Criptococose: padrões de mortalidade no Brasil e morbimortalidade em hospital de referência do Ceará

Detalhes bibliográficos
Autor(a) principal: Oliveira, Aline Silva de
Data de Publicação: 2018
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da Universidade Federal do Ceará (UFC)
Texto Completo: http://www.repositorio.ufc.br/handle/riufc/35195
Resumo: Cryptococcosis is a disease of global distribution and impact caused by Cryptococcus genus fungi. The disease greatest occurrence occurs in people with natural immunosuppression, however, it can also occur in immunocompetent people. In Brazil, there is no compulsory notification for this disease, so, there is no reliable database for measuring the morbidity and mortality magnitude in the country. Most clinical epidemiological studies are focused on South and Southeast regions, and the results can’t be generalized throughout the country. In this way, this study aims to characterize the mortality related to cryptococcosis in Brazil and the morbidity and mortality patterns of the disease in a Ceará’s reference hospital. The study was divided into two stages: 1. Ecological study of temporal trend and spatial analysis of cryptococcosis-related deaths in Brazil; and 2. A cross-sectional study with cases of cryptococcosis in patients treated at Hospital São José. In stage 1, the time trend was performed with regression analysis by inflection points (joinpoint), and the presence of spatial autocorrelation was verified using the index spatial association (LISA). In stage 2, the records of cases of cryptococcosis treated in the period from 2005 to 2016 were reviewed and epidemiological, clinical and laboratory factors were investigated. Statistical analysis was performed using Stata software version 11.2. There was a tendency to reduce the mortality coefficient in the Southeast regions (annual percentage change [APC] = -4.2 *), South (APC = -0.4) and Center-West (APC = -0.3). Regarding mortality related to cryptococcosis in Brazil, we observed a significant growth trend in the North (APC = 6.5 *) and Northeast (APC = 4.3 *), and the presence of high-high-density municipalities in the Southeast, South and Center-West, and high-low pattern in the North and Northeast. Relationed to cryptococcal morbidity and mortality pattern in Ceará, we observed a predominance of the disease occurrence in based immunosuppression people, mainly affected by HIV / AIDS, male, economically active age and living in the capital’s state. The most common clinical presentation of the disease was cryptococcal meningitis (39; 54.17%), followed by the disseminated form (12; 16.67%). The hospitalization time ranged from 3to 141 days with an average of 24 days. The cryptococcosis lethality rate in the period was 36.11%, with sequelae occurring in 24% of the patients who evolved to hospital discharge. The bivariate analysis showed a higher prevalence in the occurrence of deaths in the age groups of 40 to 59 years (prevalence ratio [RP] = 2.31, reliability interval [CI]: 1.13 -4.74) and in those older than 60 (RP = 4.63, CI: 2.74 -7.82, p- value [p] = 0.005), as well as people who underwent orotracheal intubation procedures (RP: 16.46; , 46-49.61, p <0.001), hemodialysis (RP: 4.57, CI: 2.87 -7.26, w: <0.001). In conclusion, we verified that mortality related to cryptococcosis in Brazil shows a tendency to decline, which may be related to the better survival and quality of life of people with HIV / Aids immunosuppression, transplanted and other conditions, since it wasn’t observed in the creation and / or implementation of specific policies or measures to control the disease. Related to the patterns or illness by cryptococcosis in Ceará, it’s observed that this one follows a similar patterns to that one described in literature in other regions of the country, in which occurs predominantly in males, in the economically active age group, and with based immunosuppression caused mainly by HIV / AIDS infection.
