Integrated control of neglected tropical diseases in Brazil: document review of a national campaign in light of WHO recommendations.

Objective: To describe the results of a national campaign aimed at the integrated control of neglected tropical diseases in Brazil in light of the World Health Organization (WHO) official documentation related to the integration of strategies for the prevention, control, and elimination or eradication of neglected tropical diseases. Methods: A document review that included official WHO documents published between 2007 and 2020 and campaign results extracted from the official technical report produced by the Brazilian Ministry of Health. Results: The integrated control of neglected tropical diseases was gradually incorporated in the WHO documentation over time. Preventive chemotherapy through mass drug administration, intensified case management, and integrated vector management were extensively recommended as strategies for integrated control. The Brazilian campaign was carried out in four iterations between 2013 and 2017. Children aged 5 to 14 years enrolled in municipal public schools nationwide were targeted. In summary, a total of 1 074 and 73 522 new cases of leprosy and trachoma, respectively, were detected. Nearly 18 million doses of preventive chemotherapy for soil-transmitted helminthiasis were administered. More than 700 cases of schistosomiasis were diagnosed and treated. Conclusions: The integrated strategies implemented in Brazil throughout the campaign generated results aligned with the WHO recommendations for the control of neglected tropical diseases, especially those regarding mass drug administration, active case detection, and intensified case management. Therefore, the continuity of the campaign with adequate evaluation tools must be encouraged as a constant public health policy in the Brazilian government agenda.

"It's not all about the disease": do treatment and socioeconomic status affect perceived impact and satisfaction of patients treated for cutaneous leishmaniasis?

BACKGROUND: This cross-sectional study compared the general impact of cutaneous leishmaniasis (CL) and patient satisfaction with treatment and health services as perceived by those undergoing different therapeutic regimens in an endemic region in South-Eastern Brazil. We also investigated the factors associated with both outcomes (general impact and satisfaction). METHODS: We included 84 patients with CL treated between 2018 and 2019 with intravenous meglumine antimoniate, liposomal amphotericin B, or intralesional meglumine antimoniate therapy. Data were collected through interviews that assessed sociodemographic characteristics, comorbidity status, access and use of health services for CL diagnosis and treatment, and the items of the Cutaneous Leishmaniasis Impact Questionnaire (CLIQ). The CLIQ is a psychometric questionnaire previously validated to assess the general impact of CL on patient satisfaction with treatment and health services. Multivariate logistic regression analysis was used to identify the factors associated with high CL impact and low patient satisfaction. RESULTS: The general impact of CL and patient satisfaction with treatment and health services were not significantly associated with the therapeutic regimen. High CL impact was associated with low family income (odds ratio [OR]:3.3; 95% confidence interval [CI]:1.0-10.3), occurrence of complications/adverse effects during treatment (OR:7.7; 95%CI:2.4-25.6), and additional costs during diagnosis and/or treatment (OR:12.1; 95% CI:2.8-52.4). Low satisfaction was associated with high disease impact (OR: 9.5; 95% CI:2.7-33.9), occurrence of complications/adverse effects (OR:4.2; 95% CI:1.3-13.0), and high family income (OR:7.1; 95%CI:1.7-28.2). CONCLUSIONS: Our data support public health policies aimed at reducing the impact of CL and its treatment as well as the use of therapy with fewer adverse effects.

"It's not all about the disease": do treatment and socioeconomic status affect perceived impact and satisfaction of patients treated for cutaneous leishmaniasis?

