Características clínicas, epidemiológicas, espacial e filogeográfica das espécies causadoras da hanseníase.
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Data
2020-07-10
Autores
Finardi, Amanda Juliane
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Universidade Estadual Paulista (Unesp)
Resumo
Apesar dos esforços, com a implementação de estratégias de controle e do importante progresso alcançado no manejo clínico e no tratamento, a hanseníase permanece endêmica no Brasil. O enfrentamento da doença é prioridade para o Ministério da Saúde (MS), sendo as principais estratégias de ação a detecção precoce de casos novos e o exame de contatos, com o intuito de prevenir as incapacidades físicas e favorecer a quebra na cadeia de transmissão. No entanto, mesmo na presença de um conjunto de ações, a hanseníase mantém parâmetros de alta endemicidade nas regiões Norte e Centro-Oeste. O estado do Mato Grosso, por exemplo, permanece como hiperendêmico há muitos anos, sendo que em 2018 a taxa de detecção geral do estado foi de 138.3/100mil habitantes. O presente estudo foi realizado por meio de duas abordagens distintas no Município de Rondonópolis/ Mato Grosso: A primeira se propôs a descrever e contextualizar a hanseníase em Rondonópolis (MT), a partir da análise do perfil clínico-epidemiológico e geográfico e assim realizar um diagnóstico das possíveis causas de manutenção da endemia. A segunda, identificar a presença de M. lepromatosis por meio da PCR Multiplex, com a finalidade de investigar sua distribuição e frequência. Na avaliação do perfil clínico-epidemiológico e espacial da hanseníase no período de 2011 a 2015 verificamos um predomínio de 59% de casos em homens com idade entre 35 e 59 anos. Observamos que 12% dos casos apresentaram grau de incapacidade no momento do diagnóstico e que 8% dos casos avaliados foram em menores de 15 anos. Na avaliação espacial observamos que a hanseníase está distribuída nos 5 setores administrativos do município, com as regiões Oeste e Norte apresentando grandes clusters, incluindo casos em menores de 15 anos. Na análise para a diferenciação entre isolados de M. leprae e M. lepromatosis a partir de um banco de DNA de pacientes com hanseníase, diagnosticados entre 2007 e 2010 em Rondonópolis, verificamos a existência de infecção mista com ambos os patógenos em pacientes com diferentes polos da doença. Notou-se que para os casos de infecção mista havia uma maior frequência em mulheres e casos paucibacilares. A análise multivariada mostrou também que ser mais jovem e ter menor índice baciloscópico nos tecidos foram fatores independentes para infecção pelo M. lepromatosis. Assim sendo, o conjunto de dados clínicos, epidemiológicos e demográficos obtidos e avaliados sobre a hanseníase no município de Rondonópolis sugere que a existência de focos da doença e links de transmissão estejam subnotificados. Também se observou que a associação de casos de M. lepromatosis em mulheres e em indivíduos com menor idade é um fator que necessita ser melhor investigado com a finalidade de entender o porquê dessa relação.
Despite efforts to implement control strategies and the important progress made in clinical management and treatment, leprosy remains endemic in Brazil. Fighting the disease is a priority for Ministry of Health of Brazil, main action strategies are the early detection of new cases and examination of contacts, in order to prevent physical disabilities and breaking of the transmission chain. However, even in the presence of a set of actions, leprosy maintains parameters of high endemicity in the North and Midwest regions in Brasil. The State of Mato Grosso, for example, has remained hyper-endemic for many years, and in 2018 the state's overall detection rate was 138.30/100,000 inhabitants. The present study was carried out using two different approaches in the City of Rondonópolis/ Mato Grosso: The first proposal, describes and contextualizes leprosy in Rondonópolis (MT), from the analysis of the clinical-epidemiological and geographical profile, as well as to carry out a diagnosis of the possible causes of maintenance of the endemic in the region. Secondly, to identify the presence of M. lepromatosis by means of PCR Multiplex, in order to investigate its distribution and frequency in the municipality. In assessing the clinical, epidemiological and spatial profile of leprosy in the period from 2011 to 2015, we found a predominance of 59% in men aged between 35 and 59 years. We observed that 12% of the cases had some disability grade at the moment of diagnosis and that 8% were in children under 15 years of age. In Spatial evaluation we observed that leprosy is distributed in 5 administrative sectors of the city, with the West and North regions presenting large clusters, including cases in children under the age of 15. In the analysis for the differentiation between M. leprae and M. lepromatosis isolates from a DNA bank of leprosy patients, diagnosed between 2007 and 2010 in Rondonópolis, there were mixed infection with both pathogens, in patients in different poles of the disease. It was noted that for cases of mixed infection there was a higher frequency in women and paucibacillary cases. Multivariate analysis also showed that being younger and having a lower bacilloscopic index in the tissues were independent factors for infection with M. lepromatosis. The set of clinical, epidemiological and demographic data obtained and evaluated on leprosy in the municipality of Rondonópolis suggests the existence of outbreaks of the disease and transmission links are underreported. It was also observed that the association of M. lepromatosis cases in women and in younger individuals is a factor that needs to be further investigated in order to understand the factors of this predisposition.
Despite efforts to implement control strategies and the important progress made in clinical management and treatment, leprosy remains endemic in Brazil. Fighting the disease is a priority for Ministry of Health of Brazil, main action strategies are the early detection of new cases and examination of contacts, in order to prevent physical disabilities and breaking of the transmission chain. However, even in the presence of a set of actions, leprosy maintains parameters of high endemicity in the North and Midwest regions in Brasil. The State of Mato Grosso, for example, has remained hyper-endemic for many years, and in 2018 the state's overall detection rate was 138.30/100,000 inhabitants. The present study was carried out using two different approaches in the City of Rondonópolis/ Mato Grosso: The first proposal, describes and contextualizes leprosy in Rondonópolis (MT), from the analysis of the clinical-epidemiological and geographical profile, as well as to carry out a diagnosis of the possible causes of maintenance of the endemic in the region. Secondly, to identify the presence of M. lepromatosis by means of PCR Multiplex, in order to investigate its distribution and frequency in the municipality. In assessing the clinical, epidemiological and spatial profile of leprosy in the period from 2011 to 2015, we found a predominance of 59% in men aged between 35 and 59 years. We observed that 12% of the cases had some disability grade at the moment of diagnosis and that 8% were in children under 15 years of age. In Spatial evaluation we observed that leprosy is distributed in 5 administrative sectors of the city, with the West and North regions presenting large clusters, including cases in children under the age of 15. In the analysis for the differentiation between M. leprae and M. lepromatosis isolates from a DNA bank of leprosy patients, diagnosed between 2007 and 2010 in Rondonópolis, there were mixed infection with both pathogens, in patients in different poles of the disease. It was noted that for cases of mixed infection there was a higher frequency in women and paucibacillary cases. Multivariate analysis also showed that being younger and having a lower bacilloscopic index in the tissues were independent factors for infection with M. lepromatosis. The set of clinical, epidemiological and demographic data obtained and evaluated on leprosy in the municipality of Rondonópolis suggests the existence of outbreaks of the disease and transmission links are underreported. It was also observed that the association of M. lepromatosis cases in women and in younger individuals is a factor that needs to be further investigated in order to understand the factors of this predisposition.
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Palavras-chave
Epidemiologia, Geoespacial, Hanseníase, Mycobacterium leprae, Mycobacterium lepromatosis