Distribuição espacial e temporal dos casos humanos de LTA notificados no estado do Rio de Janeiro de 2001 a 2013 e associação com variáveis clínicas e populacionais

Made available in DSpace on 2018-05-21T13:34:26Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) lucia_paes_ini_dout_2016.pdf: 7273402 bytes, checksum: adcfa59fc04e67f9969e3bd05802adf2 (MD5)Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.A leishmaniose tegumentar americana (LTA) é uma antropozoonose com alto coeficiente de detecção e capacidade de produzir deformidades, sendo a leishmaniose cutânea (LC) sua manifestação clínica mais frequente e a leishmaniose mucosa (LM) sua manifestação grave. O antimoniato de meglumina (AM) administrado na dose de 10-20mg Sb5+/kg/dia intramuscular (IM) durante 20 a 30 dias, é o tratamento de escolha. No Instituto Nacional de Infectologia Evandro Chagas (INI), a dose de 5mg Sb5+/kg/dia IM ou AM por via intralesional (IL) têm se demonstrado efetivos. O objetivo deste estudo foi analisar a distribuição espaçotemporal dos casos humanos de LTA notificados no estado do Rio de Janeiro (RJ) entre 2001 a 2013 e verificar a associação com variáveis clínicas e populacionais. Esta tese é composta por dois artigos. Artigo 1: Estudo ecológico dos casos de LTA notificados de 2001 a 2013 para avaliar a letalidade, a incidência de recidiva e a proporção da forma mucosa tardia nos casos de LTA tratados no INI. Dos 777 tratados no INI, 753 (96,9%) foram tratados com AM, sendo 692 (89,1%) com esquemas alternativos (9,9% IL e 79,2% 5mg Sb5+/kg/dia IM). Alguns pacientes necessitaram de 1 a 3 cursos adicionais de tratamento, totalizando totalizando 997 cursos de tratamento, sendo 85,2% com AM em esquemas alternativos. Letalidade foi 0,1%, incidência de recidiva foi 5,8%, e proporção de LM tardia foi 0,25%. Como desfecho final, dos 777 pacientes, 95,9% curaram, 0,1% morreram e 4,0% abandonaram o tratamento Os resultados sugerem que os esquemas alternativos, com AM, em dosagem reduzida, têm proporcionado baixa letalidade sem aumentar a incidência de recidivas ou evolução tardia para LM. Artigo 2: Comparação da distribuição espacial e temporal dos casos notificados de LC com os casos de LM no Rio de Janeiro entre 2001 e 2011 para verificar a dinâmica da ocorrência de casos de LC para LM. Foram calculadas e georreferenciadas por município as taxas de incidência (TI) de LC e LM, com elaboração de mapas temáticos das taxas da doença por ano. Para avaliar a dependência temporal entre as séries de LC e LM no Estado do RJ e nos municípios com maior número de casos de LTA no período investigado, RJ e Angra dos Reis, foi realizado modelo de regressão binomial negativa. TI mais altas de LC e LM foram observads até 2006. Os casos de LC e LM aumentaram anualmente de forma concomitante no estado do RJ e em Angra dos Reis, mesmo quando controlado pela TI de LC do ano anterior. O município do RJ apresentou uma TI anual menor após a ocorrência de alta TI de LM nos dois anos anteriores. Conclusão: A associação temporal observada entre LC e LM sugere que: ou as lesões mucosas já se encontravam incipientes desde o início da manifestação da LC, ou a espécie de Leishmania circulante no Estado do RJ é capaz de produzir lesões mucosas precocemente.American tegumentary leishmaniasis (ATL) is an anthropozoonosis with high detection coefficient and ability to produce deformities, with cutaneous leishmaniasis (CL) being its most frequent clinical manifestation and mucosal leishmaniasis (ML), its severe manifestation. Meglumine antimoniate (MA) given at a dose of 10-20mg Sb5 + / kg / day intramuscular (IM) for 20 to 30 days is the treatment of choice. At the National Institute of Infectology Evandro Chagas (INI), the dose of 5mg Sb5 + / kg / day IM or AM by intralesional (IL) has been shown to be effective. The objective of this study was to analyze the spatiotemporal distribution of human cases of ATL reported in the state of Rio de Janeiro (RJ) from 2001 to 2013 and verify the association with clinical and population variables. This thesis consists of two articles. Article 1: Ecological study of cases of ATL reported from 2001 to 2013 to evaluate the lethality, incidence of relapse and proportion of the late mucosal form in cases of ATL treated in the INI. Of the 777 treated patients at INI, 753 (96.9%) were treated with MA, 692 (89.1%) with alternative regimens (9.9% IL and 79.2% 5mg Sb5 + / kg / day IM). Some patients required 1 to 3 additional courses of treatment, totaling 997 courses of treatment, with 85.2% with MA in alternative regimens. Lethality was 0.1% incidence of relapse was 5.8%, and proportion of late ML was 0.25%. As a final outcome, of the 777 patients, 95.9% cured, 0.1% died and 4.0% discontinued treatment. The results suggest that alternative regimens, with MA, at reduced dosage, have provided low lethality without increasing the incidence of relapses or delayed evolution for ML Article 2: Comparison of the spatial and temporal distribution of the reported cases of CL with cases of LM in Rio de Janeiro between 2001 and 2011 to verify the dynamics of the occurrence of cases of CL for ML. The CL and LM incidence rates (IR) were calculated and georeferenced, with thematic mapping of disease rates per year. In order to evaluate the temporal dependence between the CL and ML series in the State of RJ and in the municipalities with the highest number of ATL cases in the investigated period, RJ and Angra dos Reis, a negative binomial regression model was used. The highest CL and ML IT were observed up to 2006. The cases of CL and ML increased annually concomitantly in the state of RJ and Angra dos Reis, even when controlled by the IR of the LC of the previous year. The municipality of RJ presented a lower annual IR after the occurrence of high IR of ML in the two previous years. Conclusion: The temporal association observed between CL and ML suggests that: either the mucosal lesions were already incipient since the onset of CL, or the circulating Leishmania species in the State of RJ is capable of producing mucosal lesions early

