Leishmaniose visceral: revisão sobre a relação com a desnutrição e correlação de uma série histórica de pacientes hospitalizados com o clima em área endêmica de Minas Gerais, Brasil

Abstract

The main objectives of this study were to delineate the panorama of the discussion between visceral leishmaniasis and malnutrition and to characterize the series of LV cases attended at a referral hospital in the north of Minas Gerais for 22 years, to describe the occurrence of the cases, according to the climatic characterization and to correlate the distribution of the cases with rainfall and ambient temperature. The guidelines used for this were descriptive integrative review with articles selected between 2006 and 2017 and series of cases compiled from 1995 to 2016. Data were extracted from medical records selected chronologically. Climate information was collected on the virtual platform of the Semi-arid Studies Center of Unimontes. There was approval of the CEP and the direction of the University Hospital. We found 76 papers in the Medline database and 13 in Lilacs, among articles, abstracts, annals of events, attendance protocols and editorials, of which 11 were the final sample. At the hospital, 967 medical records were selected, with a slight predominance of males (54.4%) and the age group of one to four years (42.9%). The duration of clinical manifestations up to the time of hospitalization ranged from 5 to 120 days, with a duration of 16 to 30 days (34.4%) more frequent. Hepatomegaly, splenomegaly, cutaneous pallor and fever were manifestations present in more than 90% of patients at the time of hospitalization. Diagnosis was performed by serological methods in the majority of cases (85.9%). The largest portion of the hospitalizations lasted between 16 and 30 days (44.0%) and hospital discharge with outpatient control was the most frequent outcome of admissions and the percentage of deaths was 2.0%. LN malnutrition appears to present two different genes, one due to deficiency in macro and micronutrient intake, prior to infection and favoring host susceptibility due to the involvement of the branches of the immune response and another through a hypercatabolic and anorectic consumptive process triggered by the response inflammatory response to the action of leishmania. Both within a global framework that involves genetic, immunological, hormonal, environmental and the parasite itself. Therefore, clinical management of malnutrition through anthropometric and laboratory parameters, regardless of origin, becomes essential. Moreover, in this study there was no statistically significant association between temperature, precipitation and number of cases, however there are nuances in the environmental factors that influence the LV transmission dynamics, which vary from region to region.