Uma revisão literária sobre a filariose linfática e a situação da endemia em Maceió - AL

Abstract

Lymphatic filariasis is a strictly human disease, caused by Wuchereria bancrofti and transmitted mainly by Culex quinquefasciatus mosquitoes. The chronic symptomatic condition is known as elephantiasis, represented by lymphatic changes, mainly in the lower limbs and scrotum. Brazil has historical areas of endemism for this parasite in the north, northeast and southeast. Currently, it is only considered an active focus, with the presence of people parasitized by the adult worm, and naturally infected mosquitoes, in the State of Pernambuco. Since 1921, Maceió has been cited as the capital where autochthonous carriers of Wuchereria bancrofti are found, when Coqueiro found a 17% microfilaremic rate, out of 634 people examined. DEANE et al (1953) found 0.3% of a total of 6,052 people examined. In the 1990s, hemoscopic surveys were carried out in the various neighborhoods of Maceió, examining 10,450 and 0.6% of microfilaremic carriers, distributed across eight neighborhoods, with the highest rates in the neighborhoods Feitosa (5.23%) and Jacintinho (1. 24%), here the focal characteristic of the endemic is observed. During this period, there was integrated work at the municipal and federal levels, with active search for and treatment of microfilaremic infections. This literature review aims to reflect on the last 20 years that our capital has been considered an infection-free area. Historically, the number of asymptomatic microfilaremic patients was concentrated in neighborhoods close to the Reginaldo Valley. Both in the 1950s and in the 1990s, mosquitoes of the Culex quinquefasciatus species found naturally infected also came from these neighborhoods (mainly Jacintinho and Feitosa). The maintenance of endemic areas is directly proportional to the lack of basic sanitation, which maintains high mosquito populations in densely populated urban areas, where socio-economically underprivileged populations reside, with low economic and social indices. Despite the environmental improvements observed in these areas, over the decades, these populations have also grown and, as they are biological agents (mosquitoes and parasites), with their adaptive capabilities, it is opportune to question the eradication certificate provided by PAHO, based on data from more than twenty years ago. From 2010 to 2013, municipal epidemiological surveillance carried out tests in several neighborhoods of Maceió, and no carriers of the parasite were found. However, the methodology and frequency of these assessments need to be better defined. Therefore, it is suggested to periodically reevaluate, at least 10 years apart, the areas historically endemic for filariasis in Maceió, in the neighborhoods bordering the Reginaldo valley (Feitosa, Jacintinho, Pitanguinha and Poço), both with active searches for asymptomatic microfilaremics, and with capture and verification of vector infection using molecular techniques.