RESUMO
BACKGROUND: Tungiasis, caused by the sand flea Tunga penetrans, is highly prevalent in many resource-poor communities in sub-Saharan Africa, Latin America and the Caribbean. Studies on knowledge and treatment practices related to tungiasis in affected populations are virtually nonexistent. To fill this gap, we performed a study in two resource-poor communities in northeast Brazil where this parasitic skin disease is highly prevalent. METHODOLOGY: Structured interviews were realized in a representative sample of household leaders in an urban slum in Fortaleza, capital of Ceará State (northeast Brazil), and in a traditional fishing village 60 km southeast of the city. RESULTS: Two hundred ninety household leaders were interviewed in the urban slum and 136 in the fishing village. Knowledge about the etiological agent of tungiasis and its transmission was high in both communities: 90% knew the flea as the etiological agent of tungiasis. Transmission of tungiasis was thought to be related to sandy soil (72% and 84% in the urban slum and in the fishing village, respectively), presence of animals (52% and 59%), walking barefoot (5% and 23%), and with the presence of garbage littering the area (23% and 21%). Surgical extraction of embedded sand fleas using unsterile sewing needles was the most commonly treatment applied (97% and 96%). In addition, a variety of topical products and medical ointments was used. Mothers were almost exclusively responsible for treatment and knowledge transfer to the next generation. The health sector neither provided health education nor treatment. CONCLUSIONS: In communities of low socio-economic status in northeast Brazil, knowledge on tungiasis was high, but individuals did not follow appropriate treatment. A reduction of intensity of infestation, bacterial superinfection and associated morbidity is feasible with minimum support from the health sector, such as supplying hypodermic needles and disinfectants to mothers, and targeted health education.
Assuntos
Ectoparasitoses/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Sifonápteros , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Brasil/epidemiologia , Criança , Pré-Escolar , Ectoparasitoses/parasitologia , Ectoparasitoses/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Autoadministração/métodos , Adulto JovemRESUMO
Tungiasis is a neglected parasitic skin disease caused by penetration of female sand fleas into the epidermis. The ectoparasitosis is widespread in resource-poor communities in South America, the Caribbean and sub-Saharan Africa. To identify risk factors for the presence of sand fleas and severe infestation in an endemic community, we examined the entire population of a traditional fishing village for the presence of embedded sand fleas and determined the number and type of lesions. Demographic, behavioural and environmental characteristics of the population were assessed using a structured questionnaire. Multivariable analysis showed that both occurrence of tungiasis and heavy infestation were significantly related to poor housing conditions (odds ratio [OR]=4.7, 95% CI 1.4-15.8), lack of health education (OR=4.1, 95% CI 2.0-8.6) and presence of animals on the compound (OR=1.9, 95% CI 1.1-3.4). Contrary to common belief, a protective effect of frequent use of closed footwear could not be demonstrated. Based on the population attributable fractions calculated for the major risk factors identified, we conclude that several low-cost interventions would have a considerable impact on the occurrence of tungiasis and heavy infestation.
Assuntos
Ectoparasitoses/epidemiologia , Áreas de Pobreza , Sifonápteros , Adolescente , Adulto , Animais , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Tungiasis (caused by the sand flea Tunga penetrans) is hyperendemic in many resource-poor communities in Brazil. To understand transmission dynamics of this parasitic skin disease in a typical endemic area, a longitudinal study was carried out in a slum in Fortaleza in northeastern Brazil. In a door-to-door survey, the population of a randomly selected area (n = 1,460) was examined on four occasions for the presence of embedded sand fleas. Prevalence rates were 33.6% in March (rainy season), 23.8% in June (end of the rainy season), 54.4% in September (peak of the dry season), and 16.8% in January (begin of the rainy season). Tungiasis was more common in males than in females. The intensity of infestation was correlated with the prevalence. The study shows that prevalence of tungiasis and parasite burden vary significantly during the year with a peak in the dry season. These findings have important consequences for the design of control measures.