ABSTRACT Background: This cross-sectional study compared the general impact of cutaneous leishmaniasis (CL) and patient satisfaction with treatment and health services as perceived by those undergoing different therapeutic regimens in an endemic region in South-Eastern Brazil. We also investigated the factors associated with both outcomes (general impact and satisfaction). Methods: We included 84 patients with CL treated between 2018 and 2019 with intravenous meglumine antimoniate, liposomal amphotericin B, or intralesional meglumine antimoniate therapy. Data were collected through interviews that assessed sociodemographic characteristics, comorbidity status, access and use of health services for CL diagnosis and treatment, and the items of the Cutaneous Leishmaniasis Impact Questionnaire (CLIQ). The CLIQ is a psychometric questionnaire previously validated to assess the general impact of CL on patient satisfaction with treatment and health services. Multivariate logistic regression analysis was used to identify the factors associated with high CL impact and low patient satisfaction. Results: The general impact of CL and patient satisfaction with treatment and health services were not significantly associated with the therapeutic regimen. High CL impact was associated with low family income (odds ratio [OR]:3.3; 95% confidence interval [CI]:1.0-10.3), occurrence of complications/adverse effects during treatment (OR:7.7; 95%CI:2.4-25.6), and additional costs during diagnosis and/or treatment (OR:12.1; 95% CI:2.8-52.4). Low satisfaction was associated with high disease impact (OR: 9.5; 95% CI:2.7-33.9), occurrence of complications/adverse effects (OR:4.2; 95% CI:1.3-13.0), and high family income (OR:7.1; 95%CI:1.7-28.2). Conclusions: Our data support public health policies aimed at reducing the impact of CL and its treatment as well as the use of therapy with fewer adverse effects.

Integrated control of neglected tropical diseases in Brazil: document review of a national campaign in light of WHO recommendations / Control integrado de las enfermedades tropicales desatendidas en Brasil: revisión documental de una campaña nacional a la luz de las recomendaciones de la OMS / Controle integrado de doenças tropicais negligenciadas no Brasil: revisão documental de uma campanha nacional considerando as recomendações da OMS

ABSTRACT Objective. To describe the results of a national campaign aimed at the integrated control of neglected tropical diseases in Brazil in light of the World Health Organization (WHO) official documentation related to the integration of strategies for the prevention, control, and elimination or eradication of neglected tropical diseases. Methods. A document review that included official WHO documents published between 2007 and 2020 and campaign results extracted from the official technical report produced by the Brazilian Ministry of Health. Results. The integrated control of neglected tropical diseases was gradually incorporated in the WHO documentation over time. Preventive chemotherapy through mass drug administration, intensified case management, and integrated vector management were extensively recommended as strategies for integrated control. The Brazilian campaign was carried out in four iterations between 2013 and 2017. Children aged 5 to 14 years enrolled in municipal public schools nationwide were targeted. In summary, a total of 1 074 and 73 522 new cases of leprosy and trachoma, respectively, were detected. Nearly 18 million doses of preventive chemotherapy for soil-transmitted helminthiasis were administered. More than 700 cases of schistosomiasis were diagnosed and treated. Conclusions. The integrated strategies implemented in Brazil throughout the campaign generated results aligned with the WHO recommendations for the control of neglected tropical diseases, especially those regarding mass drug administration, active case detection, and intensified case management. Therefore, the continuity of the campaign with adequate evaluation tools must be encouraged as a constant public health policy in the Brazilian government agenda.

RESUMEN Objetivo. Describir los resultados de una campaña nacional dirigida al control integrado de las enfermedades tropicales desatendidas en Brasil, a la luz de la documentación oficial de la Organización Mundial de la Salud (OMS) relacionada con la integración de estrategias para la prevención, el control y la eliminación o erradicación de las enfermedades tropicales desatendidas. Métodos. Revisión documental que comprendió documentos oficiales de la OMS publicados entre el 2007 y el 2020, así como los resultados de las campañas, extraídos del informe técnico oficial elaborado por el Ministerio de Salud de Brasil. Resultados. Con el tiempo, la OMS ha ido incorporando gradualmente en sus documentos el concepto de control integrado de las enfermedades tropicales desatendidas. Tanto los tratamientos quimioprofilácticos mediante la administración masiva de medicamentos como la intensificación del tratamiento de los casos y el control integrado de vectores han sido recomendados ampliamente como estrategias para el control integrado. En Brasil, la campaña se llevó a cabo en cuatro ediciones, realizadas entre el 2013 y el 2017. Las actividades estuvieron dirigidas a la población escolar de entre 5 y 14 años de las escuelas públicas municipales de todo el país. En resumen, se detectaron 1 074 y 73 522 casos nuevos de lepra y tracoma, respectivamente; se administraron casi 18 millones de dosis de tratamiento quimioprofiláctico contra las geohelmintiasis; y se diagnosticaron y trataron más de 700 casos de esquistosomiasis. Conclusiones. Las estrategias integradas aplicadas en Brasil en el transcurso de la campaña permitieron obtener resultados acordes con las recomendaciones de la OMS para el control de las enfermedades tropicales desatendidas, especialmente en lo relativo a la administración masiva de medicamentos, la búsqueda activa de casos y la intensificación de su tratamiento. Por lo tanto, es necesario fomentar la continuidad de la campaña con herramientas de evaluación adecuadas, como una política constante en materia de salud pública dentro de la agenda del Gobierno de Brasil.

