Malária por Plasmodium vivax na infância e na adolescência - aspectos epidemiológicos, clínicos e laboratoriais

• Autor(a) principal: VENTURA, Ana Maria Revorêdo da Silva
• Data de Publicação: 1997
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UFPA
• Texto Completo: http://repositorio.ufpa.br/jspui/handle/2011/3566
• topic: CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::PEDIATRIA; CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::DOENCAS INFECCIOSAS E PARASITARIAS; Malária vivax; Plasmodium vivax; Crianças; Adolescentes; Terapêutica; Amazônia brasileira

Worldwide malaria affects both children and adults, and it is known that clinical picture varies considerably in severity depending upon the immune status (particularly among children) and the infecting Plasmodium species. In the present investigation it was attempted to assess epidemiological, clinical, and laboratorial parameters of Plamodium vivax malaria during childhood and adolescence. In this study, between January, 1995 and November, 1996, it was enrolled 100 patients (both sexes), aged 0 to 14 years, who sought for medical treatment in the attendance outpacient unit of the Malaria Program of Evandro Chagas Institute, in Belem, Para State. All patients had a P. vivax-positive thick blood film. Regarding age, malaria were more frequently seen in adolescents, accounting for 37.0% of them. The fact that 34.0% of patients were identified as autochthonous cases of malaria indicates that disease is progressing in urban settings of the Amazon Region. Fever was found to be the earliest more frequent symptom in the course of illness, being recorded in 88.0% of children. At the first patients's attendance (Day 0, DO), fever, chill and headache (malarial triad) were noted in 97.0%, 91.0% and 85.0% of cases, respectively; while, hepatomegaly and splenomegaly were recorded in 29.0% and 46.0% of them, respectively. Pallor was found to be significantly associated with anaemia (p< 0.05), in that 89.2% of pale children had low haemoglobin values. It is likely that anaemia has developed mainly as a result of haemolysis; although the delay in making the malaria diagnosis (an average of 12.5 days after onset of clinical symptoms) and concurrent hookworm intestinal parasitism may also have played a role in its pathogenesis. An additional finding from this study was that malnutrition seemed not to be associated with anaemia. Once treatment had iniciated, the malarial triad began to subside and asexual parasitaemia levels tended to decrease. The former parameter, however, was shown to be more evident than the latter one. Other clinical symptoms such as pallor, weakness, arthralgia, headache and dark urine lasted longer than did malarial triad, usually persisting for up to 14 days. During or soon after finishing treatment, complications were noted in 5.0% of children including: pneumonia, bronchopneumonia, impetigo, gastroenteritis and a rash of unknown etiology. A finding of practical interest is that ultrasonography was shown to be more sensitive than abdominal palpation in the detection of hepatoesplenomegaly. The start of drug therapy was followed by a progressive increase in haemoglobin levels, reticulocyte count and mean corpuscular haemoglobin concentration (MCHC) from DO (first day of treatment) to 07 (eighth day of treatment). Conversely, the mean corpuscular haemoglobin concentration values decreased significantly from D0 to 07, probably because iron was present in bone marrow in decreased amounts.