Alterations in evoked otoacoustic emissions by the use of meglumine antimoniate in American tegumentary leishmaniasis patients

Submitted by Janaína Nascimento ([email protected]) on 2019-07-19T13:50:23Z No. of bitstreams: 1 ve_Bezerra_Débora_etal_INI_2017.pdf: 1274540 bytes, checksum: ea37b81d1d5c8c29cc86661f270e23ef (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-07-19T14:16:29Z (GMT) No. of bitstreams: 1 ve_Bezerra_Débora_etal_INI_2017.pdf: 1274540 bytes, checksum: ea37b81d1d5c8c29cc86661f270e23ef (MD5)Made available in DSpace on 2019-07-19T14:16:29Z (GMT). No. of bitstreams: 1 ve_Bezerra_Débora_etal_INI_2017.pdf: 1274540 bytes, checksum: ea37b81d1d5c8c29cc86661f270e23ef (MD5) Previous issue date: 2017Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Federal University of Rio de Janeiro. Faculty of Medicine. Department of Otorhinolaryngology and Ophthalmology. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Federal University of Rio de Janeiro. Faculty of Medicine. Department of Otorhinolaryngology and Ophthalmology. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Federal University of Rio de Janeiro. Faculty of Medicine. Department of Otorhinolaryngology and Ophthalmology. Rio de Janeiro, RJ, Brazil.Federal University of the State of the Rio de Janeiro. Faculty of Medicine. Department of Otorhinolaryngology. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Brazilian National Council for Scientific and Technological Development. Brasilia, DF, Brazil / Carlos Chagas Filho Foundation for Research Support of the state of Rio de Janeiro. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Federal University of Rio de Janeiro. Faculty of Medicine. Department of Otorhinolaryngology and Ophthalmology. Rio de Janeiro, RJ, Brazil / Carlos Chagas Filho Foundation for Research Support of the state of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / New University of Lisbon. Hygiene and Tropical Medicine Institute. Lisbon, Portugal.Tegumentary Leishmaniasis (TL) is a neglected, non-contagious, infectious disease, caused by different protozoa species of the Leishmania genus that affects skin and mucous membranes. Meglumine Antimoniate (MA), the first drug of choice for TL treatment in Brazil, has already been associated with cochlear toxicity, which is defined as damages of the cochlea caused by exposure to chemical substances, resulting in reversible or irreversible hearing loss. Auditory monitoring for cochlear toxicity aims at the early detection of auditory disorders, enabling, when possible, hearing to be preserved or an early auditory rehabilitation. Although otoacoustic emissions (OAEs) are used in this monitoring, there is no consensus on the criteria that define cochlear toxicity by this examination. The objective of this study was to describe the characteristics of the OAEs in cochlear toxicity monitoring in TL patients using MA

Auditory monitoring with distortion product evoked otoacoustic emissions before treatment, at the end of treatment and 1 and 2 months after the end of treatment of meglumine antimoniate in american tegumentary leishmaniasis patients.

