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Perfil Epidemiológico De Indivíduos Infectados Pelo Trypanosoma Cruzi Na Forma Assintomática Da Doença De Chagas Triados Em Banco De Sangue

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Perfil Epidemiológico De Indivíduos Infectados Pelo Trypanosoma Cruzi Na Forma Assintomática Da Doença De Chagas Triados Em Banco De Sangue INSTITUTO EVANDRO CHAGAS NÚCLEO DE ENSINO E PÓS-GRADUAÇÃO PROGRAMA DE PÓS-GRADUAÇÃO EM EPIDEMIOLOGIA E VIGILÂNCIA EM SAÚDE MAYARA MENDES NOGUEIRA PERFIL EPIDEMIOLÓGICO DE INDIVÍDUOS INFECTADOS PELO TRYPANOSOMA CRUZI NA FORMA ASSINTOMÁTICA DA DOENÇA DE CHAGAS TRIADOS EM BANCO DE SANGUE ANANINDEUA 2019 MAYARA MENDES NOGUEIRA PERFIL EPIDEMIOLÓGICO DE INDIVÍDUOS INFECTADOS PELO TRYPANOSOMA CRUZI NA FORMA ASSINTOMÁTICA DA DOENÇA DE CHAGAS TRIADOS EM BANCO DE SANGUE Dissertação apresentada ao Programa de Pós- Graduação em Epidemiologia e Vigilância em Saúde, do Instituto Evandro Chagas, para obtenção do título de mestre em Epidemiologia e Vigilância em Saúde Orientadora: Profª. Dra. Ana Yecê das Neves Pinto Coorientador: Prof. Dr. Haroldo José de Matos ANANINDEUA 2019 Dados Internacionais de Catalogação na Publicação (CIP) Biblioteca do Instituto Evandro Chagas Nogueira, Mayara Mendes. Perfil epidemiológico de indivíduos infectados pelo trypanosoma cruzi na forma assintomática da doença de Chagas triados em banco de sangue. / Mayara Mendes Nogueira. – Ananindeua, 2018. 85 f.: il.; 30 cm Orientadora: Dra. Ana Yecê das Neves Pinto Coorientador: Dr. Haroldo José de Matos Dissertação (Mestrado em Epidemiologia e Vigilância em Saúde) – Instituto Evandro Chagas, Programa de Pós-Graduação em Epidemiologia e Vigilância em Saúde, 2018. 1. Doença de Chagas. 2. Trypanosoma cruzi. 3. Epidemiologia. 4. Doador de sangue. I. Pinto, Ana Yecê das Neves, orient. II. Matos, Haroldo José de, coorient. III. Instituto Evandro Chagas. IV. Título. CDD: 616.9363 MAYARA MENDES NOGUEIRA PERFIL EPIDEMIOLÓGICO DE INDIVÍDUOS INFECTADOS PELO TRYPANOSOMA CRUZI NA FORMA ASSINTOMÁTICA DA DOENÇA DE CHAGAS TRIADOS EM BANCO DE SANGUE Dissertação apresentada ao Programa de Pós- Graduação em Epidemiologia e Vigilância em Saúde, do Instituto Evandro Chagas, para obtenção do título de mestre em Epidemiologia e Vigilância em Saúde Aprovado em: 31 de julho de 2018 BANCA EXAMINADORA ____________________________________________________ Dr. Sebastião Aldo da Silva Valente Instituto Evandro Chaga ______________________________________________________ Prof ª Dra. Tânia do Socorro Souza Chaves Instituto Evandro Chagas ______________________________________________________ Dra. Vera da Costa Valente Instituto Evandro Chagas ______________________________________________________ Dr. Marcelo de Oliveira Lima Instituto Evandro Chagas À Maria do Carmo Baia Nogueira, minha mãe, que com o seu infinito amor e dedicação contribuiu para o meu crescimento como pessoa, tendo como alicerce o bom caráter. AGRADECIMENTOS À Profª. Dra. Ana Yecê das Neves Pinto, minha orientadora, um exemplo de profissionalismo a ser seguido, pela sua história e expertise frente à doença de Chagas, sou grata a sua dedicação, paciência, incentivo, compreensão e, principalmente, pelos ensinamentos a mim repassados, que contribuíram diretamente para a minha formação profissional. Ao Prof. Dr. Haroldo José de Matos, meu coorientador, um dos idealizadores do Programa De Pós-Graduação em Epidemiologia e Vigilância em Saúde do Instituto Evandro Chagas (PPGEVS/IEC). Um professor excepcional, que tem a capacidade de passar o conteúdo da forma mais prática possível, pela sua dedicação e paciência, tanto com seus alunos e, principalmente com seus pacientes. Por isso dedico a você o meu carinho, gratidão, e admiração. Tenho um imenso orgulho de ter sido sua aluna. Ao instituto Evandro Chagas, uma das maiores referências em pesquisa biomédica da região amazônica. Ao laboratório de doença de Chagas do Instituto Evandro Chagas, principalmente, ao Dr. Sebastião Aldo da Silva Valente e Dra. Vera da Costa Valente, por suas conquistas na busca de compreender a doença de Chagas na região amazônica, e pelas contribuições durante a construção deste trabalho. À Fundação Centro de Hemoterapia e Hematologia do Pará (unidade Belém), particularmente, ao Núcleo de Ensino e Pesquisa (NEPES), que colaboraram com o fornecimento de dados para este estudo. À Coordenação e aos professores do PPGEVS/IEC, pelo esforço em manter o curso com qualidade, fazendo jus ao nome da instituição. À primeira turma do PPGEVS/IEC, que tanto tenho orgulho de fazer parte dessa trajetória, em especial aos momentos compartilhados com: Carolina Duarte, Darciane Cordovil, Leandro Corrêa, Lucas Trindade, Rafael Souza e Thais Queiroz. À minha tutora da Residência Multiprofissional em Saúde do Idoso da Universidade Federal do Pará (UFPA), Profª. Edilene do Socorro Nascimento Falcão Sarges, pelo suporte em uns dos momentos mais difíceis da minha vida acadêmica. Aos meus preceptores da Residência