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Doctoral Thesis
DOI
10.11606/T.6.2015.tde-01062015-120411
Document
Author
Full name
Carolina Fordellone Rosa Cruz
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2015
Supervisor
Committee
Galati, Eunice Aparecida Bianchi (President)
Cordeiro, Maria Rita Donalisio
Souza, Jose Maria Pacheco de
Tolezano, José Eduardo
Waldman, Eliseu Alves
Title in Portuguese
Fatores de Risco para Leishmaniose Tegumentar Americana (LTA) no município de Bandeirantes, Paraná, Brasil
Keywords in Portuguese
Caso-Controle
Epidemiologia
Fatores de Risco
Leishmaniose Tegumentar Americana
Abstract in Portuguese
A leishmaniose é uma ameaça para cerca de 350 milhões de pessoas em 88 países no mundo. No município de Bandeirantes, estado do Paraná, Brasil, foram notificados 183 casos de leishmaniose tegumentar americana (LTA) entre 2000 a 2013. Objetivos: Descrever e analisar os casos de LTA ocorridos no município de Bandeirantes Paraná, entre 2007 e 2013 e investigar os fatores de risco associados à ocorrência da doença, considerando-se fatores socioeconômicos, condições habitacionais e do entorno das residências, atividades ocupacionais e de lazer, conhecimento sobre a LTA na população de estudo e algumas práticas; investigar a presença de anticorpos anti Leishmania sp. na população canina e descrever as características socioeconômicas, condições habitacionais e do entorno das residências, atividades ocupacionais, de lazer nos casos que evoluíram para óbitos bem como as características clínicas. Métodos: estudo caso-controle não pareado. A amostra constou de 104 casos autóctones de LTA notificados na Secretaria Municipal de Saúde de Bandeirantes e 90 controles, residentes selecionados aleatoriamente que apresentassem reação de imunofluorescência indireta (RIFI) negativa. A amostra da população canina foi composta por animais presentes nas residências dos casos e dos controles. Foram investigados os óbitos entre os indivíduos que tiveram LTA no período do estudo. Resultados: O sexo feminino prevaleceu entre os casos (62,50 por cento ) e controles (68,89 por cento ), bem como a faixa etária maior ou igual a 60 anos em ambos os grupos (46,15 por cento e 33,33 por cento , respectivamente). Todavia estas condições não se mostraram como fatores de risco significante. Mostraram-se como fatores de risco significantes (p < 0,05) as seguintes variáveis: ser analfabeto (OR = 10,09), aposentados (OR = 2,35), praticar atividades de lazer relacionadas à zona rural (OR = 4,47), frestas na casa (OR = 2,15), presença de matos próximos ao domicílio (OR = 6,92), presença de plantas frutíferas no peridomicílio (OR=2,02), anexos peridomicilares (OR = 4,30), galinheiro (OR=2,15) e canil (OR = 3,90), dormir fora do quarto (OR=4,97), 8 combate a animais sinantrópicos (OR = 2,69), uso de repelente corporal (5,43) e conhecer o mosquito transmissor (OR = 3,48), a relação com outros animais (OR =2,51) e prevenção (OR = 2,24). Como fatores de proteção: renda familiar > 3 salários mínimo (OR = 0,22), casa de alvenaria e reboco (OR = 0,41), abastecimento de água de rede (OR = 0,41), presença de rede de esgoto (OR = 0,33), coleta de lixo pública (OR = 0,35). Os exames sorológicos realizados nos cães do estudo demonstraram que 38,23 por cento foram reagentes para os casos e 2,12 por cento nos controles. Os cães dos casos possuem 28,47 vezes mais chance de contrair a LTA quando comparados com os cães dos controles (p<0,0001). Foram investigados 14 óbitos, 35,71 por cento estavam em tratamento da LTA e 42,86 por cento apresentavam lesões compatíveis com a LTA. Conclusões: A ocorrência da LTA em Bandeirantes mostrou-se associada estatisticamente às variáveis: idade, escolaridade, renda familiar, atividades de lazer relacionadas à zona rural, presença de anexos domiciliares e vegetação próximo ao domicílio, assim como o uso de repelente corporal, dormir fora do quarto e conhecer o mosquito vetor da LTA e a sua forma de prevenção.
Title in English
Risk Factors for American Tegumentary Leishmaniasis (ATL) in Bandeirantes - Parana.
Keywords in English
American Tegumentary Leishmaniasis
Case-Control
Epidemiology
Risk Factor
Abstract in English
The leishmaniasis threat around 350 million people in 88 countries around the world. In Bandeirantes - Parana from 2000 to 2013 183 cases of American tegumentary leishmaniasis (ATL) were reported. Objectives: to describe and analyze the occurrence of ATL in human population in Bandeirantes - Parana, between 2007 and 2013; to investigate the risk factors associated with the disease considering socioeconomic factors, housing conditions and the surrounding residences, occupational and leisure activities, knowledge of the LTA in the study population and some practical; investigate the presence of antibodies against Leishmania sp. the canine population and describe the socio-economic characteristics, housing conditions and the surrounding residences, occupational activities, leisure in cases that evolved to death and the clinical characteristics. Methods: A not paired case-control study was performed in with 104 cases, individuals who had autochthonous ATL notified in the Municipal Health Department of Bandeirantes and 90 controls were randomly selected out of those who presented negative reaction of indirect immunofluorescence (IIF). The canine population was selected from the cases and controls. The deaths among those individuals who had ATL during the study period were investigated. Results: Females were more abundant in case (62,5 per cent ) and control groups (68.89 per cent ) with predominance of age equal or greater than 60 years in both groups (46,15 and 33.33 per cent respectively). However, these conditions were not significant risk factors. The significant risk factors (p < 0,05) were: illiterate people (OR = 10,09), those who receive one to three minimum wages (OR =4,48), retired people (OR=2,35), to practice leisure activities related to rural area (OR=4,47), openings on the house (OR=2,15), presence of forests near the domicilie (OR = 6,92), presence of fruit plants near the house (OR=2,02), attachments to the house (OR = 4,30), chicken stay (OR=2,15), kennel (OR = 3,90), to sleep out of the bedroom (OR=4,97), to combat urban plagues (OR = 2,69), to use repellent (5,43) and to know the phlebotomine (OR = 3,48) and its relation with other animals (OR =2,51), and prevention (OR = 2,24). The protective factors were house of masonry and plaster (OR = 0.41), water supply network (OR = 0.41), 10 presence of sewage (OR = 0.33), public garbage collection (OR = 0.35). The serological tests performed in dogs of the study showed that 38.23 per cent were reactive to the cases and 2.12 per cent to the controls. The dogs of the cases have 28.47 times more chance of catching the ATL when compared with the dogs of the controls (p< 0.0001). Fourteen deaths were investigated, out of which 35.71 per cent were in treatment of ATL and 42.86 per cent had lesions compatible with the ATL. Conclusions: The occurrence of ATL in Bandeirantes proved to be statistically associated with the variables: age, education, family income, leisure activities related to rural area, presence of attachments to the house and vegetation near the domicile, as well as the use of repellent, sleeping outside of the room and knowing the disease vector of ATL and its prevention.
 
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Publishing Date
2015-07-27
 
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