Epidemia de beribéri no Maranhão, Brasil

Abstract

This Editorial addresses the scientific community to report on a beriberi outbreak affecting part of the population in the Tocantins Region in the State of Maranhão, Brazil, with 466 and 543 reported cases and 33 and zero deaths in 2006 and 2007, respectively, predominating among males from 15 to 50 years of age, mainly with the dry beriberi clinical form (data from the Non-Communicable Diseases Division of the Superintendency for Epidemiology and Disease Control, Maranhão State Health Secretariat). During the same period, 30 cases and three deaths were recorded in the neighboring State of Tocantins, according to information provided by its respective State Health Secretariat. Importantly, the last previously recorded beriberi epidemic in Brazil occurred from 1870 to 1910, during the rubber boom in the Amazon Region, as extensively documented by Josué de Castro in Geography of Hunger (1946; English translation, 1952). After numerous patients were hospitalized in Imperatriz, Maranhão, with edema, paresthesia of the lower and upper limbs, difficulty walking, and death from cardio-respiratory failure, an investigation was launched in May 2006 by the Maranhão State Health Secretariat, with participation by the Health Surveillance Secretariat of the Brazilian Ministry of Health. The initial diagnostic hypotheses were: disease of unknown etiology, pesticide poisoning, alcohol intoxication, and Guillain-Barré syndrome. News on the disease had great national repercussion, and the investigation changed directions when a physician from the State of Ceará with experience in the Amazon Region telephoned the head of the regional health department in Imperatriz, suggesting the diagnosis of beriberi. The diagnosis was confirmed by a therapeutic test with thiamine administration. The investigation then focused on identifying the determinant factors, and confirmed the prevalence of alcohol abuse and heavy physical labor among the patients. Current studies are concentrating on the population's food consumption, pesticide exposure, and possible contamination of rice with fungal microtoxins. Among the actions to quell the beriberi outbreak, emergency measures have been taken such as the purchase and supply of thiamine, as well as short and medium term measures like: distribution of basic food baskets; specific training for health workers; epidemiological, food, and nutritional surveillance; installation of Psychosocial Care Centers for Alcohol and Drug Abuse; investigation of rice processing by local mills; food enrichment; intensification in the inspection of marketing and use of pesticides; and systematization of studies under way on beriberi in the region. The Ministry of Health coordinated the creation of an Inter-Ministerial Task Force aimed at planning and implementing these measures, with representatives from:

Perfil epidemiológico do beribéri notificado de 2006 a 2008 no Estado do Maranhão, Brasil

“…Os casos e óbitos concentraram-se no oeste do estado e acometeu a população socialmente mais excluída, inserida em atividade laboral pesada e com baixa renda e escolaridade. Logo, reiterase a preocupação de estudiosos do problema na região, no que se refere à necessidade de se buscarem mais informações da epidemia na suas dimensões social e econômica, as quais comprometem o acesso aos alimentos e à qualidade de vida da população 10 .…”

“…No entanto, casos recentes têm sido notificados a partir de 2006 nos estados do Maranhão, Tocantins e Roraima, com hipóteses diagnósticas iniciais de doença de etiologia desconhecida, intoxicação por agrotóxicos ou por bebida alcoóli-ca e síndrome de Guillain-Barré 10 .…”

A (des)nutrição e o novo padrão epidemiológico em um contexto de desenvolvimento e desigualdades

“…The main determinants were alcohol abuse and heavy physical activity, in addition to possible exposure to pesticides. All of these aspects were related to the social changes that had taken place over the previous decades in the region, including a predominance of exploratory agriculture and scant production of basic foodstuffs, extensive farming, as well as intense deforestation to meet the demands of loggers and mining companies 33 , which resulted in changes in labor relations, the local economy, and the local culture, thereby accentuating inequities.…”

Microscopic fungi recovered from honey, isolation and pathological lesions by Penicillium sp in an experimental model

“…In 2006, an outbreak of a clinical syndrome in the southwestern region of Maranhão drew the attention on the importance of fungi in the public health context. After hundreds of reported cases and approximately forty deaths, the conclusion was that the etiology of the unknown clinical syndrome involved the mycotoxin of the Penicillium fungus, which contaminated the rice eaten by the population (Lira & Ferreira, 2008).…”