Chromoblastomycosis in Latin America and the Caribbean: Epidemiology over the past 50 years.

Chromoblastomycosis is a chronic disease caused by melanized fungi that mainly affect individuals performing soil-related labor. The objective of this study was to analyze the epidemiological and clinical characteristics of chromoblastomycosis in Latin America and the Caribbean by an extensive literature review. An integrative review was performed of English, French, Portuguese, and Spanish publications in LILACS, SciELO, PubMed, SCOPUS and Web of Science databases covering the period 1969-2019. A total of 1211 articles were identified, of which 132 were included in the review, covering 2081 patients, 80.3% were males, the mean age was 56.1 years. The mean duration of the disease was 10.8 years. The lesions were mainly described in the lower limbs (60%). The most frequent clinical forms were verrucous (46.4%) and tumorous (21.7%). Major disease symptoms and signs consisted of itching and pain. Bacterial infection and functional limitation were important complications. Immunosuppression post-kidney transplantation was the most frequent comorbidity while leprosy was the main concomitant infectious disease. Fonsecaea pedrosoi and Cladophialophora carrionii were the predominant etiological agents. Majority of the cured cases were treated with itraconazole as monotherapy or in combination with other antifungals, surgery or cryosurgery. Chromoblastomycosis affects hundreds of rural workers in Latin America and the Caribbean, causing disability and personal, family and economic losses. It is important to prioritize epidemiological surveillance and early diagnosis of this disease in order to reveal its real prevalence and direct resources to preventive actions, diagnosis and early treatment. LAY SUMMARY: Chromoblastomycosis is a slowly progressing chronic disease caused by melanized fungi. We collected data from South America and the Caribbean covering 1969-2019, the 132 articles included 2081 patients, mean disease duration was 10.8 years. Fonsecaea pedrosoi and Cladophialophora carrionii predominated.

The CILAD, a model of an international dermatologic society, united by geographic, linguistic, and cultural nexus.

The Ibero Latin American College of Dermatology, CILAD, the largest dermatologic organization in the region, was established in 1948 during the course of the V International Congress of Leprosy held in Havana, Cuba. Constituted in its beginning with fewer than 100 dermatologists from nine countries, its growth has been exponential, reaching now around 4000 members spread throughout Latin America, the Iberian Peninsula, and other regions of the world. In recent years, academic activity has been intense, such as the development of several institutional programs, like its community health care program, designed for geographic areas lacking dermatologic care in the Latin American region. This contribution presents a review of its history, noting the dermatologists and personalities who ennoble the institution. The multiple areas of interest of this growing dermatologic organization are described, and the projections toward the future are discussed.

Social determinants, their relationship with leprosy risk and temporal trends in a tri-border region in Latin America.

BACKGROUND: Brazil is the only country in Latin America that has adopted a national health system. This causes differences in access to health among Latin American countries and induces noticeable migration to Brazilian regions to seek healthcare. This phenomenon has led to difficulties in the control and elimination of diseases related to poverty, such as leprosy. The aim of this study was to evaluate social determinants and their relationship with the risk of leprosy, as well as to examine the temporal trend of its occurrence in a Brazilian municipality located on the tri-border area between Brazil, Paraguay and Argentina. METHODS: This ecological study investigated newly-diagnosed cases of leprosy between 2003 and 2015. Exploratory analysis of the data was performed through descriptive statistics. For spatial analysis, geocoding of the data was performed using spatial scan statistic techniques to obtain the Relative Risk (RR) for each census tract, with their respective 95% confidence intervals calculated. The Bivariate Moran I test, Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) models were applied to analyze the spatial relationships of social determinants and leprosy risk. The temporal trend of the annual coefficient of new cases was obtained through the Prais-Winsten regression. A standard error of 5% was considered statistically significant (p < 0.05). RESULTS: Of the 840 new cases identified in the study, there was a predominance of females (n = 427, 50.8%), of white race/color (n = 685, 81.6%), age range 15 to 59 years (n = 624, 74.3%), and incomplete elementary education (n = 504, 60.0%). The results obtained from multivariate analysis revealed that the proportion of households with monthly nominal household income per capita greater than 1 minimum wage (ß = 0.025, p = 0.036) and people of brown race (ß = -0.101, p = 0.024) were statistically-significantly associated with risk of illness due to leprosy. These results also confirmed that social determinants and risk of leprosy were significantly spatially non-stationary. Regarding the temporal trend, a decrease of 4% (95% CI [-0.053, -0.033], p = 0.000) per year was observed in the rate of detection of new cases of leprosy. CONCLUSION: The social determinants income and race/color were associated with the risk of leprosy. The study's highlighting of these social determinants can contribute to the development of public policies directed toward the elimination of leprosy in the border region.

