A esquistossomose, com o desenvolvimento da agricultura, passou de doença rara a problema sério.
Muitas múmias egípcias apresentam as lesões inconfundíveis da esquistossomose por S. haematobium. A infecção pelos parasitas dava-se nos trabalhos de irrigação da agricultura. As cheias do Nilo sempre foram a fonte da prosperidade do Egito, mas também traziam os caracóis portadores dos schistosomas. O hábito dos agricultores de fazer as plantações e trabalhos de irrigação com os pés descalços metidos na água parada, favorecia a disseminação da doença crónica causada por estes parasitas. O povo, cronicamente debilitado pela doença, era facilmente dominável por uma classe de guerreiros que, uma vez que não praticavam a agricultura irrigada, não contraíam a doença, mantendo-se vigorosos. Estas condições permitiram talvez a cobrança de impostos em larga escala com excedentes consideráveis que revertiam para a nova elite de guerreiros, uma estratificação social devida à doença, que se transformaria nas civilizações.[2]
A doença foi descrita cientificamente pela primeira vez em 1851 pelo médico alemão T. Bilharz, que lhe dá o nome alternativo de bilharzíase.
[editar]Progressão e sintomas
A fase de penetração é o nome dado a sintomas que podem ocorrer quando da penetração da cercária na pele, mas mais frequentemente é assintomática, exceto em indivíduos já infectados antes. Nestes casos é comum surgireritema (vermelhidão), reação de sensibilidade com urticária (dermatite cercariana) e prurido e pele avermelhada ou pápulas na pele no local penetrado, que duram alguns dias.
Na fase inicial ou aguda, a disseminação das larvas pelo sangue, e principalmente o início da postura de ovos nas veias que vão para o fígado ativa o sistema Bulateral surgindo Bolinhas de pus, mal estar, cefaléias (dores de cabeça),astenia (fraqueza), dor abdominal, diarreia sanguinolenta, dispnéia (falta de ar), hemoptise (tosse com sangue), artralgias, linfonodomegalia e esplenomegalia, um conjunto de sintomas conhecido por síndrome de Katayama, que geralmente aparece após três a nove semanas após a penetração das cercárias. Nas análises sanguíneas há eosinofilia (aumento dos eosinófilos, células do sistema imunitário antiparasitas). Estes quadros só ocorrem secundariamente à hipersensibilidade ao parasita, sendo uma doença mais comum em pacientes moradores de áreas não endêmicas que se expõem a coleções hídricas contaminadas. Estes quadros duram em geral alguns dias, mas podem durar até meses e em casos raros podem ser fatais. Estes pacientes apresentam grandes granulomas periovulares necrótico-exsudativos dispersos pelos intestinos, fígado e outros órgãos. Estes sintomas podem ceder espontaneamente ou podem nem sequer surgir, mas a doença crônica silenciosa.
Os sintomas crônicos são quase todos devidos à produção de ovos imunogénicos. Estes são destrutivos por si mesmos, com o seus espinhos e enzimas, mas é a inflamação com que o sistema imunitário lhes reage que causa os maiores danos. As formas adultas não são atacadas porque usam moléculas self do próprio hóspede para se camuflar. Os sintomas desta fase crônica podem ser a hepatopatias/enteropatias com hepatomegalia, ascite, diarreia no caso da esquistossomose mansônica, única que existe no Brasil. As formas mais graves com hepatomegalia ehipertensão portal são as principais causas de morte por esquistossomose no Brasil. A esquistossomose hematóbia, que existe em países africanos pode levar a patologias urinárias como disúria/hematúria, nefropatias, cancer da bexiga.
Outras formas de esquistossomose graves são as formas ectópicas cujas mais importantes são neurológicas que pode ser medular, conhecida como mielopatia esquistossomótica ou esquistossomose medular[3], ou cerebral, quando atingem o cérebro, existem também casos de esquistossomose ectópica na pele, pulmão, tuba uterina e outras vísceras.
