[Comparative study of American tegumentary leishmaniasis between childhood and teenagers from the endemic areas Buriticupu, Maranhao and Corte de Pedra, Bahia, Brazil]

Effects of forest degradation on the sand fly communities of northeast Brazil

The richness and abundance of sand fly species were studied in northeastern Brazil in areas of leishmaniasis transmission. The study was carried out in two forest areas with different deforestation times for agricultural and livestock activities: one modified by long-term settlement (more than 50 years of occupation) and another less impacted by short-term settlement (10 years). The sand flies were captured with CDC light traps from 18:00 to 06:00 for three consecutive nights, once a month, from May, 2012 to April, 2014. The study captured 21,708 specimens and also 33 species of Lutzomyia and two of Brumptomyia. Species richness and abundance were higher in the more conserved area of short-term occupation (31 species; 61.7%) than in the more degraded area with long-term occupation (17 species; 38.3%). In the most conserved area, the species richness was higher in the forest fragment than in the rural settlement, whereas in the degraded area the richness was higher in the peri-domicile than in the forest. The diversity was higher in the degraded area forest. There were significant statistical differences when comparing the means of total abundance with the intra-domicile, peri-domicile, and forest environments. The average abundance was statistically higher in the peri-domicile compared to the forest (p = 0.009), but there were no statistically significant differences between intra-domicile-peri-domicile (p = 0.11) and forest-intra-domicile (p = 0.87). In conclusion, a change in vegetation cover negatively affects the richness and abundance of sand flies in the natural environment.

Influence of Deforestation on the Community Structure of Sand Flies (Diptera: Psychodidae) in Eastern Amazonia

Variation in the structure of phlebotomine (sand fly) communities in forest fragments with different degrees of preservation and human occupation (peridomicile) in eastern Amazonia was studied. We identified 43 species of sand flies in our study, of which 38 occurred in both preserved forest areas and in the peridomiciles of short-term settlements, while another 28 species occurred in altered forest fragments and long-term settlements. The composition of the community at each site changed with the type of environment (forest or peridomicile), with the species Lutzomyia evandroi, L. whitmani, L. choti, L. serrana, L. triacantha, L. migonei, L. hirsuta, L. shannoni, and L. brachyphylla accounting for more than 54% of the differences among environments. The quality of the environment exerted a significant influence on the structure of phlebotomine communities, and affected their species composition, richness, and abundance.

Socioenvironmental aspects of the Purus Region - Brazilian Amazon: Why relate them to the occurrence of American Tegumentary Leishmaniasis?

This study aims to analyze factors related to the occurrence of American Tegumentary Leishmaniasis in the Purus Region, based on the reporting of cases between 2001 and 2013, correlating them with livelihoods and subsistence farming in the region, and analyzing them in regards to sex, age, clinical form, occupation, diagnostic methods and seasonality. The analysis parameter which was used included all cases of American Tegumentary Leishmaniasis in each sub-region by municipality. The Purus Region, between the states of Amazonas and Acre, consists of three sub-regions: Upper, Middle, and Lower Purus. We observed that socio-environmental impacts influenced the livelihoods of the human population and that the interaction with extractive activities, especially latex and Brazil nut collecting, where the labor regime implies a long stay in the jungle, leads to socio-environmental conditions that are favorable to the contraction of American Tegumentary Leishmaniasis. During the referred period, there were 13,971 cases of American Tegumentary Leishmaniasis distributed among the sub-regions: High (12611 cases = 90.27%), Middle (1225 cases = 8.77%) and Lower (135 cases = 0.96%). Among the 22 municipalities that were studied, Rio Branco stands out with 31.6% of cases, followed by Xapuri with 12.6% and Sena Madureira with 12.5%. In the results, we highlight the high percentage (20.8%) of mucous forms; the age group from 11 to 50 (70.2%), however, 20.2% were in the age group of 1 month to 10 years of age; cases in males were 69.8%, and, in the reports examined, 43.7%. cited their occupation as extractivism. A statistically significant negative association was demonstrated between cutaneous leishmaniasis and rainfall between Purus municipalities. However, in regards to the association of cutaneous leishmaniasis for both, temperature and Municipal Human Development Index—MHDI, no significant associations were found in Purus. We concluded that American Tegumentary Leishmaniasis occurring in the Purus Region is related to two distinct aspects: the development of enterprises that extend the agricultural frontier, and a change in lifestyle, namely the extraction of wood as an occupation, which has, as a consequence, an environmental impact and creates difficulties in accessing treatment.

