Agentes fúngicos em diferentes sítios anatômicos nos Serviços de Saúde Pública em Cuiabá, Mato Grosso, Brasil

INTRODUCTION: A contribution to the regional epidemiological profile of the most common fungal agents in Public Health Services in Cuiabá, state of Mato Grosso, including university hospitals and polyclinics. METHODS: Clinical specimens (n = 1,496) from 1,078 patients were collected, submitted to direct mycological exam (potash or stick tape method) and cultured in specific mediums. Dermatophytic and non-dermatophytic agents were identified according to micromorphology (Ridell technique). RESULTS: The majority of the 1,496 specimens were skin (n = 985) and nail exams (n = 472). Of the 800 positive cultures, 246 (30.8%) corresponded to dermatophytes and 336 (42%) to yeasts of the genus Candida, 190 (23.7%) to other yeasts, 27 (3.4%) to non-dermatophytic filamentous fungi and one (0.1%) the agent of subcutaneous mycosis. Lesions considered primary occurred in greater numbers (59.5%) than recurrent lesions (37.4%), with a greater concentration of positivity occurring on the arms and legs. CONCLUSIONS: Comorbidities, allergies and diabetes mellitus were conditions associated with greater positivity in direct mycological exams and cultures. Positive culture was considered a definitive diagnosis of fungal infection and confirmed 47.8% of diagnostic hypotheses.INTRODUÇÃO: Contribuição sobre o perfil epidemiológico regional referente aos agentes fúngicos mais freqüentes nos Serviços de Saúde Pública em Cuiabá-MT, incluindo policlínicas e hospitais universitários. MÉTODOS: Foram examinados 1.496 espécimes clínicos colhidos a partir de 1.078 pacientes, os quais foram submetidos ao exame direto (potassa e/ou fita gomada) e cultivos em meios específicos. Os agentes foram identificados segundo micromorfologia (técnica de Ridell). RESULTADOS: Os 1.496 espécimes foram relacionados na maioria a exames de pele (n = 985), e unhas (n = 472). Dos 800 cultivos positivos, 246 (30,8%) corresponderam a dermatófitos, 336 (42%) a leveduras do gênero Candida, 190 (23,7%) a outras leveduras, 27 (3,4%) a fungos filamentosos não dermatofíticos e um (0,1%) a agente de micoses subcutâneas. Lesões consideradas primárias compareceram em maior número (59,5%), comparadas as recidivantes (37,4%). Foi observada maior positividade em membros inferiores e superiores. CONCLUSÕES: Co-morbidades, quadros alérgicos e diabetes mellitus representaram condições associadas à maior positividade em exames micológicos diretos e cultivos. O cultivo positivo foi considerado como diagnóstico definitivo de infecção fúngica, e confirmou 47,8% de hipóteses diagnósticas

The changing distribution of malaria in the Brazilian Amazon, 2003-2004 and 2008-2009

Introduction More than half of the malaria cases reported in the Americas are from the Brazilian Amazon region. While malaria is considered endemic in this region, its geographical distribution is extremely heterogeneous. Therefore, it is important to investigate the distribution of malaria and to determine regions whereby action might be necessary. Methods Changes in malaria indicators in all municipalities of the Brazilian Amazon between 2003-2004 and 2008-2009 were studied. The malaria indicators included the absolute number of malaria cases and deaths, the bi-annual parasite incidence (BPI), BPI ratios and differences, a Lorenz curve and Gini coefficients. Results During the study period, mortality from malaria remained low (0.02% deaths/case), the percent of municipalities that became malaria-free increased from 15.6% to 31.7%, and the Gini coefficient increased from 82% to 87%. In 2003, 10% of the municipalities with the highest BPI accumulated 67% of all malaria cases, compared with 2009, when 10% of the municipalities (with the highest BPI) had 80% of the malaria cases. Conclusions This study described an overall decrease in malaria transmission in the Brazilian Amazon region. As expected, an increased heterogeneity of malaria indicators was found, which reinforces the notion that a single strategy may not bring about uniformly good outcomes. The geographic clustering of municipalities identified as problem areas might help to define better intervention methods

Standardization of blood smears prepared in transparent acetate : an alternative method for the microscopic diagnosis of malaria

Background: Due to students’ initial inexperience, slides are frequently broken and blood smears are damaged in microscopy training, leading to the need for their constant replacement. To minimize this problem a method of preparing blood smears on transparent acetate sheets was developed with the goal of implementing appropriate and more readily available teaching resources for the microscopic diagnosis of malaria. Methods: Acetate sheets derived from polyester were used to standardize the preparation and staining of thin and thick blood smears on transparent acetate sheets. Thick and thin blood smears were also prepared using the conventional method on glass slides. The staining was conducted using Giemsa staining for the thick and thin smears. Results: Microscopic examination (1,000x) of the thin and thick blood smears prepared on transparent acetate produced high-quality images for both the parasites and the blood cells. The smears showed up on a clear background and with minimal dye precipitation. It was possible to clearly identify the main morphological characteristics of Plasmodium, neutrophils and platelets. After 12 months of storage, there was no change in image quality or evidence of fungal colonization. Conclusion: Preparation of thin and thick blood smears in transparent acetate for the microscopic diagnosis of malaria does not compromise the morphological and staining characteristics of the parasites or blood cells. It is reasonable to predict the applicability of transparent acetate in relevant situations such as the training of qualified professionals for the microscopic diagnosis of malaria and the preparation of positive specimens for competency assessment (quality control) of professionals and services involved in the diagnosis of malaria

