RESUMO
Este estudo avaliou as mudanças ambientais da paisagem urbana de um município com alta incidência de malária na Amazônia brasileira (Mâncio Lima, Acre) e sua relação com a doença, com o objetivo de prover evidências de que a transmissão do Plasmódio é causada pelo modo como os seres humanos interagem com o meio-ambiente. Foram efetuados três estudos populacionais consecutivos, entre 2012 e 2013, com 1260 indivíduos, com identificação do plasmódio por microscopia e técnicas moleculares. Casos de malária foram analisados mediante um questionário clinico. O estudo entomológico envolveu 8 inquéritos transversais com coleta de formas imaturas em 90 corpos dágua, bem como avaliação espacial desses dados. Os resultados mostraram que a transmissão de malária na área deveu-se em grande parte a criação de tanques de piscicultura, que elevaram em cerca de 10 vezes a produtividade de imaturos de Anopheles darlingi, e à grande mobilidade da população, que se desloca para áreas de maior transmissão (como área ribeirinha e rural) e retorna infectada para a área urbana. Foram identificados casos de portadores assintomáticos do Plasmódio, embora em pequena quantidade. Os fatores associados a ausência de sintomas (infecção assintomática) foram o sexo e o tempo da última malária. Em pacientes sintomáticos, a frequência dos sintomas se relacionou com idade, número de malárias previas e parasitemia. A concentração geográfica dos casos deveu-se em parte a características socioeconômicas agregadas no espaço, em conjunto com fatores ambientais como presença do vetor, visto que o uso infrequente de mosquiteiro associouse com a incidência maior de malária.
This study evaluated the environmental changes of the urban landscape of a municipality with a high incidence of malaria in the Brazilian Amazon (Mâncio Lima, Acre) and its relation with the disease, in order to provide evidence that the transmission of Plasmodium is caused by the way humans interact with the environment. Three consecutive population studies were carried out between 2012 and 2013, with 1260 individuals, with plasmodium identification by microscopy and molecular techniques. Malaria cases were analyzed using a clinical questionnaire. The entomological study involved 8 cross-sectional surveys with collection of immature forms in 90 bodies of water, as well as spatial evaluation of these data. The results showed that the transmission of malaria in the area was largely due to the creation of fish tanks, which increased the immature productivity of Anopheles darlingi by around 10 times, and the great mobility of the population, which moves to areas of greater transmission (as riverside and rural area) and returns infected to the urban area. Cases of asymptomatic Plasmodium carriers have been identified, albeit in small numbers. Factors associated with absence of symptoms (asymptomatic infection) were the sex and time of the last malaria. In symptomatic patients, the frequency of symptoms was related to age, number of previous malaria and parasitemia. The geographic concentration of the cases was due in part to aggregate socioeconomic characteristics in space, together with environmental factors such as vector presence, since the infrequent use of mosquito nets was associated with a higher incidence of malaria.
Assuntos
Masculino , Feminino , Humanos , Malária , Lagoas , Pesqueiros , Plasmodium , Parasitemia , Alteração AmbientalRESUMO
The aim of this study was to investigate the plasma levels of the CCL3 and CCL4 chemokines in patients with the cardiac and digestive clinical forms of chronic Chagas disease and in cardiac patients with and without left ventricular systolic dysfunction (LVSD). Plasma samples from 75 patients were evaluated by enzyme-linked immunosorbent assay (ELISA) to confirm infection by T. cruzi. Plasma levels of the CCL3 and CCL4 chemokines were measured using Milliplex® MAP assay (Millipore). There were no significant differences in the levels of CCL3 and CCL4 between patients with the digestive and cardiac clinical forms of Chagas disease. Moreover, no significant differences were found between patients without LVSD and those with LVSD. Higher CCL3 and CCL4 plasma levels were found in patients with LVSD compared to those with the digestive form of the disease. The CCL3 and CCL4 chemokines might not be involved in differential susceptibility to the digestive and cardiac clinical forms of chronic Chagas disease, and it seems they do not influence the development of LVSD.