Impact of TNF -308 G>A (rs1800629) gene polymorphism in modulation of leprosy risk: a reappraise meta-analysis of 14 case-control studies.

PURPOSE: Earlier studies have shown that tumor necrosis factor (TNF) -308 G>A (rs1800629) gene polymorphism is implicated in the susceptibility to leprosy, but results were inconsistent. METHODS: A meta-analysis of 14 studies involving 3327 leprosy cases and 3203 controls was performed to appraise the association of TNF -308 G>A polymorphism with leprosy using MEDLINE (PUBMED), EMBASE, and Google Scholar web databases. RESULTS: Overall, no significant association was observed in allelic (A vs. G: P=0.068; OR = 0.836, 95% CI = 0.689-1.013), homozygous (AA vs. GG: P=0.394; OR = 0.810, 95% CI = 0.499-1.315), heterozygous (GA vs. GG: P=0.059; OR = 0.780, 95% CI = 0.603-1.010), dominant (AA + GA vs. GG: P=0.067; OR = 0.797, 95% CI = 0.625-1.016), and recessive (AA vs. GG + GA: P=0.594; OR = 0.877, 95% CI = 0.542- 1.420) genetic models. Subgroup analysis showed no association in Asians. Whereas, reduced risk was found in allelic contrast (A vs. G: P=0.014; OR = 0.832, 95% CI = 0.718-0.963) and dominant models (AA + GA vs. GG: P=0.004; OR = 0.790, 95% CI = 0.673-0.928) of the mixed population. CONCLUSIONS: TNF -308 G>A polymorphism is not associated with leprosy risk in the overall population. However, subgroup analysis demonstrated protective effect of the said polymorphism in leprosy risk in the Latin American population, but showed no association in the Asians.

Lepra en América Latina / No disponible

No disponible

The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination.

The neglected tropical diseases (NTDs) represent some of the most common infections of the poorest people living in the Latin American and Caribbean region (LAC). Because they primarily afflict the disenfranchised poor as well as selected indigenous populations and people of African descent, the NTDs in LAC are largely forgotten diseases even though their collective disease burden may exceed better known conditions such as of HIV/AIDS, tuberculosis, or malaria. Based on their prevalence and healthy life years lost from disability, hookworm infection, other soil-transmitted helminth infections, and Chagas disease are the most important NTDs in LAC, followed by dengue, schistosomiasis, leishmaniasis, trachoma, leprosy, and lymphatic filariasis. On the other hand, for some important NTDs, such as leptospirosis and cysticercosis, complete disease burden estimates are not available. The NTDs in LAC geographically concentrate in 11 different sub-regions, each with a distinctive human and environmental ecology. In the coming years, schistosomiasis could be eliminated in the Caribbean and transmission of lymphatic filariasis and onchocerciasis could be eliminated in Latin America. However, the highest disease burden NTDs, such as Chagas disease, soil-transmitted helminth infections, and hookworm and schistosomiasis co-infections, may first require scale-up of existing resources or the development of new control tools in order to achieve control or elimination. Ultimately, the roadmap for the control and elimination of the more widespread NTDs will require an inter-sectoral approach that bridges public health, social services, and environmental interventions.

Biology-based mapping of vector-borne parasites by geographic information systems and remote sensing.

Application of growing degree day-water budget analysis and satellite climatology to vector-borne parasites will be reviewed to demonstrate the value of using the unique thermal-hydrological preferences and limits of tolerance of individual parasite-vector systems to define the environmental niche of disease agents in the landscape by modern geospatial analysis methods. Applications of geospatial modeling will be illustrated by examples on fascioliasis, malaria, leprosy and leishmaniasis.

