Eloisa da Graça do Rosario Gonçalves

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.

Identification of Vibrio spp bacteria on skin lesions of fisherman in the county of Raposa-MA

The study was undertaken aiming at identifying bacteria from the county of Raposa in the state of Maranhao. The clinical sample was collected by using a swab and held in a Cary-Blair transport medium. Enrichment in alkaline peptone water, isolation in TCBS selective indicator medium and biochemical coding of species were used for laboratory processing. Fifty fisherman with age varying from 12-65 years took part on the study. Vibrio bacteria isolated in 21 subjects had been identified. There was a predominance of V. alginolyticus (66.6%) followed by V. parahaemolyticus (42.8%), and V. cholerae non-O1 (9.5%). Lesions predominated on lower limbs, presenting hyperhemia, swelling, secretion, and pain. Some species of gram-negative bacteria of the Serratia, Proteus, Escherichia, Citrobacter, Enterobacter associated to the vibrios were isolated, as well as other non-fermenting bacteria (30.9) and gram-positive bacteria of the genos Staphylococcus.

Aspectos epidemiológicos de um foco de malária no município de São Luis, MA

The study was developed in the neighborhood of Residencial Paraiso, Sao Luis, Maranhao, Brazil, from 1999 to 2001. The aim was to analyze the epidemiological aspects of malaria. The location is receptive and vulnerable to malaria. There were 129 cases. Men from 20 to 29 years of age were most involved. Plasmodium vivax was the agent of all cases and Anopheles aquasalis was the vector. There was no evidence of transmission occurring outside of the houses.

Paracoccidioidomycosis in the state of Maranhão, Brazil: geographical and clinical aspects

INTRODUCTION The study aimed to show the situation of paracoccidioidomycosis in the state of Maranhão, Brazil. METHODS This study is a descriptive case series developed in two stages. First, a survey of cases originating from the state of Maranhão at the Instituto de Doenças Tropicais Natan Portela, Piauí (IDTNP) from 1997 to 2007, and second, the clinical description of 29 cases diagnosed in the Centro de Referências em Doenças Infecciosas e Parasitárias, Maranhão (CREDIP) from 2004 to 2010. RESULTS Two hundred and sixteen cases have been cataloged at the IDTNP. West, east, and central regions of the state of Maranhão recorded 90.3% of cases proving to be important areas for study. The western region, with a prevalence of 10.8/100,000 inhabitants, has a significantly higher proportion of cases than the northern, southern, and eastern regions (p < 0.05). The occurrence was higher in men with 89.3% of cases, and the male-to-female ratio was 8.4:1. The majority of patients were older than 20 years, lived in rural areas, and had farming or soil management as main occupation (73.8%). At CREDIP, 29 cases were diagnosed, of which 26 (89.6%) had multifocal manifestations. Mucous tissues were involved more (75.8%) frequently, followed by lymph nodes, skin, and lungs with 65.5%, 39% and 37.9 %, respectively. The diagnosis was made by combining direct examination, culture, and histopathology. CONCLUSIONS The study shows the geographical distribution and the epidemiological and clinical aspects of paracoccidioidomycosis, revealing the significance of the disease to the state of Maranhão.

Leprosy in Buriticupu, State of Maranhão: active search for cases in the adult population

INTRODUCTION This study aimed to analyze the leprosy situation, focusing on the adult population of the town of Buriticupu, State of Maranhão. METHODS An active search was conducted to identify new cases from 2005 to 2007. All patients with injuries suggestive of leprosy were submitted to cutaneous bacilloscopy and biopsies were performed when defining the clinical presentation was difficulty. RESULTS 15,409 individuals participated in the study and 62 were diagnosed with leprosy which represents a detection coefficient of 40.23/10,000. Bacilloscopy showed positive results in six patients. The predominant clinical form was tuberculoid, 31 cases, followed by the indeterminate form (20 cases), the dimorphous form (10 cases) and the lepromatous form (1 case). The study also identified other skin diseases, including pityriasis versicolor, scabies, mycosis, vitiligo and carcinoma. CONCLUSIONS The high detection coefficient defines the town of Buriticupu, MA, as hyperendemic for leprosy. Active cases search is an important method for disease control.

Plasmodium vivax malaria: related factors to severity in the State of Maranhão, Brazil

INTRODUCTION Malaria caused by Plasmodium vivax species has shown signs of severity, recorded with increasing frequency in the medical literature. This study aimed to characterize the signs of severe malaria by Plasmodium vivax in the State of Maranhão, Brazil. METHODS A descriptive cohort study of patients assisted in the field and a historical and concurrent study of a series of cases among hospitalized patients were undertaken to identify the clinical and laboratory signs of severity. RESULTS A total of 153 patients were included in the study, 13 of whom were hospitalized. Males made up the majority, numbering 103 (67.3%). The age of the patients ranged from 10 to 70 years, 92.2% were natives of the State of Maranhão, and 65% of the patients had had malaria before. The average time elapsed between symptom onset and diagnosis among outpatients was three days, while among hospitalized patients this average reached 15.5 days, a statistically significant difference (p=0.001). The parasitemia ranged from 500 to 10,000 parasites/µl in 92.8% of cases. The clinical and laboratory manifestations of severity were vomiting and diarrhea, jaundice, drowsiness, mental confusion, seizures, loss of consciousness, agitation, bleeding, pale skin, coughing and dyspnea, thrombocytopenia, anemia, elevation of nitrogenous compounds, and elevated transaminases and bilirubin. CONCLUSIONS The monitoring of malaria patients with Plasmodium vivax showed the possibility of aggravation, the intensity of which varied in different circumstances, especially the interval time between falling ill and diagnostic confirmation.

