Análise da positividade da esquistossomose mansoni em Regionais de Saúde endêmicas em Pernambuco, 2005 a 2010

OBJETIVO: analisar a tendência da positividade da esquistossomose em exames coproscópicos na população de área endêmica do estado de Pernambuco, Brasil, de 2005 a 2010. MÉTODOS: estudo ecológico de serie temporal, com dados secundários do Sistema de Informação do Programa de Controle da Esquistossomose, analisados por Regional de Saúde; foram avaliadas as tendências por regressão linear, considerando-se p<0,05 significativo. RESULTADOS: Pernambuco apresentou média de 9,2% de positividade; a Regional de Saúde III (Palmares) apresentou maior média de positividade (13,8%), seguida das regionais II (Limoeiro: 9,9%) e I (Recife: 7,8%); a Regional V (Garanhuns) apresentou melhor média de tratamento (95,6%), seguida da III (86,6%); Pernambuco apresentou tendência decrescente na positividade para esquistossomose (p=0,005). CONCLUSÃO: em geral, há uma tendência decrescente da positividade de esquistossomose em Pernambuco, apesar da queda no número de exames; é importante manter e intensificar as intervenções de controle, com prioridades estratégicas focalizadas em localidades com elevadas prevalências

New index for the diagnosis of liver fibrosis in Schistosomiasis mansoni

ABSTRACT BACKGROUND Periportal fibrosis is the major pathological consequence of the Schistosoma mansoni infection. OBJECTIVE To evaluate the accuracy of serum markers and to construct an index to assess fibrosis. METHODS Patients (n=116) with schistosomiasis were evaluated by ultrasound scan and measurements of serum levels of aminotransferases, γ-glutamyl transferase, alkaline phosphatase, hyaluronic acid, cytokines and platelets. Ultrasound images were used to evaluate the fibrosis using Niamey's classification and identified 19 patients without periportal fibrosis (patterns A and B), 48 with mild to moderate fibrosis (C and D) and 49 with advanced fibrosis (E and F). RESULTS Using multivariate analysis, a model was created, which involved alkaline phosphatase and platelets and could separate patients with different patterns of fibrosis. This index showed a better performance in separating patients without fibrosis from with advanced periportal fibrosis. The biological index showed an area under the ROC curve of 1.000. Using values below the lowest or above the highest cut-off point, the presence or absence of advanced fibrosis could be predicted in all patients. CONCLUSION The index constructed can be used to separate patients with different patterns of periportal fibrosis, specially to predict advanced fibrosis in schistosomiasis patients

Synanthropic triatomines (Hemiptera, Reduviidae) in the state of Pernambuco, Brazil: geographical distribution and natural Trypanosoma infection rates between 2006 and 2007

INTRODUCTION: The present study shows a descriptive analysis of triatomine occurrence and its natural Trypanosoma infection rates in the state of Pernambuco, Brazil, between 2006 and 2007. METHODS: Entomological data for the species, such as specimens captured in both intra and peridomiciles and natural infection index, were obtained via domiciliary capture in 147 municipalities from 11 Regional Managements of Health. The database was obtained from a sample of insects (100% infected and 20% non-infected) sent to the Central Laboratory of Pernambuco. RESULTS: A total of 18,029 triatomines were analyzed from 138 municipalities of the state. Triatoma pseudomaculata (35%), Triatoma brasiliensis (34%), and Panstrongylus lutzi (25%) were the most captured species. These species also showed a widespread geographical distribution in the state. Panstrongylus megistus, Triatoma petrocchiae, Triatoma melanocephala, Triatoma sordida, Rhodnius nasutus, Rhodnius neglectus, and Triatoma infestans showed more limited geographical distribution and lower relative abundance. The parasitological research showed that 8.8% of the triatomines were naturally infected with flagellates morphologically similar to Trypanosoma cruzi and 91.3% of them were captured inside houses in 113 municipalities. P. lutzi showed the highest rates of natural infection. CONCLUSIONS: After the control of T. infestans, synanthropic species, such as T. brasiliensis, T. pseudomaculata, and P. lutzi, maintain the risk of T. cruzi transmission to humans in the state of Pernambuco. These species are widely distributed, and infected specimens have been found inside houses. Thus, an enhanced surveillance and vector control of Chagas disease is recommended in Pernambuco