Prevalência de tracoma em crianças pré-escolares e escolares da periferia da cidade de Joinville, Estado de Santa Catarina, Brasil

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Abstract

RESUMO Joinville é a maior cidade do Estado de Santa Catarina. Graças ao seu desenvolvimento industrial, principalmente nos últimos 15 anos, a cidade tem recebido muitos migrantes vindos de áreas rurais, na maioria dos Estados de Santa Catarina e Paraná. Um estudo de prevalência de tracoma foi realizado entre 2.822 crianças pré-escolares e escolares, com idade variando de 3 meses a 15 anos (média igual a 8,4 anos), que freqüentavam seis instituições educacionais públicas localizadas em diferentes regiões da periferia de Joinville. 53,2% das crianças eram do sexo masculino. O tracoma foi avaliado de acordo com o esquema simplificado de gradação da OMS. A prevalência de TF foi de 7,9% e a de TS foi de 1,1%. Não se observou TI, TT ou CO. 65% das crianças tracomatosas eram procedentes de centros urbanos e 35% eram de áreas rurais. A citologia com a coloração pelo anticorpo monoclonal fluorescente foi positiva em 57% dos casos de TF.

Translated abstract

SUMMARY Joinville is the largest city in the State of Santa Catarina, southern Brazil. It has had a considerable industrial growth in the last fifteen years and its 1990 estimated population is of450, inhabitants. A great part of them are newly-arrived people from rural areas of this State and the neighbouring State (Paraná), seeking for better jobs. A trachoma prevalence survey was carried out among 2,822 pre-school and school children, aged 3 months to 15 years (average 8.4years), who attended six public educational institutions located in different areas in the suburbs of Joinville. 53,2% of them were males. Trachoma was assessed using the simplified W.H.O. grading scheme by two ophthalmologists. The TF prevalence was 7.9% and the TS prevalence was 1.1%. No TI, TT or CO were found among them. 65% of the trachomatous children came from urban centers and 35% came from rural areas. The DFA citology was positive in 57% of the TF cases.

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Most cited references 12

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The epidemiology of infection in trachoma.

Salvador Muñoz, S J Katala, B B Mmbaga … (1989)

Specimens for chlamydial isolation culture and direct fluorescent antibody cytology (DFA) were collected from 1671 women and children from a trachoma-endemic area in Central Tanzania. Trachoma was graded using the new World Health Organization grading scheme, and 54% of the children and 9% of the women had inflammatory trachoma (TF or TI). DFA, using the presence of five elementary bodies as the criterion for a positive test, had a sensitivity of 88.0% and a specificity of 87.5% compared to culture and a sensitivity of 54.7% and specificity of 92.8% compared to clinical diagnosis. Altogether, 52.9% of those with trachoma grade TF were positive on either or both culture and DFA versus 77.0% of those with TI. Twenty-nine isolates were serotyped; 18 were serovar A, ten were serovar B, and one was serovar Ba. Positive cultures or DFA were obtained in 6.9% of those graded clinically as not having TF or TI and in a smaller number of those without any perceptible evidence of disease. Conversely, organisms could not be demonstrated in a number of people with severe inflammation (TI) even though some became positive after multiple repeated culture. These two findings of infection without disease and disease without evidence of infection suggest the importance of the immunologic response to infection in determining the clinical status. DFA was found to be an appropriate test for future field studies of trachoma. Further studies of those with disease but without agent and of those with agent but without disease will help understand the dynamics of infection and transmission and the role of the immune response in this important blinding disease.