Spatial analysis of the natural infection index for Triatomines and the risk of Chagas disease transmission in Northeastern Brazil

ABSTRACT This study aimed to analyze the spatial pattern of natural infection index (NII) for triatomines and the risk of Chagas disease transmission in an endemic area of Northeastern Brazil. An ecological study was conducted, based on 184 municipalities in five mesoregions. The NII for triatomines was evaluated in the Pernambuco State, Brazil, from 2016 to 2018. Spatial autocorrelations were evaluated using Global Moran Index (I) and Local Moran Index (II) and were considered positive when I > 0 and p < 0.05, respectively. In total, 7,302 triatomines belonging to seven different species were detected. Triatoma brasiliensis had the highest frequency (53%; n = 3,844), followed by Triatoma pseudomaculata (25%; n = 1,828) and Panstrongylus lutzi (18.5%; n=1,366). The overall NII was 12%, and the higher NII values were P. lutzi (21%) and Panstrongylus megistus (18%). In the mesoregions of Zona da Mata, Agreste, Sertao, and Sertao do Sao Francisco, 93% of triatomines were detected indoors. The global spatial autocorrelation of I to NII was positive (0.2; p = 0.01), and II values calculated using BoxMap, MoranMap, Lisa Cluster Map were statistically significant for natural infections. With regard to the risk areas for the presence of triatomines, Zone 2 (the Agreste and Sertao regions) presented a relative risk of 3.65 compared to other areas in the state. Our study shows the potential areas of vector transmission of Chagas disease. In this study, the application of different methods of spatial analysis made it possible to locate these areas, which would not have been identified by only applying epidemiological indicators.

Mapping the morbidity and mortality of Chagas disease in an endemic area in Brazil

ABSTRACT Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients' care.

Identification of nontuberculous mycobacteria species by multiplex real-time PCR with high-resolution melting

Abstract INTRODUCTION: Nontuberculous mycobacteria (NTM) species, as human pathogens, are increasing in the world, as is the difficulty of accurately identifying them. Differential diagnosis, especially between the M. tuberculosis complex and NTM species, and the characterization of NTM species is important. This study aimed to evaluate the performance of a molecular system based on multiplex real-time PCR with high-resolution melting (HRM) for the identification and differentiation of NTM species of clinical importance of an endemic area for tuberculosis in northeastern Brazil. METHODS: The technical protocol of the molecular system was based on multiplex real-time PCR-HRM, and evaluated the sensitivity and specificity of the detection of NTM species in mycobacterial clinical isolates from the studied region. The gold standard method was specific gene sequencing. RESULTS: The sensitivity and specificity of multiplex real-time PCR-HRM modified for differentiation between NTM and M. tuberculosis were 90% and 100%, respectively. The PCR-HRM sensitivities for the characterization of NTM species (M. kansasii, M. abscesses, M. avium, and M. fortuitum) were 94.59%, 80%, 57.14%, and 54%, respectively. CONCLUSIONS The multiplex real-time PCR-HRM modified assay has the potential to rapidly and efficiently identify nontuberculous mycobacteria of clinical importance, which is crucial for immediate implementation of the appropriate therapy and thus avoiding complications and sequelae in patients.

Urine as a promising sample for Leishmania DNA extraction in the diagnosis of visceral leishmaniasis - a review

ABSTRACT Visceral leishmaniasis is a serious and debilitating infection with high fatality rate in tropical and subtropical countries. As clinical symptoms of visceral leishmaniasis are not so specific, confirmatory diagnostic methods with high sensitivity and specificity are needed. Noninvasive methods have been developed using urine as a clinical sample for visceral leishmaniasis diagnosis. In fact, there is a clear correlation between kidney impairment and Leishmania DNA in urine. However, it has been proved that Leishmania nucleic acid may also be isolated from patients without any sign of renal involvement. Even though urine has become a promissing biological sample, it is still not widely used due to several issues, such as (i) incomprehension of the whole renal pathophysiology process in visceral leishmaniasis, (ii) presence of many amplification inhibitors in urine, and (iii) lack of an efficient urinary DNA extraction method. In this article, we performed a literature review to bring a new perspective for Leishmania DNA isolation in urine.