Assuntos
Doença de Chagas/sangue , Quimiocina CCL3/sangue , Quimiocina CCL4/sangue , Gastroenteropatias/sangue , Trypanosoma cruzi , Disfunção Ventricular Esquerda/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Malaria, a parasitic disease, is a serious public health problem. In Brazil, the majority of cases are found in the Amazon. The clinical manifestations of malaria depend on several factors and they may be related to the development of anemia. This study evaluated the prevalence of anemia in malaria cases and its associated factors. The study was conducted in Mâncio Lima (Acre, Brazil). Participants were chosen through passive detection of malaria cases in the municipal health services. They were interviewed and blood samples analyzed for Plasmodium detection and for hemoglobin measurement. SPSS 13.0, software was applied for statistical analysis. One hundred and twenty patients with malaria were studied, of which 58.3% male and 41.7% female. There was a 25% prevalence of anemia, mainly among the women, and in those presenting symptoms for more than four days as well as headaches. The prevalence of anemia and its associated factors in these malaria patients may be connected, not only to the infection, but also to previous or overlapping diseases
Assuntos
Malária , Doenças Parasitárias , AnemiaRESUMO
The clinical manifestations of chronic Chagas disease include the cardiac form of the disease and the digestive form. Not all the factors that act in the variable clinical course of this disease are known. This study investigated whether the CCR5Δ32 (rs333) and CCR5 59029 A/G (promoter region--rs1799987) polymorphisms of the CCR5 gene are associated with different clinical forms of chronic Chagas disease and with the severity of left ventricular systolic dysfunction in patients with chronic Chagas heart disease (CCHD). The antibodies anti-T. cruzi were identified by ELISA. PCR and PCR-RFLP were used to identify the CCR5Δ32 and CCR5 59029 A/G polymorphisms. The chi-square test was used to compare variables between groups. There was a higher frequency of the AA genotype in patients with CCHD compared with patients with the digestive form of the disease and the control group. The results also showed a high frequency of the AG genotype in patients with the digestive form of the disease compared to the other groups. The results of this study show that the CCR5Δ32 polymorphism does not seem to influence the different clinical manifestations of Chagas disease but there is involvement of the CCR5 59029 A/G polymorphism in susceptibility to the different forms of chronic Chagas disease. Besides, these polymorphisms do not influence left ventricular systolic dysfunction in patients with CCHD.
Assuntos
Cardiomiopatia Chagásica/genética , Doença de Chagas/genética , Doenças do Sistema Digestório/genética , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único/genética , Receptores CCR5/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Cardiomiopatia Chagásica/fisiopatologia , Doença de Chagas/fisiopatologia , Doença Crônica , Feminino , Frequência do Gene/genética , Genes Dominantes , Ventrículos do Coração/fisiopatologia , Humanos , Padrões de Herança/genética , Masculino , Pessoa de Meia-Idade , Modelos Genéticos , SístoleRESUMO
BACKGROUND: Several studies have recently demonstrated that the immune responses against malaria is governed by different factors, including the genetic components of the host. The IL-4 gene appears to be a strong candidate factor because of its role in the regulation of the Th2 response. The present study investigated the role of IL-4 polymorphisms in the development of IgG antibodies against PvAMA-1 and the IL-4 levels in individuals infected with Plasmodium vivax in a malaria endemic area in the Brazilian Amazon. METHODS: The study sample included 83 patients who were diagnosed with P. vivax infection using thick smear and confirmed by nested-PCR. The IL-4 -590C>T and IL-4 -33C>T polymorphisms were genotyped by PCR-RFLP, and the intron 3 VNTR was genotyped by PCR. A standardised ELISA protocol was used to measure the total IgG against PvAMA-1. The cytokine/chemokine levels were measured using a Milliplex multiplex assay (Millipore). All of the subjects were genotyped with 48 ancestry informative markers to determine the proportions of African, European and Amerindian ancestry using STRUCTURE software. RESULTS: Of the 83 patients, 60 (73%) produced IgG antibodies against PvAMA-1. A significant decrease in the percentage of respondents was observed among the primo-infected individuals. No significant differences were observed in the frequencies of genotypes and haplotypes among individuals who were positive or negative for IgG antibodies against PvAMA-1. Furthermore, no significant correlation was observed between the IL-4 polymorphisms, antibody levels, IL-4 levels, and parasitemia. CONCLUSIONS: This study indicated that the polymorphisms identified in the IL-4 gene are not likely to play a role in the regulation of the antibody response against PvAMA-1 and IL-4 production in vivax malaria.
