominância de Triatoma brasiliensis, especialmente no período de seca. O exame do conteúdo intestinal dos insetos revelou que 28,6% eram Trypanosoma cruzi positivos. Os resultados sugerem que os abrigos de animais e armazenamento inadequado de materiais no peridomicílio, particularmente amontoados de madeiras, bem como moradias desabitadas, contribuem para o alto índice de infestação de triatomíneos na localidade.
Se investigó la presencia de insectos y seroprevalencia en la infección humana por Trypanosoma cruzi, en un área rural del estado de Ceará, Brasil, región endémica histórica de la enfermedad Chagas. Se informó sobre la presencia de insectos en los hogares durante los períodos de sequía y lluvia. La seroprevalencia en el período fue un 1,2%, mayor entre las personas de más de 50 años de edad, y no hubo diferencias significativas en relación al sexo. Se capturaron 761 ejemplares de insectos en colonias compuestas por ninfas y adultos de insectos, principalmente, Triatoma brasiliensis, especialmente durante la estación seca. El examen del contenido intestinal de los insectos reveló que un 28,6% eran T. cruzi positivo. Los resultados sugieren que los refugios de animales y el almacenamiento inadecuado de materiales fuera del hogar, especialmente pilas de madera y casas deshabitadas, contribuyen a la alta tasa de infestación de insectos en la localidad.
Subject(s)
Adolescent , Adult , Aged , Animals , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , Chagas Disease/epidemiology , Housing , Insect Vectors/parasitology , Triatoma/parasitology , Trypanosoma cruzi/isolation & purification , Brazil/epidemiology , Chagas Disease/diagnosis , Chagas Disease/transmission , Insect Vectors/classification , Prevalence , Rural Population , Seasons , Seroepidemiologic Studies , Triatoma/classification摘要
INTRODUCTION: American tegumentary leishmaniasis (ATL), including mucocutaneous leishmaniasis (MCL) and localized cutaneous leishmaniasis (LCL), is endemic in Bolivia. We describe the results of active surveillance of ATL from 2001 to 2006 and assess demographic data related to ATL epidemiology in the Yungas valleys. METHODS: Community-based active ATL surveillance was performed by the institutions SERVIR, CÁRITAS, and the Health Services Department of La Paz, whose files were reviewed retrospectively. A cross-sectional survey was carried out to assess demographic data in two communities. RESULTS: Two thousand nine hundred nine cases of ATL were detected from 2001 to 2006: 2,488 (85.5 percent) corresponded to LCL and 421 (14.5 percent) to MCL. A reduction in the proportion of mucosal cases was observed between 2001 and 2006. The proportion of MCL cases increased with age and was higher among males (15.5 percent versus 12.1 percent, p=0.018). The rate of positivity via direct observation of the parasite in dermal scrapings and in parasite cultivation was significantly higher for LCL than for MCL (p<0.001 and p=0.009, respectively). The rate of reactivity in the leishmanin skin test was higher in the group with mucosal lesions (p=0.012). The cross-sectional survey showed that 40 percent of the families had emigrated from the Altiplano. CONCLUSIONS: It is necessary to undertake continuous case detection of ATL in the area, where the disease presents a high rate of mucosal cases. Increasing incidence seems to be associated with immigration and continuous deforestation to expand the crop-growing areas.