RESUMO Objetivo. Descrever os resultados de uma campanha nacional voltada ao controle integrado de doenças tropicais negligenciadas no Brasil considerando os documentos oficiais da Organização Mundial da Saúde (OMS) que tratam da integração de estratégias para a prevenção, o controle e a eliminação ou erradicação de doenças tropicais negligenciadas. Métodos. Realizou-se uma revisão documental que incluiu documentos oficiais da OMS publicados entre 2007 e 2020 e resultados de campanhas extraídos do relatório técnico oficial produzido pelo Ministério da Saúde do Brasil. Resultados. O controle integrado de doenças tropicais negligenciadas foi gradualmente incorporado à documentação da OMS ao longo do tempo. A quimioterapia preventiva por meio da administração em massa de medicamentos, a intensificação da gestão de casos e o manejo integrado de vetores foram amplamente recomendados como estratégias para o controle integrado. A campanha brasileira foi realizada em quatro iterações entre 2013 e 2017. O público-alvo foram crianças de 5 a 14 anos matriculadas em escolas públicas municipais de todo o país. Em resumo, foi detectado um total de 1 074 e 73 522 novos casos de hanseníase e tracoma, respectivamente. Foram administradas cerca de 18 milhões de doses de quimioterapia preventiva para helmintíase transmitida pelo solo. Mais de 700 casos de esquistossomose foram diagnosticados e tratados. Conclusões. As estratégias integradas implementadas no Brasil ao longo da campanha geraram resultados alinhados com as recomendações da OMS para o controle de doenças tropicais negligenciadas, especialmente aquelas relativas à administração em massa de medicamentos, à detecção ativa de casos e à intensificação da gestão de casos. Portanto, a continuidade da campanha com ferramentas de avaliação adequadas deve ser incentivada como uma política de saúde pública constante na agenda do governo brasileiro.

Are the clinical features of leprosy and American tegumentary leishmaniasis worse in patients with both diseases?

This cross-sectional population-based study compared clinical features of leprosy and American tegumentary leishmaniasis (ATL) in patients diagnosed with both diseases (n=414) and in those diagnosed with only leprosy (n=27,790) or only ATL (n=24,357) in Mato Grosso State, which is a hyperendemic area for both diseases in Midwest Brazil. All new cases of leprosy and ATL reported in the area from 2008 to 2017 were included. Patients diagnosed with both diseases were identified by a probabilistic linkage procedure applied to leprosy and ATL databases of the national reporting system. The distribution of the frequency of clinical features between groups was compared by the chi-square test, followed by a multivariate logistic regression. Patients diagnosed with both leprosy and ATL presented higher odds of having nerve damage (OR: 1.34; 95% CI: 1.09-1.66) and leprosy reactions (OR: 1.35; 95% CI: 1.04-1.76) compared to patients diagnosed only with leprosy. Mucocutaneous leishmaniasis (OR: 2.29; 95% CI: 1.74-3.00) was more frequent among patients with both diagnoses when compared to patients who only had ATL. In conclusion, patients diagnosed with both leprosy and ATL present more severe clinical features of such diseases. Our data can be useful for designing health policies aimed at timely and integrated management of leprosy and ATL in co-endemic areas.

Are the clinical features of leprosy and American tegumentary leishmaniasis worse in patients with both diseases?