Adequação da investigação dos óbitos infantis no Recife, Pernambuco, Brasil / Evaluation of the adequacy of information from research on infant mortality in Recife, Pernambuco, Brazil

Resumo Avaliou-se a adequação da investigação do óbito infantil no Recife-PE, Brasil. Estudo transversal com 120 variáveis da ficha de investigação, agrupadas em seis dimensões (pré-natal; parto e nascimento; puericultura; características da família; ocorrência do óbito; e conclusão e recomendações), ponderadas pela técnica de consenso e analisadas quanto ao preenchimento. A investigação foi classificada (adequada, parcialmente adequada e inadequada) segundo um indicador composto de avaliação (ICA). Houve dissenso em 11 variáveis (9, na dimensão pré-natal; 1, no parto e nascimento; 1, na conclusões e recomendações). Dos 568 óbitos estudados, 56,2% apresentam investigação adequada. A ocorrência do óbito foi a dimensão melhor avaliada, e pré-natal, a mais deficiente. A elaboração do ICA possibilita aos profissionais e gestores das políticas de saúde da criança, identificar os pontos de estrangulamento da investigação dos óbitos infantis para um melhor direcionamento das ações e contribui com a reflexão sobre esta vigilância em outros municípios e estados.

Abstract This study is an evaluation of infant death research in Recife, Pernambuco (PE). It is a cross-sectional study with 120 variables grouped into six dimensions (prenatal, birth, child care, family characteristics, occurrence of death, and conclusion and recommendations), weighted by consensus technique. The research was classifiedas adequate, partially adequate or inadequate according to a composite indicator assessment (ICA). There was dissension on 11 variables (9 in prenatal dimension, one in labor and birth, and 1 in the conclusions and recommendations). Of the 568 deaths studied, 56.2% have adequate research. The occurrence of death was the best-evaluated dimension and prenatal the poorest. The preparation of the ICA enables professionals and managers of child health policies to identify bottlenecks in the investigation of infant deaths for better targeting of actions, and contributing to the discussion about surveillance in other cities and states.

Assessment of infant mortality surveillance: case study / Avaliação da vigilância do óbito infantil: estudo de caso

Abstract Objectives: assess the implementation of child mortality surveillance in Recife/PE. Methods: an analytical evaluative study was conducted on its implementation. It was a single-case study that correlated degree of implementation with the of the result indicators surveillance. A logic model on this strategy and a matrix of indicators and judgments according to model components were drawn up. The degree of implementation was obtained from structure and process indicators and this was then correlated with result indicators, in a deductive approach based on intervention theory. Results: the structure approach presented superior results to the process in all evaluated components. This strategy was considered to have been partially implemented (75. 7%), however, the components of 'identification of deaths' (85.7%), 'epidemiological research' (88.1%) and 'referral of proposals for promotion and health care and correction of official statistics' (95.8%) were classified implemented. Regarding the relation of the degree of implantation of the surveillance and its results with the logical model, only one of the 17 indicators was considered inconsistent. Conclusions: this strategy was considered to have been partially implemented. The model of child mortality surveillance and its assessment were shown to be adequate for signaling the consistency of the interrelations between the activities proposed and the effects expected, and would be reproducible within other scenarios.

Resumo Objetivos: avaliar a implantação da vigilância do óbito infantil no Recife/PE. Métodos: realizou-se pesquisa avaliativa do tipo análise de implantação da vigilância do óbito infantil. Estudo de caso único que relacionou o grau de implantação aos indicadores de resultados da estratégia. Foi elaborado um modelo lógico da intervenção e uma matriz de indicadores e julgamento por componente do modelo. O grau de implantação foi obtido a partir de indicadores de estrutura e processo e, posteriormente, relacionado aos de resultado, em uma abordagem dedutiva baseada na teoria da intervenção. Resultados: a abordagem estrutura apresentou resultados superiores ao processo em todos os componentes. A vigilância do óbito infantil foi considerada parcialmente implantada (75,7%), entretanto, os componentes 'identificação dos óbitos' (85,7%), 'investigação epidemiológica' (88,1%) e 'encaminhamento das propostas de promoção e atenção à saúde e correção das estatísticas oficiais' (95,8%) foram julgados implantados. Quanto à relação do grau de implantação da intervenção e seus resultados com o modelo lógico, apenas um dos 17 indicadores foi considerado inconsistente. Conclusões: a vigilância do óbito infantil foi classificada como parcialmente implantada. O modelo desta estratégia e a sua avaliação mostraram-se adequados ao assinalar a consistência das inter-relações entre as atividades propostas e os efeitos esperados, passíveis de reprodutibilidade em outros cenários.

