Awareness of Chagas disease and socioeconomic characteristics of Bolivian immigrants living in Sao Paulo, Brazil.

In this study which is part of a research project on Chagas disease (CD) among Bolivian immigrants in Sao Paulo, we describe socioeconomic characteristics, knowledge of CD and implications for acess to health care. We applied a structured questionnaire to a sample of 472 Bolivian adults (> 18 years) living in Sao Paulo and enrolled at the Barra Funda School Health Center. Participants' median age was 28.5 years, 75.0% were from the Bolivian department of La Paz, and >90% worked in the garment industry. Respondents had lived in Sao Paulo for a median of 5.8 years. Only 169 (35.8%) were familiar with CD, while roughly half (50.4%) had lived in natural materials houses in Bolivia, 225 (47.7%) indicated familiarity with the vector, 23.9% had seen the vector in their homes in Bolivia, and 6.4% reported having been bitten by a triatomine bug. Factors associated with awareness of CD were analyzed by chi square tests, and those with p values <0.25 were included in a multivariable logistic regression model. In the multivariable logistic regression analysis, having a relative with CD (OR=4.3, 95% CI=1.5-12.0), having lived in a house with mud or wood walls (OR=0.4, 95% CI=0.2-0.8), and having heard of the triatomine bug, or vinchuca, (OR=10.0, 95% CI=5.1-19.5) were significantly associated with awareness of CD. This study shows a low familiarity with CD among Bolivian migrants living in Sao Paulo, Brazil. Raising awareness of the disease through specific communication strategies should be an essential component of public health programs to reduce the burden of CD in this and other vulnerable populations.

Interdisciplinary approach at the primary healthcare level for Bolivian immigrants with Chagas disease in the city of São Paulo.

BACKGROUND/METHODS: In a pioneering cross-sectional study among Bolivian immigrants in the city of São Paulo, Brazil, the epidemiological profile, clinical manifestations and morbidity of Chagas disease were described. The feasibility of the management of Chagas disease at primary healthcare clinics using a biomedical and psychosocial interdisciplinary approach was also tested. Previously, a Trypanosoma cruzi (T. cruzi) infection rate of 4.4% among 633 immigrants was reported. The samples were screened using two commercial enzyme-linked immunoassay (ELISA) tests generated with epimastigote antigens, and those with discrepant or seropositive results were analyzed by confirmatory tests: indirect immunofluorescence (IFI), TESA-blot and a commercial recombinant ELISA. PCR and blood cultures were performed in seropositive patients. RESULTS: The majority of the 28 seropositive patients were women, of whom 88.89% were of child-bearing age. The predominant clinical forms of Chagas disease were the indeterminate and atypical cardiac forms. Less than 50% received the recommended antiparasitic treatment of benznidazole. An interdisciplinary team was centered on primary healthcare physicians who applied guidelines for the management of patients. Infectologists, cardiologists, pediatricians and other specialists acted as reference professionals. Confirmatory serology and molecular biology tests, as well as echocardiography, Holter and other tests, were performed for the assessment of affected organs in secondary healthcare centers. The published high performance of two commercial ELISA tests was not confirmed. CONCLUSION: An interdisciplinary approach including antiparasitic treatment is feasible at the primary healthcare level for the management of Chagas disease in Bolivian immigrants. The itinerant feature of immigration was associated with a lack of adherence to antiparasitic treatment and was considered a main challenge for the clinical management of this population. This approach is recommended for management of the infected population in endemic and nonendemic areas, although different strategies are needed depending on the severity of the disease and the structure of the healthcare system.

On an acute case of Chagas disease in a region under vector control in the state of São Paulo, Brazil.

No vector transmitted cases of Chagas disease had been notified in the state of São Paulo since the 1970s. However, in March, 2006, the death of a six-year-old boy from the municipality of Itaporanga was notified to the Center for Epidemiological Survey of the São Paulo State Health Secretariat: an autochthonous case of acute Chagas disease. The postmortem histopathological examination performed in the Hospital das Clínicas of the Botucatu School of Medicine confirmed the diagnosis. Reference to hospital records, consultation with the health professionals involved in the case and interviews with members of the patient's family supplied the basis for this study. We investigated parasite route of transmission, probable local reservoirs and vectors. No further human cases of acute Chagas disease were diagnosed. No locally captured vectors or reservoirs were found infected with Trypanosoma cruzi. Alternative transmission hypotheses - such as the possible ingestion of foods contaminated with vector excreta - are discussed, as well as the need to keep previously endemic regions and infested houses under close surveillance. Clinicians should give due attention to such signs as uni- or bilateral palpebral edema, cardiac failure, myocarditis, pericarditis, anasarca and atypical signs of nephrotic syndrome or nephritis and consider the diagnostic hypothesis of Chagas disease.

