Preval?ncia de infec??es enteroparasit?rias e soropreval?ncia de Toxoplasma gondii em idosos atendidos pela Estrat?gia Sa?de da Fam?lia

Autor: Engroff, Paula
Jazyk: portugalština
Rok vydání: 2014
Předmět:
Zdroj: Biblioteca Digital de Teses e Dissertações da PUC_RSPontifícia Universidade Católica do Rio Grande do SulPUC_RS.
Druh dokumentu: Doctoral Thesis
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Introduction : Parasitic infections are a public health problem in Brazil and in other developing countries with variations according to sanitation, socioeconomic status, educational level, age, and hygienic habits, among other variables. In the elderly population, few studies have been published about intestinal parasites and Toxoplasma gondii infections. Objective : To evaluate the prevalence of intestinal parasitic infections and T. gondii seroprevalence associated with the demographic, socioeconomic, hygienic, sanitary and health conditions of the elderly of the Family Health Strategy (FHS) in the city of Porto Alegre, Rio Grande do Sul, Brazil. Methods : This cross-sectional study collected a random sample of FHS elderly individuals living in the city of Porto Alegre, from march 2011 to december 2012. For selection of the elderly, 30 FHS teams were selected, of which 36 respondents were randomly selected by ESF. Data collection was conducted by Community Health Workers (CHW) during home visits; the CHW administered a general epidemiological questionnaire and provided instructions to each patient regarding the collection of fecal samples. Blood and stool samples were collected later by the project team at the healthcare unit where each elderly individual was registered. The blood samples intended for hemograms were sent to the Clinical Pathology Laboratory of the S?o Lucas Hospital. The blood samples intended for toxoplasmosis examination and the fecal samples intended for parasitological stool examination were sent to the Biochemistry, Molecular Genetics and Parasitology Laboratory of the Institute of Geriatrics and Gerontology, PUCRS. Results : The prevalence of intestinal parasites was 10.8%, with the following frequencies: 29 (44.0%), Endolimax nana; 21 (32.0%), Entamoeba coli; 6 (9.0%), Giardia lamblia; 4 (6.0%), Ascaris lumbricoides; 3 (5.0%), Strongyloides stercoralis; 2 (3.0%), Trichuris trichiura; and 1 (2.0%), Iodamoeba butschlii. We found no significant association between infection and the demographic and socioeconomic variables. Regarding the hygiene and sanitary variables, the elderly who had other pets that were not cats or dogs had a higher prevalence of intestinal parasites (27.8% (P=0.041)), and those who had animals that were bathed more often had a higher prevalence of enteroparasites (16.0% (P=0.024)); these associations remained significant in the multivariate analysis. Regarding the health variables, the elderly who did not have hypertension or mental disease had a higher prevalence of intestinal parasites than those who had these diseases (15.4% (P=0.032) and 12.8% (P=0.049), respectively). In assessing the hemogram, anemia was no significant relationship with intestinal parasites and association with eosinophilia was significant when examined only the prevalence of pathogenic parasites: 7.3% (P=0.010). In T. gondii analysis were evaluated 599 elderly individuals; the seroprevalence of T. gondii IgG and IgM was 88.0% and 0.8%, respectively. In the multivariate analysis, the following variables were independently associated with IgG antibody positivity: age, personal income and use of eyeglasses. With respect to IgM antibody positivity, the independently associated variables were age, self-rated health and wears glasses. In assessing the seroprevalence, 581 elderly individuals were evaluated. Conclusion : The prevalence of intestinal parasites in the elderly was low compared with that found in other studies, and the parasites were predominantly nonpathogenic, such as E. coli and E. nana. These findings implicate interpersonal transmission, environmental contamination or the ingestion of contaminated food or water in this population. There was a high prevalence of elderly individuals who were positive for toxoplasma IgG antibodies. This finding raises concern regarding potential latent infection because this population may have compromised immunity. The findings highlight the importance of the ongoing measures related to sanitation and hygiene education in this community.