Assuntos
Ectoparasitoses/epidemiologia , Sifonápteros , Adolescente , Adulto , Animais , Brasil/epidemiologia , Criança , Pré-Escolar , Ectoparasitoses/etiologia , Doenças Endêmicas , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pobreza , Prevalência , Estações do AnoRESUMO
OBJECTIVE: To assess the short-term and long-term impact of selective mass treatment with ivermectin on the prevalence of intestinal helminthiases and parasitic skin diseases in an economically depressed community in north-east Brazil. METHODS: An intervention was carried out in a traditional fishing village in north-east Brazil where the population of 605 is heavily affected by ectoparasites and enteroparasites. The prevalence of intestinal helminths was determined by serial stool examination and the prevalence of parasitic skin diseases by clinical inspection. A total of 525 people out of a target population of 576 were treated at baseline. The majority of these were treated with ivermectin (200 microg/kg with a second dose given after 10 days). If ivermectin was contraindicated, participants were treated with albendazole or mebendazole for intestinal helminths or with topical deltamethrin for ectoparasites. Follow-up examinations were performed at 1 month and 9 months after treatment. FINDINGS: Prevalence rates of intestinal helminthiases before treatment and at 1 month and 9 months after mass treatment were: hookworm disease 28.5%, 16.4% and 7.7%; ascariasis 17.1%, 0.4% and 7.2%; trichuriasis 16.5%, 3.4% and 9.4%; strongyloidiasis 11.0%, 0.6% and 0.7%; and hymenolepiasis 0.6%; 0.4% and 0.5%, respectively. Prevalence rates of parasitic skin diseases before treatment and 1 month and 9 months after mass treatment were: active pediculosis 16.1%, 1.0% and 10.3%; scabies 3.8%, 1.0% and 1.5%; cutaneous larva migrans 0.7%, 0% and 0%; tungiasis 51.3%, 52.1% and 31.2%, respectively. Adverse events occurred in 9.4% of treatments. They were all of mild to moderate severity and were transient. CONCLUSION: Mass treatment with ivermectin was an effective and safe means of reducing the prevalence of most of the parasitic diseases prevalent in a poor community in north-east Brazil. The effects of treatment lasted for a prolonged period of time.
Assuntos
Antiparasitários , Helmintíase/tratamento farmacológico , Enteropatias Parasitárias/tratamento farmacológico , Ivermectina/uso terapêutico , Prática de Saúde Pública , Adulto , Brasil/epidemiologia , Feminino , Helmintíase/epidemiologia , Helmintíase/prevenção & controle , Humanos , Enteropatias Parasitárias/epidemiologia , Enteropatias Parasitárias/prevenção & controle , Ivermectina/administração & dosagem , Masculino , Prevalência , Escabiose/tratamento farmacológico , Escabiose/epidemiologia , Escabiose/prevenção & controle , Dermatopatias Parasitárias/epidemiologia , Dermatopatias Parasitárias/prevenção & controle , Infecções por Strongylida/tratamento farmacológico , Infecções por Strongylida/epidemiologia , Infecções por Strongylida/prevenção & controle , Resultado do TratamentoRESUMO
BACKGROUND: Cutaneous larva migrans (CLM) is caused by the penetration of larvae of animal hookworms into the skin. Knowledge about this ectoparasitosis is mainly based on the examination of travelers or other expatriates. Population-based studies in an endemic area have never been performed. METHODS: A representative population sample of an urban slum in a Brazilian city was examined for the presence of CLM and asked about symptoms associated with the ectoparasitosis. RESULTS: In total, 3.1% (95% confidence interval, 2.2-4.3%) of the 1185 inhabitants examined presented CLM. Forty-three per cent had more than one larval track (range, 1-17). The prevalence rate in males was 4.2% vs. 2.3% in females. CLM occurred at similar prevalence rates in all age groups. All patients complained of moderate or severe itching. In three cases (8.1%), superinfection was present. Most lesions were located on the trunk, legs, and arms. Not a single lesion was located on the feet. CONCLUSIONS: This population-based study showed that CLM is endemic in this deprived community. The number of lesions and their topographic localization are in contrast with those obtained in previous reports based on the examination of individuals or groups affected in small outbreaks. We conclude that the clinico-epidemiologic pattern of CLM in a deprived community is different from that observed in travelers.
Assuntos
Doenças Endêmicas/estatística & dados numéricos , Larva Migrans/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Áreas de Pobreza , População UrbanaRESUMO
Tungiasis is hyperendemic in many poor communities in Brazil and is associated with considerable morbidity. In order to understand the factors that determine the distribution of this ectoparasitosis in a rural community, an epidemiological study was carried out in a traditional fishing village in Ceará State, north-eastern Brazil. Based on active case detection and voluntary participation, 91% of the population (belonging to 95% of all families) was examined. Embedded fleas were looked for over all parts of the body, counted, and the lesions were staged. The overall prevalence of infestation was 51.3% (95% CI: 47.0-55.5). More males than females were infested (54.8% vs 48.3%); however, this difference was not statistically significant. Age-specific prevalence rates followed an S-shaped curve with peaks in children aged 5-9 years and people elder than 60 years. The parasite burden was high (range 1-145 lesions; arithmetic mean: 8.9) and particularly elevated in males, children <15 years and the elderly. The distribution of the parasite burden was uneven within the population with the majority of the lesions in a few individuals: the 23 subjects (8% of all infested) with severe infestation (>30 lesions) accounted for 1,366 of the 2,493 lesions (54.8%) documented. The study shows that tungiasis is a highly prevalent ectoparasitosis in this deprived community with a peculiar distribution of prevalence and parasite burden.