INTRODUÇÃO: A leishmaniose tegumentar americana (LTA), incluindo a leishmaniose mucocutânea (LMC) e a leishmaniose cutânea (LC), é endêmica em várias regiões da Bolívia. Descreve-se um sistema de vigilância da LTA conduzido entre 2001 e 2006 e avaliando-se dados demográficos relacionados à epidemiologia da doença. MÉTODOS: O sistema de busca ativa foi realizado conjuntamente pelas instituições SERVIR e CÁRITAS e pelo Servicio de Salud de La Paz (SEDES), cujos arquivos foram revisados, retrospectivamente. Um estudo transversal foi realizado em duas comunidades para aquisição de dados sócio-demográficos. RESULTADOS: Dois mil novecentos e nove casos de LTA, sendo 2.488 (85,5 por cento) de LC e 421 (14,5 por cento) de LMC foram diagnosticados de 2001 a 2006. Foi observada redução na proporção de casos mucosos ao longo do período. A proporção de LMC aumentou proporcionalmente à idade dos pacientes, sendo mais frequente entre pessoas do sexo masculino (15,5 por cento versus 12,1 por cento, p = 0,018). A taxa de detecção do parasita nos raspados cutâneos e no cultivo foram significativamente maiores em pacientes com LC do que em pessoas com LMC (p < 0,001 e p = 0,009 respectivamente). A reatividade à reação de Montenegro foi mais frequente em pessoas com LMC (p = 0.012). O estudo transversal mostrou que 40 por cento das famílias nas comunidades estudadas emigraram do Altiplano. CONCLUSÕES: Faz-se necessária uma contínua busca ativa de casos de LTA na região, onde a doença é hiperendêmica. As elevadas taxas de incidência parecem estar relacionadas à imigração e ao desflorestamento para expansão das áreas cultivadas.
Subject(s)
Adolescent , Adult , Aged , Animals , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Endemic Diseases , Leishmaniasis, Cutaneous/epidemiology , Bolivia/epidemiology , Cross-Sectional Studies , Population Surveillance , Retrospective Studies , Rural Population , Socioeconomic Factors摘要
INTRODUCTION: Leptospirosis is a zoonotic disease found in tropical and temperate countries, and its clinical diagnostic confusion with arboviruses (dengue fever, oropouche fever and yellow fever), Brazilian spotted fever, viral hepatitis and hantaviruses has been an ongoing public health concern. The aim of this observational study was to demonstrate an association between findings of atypical lymphocytosis and the progression of endemic leptospirosis. METHODS: A retrospective analysis was performed on the demographic, epidemiological, clinical and laboratory aspects of 27 human leptospirosis cases that occurred over a period of 13 years (1996-2009) with no reported epidemic outbreaks in Rio de Janeiro, Brazil. RESULTS: The overall mortality rate was 11.1 percent in our cohort of hospitalized cases. However, there was no mortality among patients with atypical lymphocytosis (OR = 11.1; 95 percent CI = 1.12-110.9; p = 0.04). Two patients who were in the septicemic phase showed signs of expansion of γδ T cell responses in peripheral blood. CONCLUSIONS: Atypical lymphocytosis may be observed in patients with leptospirosis. Our observations suggest that these atypical leukocyte subsets are associated with partial protection during the disease course of leptospirosis.
INTRODUÇÃO: Leptospirose é uma zoonose que permanece endêmica em regiões tropicais e temperadas. A dificuldade no diagnóstico clínico diferencial entre os quadros de leptospirose humana e as várias arboviroses (dengue, febre amarela, febre de oropouche), febre maculosa brasileira, hepatite viral e hantavirose permanece um problema na Saúde Pública. MÉTODOS: No presente estudo, foi realizada análise retrospectiva de características demográficas, epidemiológicas, clínicas e laboratoriais de 27 casos de leptospirose humana que ocorrerem durante um período de 13 anos sem ocorrência de notificação de surtos epidêmicos no Rio de Janeiro, Brasil (1996-2009). RESULTADOS: A mortalidade da coorte de pacientes com leptospirose correspondeu a 11,1 por cento, sem embargo, o grupo de pacientes com atipia linfocitária não evoluiu para o óbito (OR = 11,1; 95 por cento CI = 1,12-110,9; p = 0.04). Em duas oportunidades, foi observada uma expansão dos linfócitos T gama-delta no sangue periférico de pacientes na fase septicêmica da leptospirose. CONCLUSÕES: Atipia linfocitária pode ocorrer em pacientes com leptospirose. Nossos dados também sugerem que os linfócitos atípicos podem estar envolvidos na patogênese da leptospirose.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Leptospirosis/complications , Lymphocytosis/etiology , T-Lymphocytes/immunology , Brazil , Cohort Studies , Flow Cytometry , Immunophenotyping , Leptospirosis/immunology , Lymphocytosis/immunology , Retrospective Studies摘要
