Tungíase: doença negligenciada causando patologia grave

Published by Maney Publishing (c) Liverpool School of Tropical Medicine
54 HEUKELBACH ET AL.
Caumes et al., 1995; Romano et al., 2004;
Ansart et al., 2005; Boggild et al., 2006;
Diaz, 2006; Freedman et al., 2006). In
endemic communities in the developing
world, HrCLM occurs mainly in children
and is associated with considerable morbidity
(Heukelbach et al., 2004; Jackson et al.,
2006). Usually, several larval tracks co-exist,
frequent re-infestation is the rule, and the
skin lesions rapidly become super-infected
(Heukelbach et al., 2004; Jackson et al.,
2006). In a recent study in a resource-poor
community in north–eastern Brazil, 81% of
those suffering from HrCLM said that they
were unable to sleep normally because of the
infestations (Jackson et al., 2006).
There have been few attempts to identify
the most vulnerable groups and risk factors
for HrCLM in endemic communities. The
aim of the present study was to explore such
epidemiological characteristics of the infestation
in Feliz Deserto, a village in north–
eastern Brazil, using data collected in two
door-to-door surveys — one in the dry
season of 2003 and the other in the rainy
season.
SUBJECTS AND METHODS
Setting
At the time of the present study, 3850
people lived in Feliz Deserto, which lies on
the Atlantic coast, about 120 km south of
Maceió, the capital of Alagoas state, in
north–eastern Brazil. The village is typical
of many rural communities in the region.
To get some idea of the prevalences of
HrCLM and other parasitic skin diseases in
the target population, and to determine the
sample size necessary for a risk-factor study,
a pilot study was performed in 105 randomly
selected households, which together
held 521 people, in those districts of Feliz
Deserto, where — according to local health
personnel and community leaders —
HrCLM had occurred in the previous 5
years. These districts, which were defined as
the study area, had a combined population
of about 1250. The results of the pilot study
showed that HrCLM is a known entity in
the study community and is correctly
diagnosed by all affected individuals or their
care-givers.
Study Design
After the pilot study, two cross-sectional,
door-to-door surveys covering every household
in the study area were conducted, one
in June–July 2003 (the end of rainy season)
and the other in October–November 2003
(the middle of the dry season). The members
of each household were examined
clinically for the presence of HrCLM and
other parasitic skin diseases. At the same
time, using standardized pre-tested
questionnaires, information on socio–
demographic, environmental and behavioural
variables was collected and each
subject who did not have HrCLM was asked
if they had suffered from the infestation in
the previous 6 months. If a household
member was absent, the household was
revisited up to three times, or an appointment
was made for the absentee at the local
healthcare centre. To be included in the
study, individuals had to spend at least 4
days per week in a household in the study
area. To eliminate inter-observer bias, all
the clinical examinations were carried out by
the same investigator (A.J.).
Clinical Examination and Diagnosis of
HrCLM
In each study household, in a room with
good light and in which privacy was
guaranteed, the skin of each subject was
thoroughly examined for the presence of
HrCLM. Body areas that a subject did not
want to show (the genitals and/or breasts)
were not examined.
The diagnosis of HrCLM was based upon
the characteristic clinical picture: an elevated
linear or serpiginous lesion which had
moved forward during the preceding days,
with associated pruritus and with or without
an erythematous papule. Any clinically