Assuntos
Antígenos de Protozoários/administração & dosagem , Doenças Endêmicas , Interleucina-4/genética , Vacinas Antimaláricas/administração & dosagem , Malária Vivax/genética , Proteínas de Membrana/administração & dosagem , Plasmodium vivax/imunologia , Polimorfismo Genético , Proteínas de Protozoários/administração & dosagem , Adolescente , Adulto , Idoso , Anticorpos Antiprotozoários/imunologia , Antígenos de Protozoários/imunologia , Brasil/epidemiologia , Feminino , Humanos , Imunoglobulina G/imunologia , Interleucina-4/imunologia , Vacinas Antimaláricas/imunologia , Malária Vivax/epidemiologia , Malária Vivax/imunologia , Malária Vivax/prevenção & controle , Masculino , Proteínas de Membrana/imunologia , Pessoa de Meia-Idade , Proteínas de Protozoários/imunologia , Células Th2/imunologiaRESUMO
Avaliar o perfil sorológico para toxoplasmose emamostragem de gestantes no pré-natal da região NoroestePaulista. Metodologia: Estudo retrospectivo e descritivoexploratório com abordagem quantitativa e qualitativa,realizado no período entre abril e agosto de 2013. Foramanalisados 186 prontuários de gestantes. Os dados dosprontuários foram coletados através de questionáriopadronizado pela equipe do estudo. Resultados: A média deidade das pacientes foi de 33 anos (dp ± 4,33). O pré-natal foiiniciado no primeiro trimestre por 87,63% das gestantes e93% eram primigestas. Enzyme Linked Fluorescent Assay foi atécnica laboratorial empregada na sorologia paratoxoplasmose. Foi identificada imunidade para o Toxoplasmagondii em 25,27% das gestantes, 73,65% tinham sorologianegativa e 1,08% tiveram sorologia positiva para os anticorposda classe IgM. No grupo sororreagente, 47 gestantes forampositivas somente para dosagem de anticorpos da classe IgG.Uma gestante teve sorologia positiva para os anticorpos dasclasses IgM (1,04) e IgG (700,0 UI/ml). A elevada avidez dosanticorpos IgG de 89% indica infecção há mais de três meses.Conclusão: A soronegatividade descrita na maioria dosprontuários estudados alerta sobre a importância daconscientização dessas mulheres para os riscos de contatocom o protozoário durante a gestação e reforça a necessidadedos exames diagnósticos para a toxoplasmose. Contudo, osresultados sororreagentes não garantem proteção total duranteo período gestacional, em decorrência da variabilidade decepas e virulência do Toxoplasma gondii...
The aim of this study was to evaluate the serologicalprofile for toxoplasmosis in pregnant women of the Northwestregion of São Paulo. Material and Methods: This was anexploratory descriptive study with quantitative and qualitativeapproaches, carried out between April and August 2013. Weanalyzed 186 medical records of pregnant women, which werecollected using a standardized questionnaire by the study team.Results: The mean age of the patients was 33 years (SD ±4.33). The prenatal care was initiated in the first quarter by87.63% of pregnant women and 93% were primigravidae. Thelaboratory technique used in the serology for toxoplasmosiswas the Enzyme Linked Fluorescent Assay. Immunity toToxoplasma gondii was identified in 25.27% of pregnant women,73.65% had negative serology and 1.08% had positive serologyfor IgM antibodies. Of the seropositive women, 47 were positiveonly for IgG antibodies. One pregnant woman was seropositivefor IgM (1.04) and IgG (700.0 IU/ml). The elevated IgG avidityof 89% indicates infection for more than three months.Conclusion: The seronegative results described in most of themedical records alert about the importance of awareness ofthese women to the risks of contact with the protozoan duringpregnancy. These findings reinforce the need for diagnostictests for toxoplasmosis. However, seropositive results do notguarantee full protection during pregnancy due to thevariability of strains and virulence of Toxoplasma gondii...
