[Leishmaniasis urbanization and low diagnosis capacity in the Metropolitan Region of Belo Horizonte]. / A urbanização das leishmanioses e a baixa resolutividade diagnóstica em municípios da Região Metropolitana de Belo Horizonte.

During the period from 1994 to 1999 cutaneous leishmaniasis was reported in 32 (89%) out of 36 municipalities in the Metropolitan Region of Belo Horizonte, Brazil, of which one (2,8%) municipality was classified as a very high risk area, 16 (44,5%) as high risk, seven (19,4%) as moderate risk areas and 12 (33,3%) as low risk. From 1994 to 1995, visceral leishmaniasis was reported in six (16%) municipalities whereas in 1998 - 1999 this number increased to 15 (42%). Annual numbers of cases during 1994 to 1999 were 30, 53, 64, 53 and 84, respectively. In 19 (61.3%) municipalities no reference center for the diagnosis of the infection was available, so that most of the patients (80%) were referred to Belo Horizonte. Twelve (39%) municipalities have a center for leishmaniasis evaluation, however in only eight (67%) of these basic specific diagnostic tests were available. Rapid and extensive increase of leishmaniasis associated with low diagnosis capacity has been observed in the metropolitan area of Belo Horizonte.

Visceral leishmaniasis in the Metropolitan Region of Belo Horizonte, State of Minas Gerais, Brazil.

In the last few years the number of human cases of American visceral leishmaniasis in the Metropolitan Region of Belo Horizonte (MRBH), Minas Gerais, Brazil has increased, indicating an elevation in the transmission rate of the disease. The total number of notified human cases in the MRBH since 1994, when the first case was identified, up to 1999 was 345 of which 223 (65%) were from the city itself, indicating an urbanization of the disease in this region of Minas Gerais. The age distribution of visceral leishmaniasis cases in the MRBH shows a higher prevalence in children from 0-4 years old, responsible for 28.9% of the notifications. Clinical and immunological findings from dogs infected with Leishmania chagasi are described. The majority of these animals showed no sign of the disease. Sera from all infected dogs showed detectable Leishmania-induced high titles of antibodies based on the results of an indirect fluorescent antibody test. Samples of isolated Leishmania from human and dogs were characterized as L. (L.) chagasi by biochemical and molecular techniques.

Presença de animais associada ao risco de transmissão da leishmaniose visceral em humanos em Belo Horizonte, Minas Gerais / Animal presence and the risk for transmission of visceral leishmaniasis in Belo Horizonte, Brazil

Analisou-se o risco de se contrair leishmaniose visceral (LV) e a presença de animais em residências de Belo Horizonte/MG, em 2006. O estudo de caso-controle foi feito por meio de visitas domiciliares, aplicação de questionário e registro de imagens da residência. A estimativa de risco foi mensurada por comparação de condições de moradia entre dois grupos: 1- constituído por 82 casos humanos de LV ocorridos em 2004 e 2- 164 controles (vizinhos dos casos). Os domicílios pertencentes ao grupo 1 foram os que apresentaram os maiores percentuais de presença de animais. Observou-se, pela análise univariada, que a presença de patos, roedores, pássaros e galinhas aumenta o risco de ocorrer LV em 4,18; 1,81; 1,57; e 1,47 vezes, respectivamente. Para os proprietários de cães, o aumento no risco de contrair LV é equivalente a 2,17 vezes e está relacionado ao número de cães no domicílio. O risco de contrair LV é maior 1,87 vezes para moradores com um cão e 3,36 vezes para moradores com dois cães, quando comparados a pessoas que não possuem esses animais.

This study evaluated the animal presence in dwellings and the risk for transmission of visceral leishmaniasis (VL) in Belo Horizonte, Brazil, 2006. A case-control study was conducted by means of dwelling visits, direct interviews, and image register in the houses. The risk estimates were produced comparing the dwelling condition between two groups: 1) 82 human cases of VL recorded in 2004; and 2) 164 controls (neighbors of the first). The cases presented a higher proportion in the animal presence compared to controls. Using an unconditional logistic regression, it was selected the presence of ducks with an OR of 4.18 (CI 95 percent - 0.74 to 23.32); rodents with an OR of 1.81 (CI 95 percent - 0.96 to 3.39); birds with an OR of 1.56 (CI 95 percent - 0.90 to 2.69), and chicken with an OR of 1.47 (CI 95 percent - 0.74 to 2.90). The owners of dogs were 2.17 more likely to have VL than those who did not have dogs, and this estimate increased with the number of dogs in the house. For those who had only one dog, the OR was 1.87, while for those who owned two dogs at home, the OR increased to 3.36; when compared to people who did not own those animals.

A urbanização das leishmanioses e a baixa resolutividade diagnóstica em municípios da Região Metropolitana de Belo Horizonte / Leishmaniasis urbanization and low diagnosis capacity in the Metropolitan Region of Belo Horizonte

During the period from 1994 to 1999 cutaneous leishmaniasis was reported in 32 (89%) out of 36 municipalities in the Metropolitan Region of Belo Horizonte, Brazil, of which one (2,8%) municipality was classified as a very high risk area, 16 (44,5%) as high risk, seven (19,4%) as moderate risk areas and 12 (33,3%) as low risk. From 1994 to 1995, visceral leishmaniasis was reported in six (16%) municipalities whereas in 1998 - 1999 this number increased to 15 (42%). Annual numbers of cases during 1994 to 1999 were 30, 53, 64, 53 and 84, respectively. In 19 (61.3%) municipalities no reference center for the diagnosis of the infection was available, so that most of the patients (80%) were referred to Belo Horizonte. Twelve (39%) municipalities have a center for leishmaniasis evaluation, however in only eight (67%) of these basic specific diagnostic tests were available. Rapid and extensive increase of leishmaniasis associated with low diagnosis capacity has been observed in the metropolitan area of Belo Horizonte.

No período de 1994 a 1999, foram notificados casos de leishmaniose tegumentar em 32 (89%) dos 36 municípios da Região Metropolitana de Belo Horizonte. Em um (2,8%) município o risco de adquirir a doença foi considerado muito alto, em 16 (44.5%), médio em sete (19,4%) e baixo em 12 (33.3%). Leishmaniose visceral foi notificada em seis (17%) dos 36 municípios, nos anos 94 e 95, elevando-se para 15 (42%) no biênio 98/99. O total de casos de leishmaniose visceral notificados anualmente no período 94 a 99 foi 30, 53, 64, 60, 53, 84, respectivamente. Não há serviços referenciados para atendimento da doença em 19 (61,3%) de 31 municípios, sendo 80% dos pacientes encaminhados para Belo Horizonte. Em 12 (39%) municípios com serviços referenciados, somente oito (67%) dispõem de testes diagnósticos específicos para leishmaniose. Verificou-se rápida e extensa expansão das leishmanioses na região metropolitana de Belo Horizonte e baixa capacidade de resolução diagnóstica pelos seus municípios.