Celere Beatriz Smidt, Vernal Sebastian, La Serra Leonardo, Franco Brochado Maria José, Moschini Luiz Eduardo, Roselino Ana Maria, Segura-Muñoz Susana Inés
Department of Maternal-Infant Nursing and Public Health, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Am J Trop Med Hyg. 2017 Dec;97(6):1737-1745. doi: 10.4269/ajtmh.17-0100. Epub 2017 Sep 21.
Well-defined locations of pemphigus cases support the hypothesis of environmental factors' involvement in its etiopathogenesis; however, these foci have never been described using specialized geographical tools. This is the first report to geo-reference pemphigus cases in a high-prevalence Brazilian region using geographic information systems. We aimed to report the spatio-temporal behavior of pemphigus foliaceus (PF) and vulgaris (PV) in southeastern Brazil, over the last five decades to describe geographical clusters, as well as to characterize the land use in the city with the highest number of cases. Patients were identified from 1965 to 2014. Maps were developed using ArcGIS software and organized into decades from 1965 to 2014. Ribeirão Preto was identified as the city with the greatest number of cases. Land use was analyzed within a 2 km-buffer surrounding the residence of each patient. A total of 426 cases of pemphigus were identified. PF was the predominant form (285 cases); notwithstanding, the number of new cases of PV rose, overtaking the number of new cases of PF in the last decade studied. Agricultural area (42%) and exposed soil (33.2%) are the most predominant land uses in Ribeirão Preto surrounding patients' residences. This study shows high-confidence geographical foci of PF and PV, as well as provides evidence of an increase of both clinical forms over the last five decades. All cases of PV and PF are in proximity to rivers and agricultural areas which reinforce the hypothesis that environmental factors play a role in pemphigus etiopathogenesis.
天疱疮病例明确的发病地点支持环境因素参与其病因发病机制的假说；然而，这些发病地点从未使用专门的地理工具进行描述。这是首次使用地理信息系统对巴西一个高发病地区的天疱疮病例进行地理定位的报告。我们旨在报告巴西东南部落叶型天疱疮（PF）和寻常型天疱疮（PV）在过去五十年中的时空行为，以描述地理聚集情况，并对病例数最多的城市的土地利用情况进行特征描述。从1965年到2014年对患者进行了识别。使用ArcGIS软件绘制地图，并按1965年至2014年的十年进行整理。里贝朗普雷图被确定为病例数最多的城市。在每位患者住所周围2公里的缓冲区内分析土地利用情况。共识别出426例天疱疮病例。PF是主要类型（285例）；尽管如此，PV的新病例数有所上升，在研究的最后十年中超过了PF的新病例数。农业区（42%）和裸露土壤（33.2%）是里贝朗普雷图患者住所周围最主要的土地利用类型。本研究显示了PF和PV的高可信度地理聚集区，并提供了过去五十年来这两种临床类型均有所增加的证据。所有PV和PF病例都靠近河流和农业区，这强化了环境因素在天疱疮病因发病机制中起作用的假说。