Cytokines are molecules that act as mediators of immune response; cerebral spinal fluid (CSF) IL-6 is found in all meningeal inflammatory diseases, but IL-8 is associated with acute bacterial meningitis (ABM). A case control study was done to ascertain the discriminatory power of these cytokines in differentiating ABM from aseptic meningitis (AM); IL-6 and IL-8 CSF concentrations were tested through ELISA in samples collected from patients who underwent investigation for meningitis. Sixty patients, 18 with AM, nine with bacteriologic confirmed ABM and 33 controls, assisted in 2005 (MA and controls) and 2007 (ABM) were included. Differently from controls, IL-6 concentrations were increased both in MA and ABM patients (p < 0.05). CSF IL-8 levels were higher in ABM than in AM and controls (p < 0.05). Discriminatory power in ABM as assessed by the area under receiver operator (ROC) curve was 0.951 for IL-8, using a cut-off of 1.685 ng/dL (100 percent of sensitivity and 94 percent of specificity). The CSF concentration of both IL-6 and IL-8 are increased in the presence of meningeal inflammation, IL-8 could be an important tool to differentiate ABM from AM.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , /cerebrospinal fluid , /cerebrospinal fluid , Meningitis, Aseptic/diagnosis , Meningitis, Bacterial/diagnosis , Biomarkers/cerebrospinal fluid , Case-Control Studies , Diagnosis, Differential , Enzyme-Linked Immunosorbent Assay , Meningitis, Aseptic/cerebrospinal fluid , Meningitis, Bacterial/cerebrospinal fluid , Sensitivity and Specificity摘要
Echovirus 30 belongs to the genus Enterovirus and is widely associated with aseptic meningitis (AM) outbreaks. In Brazil epidemics due to this serotype were reported in several states but in Rio de Janeiro, before this study, it was only involved in sporadic episodes. We retrospectively collected data from AM notifications charts and enterovirus isolation database from Rio de Janeiro State Health Department (RJSHD) and Enterovirus Reference Laboratory in the year of 2005. An outbreak of AM was detected during March, April and May associated with a high cell culture isolation rate for echovirus 30 (17.4 percent). Male children with ages varying from 1 to 9 years were more affected. Of the 22 patients with confirmed echovirus 30 disease, clinical information was available in eight; fever, headache and vomiting were the most common manifestations. CSF analysis showed a typical pattern of viral infection with median of cellularity of 100 cells/mm³ and mononuclear cell predominance in 64.7 percent of the cases. The median of protein and glucose levels of 49 mg/dL and 56.5 mg/dL. The fatality rate was null. Despite its benign course and the lack of treatment options, aseptic meningitis surveillance is crucial for early identification of causative agents of outbreaks, which helps to avoid additional testing and inappropriate use of antimicrobials.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , Disease Outbreaks , Echovirus Infections/embryology , Echovirus Infections/virology , Meningitis, Aseptic/epidemiology , Meningitis, Aseptic/virology , Brazil/epidemiology , Echovirus Infections/diagnosis , Meningitis, Aseptic/diagnosis , Retrospective Studies , Young Adult摘要
O objetivo do estudo foi estimar as freqüências de tuberculose e parasitoses intestinais na em comunidades indígenas da localidade de Iauareté (AM), em 2001. Estudo transversal (n=333) visando à obtenção de dados demográficos e amostras biológicas para exames de escarro e fezes. Dentre os 43 sintomáticos respiratórios, seis foram positivos na pesquisa de bacilos álcool-ácido resistentes no escarro. As parasitoses intestinais apresentaram freqüência significativamente maior entre a população Hüpda do que entre os índios que habitam os demais bairros (37,5 por cento vs. 19,3 por cento para Ascaris lumbricoides, 32,4 por cento vs. 16,3 por cento para Trichuris trichiura, 75 por cento vs. 19,3 por cento para ancilostomídeos, 75 por cento vs. 35,4 por cento para Entamoeba histolyticaD dispar e 33,3 por cento vs. 10,7 por cento para Giardia lamblia). Conclui-se que a tuberculose e o parasitismo intestinal são freqüentes nessas comunidades, exigindo medidas de controle e melhorias na assistência à saúde.