Assuntos
Ectoparasitoses/epidemiologia , Sifonápteros/patogenicidade , Adolescente , Adulto , Distribuição por Idade , Animais , Brasil/epidemiologia , Criança , Pré-Escolar , Ectoparasitoses/patologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Sifonápteros/fisiologiaRESUMO
Ectoparasitic diseases are endemic in many poor communities in north-east Brazil, and heavy infestation is frequent. We conducted two studies to assess disease perception and health care seeking behaviour in relation to parasitic skin diseases and to determine their public health importance. The first study comprised a representative cross-sectional survey of the population of a slum in north-east Brazil. Inhabitants were examined for the presence of scabies, tungiasis, pediculosis and cutaneous larva migrans (CLM). The second study assessed health care seeking behaviour related to these ectoparasitic diseases of patients attending a Primary Health Care Centre (PHCC) adjacent to the slum. Point prevalence rates in the community were: head lice 43.3% (95% CI: 40.5-46.3), tungiasis 33.6% (95% CI: 30.9-36.4), scabies 8.8% (95% CI: 7.3-10.6) and CLM 3.1% (95% CI: 2.2-4.3). Point prevalence rates of patients attending the PHCC were: head lice 38.2% (95% CI: 32.6-44.1), tungiasis 19.1% (95% CI: 14.7-24.1), scabies 18.8% (95% CI: 14.4-23.7) and CLM 2.1% (95% CI: 0.8-4.5). Only 28 of 54 patients with scabies, three of 55 patients with tungiasis, four of six patients with CLM and zero of 110 patients with head lice sought medical assistance. The physicians of the PHCC only diagnosed a parasitic skin disease when it was pointed out by the patient himself. In all cases patients were correctly informed about the ectoparasites they carried. The results show that tungiasis and pediculosis, and to a lesser extent scabies and CLM, are hyperendemic but neglected by both population and physicians, and that prevalence rates of tungiasis and scabies at the PHCC do not reflect the true prevalence of these diseases in the community.
Assuntos
Ectoparasitoses/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Áreas de Pobreza , Adolescente , Adulto , Distribuição por Idade , Idoso , Atitude Frente a Saúde , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Ectoparasitoses/psicologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Distribuição por SexoRESUMO
BACKGROUND: The objective of this study was to describe the clinical pathology and seasonal variation of cutaneous larva migrans (CLM) in an impoverished community. METHOD: A representative sample of the population of a poor urban neighbourhood in Fortaleza, northeast Brazil, was examined for CLM four times during a period of eleven months. RESULTS: In total, 4107 individuals were examined. Sixty-three individuals were diagnosed to have CLM with a total of 132 larval tracks. The prevalence varied from 3.1% (95% CI: 2.2-4.3) in the middle of the rainy season to 0.2% (95% CI: 0.0-0.9) in the peak of the dry season. This corresponds to an incidence of 1841 cases of CLM per 10,000 inhabitants per year. The male sex was significantly more often affected (P<0.01). Eighty-three percent of the lesions were located at the trunk, legs or feet. Moderate or severe itching was present in all patients; 31.2% complained of insomnia due to itching, and 21% of the lesions were superinfected. CONCLUSIONS: CLM is a common parasitic skin disease in this deprived community, it is associated with significant morbidity, and its occurrence varies according to the rainfall.
RESUMO
Tungiasis is caused by the penetration of the female sand flea Tunga penetrans into the epidermis. It is generally assumed that lesions are confined to the feet. To determine to what degree tungiasis occurs at other topographic sites, 1,184 inhabitants of a poor neighborhood in northeastern Brazil were examined; 33.6% were found to have tungiasis (95% confidence interval = 30.9-36.4%). Six percent presented lesions at locations other than the feet, with the hands being the most common ectopic site (5.5%). Other sites were the elbows, thighs, and gluteal region. Ectopic tungiasis was significantly associated with the total number of lesions (P < 0.001) and an age less than 15 years old (P = 0.02). In 86 patients actively recruited with lesions on their feet, ectopic localizations were observed in 25.6%. Since untreated sand flea lesions are prone to become superinfected, clinicians should be aware of not missing any ectopic localization of tungiasis.
Assuntos
Ectoparasitoses/parasitologia , Pé/parasitologia , Mãos/parasitologia , Sifonápteros/fisiologia , Adulto , Animais , Brasil/epidemiologia , Criança , Ectoparasitoses/epidemiologia , Feminino , Humanos , MasculinoRESUMO
Tungiasis has been reported to occur in many Latin American, Caribbean and African countries. However, epidemiological data are still very scanty and do not exist at all for Brazil. To fill this gap, a cross-sectional study has been undertaken in a shantytown (favela) in Fortaleza, Ceará State, northeast Brazil. All 327 households of a circumscribed sub-area were visited, and 1185 out of the 1460 household members were thoroughly examined for the presence of tungiasis. Thirty-four% (95% CI: 30.9-36.4) were found to be infected with Tunga penetrans with a significant preponderance of the male sex (p<0.0001). In the children five to nine years old, the age group most heavily affected, the prevalence rate was 65.4% (95% CI: 54.0-75.7) in boys and in 48.3% (95% CI: 37.4-59.2) in girls. The data show that tungiasis is hyper-endemic in the study area. As the favela is typical for the many poor communities in northeast Brazil, it can be assumed that tungiasis is a frequent infection in the underprivileged in this part of the country.