Revista da Sociedade Brasileira de Medicina Tropical最新文献

Background: The São Francisco River Integration Project (PISF) may facilitate the spread of intermediate hosts of schistosomiasis to previously unaffected areas, potentially increasing disease transmission owing to human migration and environmental changes. This study aimed to describe the distribution of freshwater mollusk fauna along the river basins involved in the PISF in the state of Ceará.

Methods: A descriptive cross-sectional study was conducted in three municipalities in the state of Ceará (Brejo Santo, Jati, and Mauriti) located along the Meta 2N axis of the PISF. Mollusks were collected from 21 water bodies near the resettlement areas (productive rural villages). Morphological identification of freshwater snails and screening for Schistosoma mansoni (S. mansoni) cercariae were also performed. Environmental variables were recorded, and the potential for transmission was assessed according to the Brazilian Ministry of Health guidelines.

Results: Overall, 765 Biomphalaria specimens were collected, with Biomphalaria straminea being the only species identified. This genus occurred in all three municipalities and 85.7% of the surveyed water bodies. The other identified mollusk genera included Melanoides, Drepanotrema, Physa, Pomacea, and members of the class Bivalvia. No S. mansoni larvae were found, and only nonpathogenic trematode larvae were observed. Eight water bodies were classified as having a high epidemiological risk.

Conclusions: The surveyed communities represent areas with the potential to sustain schistosomiasis transmission. These findings highlight the importance of developing intersectoral strategies to address the issue from a One Health perspective and to implement effective interventions in the areas impacted by the project.

Background: Chagas disease (CD) is a neglected endemic infectious disease. Primary health care (PHC) is responsible for delivering care to patients with CD in an integrated manner with other levels of the health system. We aimed to describe the use of implementation science (IS) as a tool for developing a care pathway for patients with CD from the perspective of the Brazilian Chronic Care Model (BCCM).

Methods: This study was conducted in the large municipality of Minas Gerais, Brazil. A diagnostic phase was conducted to identify barriers and facilitators related to CD care. The findings from this stage were analyzed using IS frameworks. Subsequently, the BCCM was adapted as a logical model to guide the creation of a care pathway. Health managers and professionals from the municipalities were trained to implement the proposed actions. After implementation, process and outcome indicators were monitored over a 12-month period.

Results: IS proved to be an effective strategy for applying BCCM to patients with CD in PHC settings. A total of 267 health professionals were trained. After the intervention, the following indicators increased: risk factor screening, serological testing, diagnosis, and antiparasitic treatment for CD.

Conclusion: The development of a CD care pathway using IS tools integrated with the BCCM enabled the incorporation of processes into PHC and suggested that this model may be replicated in other contexts as well as for other chronic conditions requiring longitudinal care.

Background: Visceral leishmaniasis (VL) is an infectious disease that represents a considerable public health problem. In Brazil, VL was gradually expanded in all the territory and from rural to urban areas. A notable concentration of VL emerged in 2010 in the Médio Paraíba region of the state of Rio de Janeiro, where the municipality of Barra Mansa is located. However, information on the geographic distribution of VL in this municipality is scarce. Therefore, this study aimed to characterize the spatial distribution of VL in Barra Mansa from 2014 to 2023.

Methods: This exploratory epidemiological study involved creating point maps for human visceral leishmaniasis (HVL) and canine visceral leishmaniasis (CVL), as well as kernel density and cluster maps for CVL. In addition, maps were produced by superimposing the point maps of human cases with the cluster maps of canine infections.

Results: In total, 99.1% of CVL-infected dogs and 100% of human cases were observed in the urban areas of the municipality. Persistent spatial clusters and hotspots were identified in urban areas adjacent to rural zones. Moreover, 55% of HVL cases were located within 600 m of a CVL spatial cluster. The closest clusters primarily formed up to 3 years before the HVL cases.

Conclusion: These results suggest a relationship between urban-rural interface characteristics and high density of CVL. They also highlight the spatial and temporal closeness between CVL and HVL, corroborating the influence of these factors on the maintenance of the disease cycle.