On an acute case of Chagas disease in a region under vector control in the state of São Paulo, Brazil / Sobre caso de doença de Chagas aguda em região de vetores controlados no Estado de São Paulo, Brasil

No vector transmitted cases of Chagas disease had been notified in the state of São Paulo since the 1970s. However, in March, 2006, the death of a six-year-old boy from the municipality of Itaporanga was notified to the Center for Epidemiological Survey of the São Paulo State Health Secretariat: an autochthonous case of acute Chagas disease. The postmortem histopathological examination performed in the Hospital das Clínicas of the Botucatu School of Medicine confirmed the diagnosis. Reference to hospital records, consultation with the health professionals involved in the case and interviews with members of the patient's family supplied the basis for this study. We investigated parasite route of transmission, probable local reservoirs and vectors. No further human cases of acute Chagas disease were diagnosed. No locally captured vectors or reservoirs were found infected with Trypanosoma cruzi. Alternative transmission hypotheses - such as the possible ingestion of foods contaminated with vector excreta - are discussed, as well as the need to keep previously endemic regions and infested houses under close surveillance. Clinicians should give due attention to such signs as uni- or bilateral palpebral edema, cardiac failure, myocarditis, pericarditis, anasarca and atypical signs of nephrotic syndrome or nephritis and consider the diagnostic hypothesis of Chagas disease.

Desde a década de 1970 não se notificavam casos autóctones de doença de Chagas aguda em São Paulo. Em março de 2006 a Vigilância Epidemiológica registrou óbito por doença de Chagas aguda, em Itaporanga, de paciente de seis anos de idade. Exame histopatológico post mortem realizado no Hospital das Clínicas da Faculdade de Medicina de Botucatu confirmou o diagnóstico. Consultamos prontuários de hospitais e entrevistamos profissionais de saúde envolvidos além de familiares do paciente. Descrevemos medidas adotadas in loco para identificar a via de transmissão, reservatórios e vetores. Discutimos as possíveis fontes de infecção. Na região não foram identificados outros casos humanos, vetores ou reservatórios vertebrados infectados por Trypanosoma cruzi. Salientamos a importância de manter a vigilância, mesmo em áreas onde a transmissão de doença de Chagas está interrompida e naquelas ainda infestadas por triatomíneos. Deve-se admitir a hipótese diagnóstica de doença de Chagas quando observados: edema palpebral (uni ou bilateral), insuficiência cardíaca, miocardite, pericardite, anasarca, quadros similares aos de síndrome nefrótica ou glomerulonefrite sem causas outras aparentes, em pacientes com dados epidemiológicos positivos. Encontro, mesmo em raras ocasiões, de triatomíneos na região ou ainda contato com alimento contaminável com formas infectantes de T. cruzi.

On an acute case of Chagas disease in a region under vector control in the state of São Paulo, Brazil

No vector transmitted cases of Chagas disease had been notified in the state of São Paulo since the 1970s. However, in March, 2006, the death of a six-year-old boy from the municipality of Itaporanga was notified to the Center for Epidemiological Survey of the São Paulo State Health Secretariat: an autochthonous case of acute Chagas disease. The postmortem histopathological examination performed in the Hospital das Clínicas of the Botucatu School of Medicine confirmed the diagnosis. Reference to hospital records, consultation with the health professionals involved in the case and interviews with members of the patient's family supplied the basis for this study. We investigated parasite route of transmission, probable local reservoirs and vectors. No further human cases of acute Chagas disease were diagnosed. No locally captured vectors or reservoirs were found infected with Trypanosoma cruzi. Alternative transmission hypotheses - such as the possible ingestion of foods contaminated with vector excreta - are discussed, as well as the need to keep previously endemic regions and infested houses under close surveillance. Clinicians should give due attention to such signs as uni- or bilateral palpebral edema, cardiac failure, myocarditis, pericarditis, anasarca and atypical signs of nephrotic syndrome or nephritis and consider the diagnostic hypothesis of Chagas disease.

Malária no Estado de São Paulo: Aspectos de Vigilância Epidemiológica / Malaria in the State of São Paulo: Epidemiological Surveillance Aspects

São analisados os dados referentes à malária no Estado de São Paulo, de 1983 a 2006. Foi verificado que 90,1% dos casos diagnosticados se originaram em outras áreas fora do Estado de São Paulo e que em 2,8% a transmissão ocorreu no próprio Estado. Foram confirmados 25.632 casos de malária neste período, nos quais em 67,1% foi diagnosticado Plasmodium vivax e em 26,2%, Plasmodium falciparum, sendo 84,4% do sexo masculino. A partir de 2003, o diagnóstico, tratamento e vigilância da doença foram descentralizados em São Paulo e os dados apresentados mostram que não houve uma descontinuidade importante nas atividades, embora tenham sido detectadas algumas inconsistências e alguns pontos de estrangulamento.