Molecular Identification of Leishmania spp. in Sand Flies (Diptera: Psychodidae: Phlebotominae) in the Lençóis Maranhenses National Park, Brazil

Sand flies are very common in the region of Lençóis Maranhenses National Park, an important tourist attraction in Brazil. However, the role of some species and their relative importance locally in Leishmania Ross 1903 transmission is unclear. The objective of this study was to identify Leishmania infection in phlebotomine sand flies collected around the Lençóis Maranhenses National Park, an important conservation area and popular international/national tourist destination with a high incidence of leishmaniasis. Sand flies were collected in peridomiciliary areas on the tourist route from September 2012 to August 2013. The captured females were subjected to molecular analyses for the detection of Leishmania DNA. Sand flies were infected with four Leishmania species: Leishmania (Viannia) braziliensis (Vianna, 1911) was found in Lutzomyia whitmani (Antunes and Coutinho, 1939) (2.1%) and Lutzomyia longipalpis (Lutz and Neiva, 1912) (1.7%); Leishmania (Leishmania) infantum (Nicole, 1908) infected Lutzomyia wellcomei (Fraiha, Shaw, and Lainson, 1971) (20%), Lutzomyia sordellii (Shannon and Del Ponte, 1927) (4.3%), Lu. longipalpis (3.7%), and Lu. whitmani (0.8%); Leishmania (Leishmania) amazonensis (Lainson & Shaw, 1972) was found in Lu. whitmani (0.58%), while Leishmania (Viannia) lainsoni infected Lutzomyia evandroi (Costa Lima and Antunes, 1936) (3.4%), Lu. longipalpis (1.06%), and Lu. whitmani (0.29%). The occurrence of these parasites requires control measures to reduce the incidence of cutaneous leishmaniasis and to contain a possible epidemic of visceral leishmaniasis, the most severe form of the disease.

American cutaneous leishmaniasis in infancy and childhood

Infant and young child skin diseases are among the most common features of morbidity throughout the tropics. Because the skin is directly exposed to the environment, it is considerably affected by climatic and local conditions such as vectors and microorganisms, as in the case of leishmaniasis. In America the observed magnitude of cutaneous leishmaniasis in children has led to the study of increased risk of exposure of this group due to the possibility of peri- and intradomiciliary transmission. The present review pretends to make a concrete approach all through the broad and main figures of this parasitic disease, including the clinical, physiopathological, epidemiological, diagnostic, and therapeutic aspects, in order to be used as a practical source of reference for pediatricians leading with tropical cutaneous pathology in the region.

Forecasting temporal dynamics of cutaneous leishmaniasis in Northeast Brazil

Introduction

Cutaneous leishmaniasis (CL) is a vector-borne disease of increasing importance in northeastern Brazil. It is known that sandflies, which spread the causative parasites, have weather-dependent population dynamics. Routinely-gathered weather data may be useful for anticipating disease risk and planning interventions.

Methodology/Principal Findings

We fit time series models using meteorological covariates to predict CL cases in a rural region of Bahía, Brazil from 1994 to 2004. We used the models to forecast CL cases for the period 2005 to 2008. Models accounting for meteorological predictors reduced mean squared error in one, two, and three month-ahead forecasts by up to 16% relative to forecasts from a null model accounting only for temporal autocorrelation.

Significance

These outcomes suggest CL risk in northeastern Brazil might be partially dependent on weather. Responses to forecasted CL epidemics may include bolstering clinical capacity and disease surveillance in at-risk areas. Ecological mechanisms by which weather influences CL risk merit future research attention as public health intervention targets.

