Estudo de Flebotomíneos (Diptera: Psychodidae) no município de Divinópolis, Minas Gerais, Brasil

Submitted by Nuzia Santos ([email protected]) on 2013-05-24T13:07:02Z No. of bitstreams: 1 Dissertação Bruno Nascimento.pdf: 2690979 bytes, checksum: 8895b1e7cb440d8618cfcad07cc3cb46 (MD5)Made available in DSpace on 2013-05-24T13:07:03Z (GMT). No. of bitstreams: 1 Dissertação Bruno Nascimento.pdf: 2690979 bytes, checksum: 8895b1e7cb440d8618cfcad07cc3cb46 (MD5) Previous issue date: 2013Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Belo Horizonte, MG, Brasil.A transmissão das espécies de Leishmania aos hospedeiros vertebrados envolve várias espécies de flebotomíneos no Brasil. Um estudo sobre a composição da fauna de flebotomíneos foi realizado no município de Divinópolis, Minas Gerais, Brasil, área endêmica para leishmaniose tegumentar (LT), e de transmissão moderada para leishmaniose visceral (LV). Foram realizadas coletas sistematizadas mensais para captura de flebotomíneos durante um ano, de setembro de 2010 a agosto de 2011, com armadilhas luminosas HP instaladas em área urbana, em 15 peridomicílios de casas onde se registrou pelo menos um caso de LT ou LV, e em 5 fragmentos de mata. Também foram realizadas coletas não sistematizadas utilizando armadilhas de Shannon nos fragmentos de mata. A detecção de DNA de Leishmania sp. nos espécimes de flebotomíneos foi realizada por meio da Reação em Cadeia da Polimerase (PCR) e para a identificação da amostra positiva foi utilizada a técnica de sequenciamento genético de fragmentos de DNA. Um total de 1.088 espécimes de flebotomíneos foram coletados pertencentes ao gênero Brumptomyia e Lutzomyia, e 18 espécies. Lutzomyia longipalpis, o principal vetor da Leishmania infatum no Brasil, foi a espécie mais freqüente, sendo encontrada em 14 das 20 localidades. As espécies Lu. longipalpis e Lu. whitmani foram as únicas coletadas em todos os meses de estudo. Nenhuma das espécies foi encontrada em todas as localidades de estudo. As cinco espécies mais frequentes foram: Lu. longipalpis (76,9%), Lu. lenti (8,3%), Lu. whitmani (5,0%), Lu. sallesi (2,8%) e Lu. aragaoi (2,2%). Não foi observada correlação estatisticamente significativa entre densidade total de flebotomíneos e variáveis climáticas durante o período de estudo. As análises moleculares detectaram DNA de Leishmania infantum em um exemplar de Lu. longipalpis. Os dados apontam para a necessidade de medidas de controle da população de flebotomíneos no município de Divinópolis e adoção de estratégias de vigilância entomológica.The transmission of Leishmania species to vertebrate hosts involves several species of sand flies in Brazil. A study of the sand flies fauna composition was carried out in the city of Divinópolis, Minas Gerais state, Brazil, an endemic area for cutaneous leishmaniasis (CL), and of moderated transmission of visceral leishmaniasis (VL). Monthly systematic collections were made during one year, from September 2010 to August 2011. The HP light traps were installed inperidomicile of 15 houses where at least one case of CL or VL has been recorded and in five forested areas. Systematized collections were carried out using Shannon traps. The detection of DNA of Leishmania sp. in the sand fly specimens was performed by Polymerase Chain Reaction (PCR) and the technique for identification of positive samples genetic sequencing of DNA fragments technique. A total of 1,088 specimens of sand flies were collected, belonging to the genera Brumptomyia e Lutzomyia and 18 species. Lutzomyia longipalpis, the main vector of Leishmania infatum in Brazil, was the most frequent species, being collected in 14 of the 20 locations. The species Lu. longipalpis and Lu. whitmani were the only ones collected in every month studied. None of the collected species were found in all localities sampled. The five most abundant species were: Lu. longipalpis (76.9%), Lu. lenti (8.3%), Lu. whitmani (5.0%), Lu. sallesi (2.8%) and Lu. aragaoi (2.2%). No significant statistical correlation between the total sand fly density and the climatic variables was found. Molecular analysis identified natural infection by Leishmania infantum in one specimen of Lu. longipalpis. The data points to for measures to control the sand fly populations and adoption of strategies for entomological surveillance in Divinópolis municipality

Um novo olhar sobre a elaboração de materiais didáticos para educação em saúde

O presente artigo tem como objetivo lançar um olhar crítico sobre o processo de elaboração de um conjunto de materiais didáticos em Educação em Saúde, produzido a partir do ano de 2007 na Universidade Federal de São João del-Rei, para uso em um programa que visava o combate a parasitoses intestinais. Os materiais foram analisados de forma a se avaliar as potencialidades e as deficiências encontradas. Como resultado, obtevese a necessária reelaboração deles, com o objetivo de que sejam utilizados como meios educativos que respeitem identidades e contribuam para a construção de saberes em relação à saúde. Espera-se que as propostas de reelaboração e correção, juntamente com as características positivas analisadas, possam colaborar com a produção de novos materiais e contribuir para a melhoria da oferta de produtos que medeiem o processo de construção de conhecimentos na área da saúde

