Microbiota bacteriana aeróbica conjuntival em pacientes diabéticos com hemoglobina glicada normal e alterada em duas regiões brasileiras

Purpose:To study the aerobic bacterial microbiota of the conjunctiva in diabetic patient with regard to the management of diabetes, assessed using glycated hemoglobin levels.Methods:A cross-sectional study was conducted using conjunctival smears of diabetic patients from both sexes and with different ages, residing in two different Brazilian cities (Sorocaba and Rio Branco). A control group of non-diabetic patients was also included. The diabetic patients were considered to have controlled diabetes when their glycated hemoglobin level was ≤7% and blood glucose level was ≤126 mg/dL. Patients with non-controlled diabetes were those with glycated hemoglobin levels >7% and blood glucose levels >126 mg/dL. The samples obtained were inoculated in Brain-Heart Infusion broth and in culture media for aerobic bacteria (blood and chocolate agars); bacterial growth wa evaluated in a microbiology laboratory.Results:A total of 120 eyes of 120 patients were included in the present study. The percentage of cultures in which bacterial growth was observed was greater in diabetic patients, although the difference was not statistically significant (p=0.103). There was a greater trend toward bacterial growth in the conjunctiva of diabetic patients with altered fasting blood glucose. There was no difference in the frequency of bacterial growth on the conjunctiva between diabetic patient with normal or altered glycated hemoglobin levels. In Sorocaba, conjunctival bacterial growth was similar to that observed in Rio Branco. The microorganism most frequently detected in the present study was Staphylococcuepidermidis, followed by Staphylococcus aureus,Proteus mirabilis, and Escherichia coli.Conclusion:There was no difference between diabetic patients with normal or altered glycated hemoglobin levels. The microorganisms found were similar to those found in studie investigating the conjunctival bacterial flora of diabetic and non-diabetic patients.Objetivo:Estudar a microbiota conjuntival bacteriana aeróbica dos pacientes diabéticos em relação ao controle glicêmico, verificado através da hemoglobina glicada, em dua cidades distintas.Métodos:Foi realizado um estudo transversal utilizando raspados de conjuntiva de indivíduos diabéticos de ambos os sexos e idades variáveis de duas cidades: Sorocaba e Rio Branco. O grupo controle foi constituído de pacientes não diabéticos. A amostra foi constituída de pacientes diabéticos que foram considerados controlados com hemoglobina glicada ≤7% e glicemia de jejum ≤126 mg/dl e não controlados com hemoglobina glicada >7% e glicemia de jejum >126 mg/dl. O material obtido foi semeado em meio líquido Brain Heart Infusion (BHI) e em meios de cultivo para bactérias aeróbicas (ágar sangue e ágar chocolate). O crescimento bacteriano foi avaliado em laboratório de microbiologia.Resultados:Foram incluídos 120 olhos de 120 pacientes. A porcentagem de culturas nas quai houve crescimento bacteriano foi maior em pacientes diabéticos, sendo a diferença não estatisticamente significante (p=0,103). Não houve diferença entre o crescimento bacteriano em pacientes com hemoglobina glicada normal e alterada. Houve uma tendência maior de crescimento bacteriano em conjuntivas de paciente diabéticos com glicemias de jejum elevada. Em Sorocaba houve crescimento bacteriano conjuntival semelhante a Rio Branco. O microrganismo mais frequente encontrado neste estudo foi Staphylococcus epidermidis, seguido de Staphylococcus aureus, Proteus mirabilis e Escherichiacoli.Conclusões:Não ocorreu diferença entre pacientes diabéticos com hemoglobina glicada normal e alterada. Os microrganismos encontrados foram semelhantes aos estudos da flora bacteriana de conjuntivas normais e de diabéticos.Federal University of São Paulo Department of Ophthalmology and Visual SciencesFederal University of Acre Department of OphthalmologyFederal University of São Paulo Department of Ophthalmology and Visual Sciences Cornea and External Diseases SectionUNIFESP, Department of Ophthalmology and Visual SciencesUNIFESP, Department of Ophthalmology and Visual Sciences Cornea and External Diseases SectionSciEL

Alterações oculares na hanseníase, observadas em pacientes ambulatoriais do serviço de referência da cidade de Rio Branco, Acre - Brasil Eye lesions observed in outpatients of a leprosy reference center at Rio Branco, state of Acre, Brazil

OBJETIVO: Determinar a prevalência das alterações oculares em pacientes de hanseníase ativa ou inativa, acompanhados em serviço de referência. MÉTODOS: O estudo transversal constou de exame ocular e levantamento de dados demográficos e clínico-epidemiológicos, em serviço de referência da cidade de Rio Branco (Acre), no período de outubro de 2001 a abril de 2002. RESULTADOS: Foram examinados 254 pacientes, com média de idade de 41,9 anos; 70,1% do sexo masculino e 29,9% do feminino; 73,6% residentes da área urbana e 76,8% de formas multi e 23,2% de paucibacilares. Anormalidades de anexos oculares foram descritas em 49,6% (n=126) dos casos e do globo ocular em 39,4% (n=100) dos casos, sendo as mais freqüentes: hipoestesia corneana, catarata, madarose, manchas hipercrômicas, hipolacrimejamento e ceratite ponteada. As lesões oculares (74,4%) tiveram freqüências desiguais (r<0,0001), predominando entre aqueles com mais de 40 anos de idade (48,4% versus 26,0% nos de 40 anos ou menos), nos casos multibacilares (76,8% versus 23,2%), e nas pessoas com mais de cinco anos de duração da hanseníase (r<0,001). As alterações de globo ocular foram mais observadas em pacientes com tratamento específico concluído (r<0,05). CONCLUSÕES: A freqüência da morbidade ocular na hanseníase, em quase três quartos (74,4%) dos casos, foi semelhante à descrita na literatura para pacientes ambulatoriais de serviço de referência, e foi mais prevalente nas formas multibacilares da doença e em pacientes acima de 40 anos de idade.<br>PURPOSE: To determine the prevalence of eye lesions in patients with active and non active leprosy who are being accompanied in a reference center. METHODS: The transverse study consisted of ocular examinations and the study of demographic and clinical-epidemiological data, in the reference center in the city of Rio Branco, AC (Brazil). The study was conducted between October of 2001 and April of 2002. RESULTS: Two hundred fifty-four patients were examined, the average age was 41.9 years, 70.1% were males and 29.9% females; 73.6% were from the urban area, 76.8% were of the multibacillary form and 23.2% were of the paucibacillary form. Abnormalities of the ocular annexes were observed in 49.6% of the patients (n=126) and of the ocular globe in 39.4% (n=100), the most frequent being hypoesthesia of the cornea, cataract, madarosis, hiperchromic patches, hypolacrimation, and punctate keratitis. The eye lesions (74.4%) had unequal frequencies (r<0.0001), being predominant among those older than 40 years (48.4%, against 26.0% in those under 40 years of age), multibacillary form (76.8% against 23.2% in the paucibacillary form), and in those with a leprosy history of more than 5 years (76.8% against 23.2% leprosy history of less than 5 years). Ocular globe alterations were more frequent in patients who had concluded specific treatments (r<0.05). CONCLUSIONS: The frequency of ocular morbidity in these leprosy patients, in almost three quarters (74.4%) of those examined in the outpatient clinics, appeared similar to that described in literature and was more frequent in the multibacillary form of the disease and in patients over 40 years of age