Diagnóstico epidemiológico da esporotricose em Belo Horizonte, Minas Gerais, 2015 a 2018

Abstract

Sporotrichosis is a cutaneous mycosis caused by dimorphic fungi belonging to the Sporothrix schenckii complex. Its potential for zoonotic transmission, often involving cats as a source of infection, has become a public health problem in Brazil. The aim of this study was to investigate the presence of feline sporotrichosis in Belo Horizonte, Minas Gerais, with emphasis on the Barreiro region where first human and animal cases were reported, in order to identify priority areas for action. Barreiro regional is the largest administrative area of Belo Horizonte, where feline population has grown considerably over the years. In this region, an observational, descriptive and prospective epidemiological study was conducted, with laboratory diagnosis for sporotrichosis in cats and posterior spatial analysis of the cases, from 2016 to 2018. In addition, two other studies were carried out: a questionnaire-based, with application to veterinary establishments of Barreiro region to retrospectively complement the current situational diagnosis; and a mapping of feline cases from 2015 to 2018, following different approaches, together with human cases notified by Belo Horizonte City Hall (PBH), occured in the same area, from 2016 to 2018, in order to identify the relationship between the cases and the possible zoonotic character of the transmition. At the investigation step, it was realized an active domiciliary search of cats suspected of sporotrichosis was carried out, with subsequent application of a questionnaire and collection of material for confirmatory laboratory analysis. The samples obtained from ulcerated lesions were submitted to mycological culture in Brain Heart Infusion Agar (BHI) medium, incubated at 36oC and Sabouraud Dextrose Agar (SDA) with or without chloramphenicol, incubated at 25oC. The risk factors of the variables present in the questionnaire were analyzed and the cases found were mapped. One hundred and fifty-two cats from the Barreiro region were submitted to sample collection, of which 90 (59.21%) were positive in the laboratory test, 28 (18.42%) positive in the clinical-epidemiological criteria and 34 (22.37%) negative in the laboratory test. There was a statistically significant association between sporotrichosis positive result and the following variables: street access (95% CI 3.0212, p = 0.0324), good body condition (95% CI 0.2588, p = 0.0098), presence of ulcerated lesion (95% CI 4.6666; p=0.0061), presence of wound healing (95% CI 0.1216; p=0.0011), presence of lesion in limbs (95% CI 2.8619; p=0.0185), respiratory signs (95% CI 4.0124; p=0.0057), presence of garden and /or plant pots (95% CI 2.2518; p=0.0316) and death (95% CI 6.3097; p=0.0000). There was a statistically significant association between variables body state (95% CI 0.1558; p=0.0001), extent of lesions (95% CI 3.6315; p=0.0018) and occurrence of death. The prevalence found was 8.36 ‰, the mortality coefficient was of 4.6 ‰ and fatality rate was of 55.08%. Of 26 veterinary establishments of Barreiro, 22 (84.6%) accepted to participate in the study. Of them, 86.36% (19/22) have reported cases of sporotrichosis in the period, totaling 282 cats with the disease in the last four years. Analyzing the data it was observed a growing trend in the number of cases. In the analysis of the spacial relation between human and animal cases, 186 cats and 56 humans were accounted, being distributed on the whole region. The feline cases were concentrated in Diamante/Teixeira Dias, Regina, Barreiro de Baixo and Tirol, which account for 57.52% of the cases in that period. The human cases where concentrated in Lindeia, Diamante/Teixeira Dias and Barreiro de Baixo, with special focus on the first of them. Together, both of them account for 62.49% of the human cases. From the results obtained, one can conclude that sporotrichosis is a zoonotic disease that is present and rapidly growing in Belo Horizonte and increasing in a large population density area, for human and feline cases, with unfavorable prognosis in cats. Thus, it is necessary for the government to adopt of measures in order to identify cases, to enable its notification and thus prevent this zoonosis from reaching epidemic levels in the capital. This also requires actions to raise awareness of veterinarians and owners.