Análise epidemiológica de enteroprotozooses na população humana de comunidades da região metropolitana de Recife - PE

Abstract

Infections caused by enteroproterozoans pose a major public health problem. Transmission occurs primarily through the fecal-oral route with ingestion of contaminated food and water. Unfavorable socioeconomic conditions, lack of basic sanitation and tropical climate are factors that favor the presence of enteric protozoa in the Brazilian Northeast. There are several methods to perform parasitological examination of feces, however, there are still discussions regarding the complexity and high cost in laboratory routine. In public health, rapid and low-cost diagnosis is paramount due to the demand and the need for medical intervention for the patient's health. The objective of this study was to evaluate the epidemiological aspects of enteroproterozoic infection in the human population of communities in the Metropolitan Region of Recife, Brazil, analyzing the association between the infection and the hygienic-sanitary conditions of the community to be studied and to compare the techniques used for diagnosis. Four cities of the Metropolitan Region of Recife-PE (Camaragibe, Goiana, Igarassu and Recife) were selected, using non-probabilistic sampling for convenience, of which 11 communities were approached (Barro Vermelho, Timbi, Viana, Tejucupapo, Carne de Vaca, São Lourenço , Three Hills, Rural Village, St. Helena, Dois Irmãos and Chico City). The research was approved by the Ethics Committee for Human Research (CEP) of the State University of Pernambuco (UPE), opinion nº 739708. We selected 362 individuals of both sexes and varied ages. Fecal samples were processed using the techniques of Hoffman, Willis, Faust, Kato-Katz, Kit Coproplus® and centrifugal-sedimentation in formaldehyde at the Laboratory of Parasitic Diseases of Domestic Animals at the Federal Rural University of Pernambuco. An investigative questionnaire was applied to obtain information on the hygienic-sanitary, socio-demographic and environmental aspects of the participants. Data were analyzed statistically using the Pearson's Chi-square test or Fisher's Exact test when obtaining the Odds Ratio (OR) and confidence intervals for the respective values. To compare the techniques, the McNemmar test was applied and to verify the degree of coincidence between the pairs of techniques were obtained the Kappa coincidence scores and confidence intervals for the said parameter. Positive was obtained in 4.14% for Entamoeba spp., 1.93% for Giardia spp., 9.66% for Isospora belli and 17.7% for Cryptosporidium spp. The Faust technique was significantly superior to the Kato-Katz technique for the diagnosis of I. belli and, despite the high agreement percentage, the negative Kappa values indicated practically the absence of agreement between the techniques. It is concluded that enteroproterozoal infection occurs in the studied population, taking as a risk factor family income of the individuals, time of dwelling in the area and contact of the soil with pits, and being favored by unfavorable socioeconomic conditions and inadequate hygienic-sanitary conditions. Although some techniques demonstrate better performance for certain enteroproterozoic, the use of more than one technique for the diagnosis of enteroprotozoosis is necessary for a better diagnostic accuracy in the conditions under which the present study was performed.