Human Visceral Leishmaniasis: lethality and time from suspicion to treatment in an endemic area in Brazil
DOI:
https://doi.org/10.17058/reci.v12i4.17755Keywords:
Visceral Leishmaniasis, Late Diagnose, Lethality, EpidemiologyAbstract
Background and objectives: human visceral leishmaniasis (HVL) are a persistent public health problem, configuring a challenge to reduce its lethality. In order to evaluate the factors associated with lethality, this study emphasizes the time elapsed from suspicion to treatment of HVL, in the years 2015 to 2019, in the municipality of Araguaína-TO, an area of intense transmission. Methods: an epidemiological study of case series with longitudinal follow-up with information extracted from HVL notification and investigation forms. The relative risk (RR) was used as a measure of the strength of association for death, being calculated with confidence intervals (95% CI) estimated by the Wald test. Time intervals were represented in days by box plot as medians (Md). Results: of the 191 cases of HVL, 179 (93.72%) were cured and 12 (6.28%) had a fatal outcome. There was no association of risk of death by sex, education, race, being significant only by age in the age groups of young (RR= 16.09) and older adults (RR=7.08). The time from suspicion to treatment in children was shorter (0-35 days, Md=12) than that of older patients (4-44 days, Md=18) and in those who died (7-65 days, Md=20) highlighting greater inopportunity of healing in these last two groups. Conclusion: late diagnosis was a determining indicator for worse outcomes, five days made the difference between the group with an outcome for cure with the group of those who died, highlighting the need to shorten the wait for treatment.
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Makoni M. New threats to visceral leishmaniasis control. The Lancet Microbe. 1o de novembro de 2021;2(11):574. https://doi.org/10.1016/S2666-5247(21)00285-8
Organização Pan-Americana da Saúde. Diretrizes para o tratamento das leishmanioses na Região das Américas. Washington, DC: Pan American Health Organization; 2022. https://iris.paho.org/handle/10665.2/56487
Ministério da Saúde (BR). Secretaria de Vigilância em Saúde, Coordenação-Geral de Desenvolvimento da Epidemiologia em Serviços. Guia de Vigilância em Saúde. 3a. Vol. Único [recurso eletrônico]. Brasília: Ministério da Saúde; 2019. 740 p. https://bvsms.saude.gov.br/bvs/publicacoes/guia_vigilancia_saude_3ed.pdf
Sunter J, Gull K. Shape, form, function and Leishmania pathogenicity: from textbook descriptions to biological understanding. Open Biol. Kingdon State. 2017;7(9):113. https://royalsocietypublishing.org/doi/10.1098/rsob.170165
Costa DL, Costa CHN. Leishmaniasis Visceral. Em: Atlas interactivo de leishmaniasis en las Américas: aspectos clínicos y diagnósticos diferenciales. Washington, D.C.: Organización Panamericana de la Salud; 2020.Capítulo 5. p. 495. https://iris.paho.org/handle/10665.2/52645
Empresa Brasileira de Pesquisa Agropecuária, Ministério da Agricultura, Pecuária e Abastecimento. GeoMatopiba: Inteligência Territorial [Internet]. EMBRAPA. Campinas, 2020. https://www.embrapa.br/geomatopiba
Departamento de Informática do SUS, Ministério da Saúde (BR). Casos confirmados por ano notificação segundo município de infecção, período: 2010 a 2019. [Internet]. DATASUS. Brasília 2020. http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sinannet/cnv/leishvbr.def
R Core Team. R: A language and environmeent for statistical computing [Internet]. R Foundation for Statistical Computing, Vienna, Austria; 2021. https://www.r-project.org/index.html
Aragon TJ, Fay MP, Wollschlaeger D, et al. Epitools: Epidemiology Tools [Internet]. R package version 05-10. 2020. https://CRAN.R-project.org/package=epitools
Bulstra CA, Rutte EAL, Malaviya P, et al. Visceral leishmaniasis: Spatiotemporal heterogeneity and drivers underlying the hotspots in Muzaffarpur, Bihar, India. PLoS Negl Trop Dis. 2018;12(12). https://doi.org/10.1371/journal.pntd.0006888
