Antonio Rafael da Silva

Leishmaniose visceral no estado do Maranhão, Brasil: a evolução de uma epidemia

Os autores fazem um breve relato da evolucao historica da leishmaniose visceral no Estado do Maranhao, Brasil, avaliando as possiveis causas da expansao da referida doenca no Estado, assim como as medidas de controle adotadas pelo Ministerio da Saude objetivando a diminuicao da incidencia da mesma.

Phlebotominae (Diptera: Psychodidae) de Lagoas, município de Buriticupu, Amazônia Maranhense. I - Riqueza e abundância relativa das espécies em área de colonização recente

In this study the diversity of the species and relative abundance of the sand flies in the Amazonian community of Lagoas, in Buriticupu, Maranhao State, was determined. The study consisted of adult sandflies captured with CD light-traps, Shannon-trap and manual aspiration tube, between 18 PM and 6 AM, once a month, from December/95 to January/97, in a forest fragment and in the domestic environment (peri and intra). In all, 9,393 specimens were captured (4,302 males and 5,140 females) distributed among 38 species (1 Brumptomyia and 37 Lutzomyia). The diversity and abundance of species was higher in the forest, followed by the peri and intra. The predominance in the wild ambient is a consequence of the potentialities found in the remaining fragments of the forest which have survived the lumber yard exploitation and agricultural activities. In the forest environment Lutzomyia whitmani (64.9%), L. migonei (27%) and L. serrana (3.6%) were the most frequent species. In the peri and intra domicile L. evandroi predominated (55.4% and 97.9%). The species, L. whitmani (33.4%) and L. migonei (6.4%), were important in the peri domicile. The peridomestic habit of 7.7% of the sand flies showed the greatest epidemiologic importance, due to the existence of patients with leishmaniasis ulcers, who believe they were infected near their habitations.

Aspectos epidemiológicos determinantes na manutenção da leishmaniose visceral no Estado do Maranhão - Brasil

The authors analysed the visceral leishmaniasis (VL) aspects in the State of Maranhao-Brazil, from 1982 to 1993. The disease happens to occur predominantly in Sao Luis, Island (MA) and during the epidemic period, town of Sao Luis was pointed out as the main endemic area. The greatest frequency of cases occured in 1993, despite the use of insecticid and dogs control. There was predominance of age between 0 to 4 year old population with 58.04% of cases. Neither the human disease nor the rainfall index had significant seasonal variation. However they were correlated moderately, with high number of cases after the period of great preciptation of rain. After this study, the data obtained will allow a better control of the disease, despite some factors such as: the urbanization, localization and dynamic of transmission in endemic areas in the Maranhao State.

Ecoepidemiologia da leishmaniose tegumentar no Município de Buriticupu, Amazônia do Maranhão, Brasil, 1996 a 1998

This study presents the distribution of leishmaniasis in the town of Buriticupu, Maranhao, Brazil, by month, season, occupation, gender, and age from 1996 to 1998. These data were compared with those on sand flies obtained by other authors during the same period. The disease affected all age groups, in the following order: 0-5 years (4.1%), 6-10 (7.1%), 11-15 (13.6%), 16-21 (20.8%), 22-30 (21.1%), and > 30 (33.3%). The disease predominantly affected males (70.1%) and agricultural workers (52.5%), followed by students (17.7%), and domestic workers (16.0%). Like the sand fly vector, the disease was distributed throughout the year, but the greatest concentration of cases was recorded in the dry season (58.5%), while sand flies presented bimodal peaks in the first two years and occurred more frequently in the rainy season in 1998. The disease continues to present the same characteristics as in the past, but there was a proportional increase in cases among children and females, suggesting transmission in the anthropic environment.

Leishmaniose visceral (calazar) na Ilha de São Luís, Maranhão, Brasil: evolução e perspectivas

Visceral leishmaniasis (kala-azar) was definitively an important disease of the state of Maranhao-Brasil since 1982. Since of then, many authors have been working with this topic in spite of reports. Nevertheless, the aspects of diagnosis, treatment an control of cure went through still hard worried the authors have been studing the disease, that came at Sao Luis Island since of the desestabilization of the ecotops of Lutzomya longipalpis, most important sandflies bites. After 1993 the constatation of cases with bad response to pentavalent antimonial (Glucantime®) comes to add the other worries. This actual trial accost the disease and conclude about an existence of failures to Glucantime® being important to have much vigilance in the diagnosis, treatment and control of cure of the patients.

