Crispim Cerutti Junior

Dengue: clinical forms and risk groups in a high incidence city in the southeastern region of Brazil

INTRODUCTION The article describes the epidemiologic profile of dengue cases in Vitória, the capital of Espírito Santo, Brazil, from 2000 to 2009, aimed at identifying risk groups regarding the incidence and severity of the disease. METHODS Confirmed cases of dengue among city residents during ten years were classified as dengue fever, dengue hemorrhagic fever, dengue shock syndrome and dengue with complications, and analyzed according to sex, age, race-color and education. RESULTS The proportion of dengue cases was highest among women aged 20 to 29 years-old and similar between whites and blacks. A gradual decrease occurred in the percentage of dengue cases in the population aged 15 years-old or more, in the historical series of 10 years, and a growing increase in individuals less than 15 years-old, showing statistical significance. The fatality rate ranged from zero to 0.3% for all forms of dengue and from 0.2% to 18.2% for severe forms. CONCLUSIONS The profile of those affected by the disease in the municipality is similar to those affected in Brazil. The increasing number of cases in individuals under 15 years-old corroborates the results of recent studies in other Brazilian municipalities.

Aspectos atuais da distribuição geográfica de Anopheles (Kerteszia) cruzii Dyar & Knab, 1908 no estado do Espírito Santo, Brasil

Anopheles cruzii was registered in Espirito Santo state both in 1957 and 1968. Our study provides additional evidence of its presence, including municipalities that were non mentioned before. Anopheles captures undertaken between 1998 and 2003 pointed out a distribution restricted to the forested outskirts of the mountains in the highland area of the state. Its epidemiological role is suggested by the simultaneous presence of malaria cases in the same municipalities.

Spatial analysis of new cases of leprosy in the State of Espírito Santo, Brazil, between 2004 and 2009

INTRODUCTION Leprosy in Brazil is a public health issue, and there are many regions in the State of Espírito Santo with high endemic incidence levels of leprosy, characterizing this state as a priority for leprosy programs. The aim of this study was to determine the spatial distribution of coefficients of new cases of leprosy in the State of Espírito Santo, Brazil. METHODS We conducted a descriptive and ecologic study based on the spatial distribution of leprosy in the State of Espírito Santo between 2004 and 2009. Data were gathered from the available records of the Espírito Santo State Health Secretary. The global and local Bayesian empirical methods were used to produce an estimate of leprosy risk, smoothing the fluctuation effects of the detection coefficients. RESULTS The study resulted in a coefficient adjustment of new cases in 10 towns that changed their classification, among which, 2 went from low to medium, 4 from medium to high, 3 from high to very high, and 1 from very high to hyper-endemic. An average variation of 1.02, fluctuating between 0 and 12.39 cases/100,000 inhabitants, was found in a comparative calculation between the Local Ebest value and the average coefficient of new leprosy cases in the State of Espírito Santo. CONCLUSIONS The spatial analysis of leprosy favors the establishment of control strategies with a better cost-benefit relationship since it reveals specific and priority regions, thereby enabling the development of actions that can interfere in the transmission chain.

Factors related to severe dengue during an epidemic in Vitória, State of Espírito Santo, Brazil, 2011.

INTRODUCTION The prognosis of dengue depends on early diagnosis and treatment, which can help prevent severe forms whose characteristics were evaluated here. METHODS A cross-sectional study was conducted involving dengue cases in Vitória, State of Espírito Santo, Brazil, in 2011. RESULTS Two health regions registered 56.3% of 371 cases of severe dengue. Of these cases, 21.3% presented with dengue hemorrhagic fever. There were associations between dengue hemorrhagic fever with younger ages and a longer time before receiving care. CONCLUSIONS There was a greater involvement of dengue hemorrhagic fever in young people. Delay in care, poor urban quality and high endemicity were identified as possible risk factors for dengue severity.

Confirming Rickettsia rickettsii as the etiological agent of lethal spotted fever group rickettsiosis in human patients from Espírito Santo state, Brazil

Although Espírito Santo state is considered an endemic area for Brazilian spotted fever (BSF) with related lethal cases, it also constitutes the only state of southeastern Brazil that currently lacks a specific confirmation of the specific rickettsial agent. In an attempt to a species level confirmation of the etiological agent of fatal rickettsiosis cases in Espírito Santo state, in this study we tested human sera obtained between 2015 to 2017 by means of qPCR and subsequent conventional PCR protocols targeting gltA (citrate synthase) and ompA (190-kDA outer membrane protein) rickettsial genes. All samples were found to contain rickettsial DNA through the citrate synthase qPCR protocol. By conventional PCR, rickettsial gltA and ompA specific DNA fragments were detected in 25% (one sample) and 50% (2 samples) of the screened sera, respectively. Obtained consensuses for each gene partial sequences were 100% identical to Rickettsia rickettsii gltA and ompA genes. The present study confirms for the first time R. rickettsii as the etiological agent of a lethal spotted fever group rickettsiosis in human patients from Espírito Santo state.