Alvarenga DG de, Escalda PMF, Costa ASV, et al. Leishmaniose visceral: estudo retrospectivo de fatores associados à letalidade. Rev Soc Bras Med Trop. 2010; 43:194–7. http://www.scielo.br/j/rsbmt/a/gctcGmnFCDQPSLP3WJHNNBR/?lang=pt
Santos M de A, Rodrigues SLC, Nascimento ALF, et al. Leishmaniose Visceral: Características clínico-epidemiológicas de casos e óbitos no estado de Sergipe. Rev Epidemiol E Controle Infecção. 2018;8(4):428–34. https://online.unisc.br/seer/index.php/epidemiologia/article/view/11591
Rodríguez NE, Lima ID, Dixit UG, et. al. Epidemiological and Experimental Evidence for Sex-Dependent Differences in the Outcome of Leishmania infantum Infection. Am J Trop Med Hyg. 2018;98(1):142–5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928733/
Cavalcante ÍJM, Vale MR. Epidemiological aspects of visceral leishmaniasis (kala-azar) in Ceará in the period 2007 to 2011. Rev Bras Epidemiol. 2014; 17:911–24. http://www.scielo.br/j/rbepid/a/vvNRJYdCV7x87TLL4ntSxKt/?lang=en
Ortiz RC, Anversa L. Epidemiologia da leishmaniose visceral em Bauru, São Paulo, no período de 2004 a 2012: um estudo descritivo. Epidemiol E Serviços Saúde.2015;24:97–104. http://www.scielo.br/j/ress/a/T4Xr8Xwwzv4psK9N9r8LQfR/?lang=pt
Sousa JMDS, Ramalho WM, Melo MA Caracterização demográfica e clínica da leishmaniose visceral humana no Estado de Pernambuco, Brasil entre 2006 e 2015. Rev. Soc. Bras. Med. Trop. 2018; 51(5): 622-630. http://dx.doi.org/10.1590/0037-8682-0047-201n
Almeida CP, Cavalcante FRA, Moreno JO, et al. Leishmaniose visceral: distribuição temporal e espacial em Fortaleza, Ceará, 2007-2017. Epidemol Serv Saúde, Brasília. 2020; 29(5). https://doi.org/10.1590/s1679-49742020000500002
Instituto Brasileiro de Geografia e Estatística. Censo Demográfico da população residente dos municípios do Tocantins, por cor ou raça. Brasil, 2010. https://sidra.ibge.gov.br/Tabela/3175#resultado
Instituto Brasileiro de Geografia e Estatística -IBGE, Diretoria de Pesquisas, Coordenação de Trabalho e Rendimento. Pesquisa Nacional por Amostra de Domicílios Contínua 2012/2019. Brasil, 26 de maio de 2020. https://biblioteca.ibge.gov.br/visualizacao/livros/liv101707informativo.pdf
Faria ACM de. Avaliação temporal e espacial da oportunidade do diagnóstico para leishmaniose visceral humana. Brasil, 2017 a 2019. Trabalho de Conclusão de Curso de Medicina Veterinária- Centro Universitário de Brasília, 2020. http://repositorio.uniceub.br/jspui/handle/prefix/14735
Maia-Elkhoury ANS, Romero GAS, Valadas SYOB, et al. Premature deaths by visceral leishmaniasis in Brazil investigated through a cohort study: A challenging opportunity? PLoS Negl Trop Dis. 2019;13(12):e0007841. https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0007841
Pan American Health Organization. Leishmaniasis: Epidemiological Report in the Americas. Number 9, December 2020.OPAS;2020 Washington, D.C https://iris.paho.org/handle/10665.2/51742
Van GJ, Diro E. Visceral Leishmaniasis Recent Advances in Diagnostics and Treatment Regimens. Infect Dis Clin North Am. 2019;33(1):79–99. https://linkinghub.elsevier.com/retrieve/pii/S0891552018300928
Driemeier M, de Oliveira PA, Druzian AF, et al. Late diagnosis: a factor associated with death from visceral leishmaniasis in elderly patients. Pathog Glob Health.2015;109(6):283–9. https://doi.org/10.1179/2047773215Y.0000000029
Ministério da Saúde (BR). UVR/CGDT/DEVEP/ SVS/MS. Nota Técnica nº 45/2010 - UVR/CGDT/DEVEP/ SVS/MS. Orientações sobre a utilização do Teste Rápido Imunocromatográfico rK39. Brasilia: Ministério da Saúde, 2010. Brasil, 2010. https://portalarquivos2.saude.gov.br/images/pdf/2016/dezembro/29/Nota-Tecnica-n452010-Orientacoes-sobre-a-utilizacao-do-teste-rapido-imunocromatografico-rK39.pdf
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