ABSTRACT This cross-sectional population-based study compared clinical features of leprosy and American tegumentary leishmaniasis (ATL) in patients diagnosed with both diseases (n=414) and in those diagnosed with only leprosy (n=27,790) or only ATL (n=24,357) in Mato Grosso State, which is a hyperendemic area for both diseases in Midwest Brazil. All new cases of leprosy and ATL reported in the area from 2008 to 2017 were included. Patients diagnosed with both diseases were identified by a probabilistic linkage procedure applied to leprosy and ATL databases of the national reporting system. The distribution of the frequency of clinical features between groups was compared by the chi-square test, followed by a multivariate logistic regression. Patients diagnosed with both leprosy and ATL presented higher odds of having nerve damage (OR: 1.34; 95% CI: 1.09-1.66) and leprosy reactions (OR: 1.35; 95% CI: 1.04-1.76) compared to patients diagnosed only with leprosy. Mucocutaneous leishmaniasis (OR: 2.29; 95% CI: 1.74-3.00) was more frequent among patients with both diagnoses when compared to patients who only had ATL. In conclusion, patients diagnosed with both leprosy and ATL present more severe clinical features of such diseases. Our data can be useful for designing health policies aimed at timely and integrated management of leprosy and ATL in co-endemic areas.

Leprosy and cutaneous leishmaniasis affecting the same individuals: A retrospective cohort analysis in a hyperendemic area in Brazil.

BACKGROUND: Leprosy and cutaneous leishmaniasis (CL) are neglected tropical diseases (NTDs) affecting the skin. Their control is challenging but the integration of skin NTDs control programs is recommended to improve timely detection and treatment. However, little is known about the occurrence of leprosy and CL in the same individuals, and what are the characteristics of such patients. This study aimed to identify and characterize patients diagnosed with both leprosy and CL (i.e., outcome) in the hyperendemic state of Mato Grosso, Brazil. Also, we investigated the demographic risk factors associated with the period between the diagnosis of both diseases. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective cohort study was conducted with patients diagnosed between 2008 and 2017. From the leprosy (n = 28,204) and CL (n = 24,771) databases of the national reporting system, 414 (0.8%; 414/52,561) patients presenting both diseases were identified through a probabilistic linkage procedure. This observed number was much higher than the number of patients that would be expected by chance alone (n = 22). The spatial distribution of patients presenting the outcome was concentrated in the North and Northeast mesoregions of the state. Through survival analysis, we detected that the probability of a patient developing both diseases increased over time from 0.2% in the first year to 1.0% within seven years. Further, using a Cox model we identified male sex (HR: 2.3; 95% CI: 1.7-2.9) and low schooling level (HR: 1.5; 95% CI: 1.2-1.9) as positively associated with the outcome. Furthermore, the hazard of developing the outcome was higher among individuals aged 40-55 years. CONCLUSIONS/SIGNIFICANCE: Leprosy and CL are affecting the same individuals in the area. Integration of control policies for both diseases will help to efficiently cover such patients. Measures should be focused on timely diagnosis by following-up patients diagnosed with CL, active case detection, and training of health professionals.

Impact of socioeconomic status on the knowledge, attitudes, and practices about visceral leishmaniasis among dog owners.

INTRODUCTION: This cross-sectional study evaluated the impact of socioeconomic status on the knowledge, attitudes, and practices (KAP) concerning zoonotic visceral leishmaniasis (VL) among dog owners from the municipality of Rondonópolis-a highly endemic area for the disease in Central-Western Brazil. METHODOLOGY: Data were collected between 2016 and 2017 during a household survey. A probabilistic sample of 404 dog owners were interviewed assessing sociodemographic characteristics, previous occurrence of VL cases, and KAP about human VL, vector, and canine VL. Responses regarding KAP were compared among social classes, which are indicators of socioeconomic status. Correct/appropriate answers were scored, and a multivariate Poisson regression analysis evaluated the impact of social class on scoring. RESULTS: The overall KAP regarding VL was limited. Dog owners from higher social classes differed from those of the lower classes regarding the recognition of abdominal distension (p = 0.026) and skin lesions (p < 0.001) as clinical manifestations of human and canine VL, respectively, knowledge of VL transmission (p = 0.020), use of topical repellents (p < 0.001), use of insecticide-impregnated collars (p = 0.003), and previous attempts of treatment for canine VL (p = 0.005). Higher scores were associated with the upper social classes (IRR = 1.18; CI = 1.08-1.29) adjusted by the age (IRR = 1.13; CI = 1.04-1.24) and the previous occurrence of human (IRR = 1.21; CI = 1.07-1.36) and canine (IRR = 1.25; CI = 1.14-1.36) VL in the household/neighbourhood of the respondents. CONCLUSIONS: Improved KAP concerning VL was associated with better socioeconomic status of dog owners.

