Aspectos clínicos e epidemiológicos da cromoblastomicose no Maranhão com abordagem na imunidade celular e humoral

Abstract

The chromoblastomycosis (CBM) is a» disease caused by dematiaceous fungi, which has as main agent the species Fonsecaea pedrosoz'. This fungus is found in warm and moist climates characteristics found in the Amazon lands of the region Where was once described his environmental isolation. This research aimed to identify the healthy population exposed to agent F. pedrosoi in four villages located in the Legal Amazon. ln order to clarify the risk factors for allergic immune exposure, a survey was conducted by the technique of delayed skin reaction (IDR) with the metabolic antigen (chromomycin) in 449 healthy individuals. The results showed that 14.9% (67 subjects) had IDR positive, with induration 2 5 mm, and risk factors after multivariate analysis with logistic regression: living in the village of Zé Pedro, (municipality of Bacabeìra in the state of Maranhäo, Brazil), (OR=l90.8, p <0.0l, CI = 12.1 to 2997.4), age over 40 years (OR = 19.5, p<0.05, CI = 1.65 to 230.8), density home > 5 people (OR = 12.1, p <0.0l, CI = 2.051 to 71.4) and Work on breaking the babassu coconut (<4h/day: OR = 2147.7, p <0.01, C1 = 67.2-68601.9; > 4h/day: OR=3483.4, p <0.01, CI = 17.2 to 7412.7). The dosage of anti-F. pedrosoi performed in 47 healthy individuals with IDR showed positive in 97.5%, with average titer of 2.109 (SD 3.676) and the average: 1.174 (SD 0.456), showing positive correlation with avea induration of the IDR (mm 2). The level of antibodies in 55 patients with cromoblastomycosis expressed in OD and titration shonied that before treatment, patients with sei/ere disease häd higher levels of IgG, IgGl, IgG2 and IgG3 when compared with severe or mild disease, p <0.05. In comparing the patients according to the time of treatment, mean antibody titers of IgG, IgGl and IgG2 were reduced after treatment (p <().05). In the assessment of therapeutic response, there was reduction of lgG3 and IgG titers in patients with rapid response (p <0.05) and IgG2 on rapid response and intermediate (p <0.05). There was clear evidence of what are the risk factors for exposure to F. pedrosoì in the daily life of these people, with prospects of preventive measures for the target population. The immunological analysis shows that the antibody anti- F. pedrosoi did not exhibit protective role against infection caused by this agent.