A expansão da epidemia da leishmaniose visceral no Estado de Mato Grosso, 1998-2005 The spread of the visceral leishmaniasis epidemic in the State of Mato Grosso, 1998-2005

Uma epidemia de leishmaniose visceral teve início em 1998 na Região Metropolitana de Cuiabá, capital de Mato Grosso, atingindo hoje 34 (24,1%) dos 141 municípios do estado. Entre janeiro de 1998 e dezembro de 2005, foram notificados 138 casos autóctones, predominando o sexo masculino (58%), crianças (51,5%) de 0-9 anos e residentes (66,7%) de áreas urbanas. A leishmaniose visceral canina foi identificada em 41 municípios, com soropositividade de 9% em 40.000 cães examinados. Lutzomyia longipalpis e/ou Lutzomyia cruzi foram capturadas em 14 dos 18 municípios que registraram simultaneamente leishmaniose visceral humana e canina. Os resultados indicam que a transmissão da leishmaniose visceral dissemina-se para o interior do estado, acompanhando o fluxo migratório e o processo de ocupação urbana desordenada das cidades. A presença isolada de Lutzomyia cruzi em municípios com alta incidência de casos humanos e caninos de leishmaniose visceral sugere possível participação desta espécie na cadeia de transmissão dessa parasitose em Mato Grosso.An epidemic of visceral leishmaniasis began in 1998, in the Metropolitan Region of Cuiabá, the capital of the State of Mato Grosso, Brazil. Today, it has reached 34 (24.1%) of the 141 municipalities in the state. Between January 1998 and December 2005, 138 autochthonous cases were notified, mainly in males (58%), children aged 0-9 years (51.5%) and inhabitants of urban areas (66.7%). Canine visceral leishmaniasis has been detected in 41 municipalities, with positive serum in 9% of the 40,000 dogs examined. Lutzomyia longipalpis and/or Lutzomyia cruzi were captured in 14 out of the 18 municipalities that simultaneously recorded both human and canine visceral leishmaniasis. These findings indicate that visceral leishmaniasis transmission has become disseminated throughout the state, following migratory flows and the process of disorderly occupation of urban areas. The presence of Lutzomyia cruzi alone in areas with high incidence of human and canine cases suggests possible participation by this species in the transmission chain for visceral leishmaniasis in Mato Grosso

Avaliação do programa de controle da hanseníase em municípios mato-grossenses, Brasil

INTRODUÇÃO: Avaliou-se, retrospectivamente, a situação epidemiológica e operacional do controle da hanseníase, em quatro municípios da fronteira matogrossense Brasil-Bolívia. POPULAÇÃO E MÉTODOS: As informações foram coletadas do sistema de registro/prontuário de cada paciente inscrito no Programa de Controle da Hanseníase, no período que decorreu do início da operacionalização dos programas até 1990. Foram estabelecidos os indicadores epidemiológicos e operacionais, definidos pela Organização Mundial de Saúde. RESULTADOS: Foi observado registro inadequado das informações dos pacientes em mais da metade dos prontuários. O coeficiente de prevalência oscilou entre 15 a 48/10.000, no período estudado. O coeficiente de detecção anual de casos novos para o ano de 1990 foi de 112/100.000 habitantes. CONCLUSÕES: Os resultados encontrados apontam alta prevalência da hanseníase, ineficiência na detecção de casos, tendência à expansão da endemia e uma baixa qualidade nos programas de controle à doença

Avaliação do programa de controle da hanseníase em municípios mato-grossenses, Brasil

INTRODUCTION: A retrospective analysis of the Program for Leprosy Control in four counties of Mato Grosso State, on the Brazil-Bolivian frontier, has been undertaken in the present study. POPULATION AND METHODS: The health care service records of all patients registered by the Programs for Leprosy Control during the period from the beginning of their activities up to 1990 inclusive were checked. Final analysis was performed by epidemiological and operational indicators for the follow-up of control activities of Leprosy Control, as defined by the World Health Organization. RESULTS: An inadequate recording of information given by the patient was detected in more than half of all cases. The prevalence of leprosy varied from 15 to 48/10,000, in the period studied. The annual detection rate of new cases was 112/100,000 in 1990. CONCLUSION: The results suggest a high endemicity pattern for leprosy in the region. With regard to operational indicators our finding showed inadequate practice regarding all the activities of the program probably worsened by the poor qualification of the health workers involved in the assistance given.INTRODUÇÃO: Avaliou-se, retrospectivamente, a situação epidemiológica e operacional do controle da hanseníase, em quatro municípios da fronteira matogrossense Brasil-Bolívia. POPULAÇÃO E MÉTODOS: As informações foram coletadas do sistema de registro/prontuário de cada paciente inscrito no Programa de Controle da Hanseníase, no período que decorreu do início da operacionalização dos programas até 1990. Foram estabelecidos os indicadores epidemiológicos e operacionais, definidos pela Organização Mundial de Saúde. RESULTADOS: Foi observado registro inadequado das informações dos pacientes em mais da metade dos prontuários. O coeficiente de prevalência oscilou entre 15 a 48/10.000, no período estudado. O coeficiente de detecção anual de casos novos para o ano de 1990 foi de 112/100.000 habitantes. CONCLUSÕES: Os resultados encontrados apontam alta prevalência da hanseníase, ineficiência na detecção de casos, tendência à expansão da endemia e uma baixa qualidade nos programas de controle à doença