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spelling Criptococose: padrões de mortalidade no Brasil e morbimortalidade em hospital de referência do CearáCriptococoseEpidemiologiaMorbidadeMortalidadeCryptococcosis is a disease of global distribution and impact caused by Cryptococcus genus fungi. The disease greatest occurrence occurs in people with natural immunosuppression, however, it can also occur in immunocompetent people. In Brazil, there is no compulsory notification for this disease, so, there is no reliable database for measuring the morbidity and mortality magnitude in the country. Most clinical epidemiological studies are focused on South and Southeast regions, and the results can’t be generalized throughout the country. In this way, this study aims to characterize the mortality related to cryptococcosis in Brazil and the morbidity and mortality patterns of the disease in a Ceará’s reference hospital. The study was divided into two stages: 1. Ecological study of temporal trend and spatial analysis of cryptococcosis-related deaths in Brazil; and 2. A cross-sectional study with cases of cryptococcosis in patients treated at Hospital São José. In stage 1, the time trend was performed with regression analysis by inflection points (joinpoint), and the presence of spatial autocorrelation was verified using the index spatial association (LISA). In stage 2, the records of cases of cryptococcosis treated in the period from 2005 to 2016 were reviewed and epidemiological, clinical and laboratory factors were investigated. Statistical analysis was performed using Stata software version 11.2. There was a tendency to reduce the mortality coefficient in the Southeast regions (annual percentage change [APC] = -4.2 *), South (APC = -0.4) and Center-West (APC = -0.3). Regarding mortality related to cryptococcosis in Brazil, we observed a significant growth trend in the North (APC = 6.5 *) and Northeast (APC = 4.3 *), and the presence of high-high-density municipalities in the Southeast, South and Center-West, and high-low pattern in the North and Northeast. Relationed to cryptococcal morbidity and mortality pattern in Ceará, we observed a predominance of the disease occurrence in based immunosuppression people, mainly affected by HIV / AIDS, male, economically active age and living in the capital’s state. The most common clinical presentation of the disease was cryptococcal meningitis (39; 54.17%), followed by the disseminated form (12; 16.67%). The hospitalization time ranged from 3to 141 days with an average of 24 days. The cryptococcosis lethality rate in the period was 36.11%, with sequelae occurring in 24% of the patients who evolved to hospital discharge. The bivariate analysis showed a higher prevalence in the occurrence of deaths in the age groups of 40 to 59 years (prevalence ratio [RP] = 2.31, reliability interval [CI]: 1.13 -4.74) and in those older than 60 (RP = 4.63, CI: 2.74 -7.82, p- value [p] = 0.005), as well as people who underwent orotracheal intubation procedures (RP: 16.46; , 46-49.61, p <0.001), hemodialysis (RP: 4.57, CI: 2.87 -7.26, w: <0.001). In conclusion, we verified that mortality related to cryptococcosis in Brazil shows a tendency to decline, which may be related to the better survival and quality of life of people with HIV / Aids immunosuppression, transplanted and other conditions, since it wasn’t observed in the creation and / or implementation of specific policies or measures to control the disease. Related to the patterns or illness by cryptococcosis in Ceará, it’s observed that this one follows a similar patterns to that one described in literature in other regions of the country, in which occurs predominantly in males, in the economically active age group, and with based immunosuppression caused mainly by HIV / AIDS infection.A criptococose é uma doença de distribuição e impacto mundial causada por fungos do gênero Cryptococcus. A maior ocorrência da doença se dá em pessoas com imunossupressão de base, porém, pode ocorrer também em indivíduos imunocompetentes. No Brasil, a doença não é de notificação compulsória, não existindo, portanto, uma base de dados fidedigna para mensuração da magnitude da morbimortalidade no País. A maioria dos estudos clínico epidemiológicos realizados no Brasil está focado nas regiões Sul e Sudeste, não podendo os resultados ser generalizados para todo o país. Neste sentido, este estudo tem por objetivo caracterizar a mortalidade relacionada à criptococose no Brasil e os padrões de morbimortalidade da doença em Hospital de Referência do Ceará. O estudo foi divido em duas etapas: 