Uso de substâncias psicoativas por futuros educadores

OBJECTIVE: This study aimed at tracing the profile of psychoactive substance (PAS) consumers among university students at the Federal University of Espirito Santo (UFES), Brazil. METHODS: A transversal quantitative study was carried out among Pedagogy University students, registered for the second semester of 2010 at the UFES. The study used an anonymous and closed questionnaire proposed by the National Anti-drug Secretariat (SENAD). RESULTS: Alcohol and tobacco were the most frequently used PAS in life, 62.9 and 23.8%, respectively. According to the multivariate analysis, the use of legal PAS in life was associated to religion, whereas illegal PAS were associated to gender and socioeconomic class. CONCLUSION: Universities are a privileged place for discussion, and they need further approaches to this topic, especially among future educators, since they will deal with this issue in their professional life.

Fatores associados à aquisição de Enterobactérias resistentes aos carbapenêmicos

ABSTRACT Objective: to identify possible risk factors for acquisition of Enterobacterial strains with a marker for resistance to carbapenems. Methods: exploratory case-control study performed in hospital settings. The study sample consisted of patients with biological specimens that tested positive for carbapenem-resistant Enterobacteriaceae (cases), with the disk diffusion test and Etest, and controls with biological samples testing negative for carbapenem-resistant Enterobacteriaceae. In all, 65 patients were included: 13 (20%) cases and 52 (80%) controls. Results: the microorganisms isolated were Serratia marcescens (6), Klebsiella pneumoniae (4), and Enterobacter cloacae (3). Univariate analysis revealed that length of hospitalization prior to sample collection (p=0.002) and having a surgical procedure (p=0.006) were statistically significant. In the multivariable logistic regression model, both were still significant, with odds ratios of 0.93 (p = 0.009; 95% CI: 0.89 to 0.98) for length of hospitalization prior to sample collection, and 9.28 (p = 0.05; 95% CI: 1.01 to 85.14) for having a surgical procedure. Conclusion: shorter hospitalization times and increased surveillance of patients undergoing surgery could play a decisive role in reducing the spread of carbapenem-resistant microorganisms in hospital settings.Objetivo: identificar possiveis fatores de risco para a aquisicao de cepas de Enterobacterias com marcador de resistencia a carbapenem. Metodos: estudo caso-controle exploratorio realizado em instituicoes hospitalares. A amostra do estudo consistiu de pacientes com especimes biologicos positivos para Enterobacterias resistentes aos carbapenemicos (casos) por teste de difusao em disco e Etest e controles com amostras biologicas negativas para Enterobacterias resistentes aos carbapenemicos. No total, foram incluidos 65 pacientes: 13 (20%) casos e 52 (80%) controles. Resultados: os microrganismos isolados foram Serratia marcescens (6), Klebsiella pneumoniae (4) e Enterobacter cloacae (3). A analise univariada revelou que o tempo de internacao antes da coleta da amostra (p=0,002) e o procedimento cirurgico (p=0,006) foram estatisticamente significantes. No modelo de regressao logistica multivariavel, ambos foram ainda significativos, com odds ratios de 0,93 (p=0,009; IC 95%: 0,89 a 0,98) para o periodo de hospitalizacao antes da coleta da amostra e 9,28 (p=0,05; IC 95%: 1,01 a 85,14) para o procedimento cirurgico. Conclusao: tempo de internacao mais curto e maior vigilância de pacientes submetidos a cirurgia podem desempenhar um papel decisivo na reducao da disseminacao de microrganismos resistentes aos carbapenemicos em instituicoes hospitalares.