Estado atual da leishmaniose cutânea difusa (LCD) no Estado do Maranhão: II. aspectos epidemiológicos, clínico-evolutivos

Os Autores fazem um estudo retrospectivo e prospectivo de 6 pacientes portadores de leishmaniose cutânea difusa, observados no Estado do Maranhao a partir de 1974. Os casos abordados sao oriundos de diversas regioes do estado, observando-se em todos eles o envolvimento da leishmania (Leishmania) amazonensis, sendo que 5 (84%) dos pacientes apresentaram inicio de doenca na 1a decada de vida. Em todos os pacientes envolvidos no estudo, houve relato de lesao inicial nodular unica, que, posteriormente, em periodo variavel de tempo, disseminou-se adquirindo outros aspectos. Evolutivamente apresentaram multiplas lesoes nodulares e ulceradas, intradermorreacao de Montenegro(-) e refratariedade aos esquemas terapeuticos utilizados ate ao presente momento.

Situação epidemiológica da leishmaniose visceral, na Ilha de São Luís, Estado do Maranhão

The results from a field study on autochthonous visceral leishmaniasis on the island of Sao Luis are presented. This study started in 2004 and finished in 2006 and had the aim of ascertaining the determinant epidemiological and clinical characteristics of this endemic disease. Two hundred ninety nine autochthonous cases were analyzed, of which 83.6% were children younger than 9 years old and 54.1% were male. The disease occurred in all months of the year, with a peak in June. The coefficient of incidence decreased from 46.1 to 35.2 cases per 100,000 inhabitants over the years studied. The diagnosis was confirmed by laboratory tests in 93.3% of the cases. The treatment of choice was based on N-methylglucamine, with a cure rate of 96.1%. The mean lethality rate was 3.7%. Because of the absence of systematic control actions, the authors propose the creation of a specific program to be developed by the municipalities under the coordination of the State Department of Health.

Expansão espacial da leishmaniose visceral americana em São Luis, Maranhão, Brasil

The space occupation and the expansion of American visceral leishmaniasis (AVL) were described in the municipality of São Luis, Maranhão, Northeast Brazil. AVL medical notes from the Fundação Nacional de Saúde as well as official documents about the space occupation were analyzed from September 1982 to December 1996. AVL cases were more likely to occur in recently settled suburbs and tended to follow the same spatial pattern observed for land occupations secondary to migratory fluxes.

Distribuição e infecção de triatomíneos por Trypanosoma do tipo cruzi na Ilha de São Luís-Maranhão

Data is presented on the species and infection rate of reduviid bugs collected in Sao Luis island, Maranhao State. The following species have been collected: Rhodnius pictipes, R. neglectus, R. nasutus, R. robustus, Triatoma rubrofasciata, Panstrongylus lignarus and P. geniculatus. The infection rate with T. cruzi-like trypanosomes was 19.7% of the total bugs collected. R. pictipes shows homogeneous distribution in the island and an infection rate of 38.8%.

Anopheles (Culicidae, Anophelinae) e a malária em Buriticupu-Santa Luzia, Pré-Amazônia maranhense

Female anophelines were captured in human baits in the region of Buriticupu, Santa Luzia, Maranhao State. Seven species belonging the subgenus Nyssorhyncus were found. Anopheles (N.) darlingi, the principal vector of human malaria, was the most abundant (53.1%) followed by A. (N.) evansae (21.0%), A. (N.) triannulatus (17.4%) e A. (N.) nuneztovari (4.8%). The others, A. (N.) argyritarsis, A. (N.) oswaldoi and A. (N.) rangeli, were less frequently found, representing only 3.7% of the total sample. The anophelines were most frequent in both the extra (51.7%) and peridomiciles (45.7%). The intradomicile was visited by some specimens of the A. (N.) darlingi and A. (N.) evansae (active in both the rain and dry seasons, especially in the former, when the malaria reached high leves of transmission.