Tungíase: doença negligenciada causando patologia grave

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440 Feldmeier et al JAM ACAD DERMATOL MARCH 2009 Table II. Bivariate analysis of exposure variables and scabies infestation/severe scabies in one of two surveys (n = 1183) Presence of scabies (n = 151) Presence of severe scabies y (n = 68) Exposure variable Examined n* Positive n (%) OR (95% CI) P value Positive n (%) OR (95% CI) P value Sex Female 624 87 (13.9) 1.25 (0.88-1.80) .22 37 (5.9) 1.07 (0.64-1.82) .80 Male 559 64 (11.5) Ref. 31 (5.6) Ref. Age, y # 4 184 41 (22.3) 5.66 (3.11-10.53) \.0001 24 (13.0) 7.63 (3.22-19.99) \.0001 5-9 214 43 (20.1) 4.97 (2.76-9.16) \.0001 21 (9.8) 5.54 (2.29-14.68) \.0001 10-14 171 29 (17.0) 4.03 (2.12-7.76) \.0001 11 (6.4) 3.49 (1.25-10.19) .009 15-39 415 20 (4.8) Ref. 8 (1.9) Ref. $ 40 199 18 (9.1) 1.96 (0.95-4.01) .05 4 (2.0) 1.04 (0.23-3.95) 1.00 Ratio children/adults # 2 1018 117 (11.5) Ref. 48 (4.7) Ref. [2 165 34 (20.6) 2.00 (1.27-3.09) .002 20 (12.1) 2.79 (1.52-4.94) .001 Persons/household $ 4 902 120 (13.3) 1.76 (0.99-3.32) .05 50 (5.5) 1.16 (0.55-2.73) .86 \4 187 15 (8.0) Ref. 9 (4.8) Ref. No. of individuals/room [2 94 17 (18.1) 1.64 (0.88-2.92) .10 7 (7.5) 1.46 (0.54-3.36) .34 # 2 995 118 (11.9) Ref. 52 (5.2) Ref. Child age \ 15 y with scabies in household Yes 293 109 (37.2) 11.96 (7.98-18.08) \.0001 53 (18.1) 12.88 (6.99-24.99) \.0001 No 890 42 (4.7) Ref. 15 (1.7) Ref. Time living in area, mo [6 956 129 (13.5) 3.30 (1.43-9.35) .002 57 (6.0) 4.15 (1.07-35.50) .04 # 6 133 6 (4.5) Ref. 2 (1.5) Ref. All family members illiterate Yes 162 35 (21.6) 2.28 (1.44-3.54) .0004 18 (11.1) 2.70 (1.42-4.95) .002 No 927 100 (10.8) Ref. 41 (4.4) Ref. Monthly family income, R$ z \200 661 94 (14.2) 1.56 (1.05-2.37) .02 43 (6.5) 1.79 (0.97-3.45) .05 $ 200 428 41 (9.6) Ref. 16 (3.7) Ref. Type of floor Sand/clay 147 26 (17.7) 1.64 (0.98-2.66) .04 15 (10.2) 2.32 (1.16-4.39) .01 Concrete/tiles 942 109 (11.6) Ref. 44 (4.7) Ref. Electricity No 126 25 (19.8) 1.92 (1.13-3.15) .01 12 (9.5) 2.05 (0.96-4.07) .04 Yes 963 110 (11.4) Ref. 47 (4.9) Ref. Toilet No 210 37 (17.6) 1.70 (1.09-2.61) .01 17 (8.1) 1.76 (0.92-3.23) .06 Pit latrine/WC 879 98 (11.2) Ref. 42 (4.8) Ref. Presence of dog or dogs Yes 401 59 (14.7) 1.29 (0.89-1.86) .17 27 (6.7) 1.30 (0.76-2.21) .29 No 782 92 (11.8) Ref. 41 (5.2) Ref. Sharing bed/hammock/ mattress with others Yes 774 109 (14.1) 1.31 (0.88-2.00) .18 52 (6.7) 1.69 (0.91-3.35) .10 No 343 38 (11.1) Ref. 14 (4.1) Ref. Sharing clothes with others Yes 168 43 (25.6) 2.80 (1.81-4.24) \.0001 25 (14.9) 3.87 (2.18-6.74) \.0001 No 949 104 (11.0) Ref. 41 (4.3) Ref. Continued
JAM ACAD DERMATOL VOLUME 60, NUMBER 3 Table II. Cont’d area can be considered representative for other impoverished rural communities in the Brazilian backlands. Housing is rather poor, income is generally low, illiteracy is frequent, and social attitudes and behavior facilitate the transmission of S scabiei. In Feliz Deserto, scabies was mainly a disease of children younger than 4 years, who accounted for almost 30% of all cases diagnosed during the two surveys. In Brazil, children of this age group usually wear only diapers, slips, or shorts, independent of their sex. They have frequent body contacts with other children during playing and sleeping, and with older siblings, their mothers, and other women, who carry around babies and toddlers during the day. In children aged between 10 and 14 years the infestation was also very common, with the prevalence ranging between 9.3% and 16.4%, according to sex and season. Young age remained a significant independent risk factor for the presence of scabies and severe disease in the multivariate regression analysis. Previous studies in resource-poor settings also found that children are the most vulnerable population group. 1,2,4,5,7,9,31 The overall prevalence did not vary between the surveys, although 102 individuals with scabies were treated in the first survey. We, therefore, cannot exclude that without treatment the prevalence would have been higher in the dry season. However, a clear seasonal variation has not been detected. This corroborates findings from other tropical areas, 9,20 but is in contrast to observations made in industrialized countries with a cold or moderate climate or developing countries with a rather cold and dry winter such as Malawi or Turkey. 4,21,29,43-46 Obviously, in the hot climate of Northeast Brazil reduced off-host viability of mites because of high environmental temperatures does not impede continued Presence of scabies (n = 151) Presence of severe scabies y (n = 68) Exposure variable Examined n* Positive n (%) OR (95% CI) P value Positive n (%) OR (95% CI) P value Sharing towel with others Yes 532 85 (16.0) 1.60 (1.11-2.32) .01 44 (8.3) 2.03 (1.33-4.09) .001 No 585 62 (10.6) Ref. 22 (3.8) Ref. Taking shower regularly No 690 103 (14.9) 1.53 (1.04-2.28) .03 51 (7.4) 2.19 (1.19-4.25) .009 Yes 427 44 (10.3) Ref. 15 (3.5) Ref. Using soap regularly No 21 3 (14.3) 1.10 (0.21-3.84) .75 1 (4.8) 0.79 (0.02-5.12) 1.00 Yes 1096 144 (13.1) Ref. 65 (5.9) Ref. CI, Confidence interval; OR, odds ratio; Ref., reference; WC, water closet. *Data were not available in all cases. y Individuals with $ 12 topographic areas affected. z R$1 US$0.53. Feldmeier et al 441 transmission throughout the year. 47,48 We suggest that in impoverished communities in the tropics reduced off-host viability of mites is compensated by intense exposure through prolonged and intimate body contact. In these settings, major parts of the body are not covered with clothes during day and night, irrespective of whether it is dry or raining, as air temperature remains more or less stable. Babies and small children are carried around on the hip by their mothers and older girls for several hours during the day. This should facilitate the transmission of mites from person to person. 49 The high degree of transmission occurring within households is best demonstrated by the fact that individuals who had lived in the community for more than 6 months had 3.6-fold higher odds for a diagnosis of scabieseand a 4.2-fold higher odds for the presence of severe scabieseas compared with individuals who had recently arrived. In a study in rural India an almost linear increase in the occurrence of scabies with increasing household size was observed. 2 However, crowding (defined as [4 individuals/household) was not associated with the presence of scabies in this study. This suggests that the risk of acquiring scabies in the household is not directly linked to the number of persons living in that household. Illiteracy of adult household members was a very good predictor for the presence of scabies and severe disease, and remained a significant risk factor in the multivariate regression analysis (odds ratio 2.8 and 3.2, respectively) (Table III). A low level of education has been identified as a risk factor for scabies in developing and industrialized countries. 20,50 Because illiteracy usually goes along with a low socioeconomic status, the inability to read and write can be taken as a proxy for poor living
