Epidemiological situation of leprosy in Salvador from 2001 to 2009.

Mycobacterium leprae was first described as the bacillus that causes leprosy, a chronic granulomatous infectious disease, in 1873 by Amauer Hansen. Leprosy is part of a group of 10 neglected diseases and Bahia has endemic levels of this illness, varying between high and very high. The detection of 52 new cases of leprosy in children under 15 years old in Salvador in 2006 is alarming, and suggests an early contact with the disease. The aim of this review is to analyze the epidemiological situation, the detection rate and evaluate the clinical and epidemiological profile of leprosy in Salvador, in the period 2001-2009. A retrospective cross-sectional study was performed using secondary data collected at Notifiable Diseases Information System Database (SINAN) through the notification of patients with leprosy. Over these nine years 3,226 patients were reported, with a predominance of: females (51.5%), and clinical multibacillary forms in the general population (51.7%), but when we analyze those under 15 years old, paucibacillary forms (tuberculoid + indeterminate) prevailed. The tuberculoid form was the most diagnosed type of presentation. The annual detection rate in Salvador remained at a very high level of endemicity during the studied period and for those under 15 years old it ranged between high and very high. Grade 2 disabilities both at the time of diagnosis and at discharge after cure, varied between low and medium. Based on these data we conclude that the high levels of leprosy detection rates in the general population, plus the variation between high and very high levels in those under 15 years old, associated with the medium level of grade 2 disabilities at the time of diagnosis and discharge, demonstrate the need for improvement on the existing services, investment in active case finding and training of the healthcare professionals in Salvador.

Epidemiological situation of leprosy in Salvador from 2001 to 2009

Mycobacterium leprae was first described as the bacillus that causes leprosy, a chronic granulomatous infectious disease, in 1873 by Amauer Hansen. Leprosy is part of a group of 10 neglected diseases and Bahia has endemic levels of this illness, varying between high and very high. The detection of 52 new cases of leprosy in children under 15 years old in Salvador in 2006 is alarming, and suggests an early contact with the disease. The aim of this review is to analyze the epidemiological situation, the detection rate and evaluate the clinical and epidemiological profile of leprosy in Salvador, in the period 2001-2009. A retrospective cross-sectional study was performed using secondary data collected at Notifiable Diseases Information System Database (SINAN) through the notification of patients with leprosy. Over these nine years 3,226 patients were reported, with a predominance of: females (51.5%), and clinical multibacillary forms in the general population (51.7%), but when we analyze those under 15 years old, paucibacillary forms (tuberculoid + indeterminate) prevailed. The tuberculoid form was the most diagnosed type of presentation. The annual detection rate in Salvador remained at a very high level of endemicity during the studied period and for those under 15 years old it ranged between high and very high. Grade 2 disabilities both at the time of diagnosis and at discharge after cure, varied between low and medium. Based on these data we conclude that the high levels of leprosy detection rates in the general population, plus the variation between high and very high levels in those under 15 years old, associated with the medium level of grade 2 disabilities at the time of diagnosis and discharge, demonstrate the need for improvement on the existing services, investment in active case finding and training of the healthcare professionals in Salvador.

Validation of epidemiological tools for eczema diagnosis in Brazilian children: the ISAAC's and UK Working Party's criteria.

BACKGROUND: Instruments for field diagnosis of eczema are increasingly used, and it is essential to understand specific limitations to make best use of their strengths. Our objective was to assess the validity of ISAAC and UK Working Party criteria for field diagnosis of eczema in children. METHODS: We performed a cohort study in urban Brazil. Parents/guardians of 1,419 children answered ISAAC phase II questionnaire. Children were examined for skin lesions (UKWP protocol). Two dermatologists examined most cases of eczema (according to ISAAC or UKWP), and a sample without eczema. RESULTS: Agreement between repeat questionnaires on the filter question was poor (kappa = 0.4). Agreement between the 2 dermatologists was fair (kappa = 0.6). False positive reports included scabies in 39% of ISAAC cases and 33% of UKWP cases. Sensitivity and PPV were low (ISAAC: 37.1% and 16.1%; UKWP: 28.6% and 23.8%). Specificity and NPV were high (ISAAC: 90.0% and 96.6%; UKWP: 95.3% and 96.2%). One-year prevalence of eczema was 11.3% (ISAAC), 5.9% (UKWP) and 4.9% (adjusted dermatologist diagnosis). Point prevalence of scabies (alone or not) was 43%, 33% and 18%, in eczemas according to ISAAC, to UKWP and to dermatologists. The reasons why children with eczema were not identified by ISAAC or UKWP were wrongly denying dry skin, itchy rash or personal history of atopic diseases. A limitation is that questionnaire was already validated in Brazil, but not field tested in this specific setting. CONCLUSIONS: Studies using UKWP or ISAAC criteria should include a validation arm, to contribute to the understanding of potential limitations of their use in different contexts and to explore solutions. We list specific recommendations.

