Syndromic surveillance: etiologic study of acute febrile illness in dengue suspicious cases with negative serology. Brazil, Federal District, 2008.

With the aim of identifying the etiology of acute febrile illness in patients suspected of having dengue, yet with non reagent serum, a descriptive study was conducted with 144 people using secondary serum samples collected during convalescence. The study was conducted between January and May of 2008. All the exams were re-tested for dengue, which was confirmed in 11.8% (n = 17); the samples that remained negative for dengue (n = 127) were tested for rubella, with 3.9% (n = 5) positive results. Among those non reactive for rubella (n = 122), tests were made for leptospirosis and hantavirus. Positive tests for leptospirosis were 13.9% (n = 17) and none for hantavirus. Non reactive results (70.8%) were considered as Indefinite Febrile Illness (IFI). Low schooling was statistically associated with dengue, rubella and leptospirosis (p = 0.009), dyspnea was statistically associated with dengue and leptospirosis (p = 0.012), and exanthem/petechia with dengue and rubella (p = 0.001). Among those with leptospirosis, activities in empty or vacant lots showed statistical association with the disease (p = 0.013). Syndromic surveillance was shown to be an important tool in the etiologic identification of IFI in the Federal District of Brazil.

Syndromic surveillance: etiologic study of acute febrile illness in dengue suspicious cases with negative serology. Brazil, Federal District, 2008 / Vigilância sindrômica: estudo etiológico de doenças febris agudas a partir dos casos suspeitos de dengue com sorologia não reagente. Distrito Federal, Brasil, 2008

With the aim of identifying the etiology of acute febrile illness in patients suspected of having dengue, yet with non reagent serum, a descriptive study was conducted with 144 people using secondary serum samples collected during convalescence. The study was conducted between January and May of 2008. All the exams were re-tested for dengue, which was confirmed in 11.8 percent (n = 17); the samples that remained negative for dengue (n = 127) were tested for rubella, with 3.9 percent (n = 5) positive results. Among those non reactive for rubella (n = 122), tests were made for leptospirosis and hantavirus. Positive tests for leptospirosis were 13.9 percent (n = 17) and none for hantavirus. Non reactive results (70.8 percent) were considered as Indefinite Febrile Illness (IFI). Low schooling was statistically associated with dengue, rubella and leptospirosis (p = 0.009), dyspnea was statistically associated with dengue and leptospirosis (p = 0.012), and exanthem/petechia with dengue and rubella (p = 0.001). Among those with leptospirosis, activities in empty or vacant lots showed statistical association with the disease (p = 0.013). Syndromic surveillance was shown to be an important tool in the etiologic identification of IFI in the Federal District of Brazil.

Com o objetivo de identificar a etiologia de doenças febris agudas, em suspeitos de dengue com sorologia não reagente, realizou-se estudo descritivo com 144 pessoas utilizando amostras de soro coletados na convalescença, entre janeiro e março de 2008. Todos os exames foram re-testados para dengue, sendo as amostras negativas, processadas para rubéola (n = 127). Dentre as não reagentes para rubéola, submeteu-se ao teste para leptospirose (n = 122), e em se permanecendo sem diagnóstico, testou-se para hantavirose. Confirmou-se dengue em 11,8 por cento (n = 17), rubéola em 3,9 por cento (n = 5) e leptospirose em 13,9 por cento (n = 17). Os resultados não reagentes foram considerados como doença febril aguda indiferenciada (DFI) em 70.8 por cento dos casos. Verificou-se associação estatística em baixa escolaridade nos casos de dengue, rubéola e leptospirose (p = 0,009), assim como dispnéia para dengue e leptospirose (p = 0,012), e exantema/petéquias para dengue e rubéola (p = 0,001). Dentre os doentes com leptospirose, as atividades em terreno baldio mostraram-se com diferença estatística significante (p = 0,013). A vigilância sindrômica demonstrou-se como importante ferramenta na identificação de doenças febris agudas no Distrito Federal.

Autochthonous visceral leishmaniasis in Brasília, Federal District, Brazil.