Determination of clusters and factors associated with dengue dispersion during the first epidemic related to Dengue virus serotype 4 in Vitoria, Brazil

Dengue occurrence is partially influenced by the immune status of the population. Consequently, the introduction of a new Dengue virus serotype can trigger explosive epidemics in susceptible populations. The determination of clusters in this scenario can help to identify hotspots and understand the disease dispersion regardless of the influence of the population herd immunity. The present study evaluated the pattern and factors associated with dengue dispersion during the first epidemic related to Dengue virus serotype 4 in Vitória, Espírito Santo state, Brazil. Data on 18,861 dengue cases reported in Vitória from September 2012 to June 2013 were included in the study. The analysis of spatial variation in temporal trend was performed to detect clusters that were compared by their respective relative risk, house index, population density, and income in an ecological study. Overall, 11 clusters were detected. The time trend increase of dengue incidence in the overall study population was 636%. The five clusters that showed a lower time trend increase than the overall population presented a higher incidence in the beginning of the epidemic and, compared to the six clusters with higher time trend increase, they presented higher relative risk for their inhabitants to acquire dengue infection (P-value = 0.02) and a lower income (P-value <0.01). House index and population density did not differ between the clusters. Early increase of dengue incidence and higher relative risk for acquiring dengue infection were favored in low-income areas. Preventive actions and improvement of infrastructure in low-income areas should be prioritized in order to diminish the magnitude of dengue dispersion after the introduction of a new serotype.

Ecological characterisation and infection of Anophelines (Diptera: Culicidae) of the Atlantic Forest in the southeast of Brazil over a 10 year period: has the behaviour of the autochthonous malaria vector changed?

BACKGROUND In southeastern Brazil, autochthonous cases of malaria can be found near Atlantic Forest fragments. Because the transmission cycle has not been completely clarified, the behaviour of the possible vectors in those regions must be observed. A study concerning the entomological aspects and natural infection of anophelines (Diptera: Culicidae) captured in the municipalities of the mountainous region of Espírito Santo state was performed in 2004 and 2005. Similarly, between 2014 and 2015, 12 monthly collections were performed at the same area of the study mentioned above. METHODS Center for Disease Control (CDC) light traps with CO2 were set in open areas, at the edge and inside of the forest (canopy and ground), whereas Shannon traps were set on the edge. FINDINGS A total of 1,414 anophelines were collected from 13 species. Anopheles (Kerteszia) cruzii Dyar and Knab remained the most frequently captured species in the CDC traps set in the forest canopy, as well as being the vector with the highest prevalence of Plasmodium vivax/simium infection, according to molecular polymerase chain reaction techniques. CONCLUSIONS P. vivax/simium was found only in abdomens of the mosquitoes of the subgenus Nyssorhynchus, weakening the hypothesis that this subgenus also plays a role in malaria transmission in this specific region.

Prevalência e fatores associados à infecção pelo Mycobacterium tuberculosis entre agentes comunitários de saúde no Brasil, usando-se a prova tuberculínica

Este artigo tem por objetivo determinar a prevalencia e os fatores associados a infeccao latente pelo Mycobacterium tuberculosis entre agentes comunitarios de saude (ACS), usando dois pontos de corte da prova tuberculinica 5mm e 10mm. Trata-se de estudo transversal, com dados coletados sobre sexo, idade, cicatriz de BCG, prova tuberculinica (PT) anterior, tempo que trabalha na profissao de ACS, atuar em unidade basica de saude (UBS), ter tido contato intradomiciliar com tuberculose (TB), usar alcool, ser fumante e apresentar comorbidades. Para controle de variaveis de confusao e estimativa da medida de efeito (OR), foi empregada a regressao logistica. Aplicou-se PT, com leitura apos 48-72 horas. As prevalencias foram de 57,88% e 37,3%, respectivamente, para 5mm e 10mm. Manteve-se associada a positividade para o ponto de corte de 10mm a condicao de trabalhar em UBS com Programa de Controle de Tuberculose (PCT) implementado e ja ter tido contato intradomiciliar com TB. Ja para o ponto de corte de 5mm, trabalhar em UBS com PCT e implementado. Sao necessarias acoes de conscientizacao nos municipios e fortalecimento das acoes de educacao permanente sobre a tematica.This article aimed to determine the prevalence of latent Mycobacterium tuberculosis infection and associated factors in community health workers (CHW) in Brazil, using two cutoff points for the tuberculin skin test (5mm and 10mm). This was a cross-sectional study with data on gender, age, BCG scar, working in a primary care unit (PCU), having a household contact with tuberculosis (TB), alcohol consumption, previous tuberculin skin test (TST), smoking, time on the job as CHW, and comorbidities. Logistic regression was used to estimate odds ratios (OR) and to control for confounding. TST was applied and read after 48-72 hours. Prevalence rates were 57.88% and 37.3%, respectively, for the 5mm and 10mm TST cutoffs. Variables that remained associated with positive TST using the 10mm cutoff were working in a primary care unit that had implemented a Tuberculosis Control Program (TCP) and history of household contact with TB. Variables associated with the 5mm cutoff were working in a primary care unit with a TCP. Necessary actions at the local level include awareness-raising and strengthening of continuing education.