The objective of the survey was to estimate the frequencies of tuberculosis and intestinal parasitosis in indigenous communities at the locality of Iauareté, Northern Brazil, in 2001. This was a cross-sectional survey (n=333) aimed at obtaining demographic data and biological samples for sputum and feces examinations. Among the 43 individuals with respiratory symptoms, six presented alcohol/acid-fast bacilli in sputum. Intestinal parasitosis was significantly more frequent among the Hüpda population than among the Indians living in other districts (37.5 percent vs. 19.3 percent for Ascaris lumbricoides, 32.4 percent vs. 16.3 percent for Trichuris trichiura, 75 percent vs. 19.3 percent for hookworms, 75 percent vs. 35.4 percent for Entamoeba histolyticaD dispar and 33.3 percent vs. 10.7 percent for Giardia lamblia). It is concluded that tuberculosis and intestinal parasitism are frequent in these communities, thus requiring control measures and better medical care.
El objetivo del estudio fue estimar las frecuencias de tuberculosis y parasitosis intestinales en las comunidades indígenas de la localidad de Iauareté (Norte de Brasil), en 2001. Estudio transversal (n=333) intentando obtener datos demográficos y muestras biológicas para examenes de esputo y heces. Entre los 43 sintomáticos respiratorios, seis fueron positivos en la pesquisa de bacilos alcohol-ácido resistentes en el esputo. Las parasitosis intestinales presentaron frecuencia significativamente mayor entre la población Hüpda que entre los indios que habitan las demás localidades (37,5 por ciento vs. 19,3 por ciento para Ascaris lumbricoides, 32,4 por ciento vs. 16,3 por ciento para Trichuris trichiura, 75 por ciento vs. 19,3 por ciento para ancilostomídeos, 75 por ciento vs. 35,4 por ciento para Entamoeba histolytica/dispar y 33,3 por ciento vs. 10,7 por ciento para Giardia lamblia). Se concluyó que la tuberculosis y el parasitismo intestinal son frecuentes en esas comunidades, exigiendo medidas de control y mejorías en la asistencia a la salud.
Subject(s)
Adolescent , Child , Child, Preschool , Humans , Young Adult , Indians, South American/statistics & numerical data , Intestinal Diseases, Parasitic/epidemiology , Tuberculosis/epidemiology , Brazil/epidemiology , Epidemiologic Methods , Feces/parasitology , Intestinal Diseases, Parasitic/parasitology , Sputum/microbiology , Tuberculosis/microbiology , Young Adult摘要
The Brazilian city of Três Lagoas, Mato Grosso do Sul State, has experienced an urban outbreak of visceral leishmaniasis since 2000. In 2002, due to the increase in the number of cases, 46 families with cases of visceral leishmaniasis were studied to verify the prevalence of asymptomatic infection in household contacts. Indirect immunofluorescence and ELISA showed a 36.4 percent positive infection rate. There were no cases of symptomatic disease among these contacts. There was no statistically significant difference in gender or age. Median age was 21 years, and the 10-19-year age bracket was the most heavily affected (23 percent). As for family characteristics, no differences were observed in schooling or family income; most families (58.7 percent) owned their homes, which were built of masonry (97.8 percent) and had adequate infrastructure. All the families reported what were probably phlebotomine sand flies in the peridomicile. In conclusion, asymptomatic visceral leishmaniasis infection is frequent and occurs in both males and females, regardless of age.