Basic knowledge about visceral leishmaniasis before and after educational intervention among primary health care professionals in Midwestern Brazil.

Health education and training of primary health care (PHC) professionals are highly recommended to reduce the occurrence and lethality of visceral leishmaniasis (VL). This study assessed the impact of an educational intervention on the basic knowledge about visceral leishmaniasis (VL) among PHC professionals from the Brazilian municipality of Rondonopolis, an important endemic area for VL. Responses provided by physicians, nurses, nursing technicians and community health agents from 12 PHC facilities were recorded through the application of self-completed and semi-structured questionnaires before (n=92) and after (n=64) an in-person health training course covering various aspects of VL. Closed- and open-ended responses were compared by the chi-square test and analyses of word clouds, respectively. The proportion of professionals aware of the correct etiological agent (p<0.001) and transmission route (p<0.001) of VL increased post-intervention. In addition, they increased their ability to recognize fever (p<0.001), weakness (p<0.001), weight loss (p<0.001), pallor (p<0.001) and abdominal distention (p=0.013) as clinical manifestations of human VL, and weakness (p<0.001), alopecia (p<0.001) and weight loss (p=0.019) as signs of canine VL. Analyses of word clouds suggested that the participants became more aware of the role of dogs in VL transmission and the role of environmental management in the prevention of VL. In conclusion, the intervention positively impacted the baseline knowledge concerning VL among the professionals. This can support the planning of educational activities for the PHC team regarding early case detection, prevention and control of VL in endemic areas.

Are backyard characteristics relevant factors for the occurrence of human visceral leishmaniasis in Central-Western Brazil?

BACKGROUND: This retrospective case-control study aimed to investigate the factors associated with the occurrence of human visceral leishmaniasis (VL) in the municipality of Rondonópolis, which is a highly endemic area for VL in Central-Western Brazil. METHODS: All VL cases reported in Rondonópolis from 2011 to 2016 were included. For each case, two neighborhood- and age-matched controls with the absence of past and present history of VL and negative rk39-based immunochromatographic test, were recruited. Data were retrospectively collected through interviews that assessed socioeconomic aspects, housing features, backyard characteristics, presence of animals and daily habits. A multivariate conditional logistic regression analysis was used to identify factors associated with human VL. RESULTS: During the study period, 81 VL cases were reported in Rondonópolis, of which 37 (45.7%) were included in this study. Seventy controls were also included. The variables associated with VL occurrence were the outdoor location of a bathroom and/or kitchen separated from the rest of the house (OR 7.8; 95% CI 2.1 to 29.5), the presence of a vegetable garden (OR 5.3; 95% CI 1.3 to 21.2) and the presence of decaying fruits (OR 10.7; 95% CI 2.0 to 52.1) in the backyard. CONCLUSIONS: Our findings suggest an association between backyard characteristics and VL. This may be useful in guiding preventive and control measures against zoonotic VL worldwide.

Where, when, and how the diagnosis of human visceral leishmaniasis is defined: answers from the Brazilian control program.

