Prevenção referente às modalidades alternativas de transmissão do trypanosoma cruzi no Brasil

Abstract

RESUMOConsideram-se habituais em doença de Chagas humana os mecanismos vetorial, transfusional e congênito de transmissão. Acidental, oral e por transplantes são ditos alternativos. Possibilidades como por outros vetores, sexual, criminal e por secreção de marsupiais são consideradas excepcionais. A prevenção dos mecanismos alternativos, incluindo o congênito, está hoje consensuada: Transmissão congênita: detecção precoce do caso e seu tratamento específico. Se possível começar, no pré-natal com sorologia de gestantes. Quando viável, pesquisar parasitologicamente o RN de mães reagentes, tratando-se imediatamente os que resultarem positivos. Sendo negativos, sorologia convencional aos 8 meses de vida, tratando imediatamente os que estiverem reagentes. Transmissão acidental: Usar treinamento e equipamentos de proteção. Se acidente, desinfecção local, sorologia convencional e inicio de tratamento específico por dez dias. Revisão da sorologia em 30 dias, seguindo-se o tratamento até a dose total, no caso de reação positiva. Transplantes de órgãos: sorologia prévia no doador e receptor. Sendo o primeiro positivo e o segundo negativo, evitar o transplante ou tratar especificamente o doador por 10 dias antes da cirurgia e o receptor nos dez dias subsequentes à mesma. Transmissão oral: de modo geral, higiene alimentar e cozimento de carnes de possíveis reservatórios. Hoje se recomenda a detecção precoce e tratamento imediato do caso, com intensa busca ativa entre os circunstantes mais próximos do paciente. Palavras-chaves: Doença de Chagas. Mecanismos alternativos de transmissão. Controle. AbSTRACTVectorial, transfusion and congenital are considered the main transmission mechanisms in human Chagas disease. Alternative mechanisms are accidental, oral and by organ transplantation. Other hypothetic mechanisms could be by other vectors, sexual, criminal and by means of marsupial anal secretions. The present accorded strategies for prevention are: Congenital: early case detection and immediate treatment. If possible, start during the pre natal period, throughout mothers serology, performing parasitological tests in the new born from positive women. For positive cases, immediate treatment; for those negative babies, conventional serology at the 8 th month, treating specifically those with positive results. Accidental transmission: Rigorous training and utilization of protection equipments. IF accident occurs, immediate disinfection, conventional serology and beginning of specific treatment by ten days. Revision of the serology after 30 days: if positive, extend the treatment until the total dose (60 days or more). Organ transplantation: previous serology for donor and receptor. When the former is infected and the last negative, cancel the surgery or install the specific treatment by ten days before the surgery for the donor, followed by the receptor during ten days after the transplantation. Oral transmission: Specific measures are not available, food hygiene is recommended, including the cooking of meats delivered from possi...

2 nd Brazilian Consensus on Chagas Disease, 2015

“…However, oral transmission of T. cruzi has become increasingly epidemiologically relevant, particularly in the Amazon Region (11) (23) (39) (76) (91) (92) . Transmission by the oral route is considered a primary mechanism, in particular in the wild cycle (93) ; it will occur regardless of control actions undertaken (21) (39) . It presents a common feature in the early enzootic cycle of this parasite: ingestion of vectors and reservoirs of infection by susceptible mammals (21) .…”

“…It presents a common feature in the early enzootic cycle of this parasite: ingestion of vectors and reservoirs of infection by susceptible mammals (21) . In the case of humans, this transmission occurs in a sporadic and circumstantial manner, through food contaminated with the parasite, mainly from triatomines or their feces, with records since the 1960s (93) . Therefore, the analysis of this epidemiological context refers indirectly to vectors.…”

“…Outside the Amazon region, few events have been investigated; most were related to sugar cane juice, the likely food carrier in the oral transmission of these cases (76) (93) . A recent review of the subject identified records of outbreaks or micro-outbreaks in Brazil, in the States of Rio Grande do Sul, Pará, Paraíba, Santa Catarina, Bahia, and Ceará.…”

“…In these cases, safety deficiencies are evident in the transportation of contaminated materials, among other factors (93) . Risk factors include ignorance, inattention, lack or misuse of personal protective equipment, inadequate facilities and equipment, poor lighting, lack of training, non-compliance with standard precautionary measures, and non-adoption of routine technical protocols (93) (110) .…”

Desenvolvimento e padronização de métodos para detecção de Trypanosoma cruzi em polpa de açaí (Euterpe oleracea)

“…(NÓBREGA et al, 2014). Isso se deve a mudança do perfil epidemiológico da doença em consequências dos novos padrões de migração humana e das formas alternativas de transmissão, como a oral, que levaram à urbanização e globalização da doença (COURA et al, 2010;DIAS et al, 2011). …”