[editar]O ciclo da Esquistossomose
[editar]Diagnóstico
Os ovos podem ser encontrados no exame parasitológico de fezes, mas nas infecções recentes o exame apresenta baixa sensibilidade. Para aumentar a sensibilidade podem ser usados de coproscopia qualitativa, como Hoffman ou quantitativo, como Kato-Katz. A eficácia com três amostras chega apenas a 75%.
O hemograma demonstra leucopenia, anemia e plaquetopenia. Ocorrem alterações das provas de função hepática, com aumento de TGO, TGP e fosfatase alcalina. Embora crie a hipertensão portal, classicamente a esquistossomose preserva a função hepática. Assim, os critérios de Child-Pught, úteis no cirrótico, nem sempre funcionam no esquistossomótico que não tem associado hepatite viral ou alcoólica.
A ultra-sonografia em mãos experientes pode fazer o diagnóstico, sendo patognomônico a fibrose e espessamento periportal, hipertrofia do lobo hepático esquerdo e aumento do calibre da mesentérica superior.[4]
A biopsia retal é uma técnica também utilizável, tendo uma sensibilidade de 80%.
[editar]Profilaxia
Saneamento básico com esgotos e água tratadas. Erradicação dos caramujos que são hospedeiros intermediários da doença. Proteção dos pés e pernas com botas de borracha com solado antiderrapante. Informar a população das medidas profiláticas da doença. Evitar entrar em contato com água que contenha cercárias.
[editar]Tratamento
O tratamento é feito com antiparasitários (praziquantel ou oxamniquina) para matar o parasita dentro do corpo e dura 1 ou 2 dias.
Ellis researched murders at the New York Public Library. His first draft of American Psycho left all the grisly scenes until last, to be added in later. To one reviewer, Ellis comments:
| “ | [Bateman] was crazy the same way [I was]. He did not come out of me sitting down and wanting to write a grand sweeping indictment of yuppie culture. It initiated because my own isolation and alienation at a point in my life. I was living like Patrick Bateman. I was slipping into a consumerist kind of void that was supposed to give me confidence and make me feel good about myself but just made me feel worse and worse and worse about myself. That is where the tension of "American Psycho" came from. It wasn't that I was going to make up this serial killer on Wall Street. High concept. Fantastic. It came from a much more personal place, and that's something that I've only been admitting in the last year or so. I was so on the defensive because of the reaction to that book that I wasn't able to talk about it on that level.[5]Synopsis
Set in Manhattan during the Wall Street boom of the late 1980s, American Psycho is about the daily life of wealthy young investment banker Patrick Bateman. Bateman, in his late 20s when the story begins, narrates his everyday activities, from his recreational life among the Wall Street elite of New York to his forays into murder by nightfall. Through present tense stream-of-consciousness narrative, Bateman describes his daily life, ranging from a series of Friday nights spent at nightclubs with his colleagues — where they snort cocaine, critique fellow club-goers' clothing, trade fashion advice, and question one another on proper etiquette — to his loveless engagement to fellow yuppie Evelyn and his contentious relationship with his brother and senile mother. Bateman's stream of consciousness is occasionally broken up by chapters in which he directly addresses the reader in order to critique the work of 1980s Pop music artists. The novel maintains a high level of ambiguity through such devices as mistaken identity, and contradictions which introduce the possibility that Bateman is an unreliable narrator. Characters are consistently introduced as other people, people argue over the identities of others they can see in restaurants or at parties. Whether any of the crimes depicted in the novel actually happened, or were simply the fantasies of a delusional psychotic, is deliberately left open.