Cutaneous leishmaniasis (CL) is a disease resulting from infection by the Leishmania parasites, which humans may acquire when bitten by an infected sandfly. From a public health standpoint, it is important to identify cases early and monitor patients' clinical outcomes because unsuccessfully-treated patients are at risk for severe complications. Since weather conditions affect survival and reproduction of sandflies that transmit Leishmania, routinely-gathered weather and climate data may be useful for anticipating CL outbreaks, bolstering clinical capacity for high-risk periods, and initiating interventions such as active case-finding during these periods to limit disease burden. Here we assessed whether the number of CL cases occurring per month in a rural region of Bahía, Brazil was associated temperature, humidity, precipitation, and El Niño sea surface temperature oscillation patterns observed during preceding seasons. We formulated models that improved accuracy of one, two, and three month-ahead CL predictions by accounting for weather. Forecasts of this nature can contribute to reducing CL burden by informing resource allocation and intervention planning in preparation for epidemics.

Clinical and epidemiologic profile of cutaneous leishmaniasis in Colombian children: considerations for local treatment

Treatment alternatives have seldom been evaluated in children with cutaneous leishmaniasis (CL). We examine the clinical/epidemiological profile of children with CL considering international guidelines for local treatment. Descriptive analyses were conducted using International Center for Medical Research and Training (CIDEIM) case reports of parasitologically diagnosed patients ≤ 14 years of age from 2004 to 2010. Eligibility for local treatment based on World Health Organization/Pan American Health Organization (WHO/PAHO) criteria was determined. Among 380 children, 90% presented lesions of < 3 months duration, 54% presented single lesions < 30 mm in diameter, and 45% were ≤ 5 years old. Lesions on the head and neck were more frequent among children 0-5 years, and lesions below the head/neck were more frequent among 11- to 14-year-old children (P = 0.004). Using PAHO and WHO criteria, 26% and 53% of children, respectively, were eligible for local treatment. Recommended local treatments for New World CL have potential but limited applicability in children. Individual risk-benefit assessment and effectiveness data in children may increase eligibility.

Novo surto de leishmaniose tegumentar americana em área de treinamento militar na Zona da Mata norte do Estado de Pernambuco

Relata-se novo surto de LTA em militares com 71 casos confirmados pelos critérios clínico, epidemiológico e laboratorial. Obteve-se o isolamento de sete amostras, identificadas como Leishmania (Viannia) braziliensis. A ocorrência de surtos nesta região confirma o caráter endêmico, cuja magnitude parece estar relacionada a não adoção de medidas de proteção individual.

[Bacterial infection in cutaneous leishmaniasis: bacterial pattern and sensitivity to antibiotics]

The bacterial flora from leishmanial ulcers was studied. The aerobic species Staphylococcus aureus and Pseudomonas aeruginosa were found most frequently. Evaluation of the sensitivity of these species to antibiotics showed that 100% of these isolates of Staphylococcus aureus were sensitive to vancomycin, amikacin and chloramphenicol, while 100% of the isolates of Pseudomonas aeruginosa were sensitive to amikacin, gentamicin and tobramycin. These species were generally resistant to penicillins and tetracycline.

Clinical, epidemiological and laboratory aspects of patients with American cutaneous leishmaniasis in the State of Pernambuco

The diagnosis for American cutaneous leishmaniasis is based on an association of clinical, epidemiological and laboratory characteristics. The present study identified the circulating species of Leishmania in the State of Pernambuco, described its clinical-epidemiological characteristics and diagnosed the disease. Nineteen patients presenting active lesions who had been diagnosed through clinical evaluation and laboratory tests were selected. The tests included direct investigation, in vitro culturing, Montenegro skin test, indirect immunofluorescence and polymerase chain reaction. The Montenegro Skin Test showed positive results in 89% of the patients; indirect immunofluorescence, in 79%; direct investigation, in 58%; and polymerase chain reaction in 75%. Seven Leishmania (Viannia) braziliensis samples were isolated from these patients and were characterized by means of specific monoclonal antibodies. These data confirm that a combination of different diagnosis techniques is needed in order to obtain efficient results and that, so far, Leishmania (Viannia) braziliensis is the only species responsible for American cutaneous leishmaniasis infection in Pernambuco. Thus, it is essential to identify the parasite species involved in cases of human disease in an endemic area in order to determine the clinical and epidemiological characteristics, especially with regard to diagnosis, therapy development and disease prognosis.