Risk Factors for Adverse Prognosis and Death in American Visceral Leishmaniasis: A Meta-analysis

<div><p>Background</p><p>In the current context of high fatality rates associated with American visceral leishmaniasis (VL), the appropriate use of prognostic factors to identify patients at higher risk of unfavorable outcomes represents a potential tool for clinical practice. This systematic review brings together information reported in studies conducted in Latin America, on the potential predictors of adverse prognosis (continued evolution of the initial clinical conditions of the patient despite the implementation of treatment, independent of the occurrence of death) and death from VL. The limitations of the existing knowledge, the advances achieved and the approaches to be used in future research are presented.</p><p>Methods/Principal Findings</p><p>The full texts of 14 studies conforming to the inclusion criteria were analyzed and their methodological quality examined by means of a tool developed in the light of current research tools. Information regarding prognostic variables was synthesized using meta-analysis. Variables were grouped according to the strength of evidence considering summary measures, patterns and heterogeneity of effect-sizes, and the results of multivariate analyses. The strongest predictors identified in this review were jaundice, thrombocytopenia, hemorrhage, HIV coinfection, diarrhea, age <5 and age >40–50 years, severe neutropenia, dyspnoea and bacterial infections. Edema and low hemoglobin concentration were also associated with unfavorable outcomes. The main limitation identified was the absence of validation procedures for the few prognostic models developed so far.</p><p>Conclusions/Significance</p><p>Integration of the results from different investigations conducted over the last 10 years enabled the identification of consistent prognostic variables that could be useful in recognizing and handling VL patients at higher risk of unfavorable outcomes. The development of externally validated prognostic models must be prioritized in future investigations.</p></div

Factors Associated with Visceral Leishmaniasis in the Americas: A Systematic Review and Meta-Analysis

<div><p>Background</p><p>Still today, more than 30 years after the beginning of the process of visceral leishmaniasis' urbanization, there is little knowledge about the risk factors for its occurrence, despite their relevance to the control and understanding of disease dynamics. The present study is the first systematic review with meta-analysis about factors associated with <i>Leishmania infantum</i> infection in humans in the Americas.</p><p>Methods and Findings</p><p>After searching different databases, consultations to the reference lists of articles and to experts in the field, 51 studies were reviewed. Theoretical discussions or meta-analysis of p-values or of effect sizes were used to pool information about each variable. The Q test and the I² statistic were used to assess heterogeneities among the studies. Male sex was associated with visceral leishmaniasis in studies which used the leishmanin skin test for diagnosis and in those where the outcome was the clinical disease; the opposite occurred when serological diagnosis was applied. Younger individuals were less frequently infected than adults, but were more prone to illness. Although with different levels of evidence and of heterogeneity, the presence of dogs at home, higher dog seropositivity in nearby areas, lower socioeconomic status and highly vegetated areas were associated with <i>L. infantum</i> infection. This was not noticed for the presence of chickens in the house and with nutritional status. Susceptibilities to bias and limitations in the analysis and in the description of results were often identified in the studies analyzed.</p><p>Conclusions</p><p>Results showed the existence of consistent patterns for some of the factors analyzed and should be taken into account in developing more effective and well-targeted control measures. Studies must be conducted in new areas of the continent, with improved methodological quality and prioritizing the investigation of the patterns identified and their causes, as well as variables for which knowledge is poor.</p></div

Conditions for assessment of the quality of the selected papers determined according to the principles described in the literature [15], [16], [23]–[26].

<p>Conditions for assessment of the quality of the selected papers determined according to the principles described in the literature <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002982#pntd.0002982-Moons1" target="_blank">[15]</a>, <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002982#pntd.0002982-Mallett1" target="_blank">[16]</a>, <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002982#pntd.0002982-Altman1" target="_blank">[23]</a>–<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002982#pntd.0002982-Vandenbroucke1" target="_blank">[26]</a>.</p

Forest plot for the variable age: studies divided into subgroups according to the method for measuring the outcome.

<p>CS-Cross-sectional; *Serological result from study with two tests; #Result in adults; LST- Leishmania skin test; Squares represent the weight of each study; Lozenges represent the summary measure of each subgroup; Reference: Being Over 10 y.o.a., OR = 1.</p

Forest plot: malnutrition.

<p>CS-Cross-sectional; *Serological result from study with two tests; (2) According to a study from the same publication; LST-Leishmania skin test; Squares represent the weight of each study; Lozenges represent the summary measure. Reference: Lack of Malnutrition, OR = 1.</p

Flowchart showing the selection of studies analyzed in this review.

<p>Flowchart showing the selection of studies analyzed in this review.</p