Bateman comes from a privileged background; he works as a vice president at a Wall Street investment company and lives in an expensive Manhattan apartment on the Upper West Side, where he embodies the 1980s yuppie culture. As Bateman describes his day-to-day activities, the mundane details become interspersed with descriptions of brutal murders he carries out in secret. After killing one of his colleagues, Paul Owen, one evening, Bateman appropriates his apartment as a place to kill and store more victims. In addition to describing his daily life, Bateman also details his sexual relationships. He is dating a fellow yuppie named Evelyn, though he possesses no deep feelings for her. He frequently solicits sex with attractive women, whom he refers to as "hardbodies." Bateman also documents his interactions with his estranged family, specifically his mother and his brother, Sean Bateman, who is a main character in Ellis's The Rules of Attraction.
Bateman's control over his violent urges deteriorates. The description of his murders become increasingly sadistic and complex, progressing from stabbings to drawn out sequences of torture, rape, mutilation, cannibalism, and necrophilia, and the separation between his two lives begins to blur. He introduces stories about serial killers into casual conversations, and on several occasions openly confesses his murderous activities to his co-workers, who never take him seriously, do not hear what he says, or misunderstand him completely, hearing the words "murders and executions" as "mergers and acquisitions", for example. Bateman begins to experience bizarre hallucinations such as seeing a Cheerio interviewed on a talk show, being stalked by an anthropomorphic park bench, and finding a bone in his Dove Bar. These incidents culminate in a shooting spree during which he kills several random people in the street resulting in a SWAT team being dispatched in a helicopter. Bateman flees on foot and hides in his office, where he phones his attorney, Harold Carnes, and confesses all of his crimes to the answering machine.
Later, Bateman confronts Carnes about the message only to find Carnes is amused at what he considers to be a good joke. Carnes tells Bateman that he is too much of a coward to have committed such acts and claims that he had dinner in London with Paul Owen a few days previously. Bateman re-visits the murdered Paul Owen's apartment, where he had killed and mutilated two prostitutes. Bateman enters the perfectly clean, refurbished apartment which shows no trace of decomposing bodies, but is filled with strong-smelling flowers, as though meant to hide a bad odor. He runs into a real estate agent showing the apartment to prospective buyers, and who appears suspicious of Bateman.
The book ends as it began, with Bateman and his colleagues in a club on a Friday night, engaging in mundane conversation. Bateman comes to the conclusion that he is proud of who he is, but fails when he attempts to articulate why.
[edit][edit]Controversy
The book was originally to have been published by Simon & Schuster in March 1991, but the company withdrew from the project because of "aesthetic differences." Vintage Books purchased the rights to the novel and published the book after the customary editing process. The book was never published in hardcover form in the United States, although a deluxe paperback was eventually offered.[7] Ellis received numerous death threats and hate mail after the publication of American Psycho."[8][9]
In Germany, the book was deemed "harmful to minors," and its sales and marketing were severely restricted from 1995 to 2000. In Australia, the book is sold shrink-wrapped and is classified "R18" under national censorship legislation. The book may not be sold to those under 18 years of age, or criminal prosecution may result. Along with other Category 1 publications, its sale is theoretically banned in the state of Queensland and it may only be purchased shrink-wrapped. In Brisbane, the novel is available to those over 18 from all public libraries and can still be ordered and purchased (shrink-wrapped) from many book stores despite this prohibition.[10] Bret Easton Ellis has commented on this, saying "I think it's adorable, I think it's cute, I love it."[11][12] In New Zealand, the Government's Office of Film & Literature Classification has rated the book as R18. The book may not be sold or lent in libraries to those under 18 years of age. It is generally sold shrink wrapped in bookstores. In Canada, the book generated renewed controversy during the trial of serial killer Paul Bernardo after it was discovered that Bernardo owned a copy of the book and had "read it as his 'bible'."[13]
Feminist activist Gloria Steinem was among those opposed to the release of Ellis' book because of its portrayal of violence toward women. Steinem is also the stepmother of Christian Bale, who played Bateman in the film. This coincidence is mentioned in Ellis' mock memoir Lunar Park.
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