Efficacy of the intralesional treatment with Chenopodium ambrosioides in the murine infection by Leishmania amazonensis

AIM OF THE STUDY

Leishmaniasis, caused by protozoan from Leishmania genus, is an endemic disease in the tropical and subtropical regions of the world. The chemotherapy to this disease is not always effective and can cause several side effects. Chenopodium ambrosioides L. (Chenopodiaceae) is used by the native people in the treatment of cutaneous ulcers caused by different species of Leishmania. The aim of this study was to investigate the effect of the treatment with a hydroalcoholic crude extract (HCE) from the leaves of Chenopodium ambrosioides on the murine infection with Leishmania amazonensis.

MATERIAL AND METHODS

The mice were treated for 4-6 weeks post-infection (p.i.) with HCE (5 mg/kg) or meglumine antimoniate (Sb(v)) (28 mg/kg) either by the oral route, once a day, for 15 days or by five intralesional (IL) injections at intervals of 4 days. The thickness of the infected paws was determined weekly and the parasite load evaluated in the draining lymph nodes (LN), the spleen and in the footpad after 7 weeks of infection. The nitric oxide (NO) production was evaluated in cultures with cells from peritoneum or LN.

RESULTS

The IL treatment increased the NO production in the LN and peritoneum cultures and reduced the parasite load from the footpad, spleen and LN. On the other hand, the oral treatment decreased did alter neither the NO production nor the parasite load.

CONCLUSIONS

IL HCE treatment was more efficient than the oral HCE treatment since the former was able to control the dissemination of infection. This effect can be due to either a direct leishmanicidal effect of HCE or the improvement in the NO production by HCE-stimulated macrophages. The results could justify the topical use of the Chenopodium ambrosioides' leaves in the treatment of the ulcers caused by Leishmania.

Leishmaniose tegumentar americana em crianças: aspectos epidemiológicos de casos atendidos em Manaus, Amazonas, Brasil

No período entre janeiro a dezembro de 2005, foram avaliadas crianças de zero a 14 anos de idade com leishmaniose tegumentar americana, atendidas na Fundação de Medicina Tropical do Amazonas; registraram-se 147 casos; 55,78% do sexo masculino; 48,3% procediam do Município de Rio Preto da Eva; 76% procediam de duas estradas. Entre 90 (67,67%) pacientes, entrevistaram-se os responsáveis sobre a moradia na área de transmissão e os hábitos da criança. Desses, 58,89% residiam no local da provável infecção; 60% das crianças penetravam na mata acompanhando os pais; em 91,11% dos casos havia animais domésticos na moradia; 77,78% das residências localizavam-se até 100m de distância da mata; 76,67% pacientes tinham pelo menos um parente com história de leishmaniose tegumentar americana. O padrão de transmissão foi relacionado especialmente a atividades de manejo florestal ocorrendo próximas ao domicílio, habitações próximas à floresta primária, com a ocorrência de leishmaniose tegumentar americana em crianças pequenas, sugerindo transmissão no intra e no peridomicílio, em alguns casos, crianças penetrando na floresta.

[Clinical findings of tegumentary leishmaniasis in children under five years of age in an endemic area of Leishmania (Viannia) braziliensis]

A retrospective study was performed in a field clinic to characterize the clinical findings of tegumentary leishmaniasis in children from 0 to 5 years old. The clinical records of 4,464 patients were analyzed at the Primary Health Center of Corte de Pedra, Presidente Tancredo Neves, Bahia, Brazil, from May 1987 to December 1995. Four hundred and ninety one (11.8%) children were identified among 4,275 new cases of tegumentary leishmaniasis registered at this Unit. The gender ratio (M:F) for children under six years was 1.1:1. Cutaneous lesions predominated (98%), mainly skin ulcers (99%) located above the waist (p<0.05). Thirty five percent had multiple lesions. The observed magnitude of the disease in children, the similar proportion of cases in both genders and the location of the lesions suggest the possibility of peri or intradomiciliary transmission.