Assuntos
Humanos , Feminino , Gravidez , Gestantes , Cuidado Pré-Natal , Toxoplasmose , SorologiaRESUMO
São apresentadas neste artigo a distribuição da leishmaniose tegumentar (LT) e descrição das populações de flebotomíneos em Acrelândia, Acre. Os dados epidemiológicos foram obtidos a partir de fichas de notificação de casos ocorridos entre 2001 e 2004, e os dados entomológicos são provenientes de capturas com armadilhas luminosas efetuadas entre 2004 e 2005 na zona rural de Acrelândia. Ocorreram 82 novos casos de LT, com idade entre 2 e 69 anos, sendo 75,6 por cento em homens e 83,9 por cento na zona rural. Predominou a LT com lesões únicas (78 por cento). A microscopia direta da lesão, intradermorreação de Montenegro e biópsia apresentaram positividade de 100 por cento, 98 por cento e 79,5 por cento, respectivamente. A resposta ao tratamento farmacológico foi bem sucedida em 71,6 por cento dos casos; a falência terapêutica foi maior em pacientes com diagnóstico exclusivamente clínico (41,2 por cento) e nos que receberam dose diária inadequada de antimonial pentavalente (64,3 por cento). Foram coletados 40 espécimes de flebotomíneos em propriedades rurais com casos de LT (3 gêneros, 14 espécies), sendo 3 espécies conhecidas como vetoras ou possíveis vetoras de Leishmania: Nyssomyia antunesi predominou no peridomicílio (59,1 por cento) e em margens de matas; Nyssomyia whitmani foi freqüente no peridomicílio (15 por cento) e a única espécie encontrada no intradomicílio, e Trichophoromyia ubiquitalis foi capturada no peridomicílio. O uso de dados epidemiológicos existentes no serviço de saúde de Acrelândia, embora com várias limitações, permitiu avaliar a eficácia do diagnóstico e o tratamento empregados no município, enquanto os dados entomológicos coletados podem orientar estudos mais amplos visando identificar os vetores e espécies circulantes na região.
Assuntos
Humanos , Leishmaniose Tegumentar Difusa/epidemiologia , Psychodidae , Brasil/epidemiologiaRESUMO
The aim of this study was to assess the prevalence pattern of mixed-Plasmodium falciparum malaria infections in Brazil by molecular diagnosis and to address its clinically important features. DNA was extracted from 115 thick blood film P. falciparum human blood positive samples using the phenol-chloroform method, followed by a semi-nested PCR protocol with species-specific primers. Seventy-three percent of P. falciparum single infections and 26.95% of mixed infections were found. Amongst mixed infections, the majority was double infection (96.77%). Our results suggest that the prevalence of one species over the other can be important on weakening P. falciparum malaria clinical symptoms. We confirm that P. falciparum co-infections frequently occur in Brazilian malaria endemic areas, with underestimated diagnosis. The results point to the need of improving microscopy or changing for another accurate diagnosis technique to differentiate among human malaria species, as this is essential to choose the best treatment and control measure for malaria. More investigations are necessary in order to clarify the role of mixed-infections in the severity of P. falciparum disease.
Assuntos
Malária/fisiopatologia , Malária/parasitologia , Plasmodium/classificação , Plasmodium/isolamento & purificação , Adolescente , Adulto , Animais , Sangue/parasitologia , Brasil/epidemiologia , Primers do DNA/genética , DNA de Protozoário/genética , DNA de Protozoário/isolamento & purificação , Feminino , Humanos , Malária/epidemiologia , Masculino , Pessoa de Meia-Idade , Plasmodium/genética , Reação em Cadeia da Polimerase/métodosRESUMO
For the molecular diagnosis of Plasmodium vivax variants (VK210, VK247, and P. vivax-like) using DNA amplification procedures in the laboratory, the choice of rapid and inexpensive identification products of the 3 different genotypes is an important prerequisite. We report here the standardization of a new polymerase chain reaction/restriction fragment length polymorphism technique to identify the 3 described P. vivax circumsporozoite protein (CSP) variants using amplification of the central immunodominant region of the CSP gene of this protozoan. The simplicity, specificity, and sensitivity of the system described here is important to determine the prevalence and the distribution of infection with these P. vivax genotypes in endemic and nonendemic malaria areas, enabling a better understanding of their phylogeny.