O Município de Três Lagoas, Mato Grosso do Sul, Brasil, foi alvo de uma epidemia de leishmaniose visceral a partir de 2000. Em 2002, devido ao incremento de casos, estudou-se 46 famílias que apresentavam um caso de doença para verificar-se o percentual de positividade de infecção assintomática por leishmaniose visceral em contactantes. Encontrou-se 36,4 por cento de positividade pelos testes sorológicos Reação de Imunofluorescência Indireta e/ou imunoenzimático ELISA, sem diferença estatisticamente significativa quanto ao sexo e faixa etária. A mediana de idade foi de 21 anos, sendo a faixa etária mais acometida de 10 a 19 anos (23 por cento). Quanto às características familiares não observaram-se diferenças quanto ao nível de instrução e renda familiar; a moradia, em sua maioria, era própria (58,7 por cento), em alvenaria (97,8 por cento), com infra-estrutura adequada. Todas as famílias relataram a presença de provável flebotomíneo no peridomicílio. Conclui-se que a infecção assintomática por leishmaniose visceral é freqüente, ocorrendo em homens e mulheres, independente de faixa etária.
Subject(s)
Adolescent , Adult , Animals , Child , Child, Preschool , Dogs , Female , Humans , Male , Middle Aged , Young Adult , Carrier State/transmission , Contact Tracing/statistics & numerical data , Leishmaniasis, Visceral/transmission , Brazil , Cross-Sectional Studies , Carrier State/diagnosis , Enzyme-Linked Immunosorbent Assay , Fluorescent Antibody Technique, Indirect , Leishmaniasis, Visceral/diagnosis , Socioeconomic Factors , Urban Population , Young Adult摘要
Cat scratch disease (CSD) is a self limited condition characterized by fever, lymph node enlargement and less often eye involvement. Central nervous system involvement by Bartonella henselae infection is possibly an important cause of morbidity; its role as an agent of aseptic meningitis is unknown. We report a case of a 40 years-old man with CSD accompanied by aseptic meningitis and neuroretinitis. Serum indirect immmunofluorescence (IFI) assays for B. henselae were positive and the cerebrospinal fluid (CSF) analysis showed mononuclear pleocytosis and increased level of protein. Serological tests for other etiologies were negative. The patient responded well to antibiotic therapy with oral doxycicline plus rifampin and in the 12th day of hospitalization evolved to total regression of the headache and partial regression of the visual loss. Clinicians should consider CSD as a differential diagnosis when assessing previously healthy patients with aseptic meningitis associated with regional lymphadenopathy and epidemiological history of feline contact.
Subject(s)
Adult , Humans , Male , Cat-Scratch Disease/complications , Meningitis, Aseptic/complications , Retinitis/complications , Bartonella henselae , Fluorescent Antibody Technique, Indirect摘要
Neste estudo, foi estimada a prevalência da infecção pelo HTLV 1/2 em gestantes no Estado de Mato Grosso do Sul, por meio das técnicas ELISA, Western Blot e PCR, em amostras de sangue obtidas por punção venosa periférica. Foram examinadas 116.689 gestantes, sendo diagnosticadas 153 infectadas pelo HTLV 1/2, com prevalência de 0,13 por cento. Deste total, 133 (86,9 por cento) eram do tipo 1 e 20 (11,1 por cento) do tipo 2. Das 153 gestantes, 73,2 por cento eram negras, pardas ou índias, cerca de 90 por cento tinham atividades domésticas e 75,8 por cento (116/153) tinham 7 anos ou menos de escolaridade. As 153 gestantes tiveram 172 gestações, durante o período do estudo, sendo que 164 tiveram acompanhamento. Das gestações acompanhadas, 6,7 por cento (11/164) evoluíram para aborto, 26,8 por cento (41/153) gestantes relataram abortos anteriores, sendo que 31,7 por cento (13/41) apresentaram mais de dois abortos. Co-morbidades foram detectadas em 17 por cento (26/153) sendo 3,3 por cento (5/153) com HIV (p<0,000002). Os autores enfatizam a importância da identificação das gestantes infectadas pelo HTLV1/2 na estratégia de controle e prevenção da doença.
