RESUMO
BACKGROUND: Acute schistosomiasis is a systemic hypersensitivity reaction against the migrating schistosomula and eggs. In this report, we describe an atypical outbreak of the disease with severe cases. Transmission occurred in a nonendemic area of Brazil, which became a new focus of transmission due to the in-migration of infected workers. METHODS: From December 2009 to March 2010, the 50 patients with acute schistosomiasis (group 1) bathed in a swimming pool supplied by a brook on a country estate in the outskirts of São João del Rei, Brazil. Thirty other subjects (group 2) living in the same area, who denied having contact with the swimming pool, volunteered to participate in the study. All participants were submitted to clinical, laboratory, and ultrasound examinations. RESULTS: Five of 50 (10%) patients were admitted to the hospital: 1 with myeloradiculopathy, 1 with diffuse pulmonary micronodules, and 3 with diarrhea and dehydration. All 5 had hypereosinophilia and prolonged fever. Group 1 patients more frequently had cercarial dermatitis (P = .01), blood in the stool (P = .04), and intra-abdominal lymph nodes (P = .001). All group 1 patients were treated with praziquantel; 1 patient with myeloradiculopathy also received oral prednisone (60 mg/day) for 6 months with complete recovery. CONCLUSIONS: This report describes the first time that patients from an outbreak of acute schistosomiasis have been compared to controls. Five subjects (10%) had severe manifestations of schistosomiasis. Diagnosis of the disease and its severity was delayed because physicians did not consider that an epidemic of schistosomiasis might emerge in a nonendemic area.
Assuntos
Surtos de Doenças , Schistosoma mansoni/isolamento & purificação , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Anti-Helmínticos/uso terapêutico , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Praziquantel/uso terapêutico , Esquistossomose mansoni/transmissão , Resultado do Tratamento , Adulto JovemRESUMO
A meningite é um problema de saúde pública complexo em razão da sua multicausalidade de natureza infecciosa cuja prevenção e controle exigem estratégias diversas. Objetivo: analisar características epidemiológicas e a qualidade diagnóstica da meningite em Minas Gerais. Método: realizou-se estudo descritivo das meningites emMinas Gerais no período de 1990 a 2006, notificadas à Secretaria de Estado de Saúde e registradas no Sistema de Informação de Agravos de Notificação. Foram analisadas incidência e letalidade por etiologia e faixa etária, critério diagnóstico, com destaque para a doença meningocócica (DM). Resultados: predominou a meningite de etiologia bacteriana, média de 47, seguida da meningite virótica, média de 30 . Dentre as bacterianas, o maior número de casos deveu-se à Neisseria meningitidis, seguido pelo Streptococcus pneumoniae e Haemophilus influenzae. A partir de 1999, a incidência das meningites bacterianas e das não especificadas vêm decaindo, porém a letalidade apresentou aumento. Após 2001, ocorreu diminuição também da incidência da meningite presumivelmente viral. A incidência foi maior na faixa etária menor de cinco anos e a letalidade maior no menor de um ano e após 50 anos de idade. A DM foi diagnosticada principalmente por bacterioscopia e clínica (54) e as outras etiologias pela citoquímica e clínica em 70 dos casos. Esta deficiência no diagnóstico reflete-se na baixa sorogrupagem dos casos de DM, com identificação de 25 a 30. A redução na incidência e o aumento da letalidade das meningites podem ser devidos à subnotificação que, somada à deficiência no diagnóstico etiológico, torna prioritário o aprimoramentodas ações de vigilância e melhoria da rede assistencial e laboratorial de Minas Gerais.
Meningitis is a complex public health problem by virtue of its multiple infectious causes that demand many prevention and control strategies. Objective: To analyze epidemiologic aspects and the diagnostic efficacy of meningitis in Minas Gerais in the period between 1990 and 2006. Method: A descriptive study of meningitis was carried out based on the cases notified tothe State Office of Health and registered in the Diseases of Mandatory Notification Surveillance System SINAN. Cases were analyzed regarding incidence, case fatality rates per etiologyand per age group and diagnostic criteria, with an emphasis on meningococcal disease (MD).Results: Bacterial meningitis, with an average of 47, was observed to be predominant, followed by viral meningitis, with an average of 30. Among bacterial etiologies, the most frequent agent was found to be Neisseria meningitides, followed by Streptococcus pneumoniae. From the year of 1999, the incidence of bacterial and non-specified meningitis decreased, but lethality increased. After 2001, the incidence of presumed viral meningitis incidence began to decrease. The highestincidence was found in the age group of less than 5 years, and lethality was highest in the age ranges below oneand above 50 years. MD was diagnosed mainly by means of bacterioscopy and clinical findings (54 of the cases),while the other etiologies were diagnosed with citochemistry and clinical findings in 70 of the cases. This diagnostic deficiency reflects on a low serogrouping of MD cases, withan identification rate of 25-30. The observed decrease in incidence and increase in the lethality of meningitis may be due to undernotification, which, in addition to the deficiency in etiological diagnosis, stresses the need for prioritizing improvements in surveillance actions and in the health care network of the state of Minas Gerais.