Leishmaniose visceral: análise espaço-temporal, avaliação do perfil clínico-epidemiológico e fatores associados ao óbito em Belo Horizonte e Minas Gerais

• Ano de defesa: 2017
• Autor(a) principal: Thais Almeida Marques da Silva
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; Brasil; ICB - INSTITUTO DE CIÊNCIAS BIOLOGICAS; Programa de Pós-Graduação em Parasitologia; UFMG
• Palavras-chave em Português: Leishmaniose visceral; Incidência; Modelagem de dados espaço-temporais; Mortalidade; Letalidade; Fatores prognósticos; Parasitologia; Análise espaço-temporal; Prognóstico
• Link de acesso: http://hdl.handle.net/1843/34830

Visceral leishmaniasis (VL) is a serious, systemic and fatal disease if not diagnosed and treated early. Since the decade of 1980, visceral leishmaniasis (VL) is expanding in Brazil a process that has been associated with the urbanization of the disease. The aim of the present study was to identify the clinical-epidemiological profile and prognostic factors associated with death due to visceral leishmaniasis, occurring in Minas Gerais (2002 to 2013) and in the Belo Horizonte city (2008 to 2015) and to identify spatio-temporal trends of VL in Minas Gerais (2002-2013). To better understand the epidemiology and expansion of VL in Minas Gerais, two studies were performed: (i) ecological study with spatial and time series analyzes and (ii) a historical cohort study to evaluate prognostic factors associated with death. For this analysis, were included confirmed new cases and deaths from VL (n= 5778) reported in the Brazilian Notifiable Disease Information System (SINAN), in the period from 2002 to 2013. In the ecological study, thematic maps using crude and smoothed incidences, lethality and mortality were generated. In order, to complement the incidence data obtained with the spatial analysis, a Generalized Linear Model (GLM) type Poisson (log-linear) was also used to measure quantitatively the variation of the average number of cases from one year to the following in this time series. The results show that VL had a heterogeneous spatio-temporal distribution in the State of Minas Gerais, from 2002 to 2013. Among the 12 existing mesoregions, six mesoregions (Central Mineira, Jequitinhonha, Belo Horizonte Metropolitan, Northwest Minas, North Minas and Vale do Rio Doce) are responsible for the expansion and maintenance of VL in the state. It was observed that the Vale do Rio Doce mesoregions presented a considerable increase in the incidence, mortality and lethality rates increased more considerable in the last years. In the historical cohort study, it was observed that the clinical-epidemiological profile of VL cases reported in the state of Minas Gerais presented the same trends already described in the literature. In the analysis for the evaluation of factors associated with death from LV, deaths (n = 553) and cases that did not evaluated death (n = 4766) were compared by Multivariate Logistic Regression. The following variables were identified as predictors of death: fever, weakness, Leishmania-HIV co-infection, edema, jaundice, hemorrhagic manifestations and different age categories. A study conducted in Belo Horizonte analyzed cases and deaths from VL medical assistance in the municipality between 2008 and 2015. For this analysis, the following studies were performed: (i) descriptive study of deaths (n=225): the data source was the investigation of deaths attended in the municipality of Belo Horizonte; (ii) case-control study: comparing deaths by VL (n=180) and clinical cases that did not evaluated to death (n=180), according to clinical-laboratory variables, treatment and co-infections using medical records data from patients from different hospitals in Belo Horizonte The analysis allowed to xvi identify symptoms and clinical signs and comorbidities more frequently associated with death. In the control case study, using Multivariate Logistic Regression, different models were analyzed and the factors associated with death by VL, in different moments of the disease, were: jaundice, bleeding, increased abdominal volume, dyspnea, tuberculosis, total bilirubin level greater than 2 mg/dL or greater than the reference value, TGO or TGP greater than 100 U/L, leukocytes greater than 7,000/mm3, hemoglobin less than or equal to 7 g/dL, Platlet count less than 50,000/mm3, malnutrition, unfocused infection and age > 60 years. The understanding of the clinical-epidemiological characteristics of the cases and deaths by VL, as well as the expansion of the disease (incidence rates), lethality and mortality in Minas Gerais could contribute to a better understanding of the epidemiology of the disease in the State as well as its trends in the chronological series. The knowledge of the factors associated with death in individuals with VL may help in understanding the high rates of lethality due to the disease and in a better clinical management of the patients.