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UNIVERSIDADE FEDERAL DO CEARÁ FACU
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LIANA DE MOURA ARIZA UM NOVO MÉTOD
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RESUMO Introdução: Existe pouco c
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LISTA DE FIGURAS Figura 1: Macho e
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LISTA DE TABELAS Tabela 1: Caracter
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SUMÁRIO RESUMO ...................
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1 - INTRODUÇÃO 1.1 - TUNGÍASE A
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Após a penetração na epiderme, a
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No fim do século XIX, a pulga caus
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ARIZA et al., 2007; HEUKELBACH et a
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Figure 6: Múltiplas lesões nas m
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inflamação grave observada após
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A incidência, prevalência e carga
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Figura 11: Planta dos pés de uma m
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1953; PAMPIGLIONE et al., 1998; SIL
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eivindicada como tratamento eficaz
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1.2 - MÉTODOS EPIDEMIOLOGICOS RÁP
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1.4 - HIPÓTESE A presença de pelo
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3 - MATERIAL E MÉTODOS O presente
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3.1.1 - Comunidades brasileiras O M
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Figura 15: Vila pesqueira de Balbin
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total em torno de 240.000 pessoas (
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Figura 20: Comunidade pesqueira de
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(d) presença de uma casca preta pl
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Tanto em Yovoyan como em Okunilage,
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o Prevalência grave verdadeira = [
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Toda pesquisa deve ser conduzida co
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Em torno de 60% da população era
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A presença de animais domésticos
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Em geral, a distribuição da preva
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Dos 142 indivíduos infestados nas
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4.1.4 - Sinais e sintomas associado
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4.2 - MÉTODO EPIDEMIOLÓGICO RÁPI
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Figura 27: Prevalência por grupos
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Tabela 13: Verdadeiras prevalência
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Figura 31: Gráfico de dispersão e
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Tabela 14: Coeficiente de determina
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Tabela 15: Prevalências da área p
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Tabela 16: Prevalências gerais e g
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Tais características identificadas
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cujo comportamento do uso de chinel
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As cargas parasitárias por indiví
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tungíase, a desproporcional da car
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pulgas em estágios iniciais, e sua
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comunidades. A presença destas, si
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Com esta área definida, basta insp
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comunitários prévias à coleta de
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6 - CONCLUSÕES Epidemiologia da tu
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CALLEGARI-JACQUES, S. M. Bioestatis
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GIBBS, S. Skin disease and socioeco
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HEUKELBACH, J.; SAHEBALI, S.; VAN M
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MACINTYRE, K. Rapid assessment and
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REMME, J. H. The African Programme
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WEERASOORIYA, M. V.; ISOGAI, Y.; IT
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APENDICE 1 108
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APENDICE 2 110
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112
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APÊNDICE 4 114
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9.1 AUTORIZACAO DO BAALES DAS COMUN
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Tropical Medicine and International
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Tungíase: doença negligenciada causando patologia grave

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