Tungíase: doença negligenciada causando patologia grave

Published by Maney Publishing (c) Liverpool School of Tropical Medicine
evident super-infection was documented.
The clinical characteristics of the HrCLM
seen in Feliz Deserto were recently
described by Jackson et al. (2006).
Data Analysis
Version 6.04d of the Epi Info software
package (Centers for Disease Control and
Prevention, Atlanta, GA) was used for the
data storage. All the data were entered into
an Epi Info database, checked for entry
errors and then analysed in version 9.0 of
the StataH software package (StataCorp,
College Station, TX). Fisher’s exact tests
were used to determine the significance of
the differences seen in relative frequencies.
After bivariate analysis, multivariate logistic
regression, using backward elimination, was
performed to calculate adjusted odds ratios
for the independent associations between
the explanatory variables and HrCLM. To
increase the number of positive observations,
logistic regression was performed
using not only the data on the current
presence of HrCLM (determined by clinical
examination) but also those on an history of
HrCLM in the previous 6 months (identified
through interview). Each variable that
gave a P-value of ,0.2 in the bivariate
analysis was considered in the multivariate
regression model.
Ethical Considerations
Ethical clearance was obtained from the
Ethical Committee of the Escola de Ciências
Médicas de Alagoas, the main ethical body in
the state of Alagoas, as well as from an adhoc
ethical committee of the health department
of the municipality of Feliz Deserto.
All participants were informed about the
study and written consent was obtained
from each subject (in the case of adults) or
his or her care-givers (in the case of
children). Patients with HrCLM were treated,
immediately post-diagnosis, with topical
thiabendazole. Subjects found to have
other parasitic skin diseases were referred to
CUTANEOUS LARVA MIGRANS IN BRAZIL 55
the local primary-healthcare centre, for
appropriate treatment.
RESULTS
In the first door-to-door survey, in the rainy
season, 1015 (88.6%) of the 1146 eligible
individuals in the study area were examined.
Between the first and the second surveys, 17
families moved out of the study area and 13
families moved in. In the second survey, in
the dry season, 990 (91.1%) out of the 1087
individuals then eligible for inclusion in the
study were examined.
Overall, 62 cases of HrCLM (45 in the
first survey, and 17 in the second; see
Table 1) were diagnosed, in a total of 60
subjects (two individuals were found to have
the disease in both surveys).
The disease was more common in children
than in adults (Table 1). In the rainyseason
survey, for example, 15% of infants
and children aged (4 years but only 0.7%
of adults aged .20 years had HrCLM. The
overall prevalence of HrCLM among the
subjects aged (4 years was significantly
higher than that in any other age-group
considered (with P-values of 0.04 for the
comparison with the 15- to 19-year-olds and
(0.003 for all the other comparisons).
Subjects aged ,10 years accounted for 48
(77.4%) of the 62 cases of HrCLM detected
in the community.
Although, in both surveys, the prevalence
of HrCLM was higher in males than in
females, the differences were not statistically
significant (with P-values of 0.3 in the rainy
season and 0.2 in the dry season; Table 1).
Although the overall prevalence of
HrCLM was 2.5-fold higher in the rainy
season than in the dry season (4.4% v.
1.7%; P,0.001), the level of seasonal
variation in prevalence was not equal across
all age-groups (Table 1). The increase in
prevalence in the rainy season (compared
with the corresponding dry-season value)
was most prominent in children aged (4
years, independent of their gender, although