Tungíase: doença negligenciada causando patologia grave

Published by Maney Publishing (c) Liverpool School of Tropical Medicine
barefoot to and on the beach were found to
be significant risk factors for acquiring
HrCLM (Tremblay et al., 2000). In a recent
study on international travellers who had
had vacations in north–eastern Brazil, all of
those who had acquired HrCLM during
their stay had visited beaches (Heukelbach
et al., 2007). Thus, walking barefoot
appears to be a universal risk factor, not
only for the residents in endemic areas but
also for visitors.
Besides behavioural characteristics, several
socio–economic variables were found to
be risk factors for current/recent HrCLM in
the present study. These were family
income, lack of a toilet on the compound,
and a floor consisting of sand or clay.
Theoretically, in dwellings without a solid
floor, transmission may occur inside, if
animals defecate in the house or carry faecal
material, attached to their paws, from outside
into the interior. In practice, however,
transmission within houses is probably
unlikely, and the absence of a solid floor
— together with a lack of basic sanitation
and a low family income — simply indicates
a household of relatively low economic
status.
Although dog or cat ownership were not
identified as risk factors in Feliz Deserto,
most dogs and cats in the community are
free to roam where they want and this
presumably means that owners are no more
likely to come into contact with dog or cat
faeces than those who do not own a dog or
cat themselves.
The present results have to be treated with
a little caution because they are based only on
a clinical diagnosis of current HrCLM and
self-diagnosis of recent HrCLM, and other
conditions that may cause creeping eruptions,
such as scabies, gnathostomiasis, loiasis
or dracunculiasis, may be mistaken for
HrCLM (Caumes, 2006). The entire body of
each subject was specifically checked for (and
found free of) the typical clinical signs of
scabies, however, and no gnathostomiasis,
loiasis or dracunculiasis has ever been
reported in the study area.
CUTANEOUS LARVA MIGRANS IN BRAZIL 59
The present data indicate that the most
effective strategy for controlling HrCLM in
Feliz Deserto (and probably many other
rural communities in north–eastern Brazil)
may be health education that is targetted at
mothers and the elder girls who take care of
their younger siblings. If infants, toddlers
and small children were not allowed to play
or sit on the ground outside their houses,
most cases of HrCLM in the community
could be avoided. Health education will
probably fail to reduce the incidence in the
second high-risk group: male adolescents.
Most families in Feliz Deserto are too poor to
afford shoes for all their children and, in any
case, children with shoes still often walk and
play soccer barefoot. In theory, the incidence
of HrCLM could be greatly reduced by the
regular treatment of all dogs and cats with
anthelminthic drugs, but this is a difficult
endeavour given the costs and the large
number of stray animals to be found in
Feliz Deserto and many other resource-poor
communities. It may be much more feasible
and effective to fence around public places
used for soccer, to prevent the faecal contamination
of the playing area. General
improvements in houses and compounds,
though cost-intensive, may also be beneficial
and help protect children from HrCLM as
well as other parasitic diseases, such as
tungiasis (Muehlen et al., 2006).
ACKNOWLEDGEMENTS. The authors thank
the study community, the local healthcare
workers, and E. de Barros Campelo Jr,
A. Ferreira da Silva Filho, C. Calheiros,
V. Soares and A. Dacal. This study was
financially supported in part, by a grant
from the Deutsche Akademie für Luft- und
Reisemedizin. A.J. received a travel grant
from the Deutsche Akademischer Austauschdienst
(DAAD)–Coordenação de Aperfeiçoamento de
Pessoal de Nível Superior (CAPES) PROBRAL
programme for Brazilian–German academic
exchange. L.A. received a PhD scholarship
from CAPES. The data presented here form
part of a medical thesis by A.J.