Aspectos epidemiologicos do tetano no Estado de Sao Paulo (Brasil) / Epidemiology of tetanus in Säo Paulo State (Brazil)

O tetano integra o elenco das doencas de notificacao compulsoria no Estado de Sao Paulo, desde 1978, e o seu comportamento, desde entao, revela as seguintes tendencias: incidencia declinante, embora ainda superior a existentes em areas de maior riqueza social, e letalidade elevada, ainda que constante. Neste contexto, estudou-se 133 casos de tetano acidental ocorridos em residentes do Estado de Sao Paulo, em 1989, investigados e confirmados pelo Sistema de Vigilancia Epidemiologica. As informacoes analisadas sao as que constam da ficha epidemiologica do referido sistema. A incidencia foi de 0,41 por 100.000 habitantes e a letalidade de 44,36 por cento. A partir da interpretacao dos dados descritivos foi possivel identificar a existencia de grupos sob maior risco: pessoas idosas, residentes nas regioes noroeste e oeste do Estado, e pertencentes as categorias ocupacionais de "atividades domesticas", "lavrador" e "aposentados", propondo-se, desse modo, que sejam objeto de atencao especial, ao lado dos ja conhecidos grupos de gestantes e criancas. Destaca-se ainda a existencia de 18,3 por cento de casos nos quais nao se identificou um traumatismo em data definida (como, por exemplo, os doentes com lesoes por Tunga penetrans). Em relacao ao tempo, a maior incidencia ocorreu no mes de maio...

Tentativa de controle de himenolepíase devida a Hymenolepis nana por meio do praziquantel, em coletividade semifechada / Attempt to control hymenolepiasis caused by Hymenolepis nana by means of praziquantel, in a semi-closed community

Em virtude de sugestäo decorrente da investigaçäo experimental, foi usado o praziquantel, através de duas administraçöes intervaladas por dez dias, como tentativa para controlar a himenolepiase devida a Hymenolepis nana, em coletividade semifechada. Houve emprego, em cada oportunidade de 25 mg/kg, tendo ficado comprovada a validade dessa conduta, a despeito da ocorrência de raras positivaçöes interpretadas como reinfecçöes, durante o seguimento. O presente estudo afigura-se importante no contexto das medidas destinadas a combater globalmente e himenolepiase em apreço, em comunidades fechadas ou semifechadas diante da possibilidade de aproveitamento da elevada atividade curativa do praziquante

Estudo da morbidade dos pacientes internados no Hospital das Clinicas da Faculdade de Medicina da USP - 1989 / Study of morbidity of patients admitted in the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo - 1989

Objetivou-se estudar a morbidade dos pacientes internados no Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, segundo sexo, idade e condicao de saida, em 1989. O estudo consistiu na analise de 39601 saidas hospitalares, obtidas atraves do Servico de Arquivo Medico (SAME) do Instituto Central. A analise foi feita para cada Instituto separadamente, levando em consideracao apenas o diagnostico principal de cada saida. No Instituto de Psiquiatria, das 1102 saidas, 55,4 por cento eram do sexo masculino e a predominancia foi do grupo de 20 a 49 anos (65,3 por cento). Dos casos de Transtornos Mentais (79,1 por cento) destacaram-se os diagnosticos de Psicoses Afetivas (20,3 por cento), Esquizofrenias (15,0 por cento) e Disturbios relacionados ao alcool (9,5 por cento). A taxa de mortalidade foi de 0,27 por cento...

Vigilância epidemiológica: reformulaçäo do sistema face à municipalizaçäo dos serviços de saúde; oficina de trabalho / Epidemiological surveillance: system reformulation face to the health services municipalization; workshop

A regionalizaçäo das atividades de vigilância epidemiológica no país, na perspectiva de um sistema único de saúde, deve levar em consideraçäo a redefiniçäo das funçöes próprias de cada um dos três níveis básicos deste sistema: o nível local, abrangendo um ou mais municípios, parte de um município, e compreendendo um conjunto de unidades prestadoras de serviço; o intermediário ou estadual e o nível nacional. O papel de cada nível poderá variar de acordo com as características e da situaçäo epidemiológica do agravo ou da doença, objeto de vigilância e também de acordo com o grande desenvolvimento, disponibilidade de recursos e capacidade técnico-operacional das diferentes áreas geográficas