Prevalence of helmintic infections in Brazilian Maxakali indigenous: a repeated cross-sectional design.

BACKGROUND: The prevalence of intestinal parasites is known to be high among Amerindian populations; further, there are serious problems in the healthcare of these populations in Brazil. The Maxakali, located in the northeastern region of Minas Gerais, Brazil, is an indigenous group that still preserves many of its cultural aspects. This study aimed to compare the positivity rate of schistosomiasis and soil-transmitted helminths in this ethnic group in epidemiological surveys conducted in 1972 and 2014. METHODS: Stool parasitological examinations were performed by the Kato-Katz technique during both periods in this population. In 2014, the parasitological diagnosis was also realized with the TF-Test® technique. RESULTS: In 1972, 270 inhabitants were examined. The positivity rates were 67.4% for Schistosoma mansoni, 72.9% for hookworms, 43.7% for Ascaris lumbricoides, and 23.7% for Trichuris trichiura. In 2014, 545 individuals were examined, and the positivity rates obtained were 45.7% for S. mansoni, 22.8% for hookworms, 0.6% for A. lumbricoides, and 2.8% for T. trichiura. CONCLUSIONS: The comparison of the parasitological surveys conducted in 1972 and 2014, indicates that the indigenous Maxakali remained neglected by the health and indigenous protection authorities during these four decades. The infection rate observed in 2014 for schistosomiasis and hookworm remains high, considering the current epidemiological view of these diseases in the Brazilian population.

Ultrasound evaluation of schistosomiasis-related morbidity among the Xakriabá people in the state of Minas Gerais, Brazil.

OBJECTIVE: To use ultrasound to investigate the morbidity related to schistosomiasis in the Xakriabá indigenous population. MATERIALS AND METHODS: This was a field-based census study conducted in the territory of the Xakriabá people. A total of 166 individuals were invited, and 148 (≤ 77 years of age) agreed to participate. Most participants underwent abdominal ultrasound, physical examination, and stool examination. Mann-Whitney U and chi-square tests were used for comparisons. We determined risk by calculating odds ratio (OR) and performed logistic regression analysis. RESULTS: Schistosoma mansoni eggs were found in 31 (26.7%) of the 116 stool samples examined, 22 (70.9%) of the 31 being from individuals 4-16 years of age. The median count was 144 eggs/g of feces (interquartile range, 264). Of the 105 participants examined with ultrasound, 68 (64.8%) had hepatomegaly (left lobe), 6 (5.7%) had splenomegaly, and 4 (3.8%) had portal hypertension. Egg-positive stool samples were more common in those with an enlarged left lobe (OR = 3.4; 95% confidence interval (CI): 1.1-11.2; p = 0.043). Periportal fibrosis was found in 30 participants (28.6%), of whom 9 (30%) had pattern C, 10 (33.3%) had pattern D, and 11 (36.7%) had pattern Dc. Age was the only independent risk factor for fibrosis (p = 0.007). Fibrosis was up to nine-fold more common in alcohol drinkers than in nondrinkers (OR = 9.28; 95% CI: 2.60-33.06; p < 0.001). Among the 138 participants in whom the clinical form was classified, the chronic hepatic form was identified in 54 (39.1%), of whom 32 (59.2%) were under 30 years of age and one (1.8%) was hepatosplenic. CONCLUSION: Schistosomiasis in the Xakriabá population is characterized by a high frequency of egg-positive stool samples, predominantly in children/adolescents, and by chronic hepatic form in the young, especially among alcohol drinkers.

Ultrasound evaluation of schistosomiasis-related morbidity among the Xakriabá people in the state of Minas Gerais, Brazil / Avaliação ultrassonográfica da morbidade por esquistossomose mansoni na população indígena Xakriabá, Minas Gerais, Brasil

Abstract Objective: To use ultrasound to investigate the morbidity related to schistosomiasis in the Xakriabá indigenous population. Materials and Methods: This was a field-based census study conducted in the territory of the Xakriabá people. A total of 166 individuals were invited, and 148 (≤ 77 years of age) agreed to participate. Most participants underwent abdominal ultrasound, physical examination, and stool examination. Mann-Whitney U and chi-square tests were used for comparisons. We determined risk by calculating odds ratio (OR) and performed logistic regression analysis. Results: Schistosoma mansoni eggs were found in 31 (26.7%) of the 116 stool samples examined, 22 (70.9%) of the 31 being from individuals 4-16 years of age. The median count was 144 eggs/g of feces (interquartile range, 264). Of the 105 participants examined with ultrasound, 68 (64.8%) had hepatomegaly (left lobe), 6 (5.7%) had splenomegaly, and 4 (3.8%) had portal hypertension. Egg-positive stool samples were more common in those with an enlarged left lobe (OR = 3.4; 95% confidence interval (CI): 1.1-11.2; p = 0.043). Periportal fibrosis was found in 30 participants (28.6%), of whom 9 (30%) had pattern C, 10 (33.3%) had pattern D, and 11 (36.7%) had pattern Dc. Age was the only independent risk factor for fibrosis (p = 0.007). Fibrosis was up to nine-fold more common in alcohol drinkers than in nondrinkers (OR = 9.28; 95% CI: 2.60-33.06; p < 0.001). Among the 138 participants in whom the clinical form was classified, the chronic hepatic form was identified in 54 (39.1%), of whom 32 (59.2%) were under 30 years of age and one (1.8%) was hepatosplenic. Conclusion: Schistosomiasis in the Xakriabá population is characterized by a high frequency of egg-positive stool samples, predominantly in children/adolescents, and by chronic hepatic form in the young, especially among alcohol drinkers.

