Plasmodium vivax malaria: related factors to severity in the State of Maranhão, Brazil

INTRODUCTION: Malaria caused by Plasmodium vivax species has shown signs of severity, recorded with increasing frequency in the medical literature. This study aimed to characterize the signs of severe malaria by Plasmodium vivax in the State of Maranhão, Brazil. METHODS: A descriptive cohort study of patients assisted in the field and a historical and concurrent study of a series of cases among hospitalized patients were undertaken to identify the clinical and laboratory signs of severity. RESULTS: A total of 153 patients were included in the study, 13 of whom were hospitalized. Males made up the majority, numbering 103 (67.3%). The age of the patients ranged from 10 to 70 years, 92.2% were natives of the State of Maranhão, and 65% of the patients had had malaria before. The average time elapsed between symptom onset and diagnosis among outpatients was three days, while among hospitalized patients this average reached 15.5 days, a statistically significant difference (p=0.001). The parasitemia ranged from 500 to 10,000 parasites/µl in 92.8% of cases. The clinical and laboratory manifestations of severity were vomiting and diarrhea, jaundice, drowsiness, mental confusion, seizures, loss of consciousness, agitation, bleeding, pale skin, coughing and dyspnea, thrombocytopenia, anemia, elevation of nitrogenous compounds, and elevated transaminases and bilirubin. CONCLUSIONS: The monitoring of malaria patients with Plasmodium vivax showed the possibility of aggravation, the intensity of which varied in different circumstances, especially the interval time between falling ill and diagnostic confirmation.

Paracoccidioidomycosis in the state of Maranhão, Brazil: geographical and clinical aspects / Paracoccidioidomicose no Estado do Maranhão, Brasil: aspectos geográficos e clínicos

INTRODUCTION: The study aimed to show the situation of paracoccidioidomycosis in the state of Maranhão, Brazil. METHODS: This study is a descriptive case series developed in two stages. First, a survey of cases originating from the state of Maranhão at the Instituto de Doenças Tropicais Natan Portela, Piauí (IDTNP) from 1997 to 2007, and second, the clinical description of 29 cases diagnosed in the Centro de Referências em Doenças Infecciosas e Parasitárias, Maranhão (CREDIP) from 2004 to 2010. RESULTS: Two hundred and sixteen cases have been cataloged at the IDTNP. West, east, and central regions of the state of Maranhão recorded 90.3% of cases proving to be important areas for study. The western region, with a prevalence of 10.8/100,000 inhabitants, has a significantly higher proportion of cases than the northern, southern, and eastern regions (p < 0.05). The occurrence was higher in men with 89.3% of cases, and the male-to-female ratio was 8.4:1. The majority of patients were older than 20 years, lived in rural areas, and had farming or soil management as main occupation (73.8%). At CREDIP, 29 cases were diagnosed, of which 26 (89.6%) had multifocal manifestations. Mucous tissues were involved more (75.8%) frequently, followed by lymph nodes, skin, and lungs with 65.5%, 39% and 37.9 %, respectively. The diagnosis was made by combining direct examination, culture, and histopathology. CONCLUSIONS: The study shows the geographical distribution and the epidemiological and clinical aspects of paracoccidioidomycosis, revealing the significance of the disease to the state of Maranhão.