[Description of an outbreak of lepidopterism (dermatitis associated with contact with moths) among sailors in Salvador, State of Bahia]. / Descrição de um surto de lepidopterismo (dermatite associada ao contato com mariposas) entre marinheiros, ocorrido em Salvador, Estado da Bahia.

An occurrence of pruritic papular dermatitis among the whole crew of a Filipino commercial ship in Salvador, State of Bahia, was associated with contact with Hylesia moths. This unusual type of dermatitis is caused by the bristles (flechettes) on the moths' bodies. Reporting on such cases serves to warn about possible similar situations.

Descrição de um surto de lepidopterismo (dermatite associada ao contato com mariposas) entre marinheiros, ocorrido em Salvador, Estado da Bahia / Description of an outbreak of lepidopterism (dermatitis associated with contact with moths) among sailors in Salvador, State of Bahia

A ocorrência uma dermatite pápulo-pruriginosa em toda a tripulação de um navio comercial filipino em Salvador, BA, foi associada ao contato com mariposas do gênero Hylesia. Esta enfermidade insólita é causada por cerdas corporais das mariposas (flechettes). O relato dos casos serve como alerta para possíveis situações semelhantes.

An occurrence of pruritic papular dermatitis among the whole crew of a Filipino commercial ship in Salvador, State of Bahia, was associated with contact with Hylesia moths. This unusual type of dermatitis is caused by the bristles (flechettes) on the moths' bodies. Reporting on such cases serves to warn about possible similar situations.

Perfil do albinismo oculocutâneo no estado da Bahia / Profile of oculocutaneos albinism in Bahia state

O albinismo é um conjunto heterogêneo de distúrbios genéticos que afeta a produção de melanina, podendo levar à hipopigmentação da pele, dos pêlos, cabelos e olhos. O objetivo deste trabalho foi analisar aspectos genéticos e agravos à saúde decorrentes do albinismo oculocutâneo. Foi feita uma amostragem de conveniência, utilizando-se como instrumento de coleta de dados questionários semi-estruturados aplicados a 40 probandos (23 mulheres e 17 homens) de famílias associadas a APALBA (Associação dos Portadores de Albinismo da Bahia). Os albinos eram filhos de pais normalmente pigmentados, portadores do alelo recessivo mutante. A maioria (65por cento) refere hereditariedade, com mais de um caso na família, e origem étnica predominantemente negra. A ocorrência do albinismo está associada a dificuldades e desvantagens, conseqüências do distúrbio genético e da segregação social. O diagnóstico usual do albinismo segue critérios clínicos, embora já existam métodos laboratoriais que identificam algumas mutações. A falta de assistência aos afetados contribui para a baixa da visão e a ocorrência de câncer de pele. O estudo indica a necessidade de um novo modelo de atendimento ao albino, com medidas de prevenção aos danos à saúde, que também incluam, nos casos indicados, testes laboratoriais com técnicas da biologia molecular que possam contribuir para o aconselhamento genético da condição.

Upward trend in the rate of detection of new cases of leprosy in the State of Bahia, Brazil

BACKGROUND: The worldwide fall in the rate of detection of new cases of leprosy has been partly attributed to the introduction of multidrug therapy and other improvements in control programs. However, the rate of detection of new cases has not decreased in Brazil. METHODS: An analysis was made of the temporal distribution of 18,872 newly reported leprosy cases in Bahia, Brazil, from 1974 to 1997. Population denominators for the annual detection rate were obtained from population estimates based on the national census. Trends were presented by sex, date of birth, date of diagnosis, date of release, clinical form and by residence in areas which had notified cases in the 5 years prior to the rise in detection rate. RESULTS: There was a marked increase in the new case detection rate (NCDR) in the State of Bahia, from 0.19 to 1.43 cases per 10,000 inhabitants during the study period, an increment of nearly 7% to 8% per year. This increase was also observed in people aged 14 years and younger. During this period tuberculoid and indeterminate forms have become predominant among women and younger people. The average age of male cases has shifted toward younger ages. CONCLUSIONS: We interpret this pattern to mean that the increase in NCDR reflects a real increase in incidence of leprosy, whether or not accompanied by improved detection.