[American tegumentary leishmaniasis caused by Leishmania (Viannia) braziliensis in military training area of Zona da Mata in Pernambuco]

The aim of work was to study the epidemiology of American tegumentary leishmaniasis in a military training unit situated in Zona da Mata region of Pernambuco State. Between 2002 and 2003 twenty-three cases were notified by clinical exam, detection and/or isolation of parasite and Montenegro skin test. Seven stocks of Leishmania (Viannia) braziliensis were obtained from patients, identified by a panel of specific monoclonal antibodies and isoenzymatic electrophoresis profiles. An epidemiologic survey on prevalence of infection was carried out by Montenegro skin test in the population that underwent training activities during the same period, out of which 25.3% were identified as positive. These results in association with previous data from this area, shows the maintenance of a primary transmission cycle and the occurrence of periodical outbreaks after training activities in local areas of remnant Atlantic rain forest.

Factores de riesgo para la transmisión de leishmaniasis cutánea en niños de 0 a 5 años en un área endémica de Leishmania (Viannia) braziliensis

Fue realizado un estudio caso-control pareado en Corte de Pedra, Bahía, Brasil, área endémica de Leishmania (Viannia) braziliensis para evaluar los diferentes factores de riesgo asociados a la presencia de leishmaniasis cutánea en niños de 0 a 5 años. Fueron considerados como casos, los niños con prueba de leishmanina positiva y que presentaban en el examen físico, una o más lesiones clínicas, activas o cicatrizales, compatibles con leishmaniasis cutánea. Fueron seleccionados 40 casos y 71 controles que fueron pareados por edad y área de residencia. La presencia de algún otro miembro de la familia con antecedente de leishmaniasis cutánea durante el año anterior a la aparición de la enfermedad en el niño demostró ser un importante factor de riesgo (MÔR MH = 17,75; IC95%: 4,08-77,25). No se encontraron evidencias de asociación con otros factores, como hábitos del niño dentro y fuera de casa, características de la vivienda y del peridomicilio, presencia de vectores y animales como probables reservorios. Estos hallazgos apoyan la hipótesis que el ser humano podría comportarse como un posible reservorio y servir de fuente de contagio para este grupo de edad.

Ecoepidemiologia da leishmaniose tegumentar no Município de Buriticupu, Amazônia do Maranhão, Brasil, 1996 a 1998

Estuda-se a distribuição da Leishmaniose Tegumentar no Município de Buriticupu, Maranhão, Brasil, de acordo com os meses, estações e as ocupações, sexos e faixas etárias das pessoas, nos anos de 1996 a 1998. Os dados referentes a estes aspectos são comparados com os da fauna flebotomínica obtidos por outros autores, no mesmo período. A doença atingiu todas as faixas etárias, obedecendo à seguinte ordem: 0-5 (4,1%), 6-10 (7,1%), 11-15 (13,6%), 16-21 (20,8%), 22-30 (21,1%) e > 30 (33,3%). O predomínio foi do sexo masculino (70,1%) e, quanto à ocupação, os lavradores (52,5%), seguidos dos estudantes (17,7%) e das domésticas (16,0%). A exemplo dos flebotomíneos, a doença distribuiu-se durante todos os meses do ano, mas a maior concentração de casos foi registrada na estação seca (58,5%), enquanto os flebotomíneos apresentaram picos bimodais nos dois primeiros anos. Ocorreu em maior freqüência no período chuvoso em 1998. A doença continua apresentando características que a definiam em épocas passadas, mas houve um aumento proporcional de casos em crianças e no sexo feminino, sugestivo de transmissão no ambiente antrópico.