BACKGROUND: Timely diagnosis is recommended by the Brazilian Visceral Leishmaniasis (VL) Surveillance and Control Program to reduce case fatality. Attempts at assessing this topic in Brazil are scarce. OBJECTIVE: This study aimed to describe where, when, and how the diagnosis of VL has been performed in a Brazilian endemic setting. METHODS: Data of all autochthonous cases confirmed between 2011 and 2016 (N = 81) were recorded. The care-seeking itinerary until the confirmation of VL diagnosis was assessed among 57 patients. FINDINGS: The majority of VL cases (79.1%) were reported by referral hospitals. The patients mainly sought primary health care centres at the onset of symptoms. However, they had to visit seven health services on average to achieve a confirmed diagnosis. The time from the onset of symptoms to the diagnosis of VL (TD) ranged from 1-212 (median, 25) days. The TD was longer among adult patients. There was a direct correlation between the patient's age and TD (r = 0.22; p = 0.047) and a higher occurrence of deaths due to the disease among older patients (p = 0.002). Almost all the patients (98.9%) underwent laboratory investigation, and the VL diagnosis was mainly confirmed based on clinical-laboratory criteria (92.6%). Positive results for the indirect fluorescence antibody test (22.7%) and parasitological examination plus rk39-based immunochromatographic tests (21.3%) were commonly employed. MAIN CONCLUSIONS: VL diagnosis was predominantly conducted in hospitals with a long TD and wide application of serology. These findings may support measures focused on early diagnosis, including a greater involvement of the primary health care system.

Infecção por Giardia duodenalis entre crianças em idade escolar no sul do Mato Grosso / Infection by Giardia duodenalis among school-age children in the south of Mato Grosso / Infección por Giardia duodenalis entre niños en edad escolar en el sur del Mato Grosso

Justificativa e Objetivos: A giardíase representa um problema de saúde pública com possibilidade de ocasionar agravos no desenvolvimento físico e mental, particularmente em crianças. Assim, destaca-se a relevância em efetuar a avaliação parasitológica desse público e seus determinantes. Desse modo, essa pesquisa teve como objetivo avaliar a prevalência e fatores associados à infecção por Giardia duodenalis em crianças matriculadas entre o 1º e 3º ano do ensino fundamental em duas unidades de ensino de um município no sul de Mato Grosso. Métodos: Após o consentimento dos pais e crianças, foram entregues o questionário socioepidemiológico e o coletor universal, contendo solução conservante para a coleta única de amostra fecal, que foi analisada pela técnica de sedimentação espontânea. Resultados: Foram incluídos 60 participantes com média de idade de 7,05 anos e predominância do sexo masculino (53,3%). A prevalência global de enteroparasitas foi de 36,7%, dos quais 54,5% estavam infectados por G. duodenalis. Foi encontrada associação significativa entre a ocorrência dessa infecção e o fato de a criança pertencer à família que declarou não possuir renda financeira (p=0,04). Conclusão: A infecção por G. duodenalis em crianças em idade escolar persiste e está associada à ausência de renda financeira familiar. Tais achados evidenciam a necessidade de melhoria das condições de vida, ações de educação em saúde e tratamento medicamentoso dessa população.(AU)

Background and Objectives: Giardiasis represents a health public problem that may damage the physical and mental development, particularly of children. Therefore, the importance of performing the parasitological evaluation of this population and its determinants is highlighted. Thus, this study aimed to evaluate the prevalence and factors associated with Giardia duodenalis infection in children enrolled between the 1st and 3rd grades of primary education in two educational units in the south of Mato Grosso. Methods: After the consent of parents and children, the socioepidemiological questionnaire and the universal collector containing a preservative solution for the single fecal sample collection were handed out, which were analyzed by the spontaneous sedimentation technique. Results: Sixty participants with mean age of 7.05 years and male predominance (53.3%) were included. The overall prevalence of enteroparasites was 36.7%, of which 54.5% was infected by G. duodenalis. A significant association was found between the occurrence of this infection and the fact that the child belonged to the family that declared not having financial income (p = 0.04). Conclusion: G. duodenalis infection in school-age children persists and is associated with the absence of family financial income. These findings highlight the need to improve this population's living conditions, health education practices, and drug treatment access.(AU)

