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Leptospirose e fasciolose: interacções imunológicas no polimorfismo do quadro clínico dos doentes de São Miguel (Açores)
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O arquipélago dos Açores apresenta nove ilhas vulcânicas, sendo São Miguel a maior e mais populosa. Nesta região insular portuguesa, a Leptospirose é uma zoonose endémica, que afeta acidentalmente o Homem por contacto direto ou indireto com leptospiras patogénicas. Clinicamente, esta patologia apresenta diversos sintomas que podem ser semelhantes a uma gripe ou evoluir até um quadro fulminante, daí a necessidade de um diagnóstico preciso com confirmação laboratorial. A Fasciolose é outra importante doença zoonótica nos Açores que tem sido descrita como endémica neste arquipélago, causada pelo parasita Fasciola hepatica. A infeção humana pode ocorrer devido ao consumo de vegetais e/ou águas contaminados. O diagnóstico não é fácil, pois a infeção pelo parasita pode apresentar uma larga variedade de quadros clínicos.
O objetivo deste estudo é contribuir para a clarificação de uma possível interação imunológica, ao nível da resposta humoral observada em indivíduos com diagnóstico clínico de Leptospirose e/ou Fasciolose, em pacientes da ilha de São Miguel que apresentam um quadro clínico e epidemiológico comum a ambas as patologias, contribuindo para um melhor diagnóstico diferencial.
A amostra utilizada no estudo é composta por 280 soros de indivíduos residentes na ilha de São Miguel, que foram analisados entre 2005 e 2010 pela TAM (Técnica de Aglutinação Microscópica), para deteção de aglutininas anti-Leptospira interrogans s.l.. Nas amostras de soro com resultado positivo e inconclusivo pela TAM foi aplicada a técnica de rastreio micro-ELISA para o estudo da Fasciolose. Aplicou-se ainda a técnica de Imunoeletrodifusão (IED), como técnica confirmatória, nos soros com resultado positivo e em alguns inconclusivos (n=118) para a técnica micro-ELISA.
Os resultados da TAM, previamente conhecidos, para o total de indivíduos estudados foram os seguintes: 124 (44,3%) negativos, 73 (26,1%) inconclusivos e 83 (29,6%) positivos. Estes soros foram submetidos ao teste micro-ELISA, tendo-se obtido 31,1% (n=87) resultados positivos, 31,4% (n=88) resultados inconclusivos e 37,5% (n=105) com resultado negativo para Fasciolose. Foram analisados os inquéritos clínico-epidemiológicos estabelecido para o estudo da Leptospirose humana em São Miguel para as amostras anteriormente referidas, verificando-se que os homens lavradores em idade ativa são o grupo com mais casos positivos para ambas as patologias. Além disso, os sinais e sintomas mais comuns nos doentes com resultado positivo para as duas doenças são semelhantes aos de uma gripe, e analiticamente foi notório que as transaminases, a FA/γGT (apenas nos doentes com Leptospirose) e a leucocitose tinham níveis elevados. Os resultados revelaram uma provável coinfeção em 36 doentes. A técnica de IED foi positiva em 28 amostras de soro, sendo que cinco tiveram resultado positivo para as três técnicas utilizadas.
Estes resultados são promissores, demonstrando uma possível relação entre Leptospirose e Fasciolose, sendo que os respetivos agentes etiológicos partilham nichos ecológicos, o que justifica igualmente algumas semelhanças nos aspetos sociodemográficos e clínico-epidemiológicos na população afetada.