In this study, the prevalence of HTLV 1/2 infection among pregnant women in the State of Mato Grosso do Sul was estimated by means of the ELISA, Western Blot and PCR techniques, in blood samples collected by peripheral venous puncture. 116,689 pregnant women were examined and 153 were diagnosed as presenting HTLV 1/2 infection, with prevalence of 0.13 percent. Among these 153 pregnant women, 133 (86.9 percent) had type 1 and 20 (11.1 percent) had type 2; 73.2 percent were black, brown or indigenous; about 90 percent performed domestic activities; and 75.8 percent (116/153) had been to school for seven years or less. The 153 pregnant women had 172 pregnancies during the study period and 164 pregnancies were followed. Out of pregnancies that were followed, 6.7 percent (11/164) evolved to abortion, 26.8 percent (41/153) reported previous abortions and 31.7 percent (13/41) had had more than two abortions. Comorbidities were found in 17 percent (26/153), among whom 3.3 percent (5/153) had HIV (p<0.000002). The authors emphasize the importance of identifying pregnant women with HTLV 1/2 infection, as a strategy for disease control and prevention.
Subject(s)
Adolescent , Adult , Female , Humans , Pregnancy , HTLV-I Infections/epidemiology , HTLV-II Infections/epidemiology , Human T-lymphotropic virus 1 , Pregnancy Complications, Infectious/epidemiology , Blotting, Western , Brazil/epidemiology , Enzyme-Linked Immunosorbent Assay , HTLV-I Antibodies/blood , HTLV-I Infections/diagnosis , HTLV-II Antibodies/blood , HTLV-II Infections/diagnosis , Human T-lymphotropic virus 1/genetics , Human T-lymphotropic virus 1/immunology , /genetics , /immunology , Polymerase Chain Reaction , Prevalence , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/virology , Prenatal Diagnosis/statistics & numerical data , Risk Factors摘要
The goal of this survey was to estimate the seroprevalence of Toxoplasma gondii infection in Iauareté, a multiethnic Indian community in the upper Rio Negro basin. We carried out a cross-sectional survey (n = 260), in order to obtain serum samples and demographic data. The sample was randomly selected, by family conglomerate analysis. Serodiagnosis was performed by an enzyme-linked immunosorbent assay and indirect immunofluorescence. Prevalence of reactivity was 73.5 percent (191/260), being higher in the older-age groups, reaching 95.7 percent (44/46) in the group aged 50 years or more. The majority of seropositive subjects had titers equal to or less than 1:64. Seroprevalence was greater in Indians belonging to the Hupda ethnic group (p = 0.03). According to the present survey, Indian people living in Iauareté have a high prevalence of antibodies to T. gondii. Demographic concentration and urbanization within low sanitation and poor hygiene backgrounds, as well as unfiltered water consumption, may be related to the high frequency of T. gondii seroprevalence observed in the studied area.
Este estudo objetivou estimar a soroprevalência da infecção por Toxoplasma gondii em Iauareté, uma comunidade indígena multiétnica situada na bacia do Alto Rio Negro. Foi realizado um estudo seccional (n = 260), obtendo-se amostras de soro e dados demográficos, através de amostragem sistemática por conglomerado. Os testes sorológicos foram realizados através de ensaio imunoenzimático e imunofluorescência indireta. A prevalência da reatividade foi de 73,5 por cento (191/260), aumentando com a faixa etária e atingindo 95,7 por cento (44/46) em maiores de 50 anos. A maioria das amostras reativas apresentou títulos iguais ou inferiores a 1:64. Observou-se maior freqüência de reatividade entre os índios da etnia Maku Hupda. De acordo com o presente estudo, a população indígena de Iauareté apresenta alta prevalência da presença de anticorpos contra T. gondii. A concentração demográfica e a urbanização, conduzidas sem infra-estrutura sanitária, levadas a cabo na região no ultimo século, podem estar relacionadas à alta freqüência de detecção de anticorpos contra T. gondii na área estudada.