Justificación y Objetivos: La giardiasis representa un problema de salud pública con posibilidad de ocasionar agravios en el desarrollo físico y mental, particularmente en niños. Así se pone en relieve la importancia en efectuar la evaluación parasitológica de ese público y sus determinantes. De este modo, esta investigación tuvo como objetivo evaluar la prevalencia y los factores asociados a la infección por Giardia duodenalis en niños matriculados entre el 1º y el 3º año de la enseñanza básica en dos unidades de enseñanza en un distrito en el sur de Mato Grosso (Brasil). Métodos: Después del consentimiento de los padres y de los niños, se les entregó el cuestionario socioepidemiológico y el colector universal conteniendo solución conservante para extraer una única muestra fecal, que fue analizada por el técnica de sedimentación espontánea. Resultados: Se incluyeron 60 participantes con media de edad de 7,05 años y predominancia del sexo masculino (53,3%). La prevalencia global de enteroparasitas fue del 36,7%, de los cuales el 54,5% estaban infectados por G. duodenalis. Se encontró una asociación significativa entre la ocurrencia de esta infección y el hecho del niño pertenecer a la familia que declaró no tener ingresos financieros (p = 0,04). Conclusión: La infección por G. duodenalis en niños en edad escolar persiste y estuvo esencialmente asociada a la ausencia de renta financiera familiar. Estos resultados evidencian la necesidad de mejorar las condiciones de vida, de contar con acciones de educación en salud y tratamiento medicamentoso para esa población.(AU)

Visceral leishmaniasis in a Brazilian endemic area: an overview of occurrence, HIV coinfection and lethality.

The Brazilian municipality of Rondonópolis, Mato Grosso State, represents an important visceral leishmaniasis (VL) endemic area. This study described epidemiological and clinical aspects of the occurrence, VL/HIV coinfection and lethality related to VL in Rondonópolis. Data from autochthonous cases reported between 2011 and 2016 were obtained from official information systems. During this period, 81 autochthonous cases were reported, with decreasing incidence through 2016. Contrastingly, the lethality rate was 8.6% overall, but varied widely, reaching a peak (20%) in 2016. Almost 10% of patients had VL/HIVcoinfection. The occurrence of VL prevailed among men (56.8%), brown-skinned (49.4%), urban residents (92.6%), aged 0-4 years (33.3%). Housewives or retired (29.6%) were the most affected occupational groups. Lower age was the main difference among the total VL cases and those who were coinfected or died. Clinically, fever, weakness and splenomegaly were more frequent among all VL cases and VL/HIV coinfected individuals. Bacterial infections (p=0.001) and bleeding (p<0.001) were associated with death due to VL. Pentavalent antimonial and liposomal amphotericin B were the first choices for treatment among all VL cases (71.6%) and those who died (71.4%), respectively. VL/HIV patients were equally treated with both drugs. These findings may support control measures and demonstrate the need for further investigations.

High seroprevalence and peripheral spatial distribution of visceral leishmaniasis among domestic dogs in an emerging urban focus in Central Brazil: a cross-sectional study.

The Brazilian municipality of Rondonópolis is an emerging urban focus of intense transmission of visceral leishmaniasis (VL), where few investigations have addressed canine reservoirs. This study assessed the seroprevalence and spatial distribution of canine visceral leishmaniasis (CVL) in the urban area of Rondonópolis. A CVL serosurvey was conducted between October 2016 and February 2017 using an immunochromatographic rapid test and enzyme-linked immunosorbent assay. Domestic dogs were sampled from 25 heterogeneous regions previously defined by the Spatial 'K'luster Analysis by Tree Edge Removal algorithm, which considered the socioeconomic and environmental features from the last demographic census. The CVL spatial distribution was analyzed by kernel density estimation (KDE) and spatial scan statistic. All the  autochthonous human VL cases reported between 2014 and 2016 were georeferenced. Of the 600 dogs tested, 115 were seropositive in both tests. The overall CVL prevalence was 19.2% (95%CI: 16.1-22.3%), which varied widely among the evaluated regions (0.0-35.1%). Almost 25% of the sampled households (n = 405) had at least one infected dog. KDE demonstrated that positive CVL households were concentrated in the peripheral areas of the city. Spatial scan statistics detected a spatial cluster with significantly low CVL prevalence in the central region (relative risk = 0.37; p = 0.04), where only one human VL case was reported. Thus, we demonstrated a high prevalence of CVL in domestic dogs from diverse socioeconomic and environmental urban contexts in Rondonópolis. The CVL cases were peripherally distributed and occurred more frequently in areas that had reported human VL.