<p>* Higher number of alterations in distortion product evoked otoacoustic emissions at the end of treatment than before treatment (p = 0.039).</p

Auditory monitoring with transient evoked otoacoustic emissions before treatment, at the end of treatment and 1 and 2 months after the end of treatment of meglumine antimoniate in american tegumentary leishmaniasis patients.

<p>Auditory monitoring with transient evoked otoacoustic emissions before treatment, at the end of treatment and 1 and 2 months after the end of treatment of meglumine antimoniate in american tegumentary leishmaniasis patients.</p

Comparison between presence and absence of alterations in distortion product evoked otoacoustic emissions (DPEOAE) before beginning treatment with Meglumine Antimoniate (MA) of 64 ears of 32 patients with tegumentary leishmaniasis.

<p>Evandro Chagas National Institute of Infectious Diseases–Oswaldo Cruz Foundation, 2016.</p

Comparison of the medians of the signal/noise ratio in distortion product evoked otoacoustic emissions before treatment and at the end of treatment, in patients with tegumentary leishmaniasis treated with meglumine antimoniate, Rio de Janeiro, 2016.

<p>* signal/noise ratio significantly smaller at the end of treatment than before treatment at the frequencies of 2 kHz (difference of 1.7dB; p = 0.016) and 4 kHz (difference of 2.45dB; p = 0.016)</p

3 Sensitivity, specificity, predictive values, false positives and false negatives in the diagnosis of cochlear toxicity from self-reported hearing loss and tinnitus in relation to the ototoxicity alteration at three different frequencies ranges of tone threshold audiometry in 102 patients with American Tegumentary Leishmaniasis treated with meglumine antimoniate.

Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.</p

S1 File -

IntroductionAmerican Tegumentary Leishmaniasis (ATL) treatment is based on pentavalent antimonials (Sb5+), but these drugs have been associated to several adverse effects. Hearing loss and tinnitus during treatment with meglumine antimoniate (MA) have already been reported. This study aimed to describe the usefulness of self-reporting of hearing loss and tinnitus in diagnosing MA-induced ototoxicity.MethodsA prospective longitudinal study was conducted with 102 patients with parasitological diagnosis of ATL, treated with different MA schemes. The presence of clinical auditory toxicity was defined as the emergence or worsening of self-reporting hearing loss and/or tinnitus during monitoring. Measures of sensitivity, specificity, and the positive and negative predictive value of the patient’s self-reporting of hearing loss and tinnitus in relation to the result of the audiometric test (considered the gold standard) were calculated.ResultsThe age of the evaluated patients ranged from 15 to 81 years, with a median of 41 years, and most were male (73.5%). Seventy-five patients (73.5%) had cutaneous leishmaniasis and 27 (26.5%) mucosal leishmaniasis. Eighty-six patients (84.3%) received intramuscular (IM) treatment and 16 (15.7%) were treated with intralesional MA. During treatment, 18 (17,6%) had tinnitus and 7 (6,9%) had complaint of hearing loss. 53 (52%) patients had cochlear toxicity confirmed by tone threshold audiometry and high frequency audiometry, from which 60% received a dose of 20 mg Sb5+/kg/day (p = 0.015) and 96.2% were treated with IM MA (p = 0.001). Tinnitus has greater specificity and positive predictive value than hearing loss, with a low number of false positives, but with a high false negative value.ConclusionAlthough the large number of false negatives suggests that self-report of hearing loss or tinnitus cannot be considered a good screening test for referring the patient to an audiometry, the low number of false positives suggests the need to value the patient’s complaint for referral. Otherwise, this study reinforces the importance of audiological monitoring during treatment with MA, especially in those patients with self-reporting of hearing loss or tinnitus when treated with 20 mg Sb5+/kg/day via IM.</div

Sensitivity, specificity, predictive values, false positives and false negatives in the diagnosis of cochlear toxicity from self-reported hearing loss in relation to the ototoxicity alteration at three different frequencies ranges of tone threshold audiometry in 102 patients with American Tegumentary Leishmaniasis treated with meglumine antimoniate.

Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.</p