1) Estudo ecológico de tendência temporal e análise espacial dos óbitos relacionados à criptococose no Brasil; e 2) Estudo transversal realizado com casos de criptococose em pacientes atendidos no Hospital São José. Na etapa 1, a tendência temporal foi realizada com análise de regressão por pontos de inflexão (Joinpoint), e a presença de autocorreção espacial foi verificada utilizando o índice local de associação espacial (LISA). Na etapa 2, foram revisados os prontuários de casos de criptococose atendidos no período de 2005 a 2016 e investigados fatores epidemiológicos, clínicos e laboratoriais. A análise estatística foi realizada utilizando o software Stata versão 11.2. Foi observada tendência de redução do coeficiente de mortalidade nas regiões Sudeste (variação percentual anual [APC]=-4,2*), Sul (APC=-0,4) e Centro-Oeste (APC=-0,3). Sobre a mortalidade relacionada a criptococose no Brasil, verificamos uma tendência de crescimento significativo no Norte (APC=6,5*) e Nordeste (APC=4,3*), e a presença de agregados de municípios com padrão alto-alto no Sudeste, Sul e Centro-Oeste, e padrão alto-baixo no Norte e Nordeste. Com relação ao padrão de morbimortalidade por criptococose no Ceará, verificamos predominância da ocorrência da doença em indivíduos com imunossupressão de base, principalmente naqueles com HIV/aids, do sexo masculino, em idade economicamente ativa e residentes da Capital. A apresentação clínica mais comum da doença foi a meningite criptocócica (39; 54,17%), seguida da forma disseminada (12; 16,67%). O período de internação variou de 3 a 141 dias com mediana de 24 dias. A taxa de letalidade por criptococose foi de 36,11%, com ocorrência de sequelas em 24% dos pacientes. A análise bivariada mostrou maior prevalência de óbitos nas faixas etárias de 40 a 59 anos (razão de prevalência [RP]=2,31; intervalo de confiança [IC]: 1,13 –4,74) e naqueles maiores de 60 anos (RP=4,63; IC: 2,74 – 7,82; p-valor [p]= 0,005), assim como nos indivíduos que foram submetidos aos procedimentos de intubação orotraqueal (RP: 16,46; IC: 5,46 –49,61; p: <0,001) e hemodiálise (RP: 4,57; IC: 2,87 –7,26; p: <0,001). Em conclusão, verificamos que a mortalidade relacionada à criptococose no Brasil apresenta tendência de declínio, o que pode estar relacionado à melhor sobrevida e qualidade de vida dos indivíduos com imunossupressão por HIV/Aids, transplantados e outras condições. Quanto aos padrões de adoecimento por criptococose no Ceará, o acometimento pela doença ocorreu predominantemente em homens imunossuprimidos por HIV/aids, com elevada letalidade, principalmente naqueles maiores de 40 anos de idade, intubados e submetidos a hemodiálise.Leitão, Terezinha do Menino Jesus SilvaOliveira, Aline Silva de2018-08-28T16:32:52Z2018-08-28T16:32:52Z2018-04-27info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfOLIVEIRA, A. S. Criptococose: padrões de mortalidade no Brasil e morbimortalidade em hospital de referência do Ceará. 2018. 77 f. Dissertação (Mestrado em Saúde Pública) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2018.http://www.repositorio.ufc.br/handle/riufc/35195porreponame:Repositório Institucional da Universidade Federal do Ceará (UFC)instname:Universidade Federal do Ceará (UFC)instacron:UFCinfo:eu-repo/semantics/openAccess2021-03-20T12:43:24Zoai:repositorio.ufc.br:riufc/35195Repositório InstitucionalPUBhttp://www.repositorio.ufc.br/ri-oai/requestbu@ufc.br || repositorio@ufc.bropendoar:2024-09-11T18:32:35.038672Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC)false
dc.title.none.fl_str_mv Criptococose: padrões de mortalidade no Brasil e morbimortalidade em hospital de referência do Ceará
title Criptococose: padrões de mortalidade no Brasil e morbimortalidade em hospital de referência do Ceará
spellingShingle Criptococose: padrões de mortalidade no Brasil e morbimortalidade em hospital de referência do Ceará
Oliveira, Aline Silva de
Criptococose
Epidemiologia
Morbidade
Mortalidade
title_short Criptococose: padrões de mortalidade no Brasil e morbimortalidade em hospital de referência do Ceará
title_full Criptococose: padrões de mortalidade no Brasil e morbimortalidade em hospital de referência do Ceará
title_fullStr Criptococose: padrões de mortalidade no Brasil e morbimortalidade em hospital de referência do Ceará
title_full_unstemmed Criptococose: padrões de mortalidade no Brasil e morbimortalidade em hospital de referência do Ceará
title_sort Criptococose: padrões de mortalidade no Brasil e morbimortalidade em hospital de referência do Ceará
author Oliveira, Aline Silva de
author_facet Oliveira, Aline Silva de
author_role author
