Tungíase: doença negligenciada causando patologia grave

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Published by Maney Publishing (c) Liverpool School of Tropical Medicine TABLE 2. Bivariate analysis factors associated with hookworm-related cutaneous larva migrans (HrCLM), determined using the data from 1184 subjects Variable No. of subjects No. and (%) positive Current HrCLM (N560) CUTANEOUS LARVA MIGRANS IN BRAZIL 57 Odds ratio and (95% confidence interval) P No. and (%) positive Current or previous HrCLM (N5150) * Odds ratio and (95% confidence interval) P SOCIO–DEMOGRAPHIC FACTORS Gender Male 559 33 (5.9) 1.38 (0.80–2.43) 0.23 70 (12.5) 0.96 (0.68–1.40) 0.93 Female 625 27 (4.3) 80 (12.8) Age-group (years) ,15 569 50 (8.8) 5.82 (2.88–13.00) ,0.0001 108 (19.0) 3.20 (2.17–4.78) ,0.0001 >15 615 10 (1.6) 42 (6.8) Literacy Illiterate 354 23 (6.5) 1.48 (0.82–2.64) 0.19 51 (14.4) 1.19 (0.81–1.74) 0.34 Literate 760 34 (4.5) 94 (12.4) Monthly family income (R$) { ,200 662 33 (5.0) 1.20 (0.64–2.29) 0.66 95 (14.4) 1.71 (1.14–2.63) 0.01 >200 428 18 (4.2) 38 (8.9) No. of people in household: >4 903 45 (5.0) 1.58 (0.66–4.61) 0.35 120 (13.3) 2.05 (1.12–4.06) 0.14 ,4 187 6 (3.2) 13 (7.0) HOUSING AND ASSOCIATED FACTORS Type of house Palm products or similar 14 1 (7.1) 1.58 (0.04–10.91) 0.49 4 (28.6) 2.94 (0.66–10.35) 0.08 Bricks/adobe 1076 50 (4.7) 129 (12.0) Type of floor inside house Sand/clay 148 11 (7.4) 1.81 (0.82–3.70) 0.09 30 (20.3) 2.07 (1.27–3.30) 0 Concrete/tiles Electricity? 942 40 (4.3) 103 (10.9) No 127 8 (6.3) 0.37 (0.57–3.19) 0.37 20 (15.8) 1.41 (0.79–2.39) 0.2 Yes Toilet 963 43 (4.5) 113 (11.7) None 211 12 (5.7) 1.30 (0.61–2.59) 0.47 35 (16.6) 1.58 (1.01–2.44) 0.035 Pit latrine/water closet 879 39 (4.4) 98 (11.2) Public waste collection? No 139 9 (6.5) 1.50 (0.63–3.21) 0.28 23 (16.6) 1.52 (0.89–2.51) 0.1 Yes 951 42 (4.4) 110 (11.6) BEHAVIOURAL FACTORS Dog ownership? Yes 401 17 (4.2) 0.76 (0.41–1.39) 0.4 53 (13.2) 1.08 (0.74–1.56) 0.71 No 783 43 (5.5) 97 (12.4) Cat ownership? Yes 391 13 (3.3) 0.55 (0.27–1.04) 0.07 46 (11.8) 0.88 (0.60–1.30) 0.58 No 793 47 (5.9) 104 (13.1) Spends evening in area? Yes 1032 54 (5.2) 1.52 (0.47–7.80) 0.62 139 (13.5) 1.76 (0.79–4.06) 0.18 No 86 3 (3.5) 7 (8.1) Walks barefoot? Always 43 5 (11.6) 11.6 (1.52–20.33) 0.006 8 (18.6) 3.09 (1.14–7.52) 0.013 Sometimes 480 30 (6.3) 3.03 (1.42–7.03) 0.002 82 (17.1) 2.79 (1.78–4.43) ,0.0001 Never 465 10 (2.2) 32 (6.9) * The 60 individuals with current infestation plus 90 with history of infestation in the previous 6 months. { At the time of this study 2.40 Brazilian Reais (R$) were the equivalent of U.S.$1.00.
Published by Maney Publishing (c) Liverpool School of Tropical Medicine 58 HEUKELBACH ET AL. DISCUSSION Although generally neglected by the publichealth sector and the scientific community, HrCLM can be a common condition in warm-climate countries, especially in resource-poor communities. There are few basic epidemiological data available and control in the endemic areas has rarely been attempted (McCrindle et al., 1996). Thus, HrCLM can be considered another neglected disease of neglected populations (Molyneux et al., 2005; Harms and Feldmeier, 2007). The present results indicate that, in a typical rural village in Brazil, HrCLM is a common parasitic skin disease in small children and male adolescents. While the infants and small children appear to be at constant high risk of acquiring HrCLM, boys aged 15–19 years are predominantly affected in the rainy season. The latter observation may be explained by genderrelated behaviour patterns that are accentuated in the rainy season. Adolescent girls generally stay at home during the day, performing domestic chores, chatting with friends, styling their hair, or grooming younger siblings, whereas their male counterparts, whatever the season, tend to linger in the streets or play soccer barefoot in public squares, where dogs and cats stroll around. The age-, gender- and season-specific trends seen in the prevalence of HrCLM in Feliz Deserto are useful indicators of where and when the larvae that cause the disease are acquired. In rural Brazil, infants and toddlers are allowed to crawl or sit on the ground inside the house or in the surrounding compound, whatever the season, sometimes without wearing nappies or underwear. Given these habits, the observation that, in children aged ,5 years, prevalence was high (and 3.7-fold higher in the rainy season than in the dry season) indicates that most transmission to humans of the larvae causing HrCLM probably occurs in domestic or, particularly, peridomestic areas. In the rainy season, animal faeces will be dispersed with each precipitation, thereby increasing the area of contamination, and the parasites that cause HrCLM are more likely to develop successfully into the mammal-infective third-stage larvae, and also survive longer, in damp soil than in dry soil (Heukelbach et al., 2003). This is why, in another endemic area of Brazil, precipitation and the incidence of HrCLM were found to be closely related (Heukelbach et al., 2003). Interestingly, those living in endemic areas are often aware that HrCLM is associated with rainfall (Dafalla et al., 1977; Heukelbach et al., 2003). Although tourists to endemic areas rarely visit resource-poor communities, they may often walk barefoot, across soil that may well be contaminated with the larvae that can cause HrCLM, on their way to and from beaches and on the beaches themselves. In France, Ansart et al. (2007) recently found tourists to be at significantly greater risk of HrCLM than migrants, expatriates or business travellers. In a group of Canadian tourists who had visited Barbados, walking TABLE 3. The results of a logistic regression analysis for factors associated with hookworm-related cutaneous larva migrans Factor Adjusted odds ratio and (95% confidence interval) P Age (years) 0.96 (0.94–0.98) ,0.001 Monthly family income ,R$200 * 1.50 (0.97–2.33) 0.07 Sand or clay floor inside house 1.99 (1.22–3.23) 0.005 Always walks barefoot 1.77 (1.12–2.80) 0.014 * At the time of this study 2.40 Brazilian Reais (R$) were the equivalent of U.S.$1.00.
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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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