INTRODUÇÃO: O estudo teve o objetivo de mostrar a situação da paracoccidioidomicose no Estado do Maranhão, Brasil. MÉTODOS: Trata-se de um estudo descritivo do tipo série de casos, desenvolvido em duas etapas: na primeira, levantamento de casos originários do Maranhão, atendidos no Instituto de Doenças Tropicais Natan Portela, Piauí (IDTNP), de 1997 a 2007; na segunda, descrição clínica de 29 casos diagnosticados no Centro de Referência em Doenças Infecciosas e Parasitárias, Maranhão (CREDIP), no período de 2004 a 2010. RESULTADOS: Foram catalogados 216 casos no IDTNP. As regiões Oeste, Leste e Centro do Maranhão registraram 90,3% destes casos, demonstrando serem áreas importantes para estudo. A região oeste, com prevalência de 10,8/100.000 habitantes, apresenta proporção de casos significativamente maior que as regiões Norte, Sul e Leste (p<0,05). A ocorrência foi maior em indivíduos do sexo masculino (89,3% dos casos), sendo a proporção entre homens e mulheres de 8,4:1. A maioria dos acometidos possuía mais de 20 anos, residia na zona rural e tinha como principal ocupação a lavoura ou o manejo do solo (73,8%). Foram diagnosticados 29 casos no CREDIP, dos quais 26 (89,6) tinham manifestações multifocais. O acometimento mais comum foi de mucosas (75,8%), seguindo-se gânglios, pele e pulmões com 62%, 39% e 34,7%, respectivamente. A confirmação do diagnóstico foi feita pela combinação de exame micológico direto, cultura e histopatológico. CONCLUSÕES: O estudo mostra a distribuição geográfica, os aspectos epidemiológicos e clínicos da paracoccidioidomicose, revelando a importância da doença no Estado do Maranhão.

Leprosy in Buriticupu, state of Maranhão: active search in the general population / Hanseníase no município de Buriticupu, estado do Maranhão: busca ativa na população geral

INTRODUCTION: This study was developed to evaluate the situation of leprosy in the general population of the municipality of Buriticupu, State of Maranhão, Brazil. METHODS: We used the method of active search to identify new cases from 2008 to 2010. Bacilloscopy of intradermal scrapings was performed in all patients with skin lesions compatible with leprosy, and histopathological examination in those who had doubts on the definition of the clinical form. RESULTS: The study included 19,104 individuals, with 42 patients diagnosed with leprosy after clinical examination, representing a detection rate of 219.84 per 100,000 inhabitants. The predominant clinical presentation was tuberculoid with 24 (57.1%) cases, followed by borderline with 11, indeterminate with four, and lepromatous with three cases. The study also allowed the identification of 81 patients with a history of leprosy and other skin diseases, such as pityriasis versicolor, dermatophytosis, scabies, vitiligo, and skin carcinoma. The binomial test showed that the proportion of cases in the headquarters was significantly higher than that in the villages (p = 0.04), and the generalized exact test showed that there was no association between age and clinical form (p = 0.438) and between age and gender (p = 0.083). CONCLUSIONS: The elevated detection rate defines the city as hyperendemic for leprosy; the active search for cases, as well as the organization of health services, is an important method for disease control.

INTRODUÇÃO: O estudo foi desenvolvido com o objetivo de avaliar a situação da hanseníase na população geral do município de Buriticupu, Estado do Maranhão, Brasil. MÉTODOS: Foi empregado o método de busca ativa na identificação de casos novos, de 2008 a 2010. Baciloscopia de raspado intradérmico foi feita em todos os pacientes com lesões de pele compatíveis com hanseníase e exame histopatológico, naqueles em que havia dúvidas na definição da forma clínica. RESULTADOS: Participaram do estudo 19.104 indivíduos, sendo que o exame clínico definiu o diagnóstico de hanseníase em 42 pacientes, o que representa um coeficiente de detecção de 219,84/100.000 habitantes. A forma clínica predominante foi a tuberculóide com 24 (57,1%) casos, seguindo-se da dimorfa, com 11, da indeterminada, com 4 e da virchowiana com 3 casos. O estudo permitiu, ainda, a identificação de 81 pacientes com passado de hanseníase, além de outras doenças da pele, tais como pitiríase versicolor, dermatofitose, escabiose, vitiligo e carcinoma de pele. O teste binomial mostrou que a proporção de casos na sede foi significativamente maior que a dos povoados, p= 0,04 e o teste exato generalizado que não há associação entre faixa etária e forma clínica (p=0,438), bem como entre faixa etária e sexo (p=0,083). CONCLUSÕES: O elevado coeficiente de detecção define o município como hiperendêmico para a hanseníase; a busca ativa de casos é um método importante, bem como a organização dos serviços de saúde, para o controle da doença.