Introdu??o : As parasitoses constituem um problema de sa?de p?blica no Brasil, apresentando varia??es de acordo com as condi??es de saneamento b?sico, n?vel socioecon?mico, grau de escolaridade, idade e h?bitos de higiene, entre outras vari?veis. Na popula??o idosa s?o raros os estudos publicados sobre infec??es por enteroparasitos e pelo Toxoplasma gondii. Objetivo : Avaliar a preval?ncia das infec??es enteroparasit?rias e a soropreval?ncia de T. gondii de acordo com as condi??es demogr?ficas, socioecon?micas, higi?nicas, sanit?rias e de sa?de dos idosos atendidos pela Estrat?gia Sa?de da Fam?lia (ESF) do munic?pio de Porto Alegre, Rio Grande do Sul, Brasil. Metodologia : Estudo transversal coletado em uma amostra aleat?ria de idosos da ESF do munic?pio de Porto Alegre, no per?odo de mar?o de 2011 a dezembro de 2012. Para a sele??o dos idosos, foram sorteadas 30 equipes da ESF, das quais foram sorteados 36 idosos por ESF. A coleta de dados foi realizada pelos Agentes Comunit?rios de Sa?de (ACS), em visita domiciliar, por meio de question?rio geral de inqu?rito epidemiol?gico e orienta??o quanto ? coleta de amostras fecais. A coleta de sangue e fezes foi realizada posteriormente pela equipe do projeto na unidade de sa?de onde os idosos estavam cadastrados. As amostras de sangue para a realiza??o de hemograma foram encaminhadas para o Laborat?rio de Patologia Cl?nica do Hospital S?o Lucas da PUCRS. As amostras de sangue para o exame de toxoplasmose e as amostras para a realiza??o do exame parasitol?gico de fezes foram encaminhadas para o Laborat?rio de Bioqu?mica, Gen?tica Molecular e Parasitologia do Instituto de Geriatria e Gerontologia da PUCRS. Resultados : Na avalia??o dos enteroparasitos, foram avaliados 581 idosos e a preval?ncia de enteroparasitoses foi de 10,8%, sendo 29 (44,0%) de Endolimax nana, 21 (32,0%) de Entamoeba coli, 6 (9,0%) de Giardia lamblia, 4 (6,0%) de Ascaris lumbricoides, 3 (5,0%) de Strongyloides stercoralis, 2 (3,0%) de Trichuris trichiura e 1 (2,0%) de Iodamoeba b?tschlii. N?o foi encontrada nenhuma associa??o significativa com as vari?veis demogr?ficas e socioecon?micas. Nas vari?veis higi?nicas e sanit?rias, os idosos que diziam ter outros animais de estima??o, exceto gato ou cachorro, apresentaram maior preval?ncia de enteroparasitos: 27,8% (P=0,041), e os que possu?am animais que eram banhados com maior frequ?ncia tamb?m apresentaram maior preval?ncia de enteroparasitos: 16,0% (P=0,024); essas vari?veis se mantiveram na an?lise multivariada. Na associa??o com as vari?veis de sa?de, os idosos que n?o apresentavam hipertens?o arterial ou doen?a mental tiveram maior preval?ncia de enteroparasitos do que os que tinham essas doen?as: 15,4% (P=0,032) e 12,8% (P=0,049), respectivamente. Na avalia??o do hemograma, anemia n?o teve rela??o significativa com as enteroparasitoses, e a associa??o com eosinofilia foi significativa quando avaliada a preval?ncia somente de parasitos patog?nicos: 7,3% (P=0,010). Na an?lise do T. gondii, foram avaliados 599 idosos com soropreval?ncia para T. gondii IgG de 88,0% e 0,8% para T. gondii IgM. Na an?lise multivariada, as vari?veis que se associaram de forma independente para IgG positivo foram: faixa et?ria, renda pessoal e uso de ?culos; e para IgM positivo: faixa et?ria, autopercep??o de sa?de e uso de ?culos. Conclus?o : A preval?ncia de enteroparasitos encontrada nos idosos foi baixa quando comparada com outros estudos, ocorrendo um predom?nio de parasitos n?o patog?nicos, como E. coli e E. nana. Esses achados indicam a possibilidade de transmiss?o interpessoal, contamina??o ambiental ou mesmo a ocorr?ncia de ingest?o de alimentos ou ?gua contaminados. Com rela??o ? toxoplasmose, foi encontrada uma alta preval?ncia de anticorpos IgG positivo para T. gondii nos idosos. A preocupa??o ? para uma potencial infec??o latente, uma vez que essa popula??o est? sujeita a condi??es que podem comprometer sua imunidade. Sugere-se, assim, o desenvolvimento de medidas relacionadas a saneamento b?sico e programas cont?nuos de educa??o sanit?ria na comunidade estudada.
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