Fatores associados ao aumento da vulnerabilidade de participantes de pesquisa / Factors linked to the increased vulnerability of research subjects / Factores asociados al aumento de la vulnerabilidad de los participantes de la investigación

Resumo Trata-se de estudo de corte transversal cujo objetivo foi avaliar a prevalência de fatores associados ao aumento da vulnerabilidade de participantes de pesquisas. Foram entrevistados 116 pacientes e 18 médicos. Entre os pacientes, 15% eram analfabetos, 27% desconheciam o motivo do seu internamento e 45% não sabiam qual tratamento estavam recebendo. Do total da amostra, 43% procediam de zona rural e 70% haviam cursado, no máximo, ensino fundamental, fatores que tornam essa população especialmente vulnerável. Os percentuais de acerto em questões relacionadas à compreensão do termo de consentimento livre e esclarecido e de prescrição médica foram, respectivamente, 12% e 7%. Entre os médicos, 44% não conheciam todas as pesquisas realizadas na enfermaria pela qual eram responsáveis e 17% afirmaram que a permanência hospitalar de pacientes que participam de pesquisas é maior. É elevada a prevalência de fatores que aumentam a vulnerabilidade de participantes em pesquisas médicas.

Abstract A cross-sectional study was carried out that aimed to assess the prevalence of factors associated with the increased vulnerability of research subjects. A total of 116 patients and 18 doctors were interviewed. A proportion of 15% of patients were illiterate, 27% did not know the reason for their hospitalization and 45% did not know what treatment they were receiving. Of the total sample, 43% were from rural areas and 70% had at most an elementary level education, factors that make this population especially vulnerable. The percentage of correct answers on issues related to the understanding of free and informed consent and prescriptions were 12% and 7%, respectively. Among the doctors, 44% were not aware of all the research projects being carried out in the ward for which they were responsible, and 17% said that the hospital stays of patients participating in research were longer. The prevalence of factors that increased the vulnerability of subjects in medical research was high.

Se trata de un estudio de corte transversal que tuvo como objetivo evaluar la prevalencia de los factores asociados con el aumento de vulnerabilidad de los participantes de investigación. Fueron entrevistados 116 pacientes y 18 médicos. Entre los pacientes, el 15% eran analfabetos, el 27% desconocía el motivo de su hospitalización y el 45% no sabía qué tratamiento estaba recibiendo. Del total de la muestra, el 43% era de zonas rurales, y el 70% había cursado, como máximo, la educación básica, factores que tornan a esta población especialmente vulnerable. El porcentaje de respuestas correctas en cuestiones relacionadas con la comprensión del consentimiento libre e informado y de la prescripción médica fue de, respectivamente, 12% y 7%. Entre los médicos, el 44% no conocía todas las investigaciones realizadas en la enfermería de la cual eran responsables y el 17% afirmó que la permanencia hospitalaria de los pacientes que participan de investigaciones es mayor. Es elevada la prevalencia de factores que aumentan la vulnerabilidad de los participantes en investigaciones médicas.

Mortalidade infantil: tendência temporal e contribuição da vigilância do óbito / Infant mortality: temporal trend and contribution of death surveillance

Resumo Objetivo Analisar a tendência temporal da mortalidade infantil na cidade de Recife, Pernambuco, Brasil e avaliar a contribuição da vigilância do óbito como instrumento para aprimoramento das estatísticas vitais e planejamento de ações. Métodos Foram calculados os coeficientes de mortalidade infantil, neonatal e pós-neonatal para o período de 1980 a 2012. Utilizou-se o modelo de regressão exponencial para análise da tendência. Para avaliar a contribuição da vigilância do óbito infantil foi realizado um estudo sobre as variáveis, causas básicas e associadas da Declaração de Óbito, e da evitabilidade. Resultados A tendência do coeficiente de mortalidade infantil e seus componentes etários foram decrescentes. Após a investigação da vigilância do óbito infantil nenhuma variável da Declaração de Óbito ficou incompleta e, em 52% dos óbitos, a causa básica foi melhor definida. Quase 80% dos óbitos foram classificados como evitáveis e 51,3% reduzíveis por adequada atenção à mulher na gestação. Conclusão A mortalidade infantil apresentou tendência decrescente e a vigilância do óbito infantil contribuiu para aprimorar as estatísticas vitais, fundamental para o planejamento das ações de saúde materno-infantil.

Abstract Objective To analyze the temporal trend in infant mortality in the city of Recife, state of Pernambuco, Brazil and evaluate the contribution of death surveillance as an instrument for improving vital statistics and action planning. Methods Infant, neonatal, and post-neonatal mortality rates were calculated from 1980 to 2012. An exponential regression model was used for trend analysis. A study on the variables, the basic and associated causes of death certificates, and avoidability was conducted to evaluate the contribution of infant death surveillance. Results The trend in infant mortality rate and its age components was shown to be decreasing. After research on infant death surveillance, no death certificate variable remained incomplete, and the underlying cause of death was better determined in 52% of deaths. Almost 80% of deaths were classified as preventable, and 51.3% were classified as reducible by appropriate care provided to women during their pregnancy. Conclusion Infant mortality presented a decreasing trend, and infant death surveillance contributed to improve vital statistics, which are essential for maternal-infant health planning actions.