Consideraciones histórico-epidemiológicas de la lepra en América / History and epidemiology of leprosy in America

Se realiza un recorrido histórico del origen de la Lepra en América, con el descubrimiento y colonización por españoles y portugueses, y la posterior expansión por el tráfico de esclavos africanos. Su inicio en las Antillas y después a América Central, del Sur y Norteamérica e igualmente los eventos científicos más importantes y figuras destacadas, y por último la situación epidemiológica actual

An historical development of the origin pof the leprosy in American since the colonization by the Spanish and Portuguese peoplesand the post extension through the african slaves traffi c is reported. First, in the Antillas and then to Central and South America the leprosy was expanded also in North America. A review of the most important scientifi c events and leprologists; finally the epidemiological situation is considered

New and re-emerging cutaneous infectious diseases in Latin America and other geographic areas.

Due to environmental factors and inadequate public health measures in many developing countries, new tropical infections, as well as infections that were previously isolated to remote locales, are becoming more prevalent in several areas of Latin America. This article discusses some tropical infections and infestations with predominantly cutaneous manifestations. Previously uncommon diseases such as gnathostomiasis, mycobacteria ulcerans infection, paederus dermatitis, Balamuthia mandrillaris infection, and human T-lymphotrophic virus 1 dermatitis are increasingly being reported. Well-known tropical infections such as bartonellosis, leishmaniasis, chromomycosis, larva migrans, and larva currens are also becoming more prevalent. On the other hand, the incidence of Hansen's disease, the quintessential tropical infection, is dwindling all over the globe thanks to a highly effective eradication campaign launched by the World Health Organization. Because of increased immigration and tourist travel, the number of cases of these diseases in the United States may escalate.

[Eradication of leprosy and public health. Vaccination and multidrug therapy]. / Perspektywy eliminacji tradu w swiecie. Szczepienia ochronne a leczenie etiotropowe.

Leprosy is a disease, which still affects large populations in the developing countries particularly in Africa, Asia and Latin America. For the last 15 years significant advances have been made towards leprosy elimination. The most effective strategy for leprosy control is an early identification of cases and an effective treatment with multidrug therapy (MDT). The vaccination against leprosy plays only an additional role. There are two possible approaches to develop vaccine against leprosy. One is to produce a vaccine based on organisms related to M. leprae, such as: BCG, ICRC bacillus, Mycobacterium w, Mycobacterium vaccae, Mycobacterium habana. However, these organisms related to M. leprae are not very promising in experimental animal studies. In 1970s a new vaccine was prepared based on killed M. leprae. This vaccine, tested alone and together with BCG revealed little impact on increasing vaccine efficacy. The success in cloning and expressing the M. leprae genome in E. coli created the possibility of moving towards a second generation vaccine using peptide antigens. Up till now only MDT has essential impact on decline of global leprosy prevalence. Out of 122 endemic countries in 1985, 107 countries have reached elimination of leprosy at country level. At the end of 2000 leprosy was a public health problem only in 15 countries (prevalence rate > 1/10.000). Currently leprosy remains a problem mainly in 6 major endemic countries. Among these, India alone accounts for 64% of prevalence and 78% of detection worldwide.

[Eradication of leprosy in the Americas: current status and perspectives]. / La eliminación de la lepra de las Américas: situación actual y perspectivas.

Leprosy, a disease that used to be shrouded in darkness and fear, can now be cured thanks to a multidrug treatment schedule with rifampicin, clofazimine, and dapsone which has been in use since 1981. In 1991 the World Health Assembly, encouraged by the efficacy of this treatment regimen, established the goal of eliminating the disease as a public health problem globally and nationally by the year 2000. This goal, which calls for reducing disease prevalence to less than one case per 10,000 inhabitants, should not be confused with the goal of eradicating the disease, which implies a complete interruption of its transmission. Eliminating leprosy is an attainable goal which will depend on the forceful and massive use of the multidrug treatment regimen. This paper describes and discusses the various initiatives that have been launched in Latin America for the purpose of achieving this goal and the results obtained so far. It also explores the factors that impact on the feasibility of eradicating the disease.

