Epidemiologia molecular das leishmanioses no sul de Mato Grosso do Sul

Abstract

Leishmaniasis are zoonoses of high global prevalence, with significant lethality recognized in humans for more than a century and continue to reach large populations despite efforts to contain them. In Brazil, leishmaniasis is present in all states, becoming a public health problem given its degree of mortality when undiagnosed and treated correctly. In this sense, the present study aimed to determine the epidemiological and molecular profile of leishmaniasis in southern of Mato Grosso do Sul, contributing to improve the diagnosis and treatment of patients affected by leishmaniasis. To do this, a descriptive epidemiological study was carried out, divided into three stages: a retrospective study was conducted in the first stage with the analysis of the reports for Visceral Leishmaniasis (VL) and Tegumentary Leishmaniasis (TL) available in the Notification of Injury Information System (SINAN) from the Department of Epidemiological Surveillance of the Municipal Health Department of Dourados from 2007 to 2017, totaling 112 notifications, of which 62 cases were VL and 50 TL, in relation to VL cases, 33.81% of the individuals were Ponta Porã, 80.77% of the cases were autochthonous and 67.86% of them had the urban area as an infection site, in 67.75% of the cases the individuals were male and 27.41% were between 1- 4 years. The laboratory diagnosis was performed in 90.32% and in 8.06 there was co-infection with HIV. The first choice medication for treatment was Amphotericin B in 55.56% of the cases and the evolution to death was 11.11% of the cases. In TL cases, in 60.0% of the cases were of Dourados, 92.0% were new cases and 52.0% of the cases were the mucosal form. It was found that 72.0% were males and 26.0% had the age group 41-59 years of age. Laboratory diagnosis was performed in 90.0% and in 13.33% there was co-infection with HIV. The use of Pentavalent Antimonial was in 70.0% of the cases and the cure was of 100%. The second stage consisted in reporting a case of a 54-year-old patient, of Dourados, hypertensive, smoker, with a history of residence for one year in the capital of Mato Grosso do Sul, to care for his mother. In this period, the patient presented a loss of 26 kg of consumptive syndrome in less than a year due to inappetence, with successive histories of searches to the health system to solve his problem, which had as initial diagnosis anemia. Upon returning to Dourados in 2017, he sought the local health system, where he performed several blood and imaging tests to investigate pulmonary tuberculosis and HIV. Due to the worsening of the clinical picture of the patient, it was necessary for him to be admitted to the Municipal Hospital with a subsequent transfer to a bed of the Intensive Care Unit (ICU) of the local University Hospital, which is a reference in infectious diseases in the Dourados region. The patient required mechanical ventilation via the orotracheal tube, as a consequence of acute respiratory failure, presenting hypotension (66x43 mmHg), tachycardia (117 bpm), afebrile (36.8ºC). Although the patient sought help in the health system for a period of approximately two years, the diagnosis for VL was laboratory confirmed, on the day after death (biological material collected on the tenth day of hospitalization), by the serological test of indirect immunofluorescence (IFI) (titre ≥1: 160), by the direct search for bone marrow aspirate showing amastigote forms suggestive of Leishmania spp. For the third stage, biological samples (peripheral blood, lesion biopsy and/or marrow blood) of 100 patients were analyzed. For 55% of the cases the sex was male, the mean age was 42.57 years, 50% of the cases were of Dorados, the fever was present 32% of the cases. The comorbidities diagnosed were: HIV in 6.0% (6) of the cases; Diabetes mellitus and Hypertension in 6.0% (6); Acute renal failure (ARF) in 4.0% (4); Chronic renal insufficiency (CRF) in 3.0% (3); Syphilis in 3.0% (3); Rheumatoid arthritis in 2.0% (2). PCR was positive in the peripheral blood of 15.0% (15) of the cases, and in two patients coinfected with HIV only PCR was positive. The rapid test was positive in 12.0% (12) of the cases. Direct research (DR) was positive in 6.0% (6). The IFI was positive in 4.0% (4) and undetermined in 3.0% (3) of the cases. In 7.0% (7) of the cases only the rapid test was positive. In 8.0% (8) of the cases, only PCR was positive. DR and PCR were both positive in 4.0% (4) of the cases and in only 5.0% (5) of the cases, both the rapid test and the PCR, had positive results. The overall death rate was 6.0% (6), with 3 patients coinfected with HIV.