Subject(s)
Adolescent , Adult , Animals , Child , Female , Humans , Male , Middle Aged , Indians, South American/statistics & numerical data , Toxoplasmosis/epidemiology , Brazil/epidemiology , Cross-Sectional Studies , Enzyme-Linked Immunosorbent Assay , Fluorescent Antibody Technique, Indirect , Prevalence , Seroepidemiologic Studies , Toxoplasmosis/diagnosis摘要
OBJETIVOS: Descrever os aspectos clínicos e terapêuticos da tuberculose pulmonar e comparar os efeitos adversos e resultados do tratamento entre idosos e não idosos. MÉTODOS: Foi realizado um estudo caso-controle com 117 indivíduos idosos (acima de 60 anos) e 464 não idosos (15-49 anos) portadores de tuberculose pulmonar atendidos no Instituto de Doenças do Tórax da Universidade Federal do Rio de Janeiro no período de 1980 a 1996. RESULTADOS: No grupo de idosos, houve associação entre diabetes mellitus (OR = 3,98; IC95 por cento = 2,07-7,65; p = 0,001), doenças pulmonares (OR = 7,24; IC95 por cento = 3,64-14,46; p = 0,001) e cardiovasculares (OR = 5,86; IC95 por cento = 2.88-11.95; p = 0,001). O tabagismo (OR = 2,07; IC95 por cento = 1,26-3,42; p = 0,002) e o etilismo (OR = 1,63; IC95 por cento = 1,01-2,68; p = 0,041) também foram mais freqüentes neste grupo. O tratamento levou a freqüentes reações adversas nos idosos (OR = 1,62; IC95 por cento = 1,04-2,54; p = 0,024), principalmente de origem gastrintestinal (OR = 1,64; IC95 por cento = 1,01-2,77; p = 0,047), e sua eficácia foi menor neste grupo: apenas 51 por cento de cura e 24 por cento de óbitos. O abandono do tratamento foi elevado nos dois grupos, em torno de 23 por cento. CONCLUSÕES: As reações adversas e o resultado do tratamento foram piores nos idosos, com maior freqüência de complicações e letalidade, devido a uma maior toxicidade farmacológica e a uma maior prevalência de doenças associadas neste grupo etário.
OBJECTIVE: To describe the clinical and therapeutic aspects of pulmonary tuberculosis and compare the adverse effects of the treatment and its outcome in elderly and nonelderly patients. METHODS: This was a case-control study of 117 elderly individuals (over the age of 60 years) and 464 nonelderly individuals (aged 15-49 years). All subjects presented pulmonary tuberculosis that had been diagnosed and treated at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro between 1980 and 1996. RESULTS: In the elderly group, pulmonary tuberculosis was found to be correlated with diabetes (OR = 3.98; 95 percent CI = 2.07-7.65; p = 0.001), lung disease (OR = 7.24; 95 percent CI = 3.64-14.46; p = 0.001) and heart disease (OR = 5.86; 95 percent CI = 2.88-11.95; p = 0.001). Smoking (OR = 2.07; 95 percent CI = 1.26-3.42; p = 0.002) and alcohol abuse (OR = 1.63; 95 percent CI = 1.01-2.68; p = 0.041) were also more common in the elderly group. In the elderly group, the treatment more frequently resulted in adverse reactions (OR = 1.62; 95 percent CI = 1.04-2.54; p = 0.024), especially gastrointestinal reactions (OR = 1.64; 95 percent CI = 1.01-2.77; p = 0.047), and treatment efficacy was lower: cure rate, 51 percent; mortality rate, 24 percent. Treatment adherence was low (approximately 77 percent) in both groups. CONCLUSIONS: In the elderly group, adverse reactions were more common, treatment outcomes were less favorable, there was a greater frequency of clinical complications and deaths related to drug toxicity, and the prevalence of concomitant diseases was higher.