La eliminación de la lepra de las Américas: situación actual y perspectivas / Eliminating leprosy from the Americas: Current situation and future perspectives

La lepra, enfermedad que antes evocaba una imagen sombría e inspiraba terror, ahora se puede curar gracias al esquema politerapéutico a base de rifampicina, clofazimina y dapsona que se ha venido usando desde 1981. En 1991 la Asamblea Mundial de la Salud, alentada por la eficacia de este régimen, fijó la meta de eliminar la enfermedad como problema de salud pública mundial y nacional para el año 2000. Esta meta, que equivale a reducir la prevalencia a menos de un caso por 10 000 habitantes, no debe confundirse con la de erradicar la enfermedad, que implica interrumpir por completo su transmisión. La eliminación de la lepra es una meta asequible que dependerá del uso enérgico y a gran escala del régimen poliquimioterapéutico. El presente trabajo describe y examina las iniciativas que se han puesto en marcha en América Latina para lograr la meta y los resultados observados hasta el momento. También se exploran los factores que inciden en la factibilidad de erradicar la enfermedad.

Leprosy, a disease that used to be shrouded in darkness and fear, can now be cured thanks to a multidrug treatment schedule with rifampicin, clofazimine, and dapsone which has been in use since 1981. In 1991 the World Health Assembly, enouraged by the efficacy of this treatment regimen, established the goal of eliminating the disease as a public health problem globally and nationally by the year 2000. This goal, which calls for reducing disease prevalence to less than one case per 10 000 inhabitants, should not be confused with the goal of eradicating the disease, which implies a complete interruption of its transmission. Eliminating leprosy is an attainable goal which will depend on the forceful and massive use of the multidrug treatment regimen. This paper describes and discusses the various initiatives that have been launched in Latin America for the purpose of achieving this goal and the results obtained so far. It also explores the factors that impact on the feasibility of eradicating the disease.

Trends in leprosy case detection rates.

BACKGROUND: A systematic review of the trends in leprosy incidence is lacking. The question of whether leprosy transmission has declined remains, therefore, unanswered. This study investigates trends in new case detection rates (NCDRs) in selected leprosy-endemic areas from different continents. METHODS: A literature search using specific inclusion criteria was performed. Average annual rates of change in NCDRs were obtained by exponential curve fitting. The variation in trends within individual areas was investigated using direct and indirect information on leprosy control activities. RESULTS: This review covers 16 areas in the Pacific, Asia, Africa and Latin America. For 10 out of the 16 areas, the trend was seen to be declining consistently over the last 10 years or longer. Near stabilization or stabilization after decline was observed for two areas. For three areas, interpretation of recent NCDRs was difficult due to changes in control, but two of them showed a decline over the study period. A consistently increasing trend was observed over the last 20 years in the one remaining area. The observed downward trends could not be attributed to reduced control activities or changed diagnostic criteria. A general acceleration of downward trends in the NCDR after the introduction of multidrug therapy (MDT) has not so far occurred. CONCLUSION: Our main conclusion is that despite many differences between the studies and study areas, the review demonstrates a considerable tendency of downward NCDR trends. Lack of information and changing control conditions necessitate caution in interpreting NCDR trends in individual areas. A general impact of MDT on NCDR trends is so far not visible. The coming years will be crucial for MDT-based control to prove its ability to reduce leprosy incidence.

Global review of multidrug therapy (MDT) in leprosy.

Leprosy continues to be an important public health problem in most countries of Asia, Africa and Latin America. While there has been a steady increase in the number of registered leprosy cases from 1966 to 1985, since then there has been a substantial reduction of over 30% in the number of registered cases. This is mainly attributed to the introduction of multidrug therapy (MDT) as recommended by a WHO study group on chemotherapy of leprosy for control programmes in 1981. The coverage for MDT has steadily increased over the last 5 years, reaching a global figure of 55.7% of all registered cases by October 1990. Over 2 million leprosy patients are currently undergoing MDT and, in addition, over 1 million patients have completed MDT since 1985. MDT has been found to be generally well tolerated with a high level of acceptability leading to improved treatment compliance. MDT coverage shows wide variations among WHO regions and among individual countries. The prospects for further reductions in prevalence of registered cases in the next decade are very bright. However, problems such as early case detection, and prevention and management of disabilities after patients have been curred for several years, will continue to pose significant challenges.