[Assessment of a leprosy control program in a hyperendemic county in the State of Maranhão, Brazil, 1991-1995]

This is a descriptive study to assess the leprosy control program in the municipality of Buriticupu in Maranhão State, Brazil. The records of 214 patients with different forms of leprosy were studied. Patients were treated at a health center of the Federal University in Maranhão located in the above-mentioned municipality. The study population was comprised of 110 cases with paucibacillary leprosy (PB) and 104 with multibacillary leprosy (MB). The patients were registered between January 1991 and December 1995. Data on the form of the disease, number of contacts registered, examined, and assessed, degree of disability at the beginning and end of treatment, and the register's status were collected on a form designed specifically for this purpose. Analysis of results was based on operational guidelines developed by the Ministry of Health. There was a slight predominance of the PB form. Observation of patients with physical disabilities at the beginning and end of treatment was low, as were levels of successful treatment and examined contacts. There was a high dropout level. The program was considered "low-level performance" for all indicators used in the study.

[Profile of leprosy patients in a hiperendemic area of Amazonian Maranhão, Brazil]

An epidemiological cross-sectional study of 207 patients with leprosy disease, was undertaken between August 1998 to november 2000, aiming at evaluating the socioeconomic, demographic and ambiental profiles of the patients as well as physical incapacity due to the disease. The study was performed in the municipality of Buriticupu-Maranh o state, a hiperendemic leprosy area in the Amazonian Maranh o. The level of incapacity was assessed from parameters established by the Brazilian Health Minister. The clinical evaluation and the results of the physical tests were registered in a standardized form. It was observed a predominance of married people (45,9%), with low level of education (56%), being lend workers (40,1%), with familiar income to the minimum wage (76,3%), aged from 14 to 44 years (63,3%), males (60,9%) and brown (67,6%); 44% living in mud huts, 82,6% deposited their excrements in cesspits and 63,8% do not treat the drinking water, 58% utilized well-water and 51,7% do not use treated water for ingestion. The most affected segments of the body were the feet (62,3%), eyes (51,2%) end hands (7,2%), being the higher percentage of physical incapacitaties found among the patients bearing the borderline form of the disease (93%) mainly hands and feet, and in the virchowian form greatest frequency of eyes incapacities. It is concluded that the hyperendemicity associated with the precarious socioeconomic conditions and with a high level of physical incapacities may be involved with the living quality of the patients.

[knowledge level about of American tegumentary leishmaniasis (ATL) and use of alternative therapies in an endemic area in the Amazon Region in the State of Maranhão, Brazil]

The level of knowledge concerning American tegumentary leishmaniasis (ATL) and use of alternative therapies was evaluated in five rural communities in Buriticupu, Maranhão State, Brazil. The study lasted from September 1997 to January 1998. Local inhabitants answered an interview on housing conditions, epidemiological aspects, prevention, standard clinical treatment, and alternative therapies. The study population was 378 (19%) out of a total of 1,980 inhabitants, from Sexta Vicinal (35), Quinta Vicinal (63), Trilha 410 (96), Vila União (85), and Buritizinho (99). Of the interviewees, 72% had little knowledge of ATL transmission, 96% had heard something about the disease from friends, and 60.7% knew ATL by the local term "lésh". Glucantime was the most familiar drug for treatment, while 29.6% referred to use of herbal remedies on the ulcers. Citrus limon (lemon) was the plant most frequently used, and 15.4% of the interviewees used it as a powder spread on the wound. We conclude that the population had little correct knowledge of ATL in the five areas studied, especially with regard to prevention and treatment.

[American cutaneous leishmaniasis in the State of Acre, Brazil]

OBJECTIVE

Present a statistical survey of American Cutaneous Leishmaniasis (ACL) in the State of Acre.

METHODS

Data were obtained from the forms of the "Campaign against Leishmaniasis", from January 1992 to December 1997. Descriptive statistical analysis was applied.

RESULTS

There were 2.557 registered cases. The highest prevalence was found at the microregion of Brasiléia (231.8 cases/10,000 inhab.). The predominant clinical form was cutaneous (84.05%). The disease occurred mostly among males (71.02%). Half of the cases were among people with 24 years of age or younger. Most cases were people with rural occupations. 83.97% of the cases were diagnosed by clinical examination. The longest period to seek medical treatment was registered in the mesoregion of Juruá Valley (10.37 months)

CONCLUSION

The high number of cases suggests that it might be necessary to study the psychosocial implications of the disease and identify factors contributing to the delay in treatment.