Dengue epidemiological profile in southern Mato Grosso, Brazil (2008-2012)

Dengue is an arboviral disease that is a serious public health concern, especially due to its increasing incidence in the past decades. This study aimed to characterize the epidemiological incidence of dengue in 2008­2012 in Southern Mato Grosso, Brazil. This is an epidemiological and descriptive study of dengue in the 19 municipalities of the Rondonópolis Regional Health Office using data obtained from the Information System of Diseases Notification. An analysis of the number of confirmed cases of dengue, according to year, age, and gender was performed. Data was associated with the rainfall of the region as well. There were 13,580 reported dengue cases; 2010 had the highest number of cases, with 7,244 dengue cases. In 2011, the number fell dramatically to only 236 notified cases. With regard to age, the most often affected were young adults (20-39 years of age); no difference was noted regarding gender. As expected, dengue cases were higher during the rainy season. In 2009 and 2010, in Southern Mato Grosso, there was a significant increase in the proportion of dengue cases compared with other years during the period evaluated. However, a rapid decline in the subsequent year was noted, possibly because of the intensification of preventive actions in vector control. Interestingly, 2012 presented an increasing number of dengue cases. This fact highlights the importance of actively combating dengue in order to prevent future epidemics.

Contamination by intestinal parasites in vegetables marketed in an area of Jequitinhonha Valley, Minas Gerais, Brazil / Contaminação por parasitas intestinais em hortaliças comercializadas em uma área do Vale do Jequitinhonha, Minas Gerais, Brasil

ABSTRACT Objective: The present study aimed to evaluate the presence of helminthes and intestinal protozoa in vegetables commercialized in Diamantina, a municipality located at Jequitinhonha Valley, one of the poorest regions of the world. Methods: A total of 108 specimens, including lettuce, green onion and rocket, were monthly collected from the most popular open street market, green grocery and supermarket of the municipality. The samples were processed by a concentration method and evaluated by light microscopy for parasitological identification. Results: The percentage of contamination was 50.9% (55/108), with predominance of nematode larvae (36.5%), cysts of Entamoeba coli (26.0%) and eggs of hookworms/Strongyloides spp. (12.9%). Lettuce showed greater contamination rate (61.1%) and samples from the open street market were more contaminated (77.8%). Information collected at each point of sale pointed the field cultivation as the critical step for such contaminations. Conclusion: Vegetables marketed in Diamantina presents a wide variety of intestinal parasites, which may represent a potential risk to the health of consumers of fresh vegetables.

RESUMO Objetivo: O presente estudo teve como objetivo avaliar a presença de helmintos e protozoários intestinais em hortaliças comercializados em Diamantina, um município localizado no Vale do Jequitinhonha, uma das regiões mais pobres do mundo. Métodos: Cento e oito exemplares, incluindo alface, cebolinha e rúcula, foram mensalmente coletados em uma feira livre, uma quitanda e um supermercado do município. As amostras foram processadas por um método de concentração e avaliadas por microscopia óptica para pesquisa de estruturas parasitárias. Resultados: O percentual global de contaminação foi de 50,9% (55/108), com predominância de larvas de nematódeos (36,5%), cistos de Entamoeba coli e ovos de ancilostomídeos/Strongyloides spp. (12,9%). A alface demonstrou a maior taxa de contaminação (61,1%) e as amostras da feira livre foram as mais contaminadas (77,8%). Informações coletadas em cada ponto de venda apontaram o cultivo em campo como a etapa crítica para a contaminação. Conclusão: Hortaliças comercializadas em Diamantina apresentam uma ampla variedade de parasitas intestinais, o que representa um risco potencial à saúde dos consumidores da área.