Perfil epidemiológico de pacientes atendidos no ambulatório do serviço de referência nacional em filarioses do Centro de Pesquisas Aggeu Magalhães, Recife-PE / Epidemiological profile of patients seen at in the outpatient National Reference Service for Filariasis, of Aggeu Magalhães Research Center, Recife-PE

Este trabalho descreve o perfil epidemiológico dos pacientes atendidos no ambulatório do Serviçode Referência Nacional em Filarioses (SRNF), onde são desenvolvidas atividades clínicas,epidemiológicas e laboratoriais relacionadas à pesquisa e assistência aos pacientes acometidos porfilarioses. As informações foram obtidas de 1.109 prontuários de pacientes atendidos no período deseis anos. Do total de prontuários analisados, foi observado que 62,8 por cento dos indivíduos atendidoseram do gênero masculino e que 85,4 por cento eram residentes na Região Metropolitana do Recife (RMR).A frequência de indivíduos encaminhados ao SRNF que se apresentavam microfilarêmicos e/ouantígenos positivos para filariose bancroftiana foi de 55 por cento. Tal resultado foi considerado baixo umavez que esses indivíduos apresentavam forte indicativo clínico ou epidemiológico para infecçãofilarial. Esta informação evidencia a necessidade de um esforço maior no estabelecimento deparâmetros que determinem o fluxo de encaminhamento dos pacientes ao SRNF, de modo que seevite demanda desnecessária e sejam otimizados os recursos.

This paper describes the epidemiological profile of patients attending the outpatient clinic of theDepartment of the National Reference Service for Filariasis (SRNF), where clinical, epidemiological and laboratory activities are carried out relating to research, care, investigation and monitoring of patients suffering from filariasis. Information was obtained from the medical records of 1,109patients treated over a six year period. It was observed that most of the subjects attending came fromof the Metropolitan Region of Recife (RMR) - 85.4 per cent, –most of whom (62.8 per cent.) were male. A lowfrequency of individuals referred to SRNF showed microfilariae or antigen positivity for lymphaticfilariasis (55 per cent), although these patients represent strong evidence for clinical or epidemiologicalfilarial infection. This information makes clear the need for a greater effort to establish parameters that determine the flow of referral of patients to SRNF, avoiding unnecessary demand and allowing optimization of resources.

Case study of appatient with hiv-aids and visceal leishmaniasis co-infection iin multiple episodes / Estudo de caso de paciente com multiplos episodios da coinfeccao HIV-AIDS e leishmaniose visceral

SUMMARY Report of a 45-year-old male farmer, a resident in the forest zone of Pernambuco, who was diagnosed with human immunodeficiency virus (HIV) in 1999 and treated using antiretroviral (ARV) drugs. In 2005, the first episode of visceral leishmaniasis (VL), as assessed by parasitological diagnosis of bone marrow aspirate, was recorded. When admitted to the hospital, the patient presented fever, hepatosplenomegaly, weight loss, and diarrhea. Since then, six additional episodes of VL occurred, with a frequency rate of one per year (2005-2012, except in 2008). In 2011, the patient presented a disseminated skin lesion caused by the amastigotes of Leishmania, as identified by histopathological assessment of skin biopsy samples. In 2005, he was treated with N-methyl-glucamine-antimony and amphotericin B deoxycholate. However, since 2006 because of a reported toxicity, the drug of choice was liposomal amphotericin B. As recommended by the Ministry of Health, this report emphasizes the need for HIV patients living in VL endemic areas to include this parasitosis in their follow-up protocol, particularly after the first infection of VL. .

RESUMO Relato de caso de paciente masculino de 45 anos, agricultor, residente na zona da mata do Estado de Pernambuco, diagnosticado com HIV em 1999 e em uso de ARV. Em 2005 foi registrada a primeira ocorrência de LV através do diagnóstico parasitológico a partir do aspirado da medula óssea. À admissão no hospital apresentava-se com febre, hepatoesplenomegalia, perda de peso e diarréia. Desde então houve a ocorrência de mais sete episódios de LV, tendo ocorrido em media, um evento a cada ano (2005-2012 exceto em 2008). O paciente apresentou, em 2011, um quadro cutâneo disseminado, sendo realizada biopsia de pele que evidenciou formas amastigotas de Leishmania no exame histopatológico. Em 2005, o tratamento foi realizado com antimoniato de N-metil-glucamina e anfotericina B desoxicolato, mas desde 2006, devido à toxicidade, o medicamento de escolha foi a anfotericina B lipossomal. Como recomendado pelo Ministério da Saúde, esse relato reforça a necessidade de que os casos de HIV residentes em área endêmica de LV deverão ter inserido em seu protocolo de acompanhamento essa parasitose, principalmente após o primeiro episódio. .