INTRODUCTION: Visceral leishmaniasis is a public health threat in Brazil considering the high lethality rates and increasing geographical dispersion to large urban conglomerates over the past 25 years. This study aimed to confirm suspected autochthonous cases of visceral leishmaniasis reported from 2005 to 2009 among individuals living in Brasilia, Federal District. METHODS: A retrospective review of the surveillance data obtained on a regular basis and clinical records of the reported cases were performed in 2009. RESULTS: Data from entomological and canine surveys revealed the presence of both Lutzomyia longipalpis and positive serology for Leishmania in dogs within 19 of the 21 neighborhoods where human cases occurred since 2005. The review of surveillance data and medical records, together with the entomological and canine survey data, permitted confirmation of 21 autochthonous human cases in the Federal District. The disease predominantly affected children (12/21) and those from the Sobradinho region (16/21); the typical presentation of fever, hepatosplenomegaly and pancytopenia was observed in 67% of cases. Three deaths occurred during the study period. Leishmania (Leishmania) chagasi was successfully isolated from one human case and twelve canine cases. CONCLUSIONS: Visceral leishmaniasis should be considered endemic in Brasilia based on the documented epidemiological behavior herein described and the confirmed autochthony of human cases.

Autochthonous visceral leishmaniasis in Brasília, Federal District, Brazil / Leishmaniose visceral autóctone em Brasília, Distrito Federal, Brasil

INTRODUCTION: Visceral leishmaniasis is a public health threat in Brazil considering the high lethality rates and increasing geographical dispersion to large urban conglomerates over the past 25 years. This study aimed to confirm suspected autochthonous cases of visceral leishmaniasis reported from 2005 to 2009 among individuals living in Brasilia, Federal District. METHODS: A retrospective review of the surveillance data obtained on a regular basis and clinical records of the reported cases were performed in 2009. RESULTS: Data from entomological and canine surveys revealed the presence of both Lutzomyia longipalpis and positive serology for Leishmania in dogs within 19 of the 21 neighborhoods where human cases occurred since 2005. The review of surveillance data and medical records, together with the entomological and canine survey data, permitted confirmation of 21 autochthonous human cases in the Federal District. The disease predominantly affected children (12/21) and those from the Sobradinho region (16/21); the typical presentation of fever, hepatosplenomegaly and pancytopenia was observed in 67 percent of cases. Three deaths occurred during the study period. Leishmania (Leishmania) chagasi was successfully isolated from one human case and twelve canine cases. CONCLUSIONS: Visceral leishmaniasis should be considered endemic in Brasilia based on the documented epidemiological behavior herein described and the confirmed autochthony of human cases.

INTRODUÇÃO: A leishmaniose visceral é uma ameaça para a saúde pública no Brasil, considerando a elevada taxa de letalidade e a sua dispersão geográfica para grandes conglomerados urbanos durante os últimos 25 anos. Este trabalho teve como objetivo confirmar a suspeita de autoctonia de casos de leishmaniose visceral notificados de 2005 até 2009 em moradores de Brasília, Distrito Federal. MÉTODOS: Foi realizado em 2009 um estudo retrospectivo dos dados da vigilância obtidos na rotina e dos registros clínicos dos casos humanos notificados. RESULTADOS: Os dados dos inquéritos canino e entomológico revelaram a presença de Lutzomyia longipalpis e de cães com sorologia positiva para Leishmania na vizinhança onde ocorreram 19 dos 21 casos humanos desde 2005. A revisão das fichas de notificação e prontuários dos pacientes, em conjunto com os dados dos inquéritos canino e entomológico permitiram a comprovação da autoctonia de 21 casos humanos no Distrito Federal. A doença afetou predominantemente crianças (12/21), da região de Sobradinho (16/21), com quadro típico de febre, hepatoesplenomegalia e pancitopenia em 67 por cento dos casos. Houve três óbitos no período. Houve sucesso no isolamento de Leishmania (Leishmania) chagasi de um caso humano e de doze casos caninos. CONCLUSÕES: A leishmaniose visceral deve ser considerada endêmica em Brasília, considerando o comportamento epidemiológico aqui descrito e a confirmação da autoctonia dos casos humanos.