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Authors
Abstract(s)
Este trabalho expõe o levantamento estatístico e a caracterização clínica da
leishmaniose cutânea na Beira Interior. Pretende-se, assim, tentar definir a importância que
esta infecção assume neste meio e identificar os principais problemas epidemiológicos e
clínicos com ela relacionados, bem como propor algumas medidas a tomar para a sua
resolução.
Foi efectuado um estudo descritivo tipo série de casos exploratório, tendo por base os
doentes observados nas consultas de Dermatologia do Centro Hospitalar da Cova da Beira e
da Unidade Local de Saúde da Guarda, entre Abril de 2004 e Maio de 2009, com diagnóstico
de leishmaniose cutânea confirmado por biópsia cutânea.
Os dados submetidos à análise estatística provêm das informações recolhidas nos
processos clínicos e junto dos doentes, através de um inquérito epidemiológico. Para
caracterização epidemiológica foi inquirido o local de residência, a proximidade a zonas
verdes e a recursos hídricos, o contacto com animais domésticos, nomeadamente cães, mas
também selvagens ! raposas e roedores. Para além da ocupação profissional e de
passatempos, foram também registadas viagens para fora de Portugal, assim como o momento
em que ocorreu a picada de flebótomo potencialmente infectante. Na caracterização da doença
tentou-se obter a descrição da lesão, questionando-se igualmente a ocorrência de leishmaniose
mucocutânea ou visceral, e o tempo decorrido até à procura de ajuda médica e tratamentos
prévios realizados. Recolheram-se dados sobre a abordagem diagnóstica, a resposta ao
tratamento e a evolução depois deste. Para avaliar o grau de informação sobre a leishmaniose,
os doentes foram inquiridos quanto à ocorrência de história familiar e quanto ao seu
conhecimento prévio acerca da leishmaniose cutânea.
Foram seleccionados 13 doentes. Todos viviam na região da Beira Interior. A maior
ocorrência foi no sexo feminino (77%). Cinquenta porcento dos doentes tinham idade inferior
a quarenta e quatro anos. O maior número de diagnósticos confirmados por biópsia ! seis !,
ocorreu no ano de 2006. A maioria vivia perto de espaços verdes (92%), numa zona rural
(69%) e próximo de recursos hídricos (62%). A apresentação típica foi a lesão única na face
(85%), mais frequentemente um nódulo (69%), sem eritema, prurido ou dor. O tempo médio
de espera até procurar assistência médica foi de 22 semanas. A maioria dos doentes foi
primeiro ao Médico de Família (92%). Em nenhum caso se observou associação com a forma
mucosa ou visceral da doença. Todos os doentes evoluíram para a cura, não tendo ocorrido
recidivas nem reinfecções.
Em conclusão, o presente estudo permite-nos sugerir que a leishmaniose cutânea deve
ser considerada no diagnóstico diferencial das lesões cutâneas inflamatórias crónicas na Beira
Interior, principalmente em doentes com factores de risco adequados associados.
This paper presents a survey of statistical and clinical characterization of cutaneous leishmaniasis in Beira Interior. The aim is to try to define the importance of this infection in this region, as well as identify key epidemiological and clinical problems related with it, as well as some measures to resolve them. A descriptive exploratory case-series study was conducted, based on patients seen in the Dermatology department of the Hospital Center of Cova da Beira and the Local Health Unit of Guarda, between April 2004 and May 2009, with diagnosis of cutaneous leishmaniasis confirmed by skin biopsy. "#$% &'('% )*+,-(($&% (.% )('(-)(-/'0% '1'02)-)% 3')% /.00$/($&% 45.,% (#$% 6'(-$1()7% ,$&-/'0% records and through field work. For the epidemiological characterization, besides the place of residence, it was asked the proximity to green areas and water resources, contact with household animals, mainly dogs but also wildlife ! foxes and rodents. In addition to occupation and hobbies, the trips out of Portugal and the time when the bite occurred was inquired. For the characterization of the disease, we tried to get a description of the injury, and we also questioned the occurrence of mucocutaneous or visceral leishmaniasis, the weeks that elapsed until the patient seeked medical advice and any treatments he made before. We also analyzed the diagnostic approach, the response to treatment and the evolution after this. To assess the degree of information about leishmaniasis, the patient was questioned about previous family history and their prior knowledge of the disease. Thirteen patients were selected. All lived in the region of Beira Interior. Most occurrences were in females (77%). Fifty percent of patients had less than forty-four years. The highest number of cases confirmed by biopsy, 6 patients, was registered in 2006. Most patients lived close to green areas (92%), in a rural zone (69%), near water resources (62%). The typical presentation was a single lesion on the face (85%), most often a nodule (69%) without erythema, itching or pain. The average time elapsed before seeking medical advice was 22 weeks. Most patients first went to the family practitioner (92%). In no case the disease was associated with the mucosal or visceral form. All patients progressed to a cure. There were no relapses or reinfections. In conclusion, this study allows us to suggest that cutaneous leishmaniasis should be considered in the differential diagnosis of chronic inflammatory skin lesions in Beira Interior, mainly in patients with known risk factors.
This paper presents a survey of statistical and clinical characterization of cutaneous leishmaniasis in Beira Interior. The aim is to try to define the importance of this infection in this region, as well as identify key epidemiological and clinical problems related with it, as well as some measures to resolve them. A descriptive exploratory case-series study was conducted, based on patients seen in the Dermatology department of the Hospital Center of Cova da Beira and the Local Health Unit of Guarda, between April 2004 and May 2009, with diagnosis of cutaneous leishmaniasis confirmed by skin biopsy. "#$% &'('% )*+,-(($&% (.% )('(-)(-/'0% '1'02)-)% 3')% /.00$/($&% 45.,% (#$% 6'(-$1()7% ,$&-/'0% records and through field work. For the epidemiological characterization, besides the place of residence, it was asked the proximity to green areas and water resources, contact with household animals, mainly dogs but also wildlife ! foxes and rodents. In addition to occupation and hobbies, the trips out of Portugal and the time when the bite occurred was inquired. For the characterization of the disease, we tried to get a description of the injury, and we also questioned the occurrence of mucocutaneous or visceral leishmaniasis, the weeks that elapsed until the patient seeked medical advice and any treatments he made before. We also analyzed the diagnostic approach, the response to treatment and the evolution after this. To assess the degree of information about leishmaniasis, the patient was questioned about previous family history and their prior knowledge of the disease. Thirteen patients were selected. All lived in the region of Beira Interior. Most occurrences were in females (77%). Fifty percent of patients had less than forty-four years. The highest number of cases confirmed by biopsy, 6 patients, was registered in 2006. Most patients lived close to green areas (92%), in a rural zone (69%), near water resources (62%). The typical presentation was a single lesion on the face (85%), most often a nodule (69%) without erythema, itching or pain. The average time elapsed before seeking medical advice was 22 weeks. Most patients first went to the family practitioner (92%). In no case the disease was associated with the mucosal or visceral form. All patients progressed to a cure. There were no relapses or reinfections. In conclusion, this study allows us to suggest that cutaneous leishmaniasis should be considered in the differential diagnosis of chronic inflammatory skin lesions in Beira Interior, mainly in patients with known risk factors.
Description
Keywords
Leishmaniose cutânea Leishmaniose cutânea - Tratamento Leishmaniose cutânea - Saúde pública Leishmania infantum Phlebotomus
Citation
Publisher
Universidade da Beira Interior