Aspectos da transmissão focal de malária na Ilha de São Luis, Maranhão

The aim of the study was to typify a malaria focus in Guarapiranga, in the district of Sao Jose de Ribamar, MA. A questionnaire regarding identification, economic situation, habits of the residents and characteristic of the residences was applied to each family. Fifty four families were visited and 207 inhabitants were interviewed (113 men and 95 women); 95 individuals were aged between 5 and 24 years old. Agriculture and fishing are the basis of the local economy; 64.8% of the families earn less than one living wage. The majority of the residences are constructed of mud walls, straw roofs, a beaten earth floor, with no basic sanitation. 62.2% of the residences are partially protected against the entry of mosquitoes. Water for domestic use comes from natural waterholes in 78.8% of the residences. Rubbish is left in the open air in 53.7% of the residences. 106 cases of malaria by Plasmodium vivax were notified. Anopheles (N) aquasalis was the probable vector and treatment with chloroquine associated with primaquine showed good results.

Hanseníase no município de Buriticupu, Estado do Maranhão: busca ativa na população estudantil

This study had the aim of determining the coefficient of leprosy detection among the student population of the municipality of Buriticupu, State of Maranhao. An active case search method was used, covering a population of 14,653 students, in 53 schools within the municipal network. Clinical examination gave rise to a leprosy diagnosis for 20 students, which represents a detection coefficient of 13.6/10,000 students. Cutaneous lymph bacilloscopy was performed on all cases, and it was positive in two samples. The predominant clinical form was the indeterminate form, with 12 cases (60%), followed by the tuberculoid form, with five (25%) and the dimorphous form with two (10%). Biopsies were then taken from the lesions of 11 patients, and histopathological analysis showed common findings of hyperkeratosis, mononuclear inflammatory infiltrate and ectasia of vessels and isolated arrector pili muscles. The study also enabled identification of some other infectious skin diseases: pityriasis versicolor in 793, scabies in 361 and dermatophytosis in 119. A variety of nonspecific conditions were also detected, such as scars, nevi and excoriation, in 1,020 students.

Associação de Vibrio cholerae com o zooplâncton de águas estuárias da Baía de São Marcos/São Luis - MA, Brasil

This study was carried from October 1997 to October 1998 with the purpose of investigating the link between the species Vibrio cholerae and zooplankton in the estuaries of rivers Anil and Bacanga in Sao Luis, Maranhao. Research of viable but non culturable forms of Vibrio cholerae O1, and analyze the correlation between pH values, salinity and water temperature with the presence of bacteria in zooplankton samples. The traditional method of cultivation and fluorescent antibody technique were applied to detect the bacteria. A total of 52 samples of zooplankton were collected. There was a predominance of Copepoda. The culture enabled 55 isolates of Vibrio cholerae non-O1. The serogroups O1 and O139 were identified in 37 (71.1%) and 17 (32.7%) samples respectively by the fluorescence. Viable but non culturable forms of Vibrio cholerae were detected in 70.8% of the samples studied. A significant correlation was established between salinity and the waters pH value and Vibrio cholerae.

Severe visceral leishmaniasis in children: the relationship between cytokine patterns and clinical features

INTRODUCTION The relationship between severe clinical manifestations of visceral leishmaniasis (VL) and immune response profiles has not yet been clarified, despite numerous studies on the subject. This study aimed to investigate the relationship between cytokine profiles and the presence of immunological markers associated with clinical manifestations and, particularly, signs of severity, as defined in a protocol drafted by the Ministry of Health (Brazil). METHODS We conducted a prospective, descriptive study between May 2008 and December 2009. This study was based on an assessment of all pediatric patients with VL who were observed in a reference hospital in Maranhão. RESULTS Among 27 children, 55.5% presented with more than one sign of severity or warning sign. Patients without signs of severity or warning signs and patients with only one warning sign had the highest interferon-gamma (IFN-γ) levels, although their interleukin 10 (IL-10) levels were also elevated. In contrast, patients with the features of severe disease had the lowest IFN-γ levels. Three patients who presented with more than two signs of severe disease died; these patients had undetectable interleukin 2 (IL-2) and IFN-γ levels and low IL-10 levels, which varied between 0 and 36.8pg/mL. CONCLUSIONS Our results showed that disease severity was associated with low IFN-γ levels and elevated IL-10 levels. However, further studies with larger samples are needed to better characterize the relationship between disease severity and cytokine levels, with the aim of identifying immunological markers of active-disease severity.