Epidemic of American visceral leishmaniasis in Fortaleza, CearÃ: dynamic space and time

• Autor(a) principal: Ronaldo Pinheiro GonÃalves
• Data de Publicação: 2010
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UFC
• Texto Completo: http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=12223
• topic: ANATOMIA PATOLOGICA E PATOLOGIA CLINICA

The American Visceral Leishmaniasis (AVL) is endemic in tropical and subtropical regions of Latin America. In Brazil, in recent years has been expanding and building up. Historically, the state of Ceara has been presented in several cities a high prevalence of the disease, however, the city of Fortaleza, escaping this epidemiological pattern always reported low incidence of the disease, however, from 2005, showed an increase in the number of cases and spatial distribution, showing an expanding epidemic of the disease. The aim of this study was to evaluate the spatial and temporal distribution of disease incidence in the period 1995 to 2008. We analyzed the cases of AVL reported in SINAN and SIM, considering only patients in Fortaleza, who met the criteria adopted by the Ministry of Health for confirmation of diagnosis and the site of infection. The cases were georeferenced and analyzed based on the indicators: incidence and mortality and the following variables: dependent - confirmed cases of the disease and independent - age, age group, sex, place of residence, clinical manifestation, clinical course and type of diagnosis. We used spatial analysis techniques to analyze the cases. During the study period were recorded human cases of AVL 1267, of which 50% were younger than 4 years and 74 deaths. The year 2007 was presented the highest incidence of the disease. The highest incidence of cases were in males (64.3%). The average age of cases of AVL increased in epidemic period. The disease is clinically expressed differently in the epidemic phase, compared with the endemic phase. The risk of infection was higher in males than in females. Mortality was high only in the age group above 60 years. There was a significant increase in disease incidence in the elderly. Diagnostic tests showed high sensitivity and specificity. Over 70% of cases were confirmed through laboratory tests. We observed a decrease in cure rate and an increase in cases of co-infection with HIV. In the epidemic phase, spatial diffusion of disease was the kind of contagion. The diffusion process was linked to environmental factors and socioeconomic factors. We identified areas of high risk for the disease occurrence based on spatial analysis techniques. The study revealed the establishment of a new epidemiological pattern for kala-azar in Fortaleza, mainly characterized by the appearance of an emerging problem: the increase of cases of co-infection with HIV. Also revealed that environmental factors and socioeconomic factors were crucial in the processes of urbanization and expansion of the disease in the city.