Multiprofissional em Saúde do Idoso (UFPA), especialmente, aos fisioterapeutas, Aline do Socorro de Souza Mendes e João Sérgio de Sousa Oliveira, pela amizade e compreensão. Ao meu padrasto, Marcos Pedreira Ferreira, pelo apoio incondicional, desde os meus primeiros passos. Obrigada por fazer parte da minha vida. À Maria Antônia Bahia, pelo suporte, amor e carinho de mãe. O saber se aprende com os mestres. A sabedoria, só com o corriqueiro da vida. Cora Coralina RESUMO A doença de Chagas é uma doença de caráter infeccioso que permanece como desafio à saúde pública notadamente na Amazônia brasileira, cujo potencial endêmico tem se desenhado ao longo de 40 anos desde os primeiros registros de casos autóctones. Descrita em duas fases clínicas, aguda e crônica, apenas a fase aguda é considerada um agravo notificável compulsoriamente. Na fase crônica, a doença assume várias formas, incluindo a forma indeterminada e não notificável, portanto, é invisível para os sistemas de vigilância. Para a Amazônia brasileira, onde predomina a doença aguda, pouco tem se descrito sobre as infecções assintomáticas. O objetivo deste estudo foi analisar o perfil epidemiológico de indivíduos assintomáticos infectados pelo Trypanosoma cruzi, detectados durante a triagem de doadores de sangue. Trata-se de um estudo transversal de pacientes rastreados para infecção por T. cruzi na Fundação Centro de Hemoterapia do Pará (HEMOPA) e confirmados no serviço clínico do Instituto Evandro Chagas (SOAMU/IEC), entre 2012 e 2017. Os participantes foram entrevistados com formulário próprio incluindo variáveis epidemiológicas, socioeconômicas e demográficas de interesse. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa do IEC (nº 2.038.717). No período entre 2012 a 2017, 534 indivíduos com doença de Chagas foram diagnosticados no IEC e, dentre eles, 11% (n= 59) eram doadores de sangue com sorologia positiva para a infecção chagásica e foram elegíveis para o estudo. Destes, 35 pacientes foram incluídos, com média de idade 34 anos, sexo masculino predominante (60%), procedente da região metropolitana de Belém do Pará (71,4%) de área urbana (88,5%). Possuem, em sua maioria, ensino médio completo (54,2%) e renda mensal familiar de mais de um até três salários mínimos (74,2%). Quanto aos prováveis fatores de transmissão do T. cruzi destacou- se: o consumo da polpa de açaí (100%), bacaba (54,2%) e carne de caça (62,8%); presença de animais errantes (54.2%) e acúmulo de matérias (34,2%) em domicílio e ou peridomicílio, associado à provável presença do inseto vetor; o não uso de métodos de proteção durante ato sexual (55,8%). O perfil ora descrito revela índices subestimados de infecção silenciosa em população jovem para uma doença cuja magnitude de potencial evolutivo ainda se encontra indefinida. Palavras-Chave: Doença de Chagas; Trypanosoma cruzi; Epidemiologia; Doador de Sangue; Transmissão. ABSTRACT Chagas disease is an infectious disease that remains a challenge to public health, specially in the Brazilian Amazon, whose endemic potential has been designed over 40 years since the first records of autochthonous cases. Described in two clinical phases: acute and chronic. Nonetheless, only the acute phase has been considered a notifiable disease. On the chronicle phase, the disease takes on different forms, including the indeterminate form and non-notified; therefore, it is invisible to the health care system vigilance. In the Brazilian Amazon, where acute phase is the majority, has been identified lack of asymptomatic infections description. The objective of this study is to analyze the epidemiological profile of asymptomatic individual infected by Trypanosoma cruzi, identified during the blood donor screening. It is a cross-sectional study of patients screened for T. cruzi infection at the Hemotherapy and Hematology Service of Pará (HEMOPA) and confirmed at the Evandro Chagas Institute clinical service (SOAMU/IEC), between 2012 and 2017. The participants were interviewed by using a form developed by the authors including epidemiological, socioeconomic and demographic variables of interest. The project was approved by the Research Ethics Committee of IEC (nº 2.038.717). In the period of 2012 and 2017, 534 individuals were diagnosed with Chagas disease in IEC and, among them, 11% (n= 59) were blood donor with positive serology to Chagas disease, coming from HEMOPA and were eligible for this study. Considering 59 blood donors, only 35 participants were included to this study, with average age of 34 years old, are predominantly male (60%), living in the metropolitan region of Belém- Pará (71.4%) and urban areas (88.5%). Others predominant characteristics: complete high school (54.2%), monthly family income among 1 to 3 minimum wage (74.2%). About the principal factors implicating on the transmission of T. cruzi are: the consumption of açaí pulp (100%), bacaba (54,2%) and game meat (62,8%); presence of stray animals
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