Malaria in Brazil: what happens outside the Amazonian endemic region
Malaria in Brazil: what happens outside the Amazonian endemic region
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DOI：
10.1590/0074-0276140228
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发表时间：
2014-08-01
期刊：
影响因子：
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通讯作者：
Daniel-Ribeiro, Cláudio Tadeu
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文献类型：
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作者：
Pina-Costa, Anielle de;Brasil, Patrícia;Daniel-Ribeiro, Cláudio Tadeu
巴西是一个大陆型国家，它有三种疟疾传播情况。第一个也是最重要的数字，发生在亚马逊内部。亚马逊河流域占巴西国土面积的60%，约占巴西人口的13%。该地区拥有全国99.5%的疟疾病例，主要由间日疟原虫引起（即，2013年的82%）。第二种是输入性疟疾，即在个人居住或诊断所在地区以外感染的疟疾病例。这些病例是从巴西的流行地区输入的（即，亚马逊河）或来自南美洲和中美洲、非洲和亚洲的其他国家。2013年，输入性疟疾占巴西活跃传播地区以外发现病例的89%。这些病例突出了治疗和流行病学方面的一个重要问题，因为病人，特别是恶性疟疾病人，如果到达一个保健专业人员可能没有疟疾临床表现经验的地区，其诊断可能会遭受与治疗可能延误有关的严重后果。此外，由于该国大部分地区都存在按蚊病媒，即使是一个疟疾病例，如果不立即诊断和治疗，也可能导致传入病例，造成疾病爆发，甚至将疾病传入或重新传入非流行的易受感染地区。亚马逊河以外的病例通常发生在疟疾以前流行的地区，并由属于Nyssorhynchus亚属的有能力的媒介传播（即，达氏按蚊、水生按蚊和白跗复合体的种）。第三种传播仅占所有病例的0.05%，是由主要位于大西洋东南部沿着的大西洋森林中的本土疟疾引起的。它们是由似乎是（或非常接近）间日疟原虫的寄生虫引起的，在较小程度上是由三日疟原虫引起的，它是由凤梨科蚊子克氏按蚊传播的。本文主要论述亚马逊河流域以外发现的两种疟疾概况：输入和随后传入的病例和本地病例。我们还提供有关巴西和巴西亚马逊地方病的最新情况。
Brazil, a country of continental proportions, presents three profiles of malaria transmission. The first and most important numerically, occurs inside the Amazon. The Amazon accounts for approximately 60% of the nation's territory and approximately 13% of the Brazilian population. This region hosts 99.5% of the nation's malaria cases, which are predominantly caused by Plasmodium vivax (i.e., 82% of cases in 2013). The second involves imported malaria, which corresponds to malaria cases acquired outside the region where the individuals live or the diagnosis was made. These cases are imported from endemic regions of Brazil (i.e., the Amazon) or from other countries in South and Central America, Africa and Asia. Imported malaria comprised 89% of the cases found outside the area of active transmission in Brazil in 2013. These cases highlight an important question with respect to both therapeutic and epidemiological issues because patients, especially those with falciparum malaria, arriving in a region where the health professionals may not have experience with the clinical manifestations of malaria and its diagnosis could suffer dramatic consequences associated with a potential delay in treatment. Additionally, because the Anopheles vectors exist in most of the country, even a single case of malaria, if not diagnosed and treated immediately, may result in introduced cases, causing outbreaks and even introducing or reintroducing the disease to a non-endemic, receptive region. Cases introduced outside the Amazon usually occur in areas in which malaria was formerly endemic and are transmitted by competent vectors belonging to the subgenus Nyssorhynchus (i.e., Anopheles darlingi, Anopheles aquasalis and species of the Albitarsis complex). The third type of transmission accounts for only 0.05% of all cases and is caused by autochthonous malaria in the Atlantic Forest, located primarily along the southeastern Atlantic Coast. They are caused by parasites that seem to be (or to be very close to) P. vivax and, in a less extent, by Plasmodium malariae and it is transmitted by the bromeliad mosquito Anopheles (Kerteszia) cruzii. This paper deals mainly with the two profiles of malaria found outside the Amazon: the imported and ensuing introduced cases and the autochthonous cases. We also provide an update regarding the situation in Brazil and the Brazilian endemic Amazon.