The Azores archipelago features nine volcanic islands, São Miguel is the largest and most populous. In this Portuguese region, Leptospirosis is a endemic zoonosis, affecting man accidentally by direct or indirect contact with pathogenic leptospires. Clinically, this disease has many symptoms that can be similar to influenza like or evolved into a fulminant death thereof the need for an accurate diagnosis with laboratory confirmation. The Fascioliasis is another important zoonotic disease in the Azores, which has been described as being endemic to this archipelago caused by the parasite Fasciola hepatica. The human infection can occur due to consumption of contaminated vegetables and/or water. The diagnosis is not easy, since infection by the parasite may have a wide variety of clinical conditions. The objective of this study is to contribute to the clarification of a possible interaction at the immunological humoral response observed in subjects with a clinical diagnosis of Leptospirosis and/or Fasciolosis in patients from São Miguel Island and presenting a clinical and epidemiological condition common to both pathologies, contributing to a better differential diagnosis. The sample used in this study consists of 280 sera from individuals living on São Miguel Island, which were analyzed between 2005 and 2010 by MAT (Microscopic Agglutination Technique) for detection of anti-Leptospira interrogans s.l. agglutinins. The Serum samples which were positive and inconclusive by TAM were applied with the screening technique micro-ELISA for the study of Fascioliasis. Also it was applied the Imunoeletrodifusion technique (IED) as a confirmatory technique in positive and some inconclusive sera (n=118) for micro-ELISA technique. The results of TAM, previously known for the total subjects studied were: 124 (44.3%) negative, 73 (26.1%) inconclusive and 83 (29.6%) positive. These sera were tested by micro-ELISA thereby obtaining 31.1% (n = 87) positive results, 31.4% (n=88) inconclusive results and 37.5% (n=105) with a negative results for Fasciolosis. We analyzed the clinical-epidemiological surveys established for the study of human Leptospirosis in São Miguel Island, for the mentioned samples above, verifying that men, farmers in the active age group have the most positive cases for both diseases. Furthermore, the most common signs and symptoms in patients with positive results for both diseases are similar to the flu and analytically it was notorious that transaminases, FA/γGT (only in patients with Leptospirosis) and leukocytosis had elevated levels. The results revealed a probable co-infection in 36 patients. The technique of IED was positive in 28 serum samples, in which five sera were positive for the three techniques. These results are promising, showing a possible relationship between Leptospirosis and Fasciolosis whereas the respective etiologic agents share ecological niches which justify also some similarities in sociodemographic and clinical-epidemiological aspects in the affected population.
The Azores archipelago features nine volcanic islands, São Miguel is the largest and most populous. In this Portuguese region, Leptospirosis is a endemic zoonosis, affecting man accidentally by direct or indirect contact with pathogenic leptospires. Clinically, this disease has many symptoms that can be similar to influenza like or evolved into a fulminant death thereof the need for an accurate diagnosis with laboratory confirmation. The Fascioliasis is another important zoonotic disease in the Azores, which has been described as being endemic to this archipelago caused by the parasite Fasciola hepatica. The human infection can occur due to consumption of contaminated vegetables and/or water. The diagnosis is not easy, since infection by the parasite may have a wide variety of clinical conditions. The objective of this study is to contribute to the clarification of a possible interaction at the immunological humoral response observed in subjects with a clinical diagnosis of Leptospirosis and/or Fasciolosis in patients from São Miguel Island and presenting a clinical and epidemiological condition common to both pathologies, contributing to a better differential diagnosis. The sample used in this study consists of 280 sera from individuals living on São Miguel Island, which were analyzed between 2005 and 2010 by MAT (Microscopic Agglutination Technique) for detection of anti-Leptospira interrogans s.l. agglutinins. The Serum samples which were positive and inconclusive by TAM were applied with the screening technique micro-ELISA for the study of Fascioliasis. Also it was applied the Imunoeletrodifusion technique (IED) as a confirmatory technique in positive and some inconclusive sera (n=118) for micro-ELISA technique. The results of TAM, previously known for the total subjects studied were: 124 (44.3%) negative, 73 (26.1%) inconclusive and 83 (29.6%) positive. These sera were tested by micro-ELISA thereby obtaining 31.1% (n = 87) positive results, 31.4% (n=88) inconclusive results and 37.5% (n=105) with a negative results for Fasciolosis. We analyzed the clinical-epidemiological surveys established for the study of human Leptospirosis in São Miguel Island, for the mentioned samples above, verifying that men, farmers in the active age group have the most positive cases for both diseases. Furthermore, the most common signs and symptoms in patients with positive results for both diseases are similar to the flu and analytically it was notorious that transaminases, FA/γGT (only in patients with Leptospirosis) and leukocytosis had elevated levels. The results revealed a probable co-infection in 36 patients. The technique of IED was positive in 28 serum samples, in which five sera were positive for the three techniques. These results are promising, showing a possible relationship between Leptospirosis and Fasciolosis whereas the respective etiologic agents share ecological niches which justify also some similarities in sociodemographic and clinical-epidemiological aspects in the affected population.
Descrição
Palavras-chave
Parasitologia médica Leptospirose Fasciolose Parasitas São Miguel Portugal
Contexto Educativo
Citação
Editora
Instituto de Higiene e Medicina Tropical