Tungíase: doença negligenciada causando patologia grave

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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.
Published by Maney Publishing (c) Liverpool School of Tropical Medicine 60 HEUKELBACH ET AL. REFERENCES Albanese, G., di Cintio, R., Beneggi, M., Crippa, D., Galbiati, G., Nicoletti, A., Rossi, E. & Sala, G. (1995). Larva migrans in Italy. International Journal of Dermatology, 34, 464–465. Ansart, S., Perez, L., Vergely, O., Danis, M., Bricaire, F. & Caumes, E. (2005). Illnesses in travelers returning from the tropics: a prospective study of 622 patients. Journal of Travel Medicine, 12, 312–318. Ansart, S., Perez, L., Jaureguiberry, S., Danis, M., Bricaire, F. & Caumes, E. (2007). Spectrum of dermatoses in 165 travellers returning from the tropics with skin diseases. American Journal of Tropical Medicine and Hygiene, 76, 184–186. Blackwell, V. & Vega-Lopez, F. (2001). Cutaneous larva migrans: clinical features and management of 44 cases presenting in the returning traveller. British Journal of Dermatology, 145, 434– 437. Boggild, A. K., Yohanna, S., Keystone, J. S. & Kain, K. C. (2006). Prospective analysis of parasitic infections in Canadian travelers and immigrants. Journal of Travel Medicine, 13, 138– 144. Caumes, E. (2006). It’s time to distinguish the sign ‘creeping eruption’ from the syndrome ‘cutaneous larva migrans’. Dermatology, 213, 179– 181. Caumes, E. & Danis, M. (2004). From creeping eruption to hookworm-related cutaneous larva migrans. Lancet Infectious Diseases, 4, 659– 660. Caumes, E., Carriere, J., Guermonprez, G., Bricaire, F., Danis, M. & Gentilini, M. (1995). Dermatoses associated with travel to tropical countries: a prospective study of the diagnosis and management of 269 patients presenting to a tropical disease unit. Clinical Infectious Diseases, 20, 542–548. Dafalla, A. A., Satti, M. H. & Abdelnur, O. M. (1977). Cutaneous larva migrans in northern Kordofan- Sudan: a preliminary report. Journal of Tropical Medicine and Hygiene, 80, 63–64. Davies, H. D., Sakuls, P. & Keystone, J. S. (1993). Creeping eruption. A review of clinical presentation and management of 60 cases presenting to a tropical disease unit. Archives of Dermatology, 129, 588–591. Diaz, J. H. (2006). The epidemiology, diagnosis, management, and prevention of ectoparasitic diseases in travelers. Journal of Travel Medicine, 13, 100– 111. Freedman, D. O., Weld, L. H., Kozarsky, P. E., Fisk, T., Robins, R., von Sonnenburg, F., Keystone, J. S., Pandey, P. & Cetron, M. S. (2006). Spectrum of disease and relation to place of exposure among ill returned travelers. New England Journal of Medicine, 354, 119–130. Harms, G. & Feldmeier, H. (2007). Neglected Tropical Diseases — Referenzdokumentation Gesundheitsförderung und Krankheitsbekämpfung. Eschborn, Germany: Gesellschaft für Technische Zusammenarbeit. Heukelbach, J., Mencke, N. & Feldmeier, H. (2002). Cutaneous larva migrans and tungiasis: the challenge to control zoonotic ectoparasitoses associated with poverty. Tropical Medicine and International Health, 7, 907–910. Heukelbach, J., Wilcke, T., Meier, A., Saboia Moura, R. C. & Feldmeier, H. (2003). A longitudinal study on cutaneous larva migrans in an impoverished Brazilian township. Travel Medicine and Infectious Disease, 1, 213–218. Heukelbach, J., Wilcke, T. & Feldmeier, H. (2004). Cutaneous larva migrans (creeping eruption) in an urban slum in Brazil. International Journal of Dermatology, 43, 511–515. Heukelbach, J., Gomide, M., Araújo Jr, F., Pinto, N. S., Santana, R. D., Brito, J. R. & Feldmeier, H. (2007). Cutaneous larva migrans and tungiasis in international travelers exiting Brazil: an airport survey. Journal of Travel Medicine, 14, 374– 380. Jackson, A., Heukelbach, J., Calheiros, C. M., Soares, V. de L., Harms, G. & Feldmeier, H. (2006). A study in a community in Brazil in which cutaneous larva migrans is endemic. Clinical Infectious Diseases, 43, e13–e18. Jelinek, T., Maiwald, H., Nothdurft, H. D. & Loscher, T. (1994). Cutaneous larva migrans in travelers: synopsis of histories, symptoms, and treatment of 98 patients. Clinical Infectious Diseases, 19, 1062–1066. McCrindle, C. M., Hay, I. T., Kirkpatrick, R. D., Odendaal, J. S. & Calitz, E. M. (1996). A primary health care approach to an outbreak of cutaneous larva migrans. Journal of the South African Veterinary Association, 67, 133– 136. Molyneux, D. H., Hotez, P. J. & Fenwick, A. (2005). ‘Rapid-impact interventions’: how a policy of integrated control for Africa’s neglected tropical diseases could benefit the poor. PLoS Medicine, 2, e336. Muehlen, M., Feldmeier, H., Wilcke, T., Winter, B. & Heukelbach, J. (2006). Identifying risk factors for tungiasis and heavy infestation in a resource-poor community in northeast Brazil. Transactions of the Royal Society of Tropical Medicine and Hygiene, 100, 371–380. Romano, C., Albanese, G. & Gianni, C. (2004). Emerging imported parasitoses in Italy. European Journal of Dermatology, 14, 58–60.
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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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Table 1 Animals examined for tungia
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