dc.contributor.none.fl_str_mv Leitão, Terezinha do Menino Jesus Silva
dc.contributor.author.fl_str_mv Oliveira, Aline Silva de
dc.subject.por.fl_str_mv Criptococose
Epidemiologia
Morbidade
Mortalidade
topic Criptococose
Epidemiologia
Morbidade
Mortalidade
description Cryptococcosis is a disease of global distribution and impact caused by Cryptococcus genus fungi. The disease greatest occurrence occurs in people with natural immunosuppression, however, it can also occur in immunocompetent people. In Brazil, there is no compulsory notification for this disease, so, there is no reliable database for measuring the morbidity and mortality magnitude in the country. Most clinical epidemiological studies are focused on South and Southeast regions, and the results can’t be generalized throughout the country. In this way, this study aims to characterize the mortality related to cryptococcosis in Brazil and the morbidity and mortality patterns of the disease in a Ceará’s reference hospital. The study was divided into two stages: 1. Ecological study of temporal trend and spatial analysis of cryptococcosis-related deaths in Brazil; and 2. A cross-sectional study with cases of cryptococcosis in patients treated at Hospital São José. In stage 1, the time trend was performed with regression analysis by inflection points (joinpoint), and the presence of spatial autocorrelation was verified using the index spatial association (LISA). In stage 2, the records of cases of cryptococcosis treated in the period from 2005 to 2016 were reviewed and epidemiological, clinical and laboratory factors were investigated. Statistical analysis was performed using Stata software version 11.2. There was a tendency to reduce the mortality coefficient in the Southeast regions (annual percentage change [APC] = -4.2 *), South (APC = -0.4) and Center-West (APC = -0.3). Regarding mortality related to cryptococcosis in Brazil, we observed a significant growth trend in the North (APC = 6.5 *) and Northeast (APC = 4.3 *), and the presence of high-high-density municipalities in the Southeast, South and Center-West, and high-low pattern in the North and Northeast. Relationed to cryptococcal morbidity and mortality pattern in Ceará, we observed a predominance of the disease occurrence in based immunosuppression people, mainly affected by HIV / AIDS, male, economically active age and living in the capital’s state. The most common clinical presentation of the disease was cryptococcal meningitis (39; 54.17%), followed by the disseminated form (12; 16.67%). The hospitalization time ranged from 3to 141 days with an average of 24 days. The cryptococcosis lethality rate in the period was 36.11%, with sequelae occurring in 24% of the patients who evolved to hospital discharge. The bivariate analysis showed a higher prevalence in the occurrence of deaths in the age groups of 40 to 59 years (prevalence ratio [RP] = 2.31, reliability interval [CI]: 1.13 -4.74) and in those older than 60 (RP = 4.63, CI: 2.74 -7.82, p- value [p] = 0.005), as well as people who underwent orotracheal intubation procedures (RP: 16.46; , 46-49.61, p <0.001), hemodialysis (RP: 4.57, CI: 2.87 -7.26, w: <0.001). In conclusion, we verified that mortality related to cryptococcosis in Brazil shows a tendency to decline, which may be related to the better survival and quality of life of people with HIV / Aids immunosuppression, transplanted and other conditions, since it wasn’t observed in the creation and / or implementation of specific policies or measures to control the disease. Related to the patterns or illness by cryptococcosis in Ceará, it’s observed that this one follows a similar patterns to that one described in literature in other regions of the country, in which occurs predominantly in males, in the economically active age group, and with based immunosuppression caused mainly by HIV / AIDS infection.
publishDate 2018
dc.date.none.fl_str_mv 2018-08-28T16:32:52Z
2018-08-28T16:32:52Z
2018-04-27
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dc.identifier.uri.fl_str_mv OLIVEIRA, A. S. Criptococose: padrões de mortalidade no Brasil e morbimortalidade em hospital de referência do Ceará. 2018. 77 f. Dissertação (Mestrado em Saúde Pública) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2018.
http://www.repositorio.ufc.br/handle/riufc/35195
identifier_str_mv OLIVEIRA, A. S. Criptococose: padrões de mortalidade no Brasil e morbimortalidade em hospital de referência do Ceará. 2018. 77 f. Dissertação (Mestrado em Saúde Pública) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2018.
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