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巴西的疟疾:亚马孙地方病流行区以外的情况

Malaria in Brazil: what happens outside the Amazonian endemic region.

作者信息

de Pina-Costa Anielle, Brasil Patrícia, Di Santi Sílvia Maria, de Araujo Mariana Pereira, Suárez-Mutis Martha Cecilia, Santelli Ana Carolina Faria e Silva, Oliveira-Ferreira Joseli, Lourenço-de-Oliveira Ricardo, Daniel-Ribeiro Cláudio Tadeu

机构信息

Centro de Pesquisa, Diagnóstico e Treinamento em Malária, Reference Laboratory for Malaria in the Extra-Amazonian Region for the Brazilian Ministry of Health, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, RJ, Brasil.

Núcleo de Estudos em Malária, Superintendência de Controle de Endemias, Secretaria de Saúde do Estado de São Paulo, São Paulo, SP, Brasil.

出版信息

Mem Inst Oswaldo Cruz. 2014 Aug;109(5):618-33. doi: 10.1590/0074-0276140228.

Abstract

Brazil, a country of continental proportions, presents three profiles of malaria transmission. The first and most important numerically, occurs inside the Amazon. The Amazon accounts for approximately 60% of the nation's territory and approximately 13% of the Brazilian population. This region hosts 99.5% of the nation's malaria cases, which are predominantly caused by Plasmodium vivax (i.e., 82% of cases in 2013). The second involves imported malaria, which corresponds to malaria cases acquired outside the region where the individuals live or the diagnosis was made. These cases are imported from endemic regions of Brazil (i.e., the Amazon) or from other countries in South and Central America, Africa and Asia. Imported malaria comprised 89% of the cases found outside the area of active transmission in Brazil in 2013. These cases highlight an important question with respect to both therapeutic and epidemiological issues because patients, especially those with falciparum malaria, arriving in a region where the health professionals may not have experience with the clinical manifestations of malaria and its diagnosis could suffer dramatic consequences associated with a potential delay in treatment. Additionally, because the Anopheles vectors exist in most of the country, even a single case of malaria, if not diagnosed and treated immediately, may result in introduced cases, causing outbreaks and even introducing or reintroducing the disease to a non-endemic, receptive region. Cases introduced outside the Amazon usually occur in areas in which malaria was formerly endemic and are transmitted by competent vectors belonging to the subgenus Nyssorhynchus (i.e., Anopheles darlingi, Anopheles aquasalis and species of the Albitarsis complex). The third type of transmission accounts for only 0.05% of all cases and is caused by autochthonous malaria in the Atlantic Forest, located primarily along the southeastern Atlantic Coast. They are caused by parasites that seem to be (or to be very close to) P. vivax and, in a less extent, by Plasmodium malariae and it is transmitted by the bromeliad mosquito Anopheles (Kerteszia) cruzii. This paper deals mainly with the two profiles of malaria found outside the Amazon: the imported and ensuing introduced cases and the autochthonous cases. We also provide an update regarding the situation in Brazil and the Brazilian endemic Amazon.

摘要

巴西是一个幅员辽阔的国家,呈现出三种疟疾传播情况。第一种,从数量上看也是最重要的一种,发生在亚马逊地区内部。亚马逊地区约占该国领土的60%,约占巴西人口的13%。该地区承载了全国99.5%的疟疾病例,这些病例主要由间日疟原虫引起(即2013年82%的病例)。第二种涉及输入性疟疾,即个体在其居住地区或确诊地区以外感染的疟疾病例。这些病例是从巴西的疟疾流行地区(即亚马逊地区)或南美洲、中美洲、非洲和亚洲的其他国家输入的。2013年,巴西活跃传播地区以外发现的病例中,输入性疟疾占89%。这些病例凸显了一个关于治疗和流行病学问题的重要疑问,因为患者,尤其是那些患恶性疟的患者,到达一个卫生专业人员可能对疟疾临床表现和诊断缺乏经验的地区,可能会因治疗延误而遭受严重后果。此外,由于按蚊在该国大部分地区都存在,即使是单一疟疾病例,如果不立即诊断和治疗,也可能导致病例传入,引发疫情,甚至将疾病引入或重新引入非流行但易感的地区。亚马逊地区以外传入的病例通常发生在以前疟疾流行的地区,由属于尼氏按蚊亚属(即达林按蚊、咸水按蚊和阿尔比塔尔西斯复合体的物种)的有效传播媒介传播。第三种传播类型仅占所有病例的0.05%,是由主要位于大西洋东南沿岸的大西洋森林中的本地疟疾引起的。它们由似乎是(或非常接近)间日疟原虫的寄生虫引起,在较小程度上由三日疟原虫引起,由凤梨按蚊传播。本文主要讨论亚马逊地区以外发现的两种疟疾情况:输入性及随后传入的病例和本地病例。我们还提供了巴西及巴西疟疾流行地区亚马逊的最新情况。

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