Resumo Objetivo: Investigar a morbidade por esquistossomose na população indígena Xakriabá usando a ultrassonografia. Materiais e Métodos: Estudo de campo censitário realizado na terra da população indígena Xakriabá (166 convidados; 148 participantes; idade de 0-77). Foram feitos ultrassonografia abdominal, exame físico e coproscopia (EPF). Os testes Mann-Whitney U e qui-quadrado foram usados para comparações. Foram realizadas análise de risco (odds ratio - OR) e regressão logística. Resultados: De 116 índios com resultado de EPF, 31 (26,7%) tiveram ovos de Schistosoma; 22/31 (70,9%) tinham idade entre 4-16 anos. A carga parasitaria mediana foi 144 ovos/g (intervalo interquartílico: 264). De 105 examinados por ultrassom, 68 (64,8%) tiveram lobo hepático esquerdo aumentado, 6 (5,7%) tiveram esplenomegalia e 4 (3,8%) tiveram hipertensão portal. EPF+ foi mais frequente nos indivíduos com lobo esquerdo aumentado (OR: 3,4; intervalo de confiança (IC) 95%: 1,1-11,2; p = 0,043). Fibrose periportal ocorreu em 30/105 (28,6%) examinados, e desses 30, 9 (30%) apresentavam padrão C, 10 (33,3%) apresentavam padrão D e 11 (36,7%) apresentavam padrão Dc. A idade foi o único fator de risco independente para fibrose (p = 0,007). A fibrose ocorreu até nove vezes mais em usuários de álcool que em não usuários (OR: 9,28; IC 95%: 2,60-33,06; p < 0,001). Formas crônicas ocorreram em 54/138 (39,1%) participantes, sendo 32 dos 54 (64,8%) em menores de 30 anos; um (1,8%) era hepatoesplênico. Conclusão: A esquistossomose na população Xakriabá caracteriza-se por alta positividade, predomínio em crianças e presença de formas hepáticas crônicas em jovens, especialmente entre usuários de álcool.

Prevalence of schistosomiasis mansoni in indigenous Maxakali villages, Minas Gerais, Brazil.

Intestinal parasitic infections are a common health problem among Amerindian populations and schistosomiasis represents one of the most prevalent diseases in Maxakali people. The Kato-Katz is the diagnostic method recommended by WHO for epidemiological studies; however, one of the technique's limitations is the failure to detect parasites in individuals with low parasite load. The aim of this study was to establish the prevalence of Schistosoma mansoni in indigenous Maxakali villages, evaluating the TF-Test® performance for diagnosis compared to the Kato-Katz technique. Stool samples from 545 individuals were processed by the TF-Test® (1 sample) and Kato-Katz (1 slide). The positivity rate for S. mansoni by Kato-Katz was 45.7%. The rate by the TF-Test® was 33.2%, and 51.9% by the combined parasitological techniques. The amplitude of parasite load was 24 to 4,056 eggs per gram of feces (epg), with a geometric mean of 139 epg. The co-positivity, co-negativity, and accuracy values by TF-Test® in relation to Kato-Katz were 59.0%, 88.5%, and 75.0%, respectively. The agreement between these techniques was moderate (k=0.486) as determined by the kappa index. Thus, the results of this study demonstrated that the performance of Kato-Katz was superior (p <0.05) to that of TF-Test® in the detection of S. mansoni. The combination of TF-Test® and Kato-Katz resulted in an increased positivity rate of S. mansoni, demonstrating the high risk of infection to which indigenous populations are exposed and the importance of the implementation of control strategies in Maxakali villages.

[Control of visceral leishmaniasis in the town of Porteirinha, state of Minas Gerais, Brazil, from 1998 to 2003]. / Controle da leishmaniose visceral no município de Porteirinha, estado de Minas Gerais, no período de 1998 a 2003.

INTRODUCTION: In the town of Porteirinha, State of Minas Gerais, 23 human cases of visceral leishmaniasis (VL) in 1998 and 1999 were recorded. METHODS: A study was conducted involving the triad of action recommended for the control of VL. Patients were treated and serologically positive dogs were euthanized quarterly. The pyrethroid insecticide α-cypermethrin was applied in the neighborhoods where human cases were recorded. RESULTS: A reduction in canine seroprevalence and sand flies occurred following the implementation of control measures, reflecting in a reduction in human cases of VL. CONCLUSIONS: The results show the efficiency of such control measures when used in association.

Controle da leishmaniose visceral no município de Porteirinha, estado de Minas Gerais, no período de 1998 a 2003 / Control of visceral leishmaniasis in the town of Porteirinha, state of Minas Gerais, Brazil, from 1998 to 2003

INTRODUÇÃO: No município de Porteirinha, Estado de Minas Gerais, foram registrados 23 casos humanos de leishmaniose visceral (LV) nos anos de 1998 e 1999. MÉTODOS: Foi realizado um estudo envolvendo a tríade de ações preconizadas no controle da LV. Pacientes com leishmaniose humana foram tratados e cães sorologicamente positivos foram eutanasiados, trimestralmente. O inseticida piretróide α-cipermetrina foi aplicado nos bairros onde casos humanos foram registrados. RESULTADOS: Houve uma redução da soroprevalência canina e de flebotomíneos capturados, após a implementação das medidas de controle, refletindo na diminuição de casos humanos de leishmaniose visceral. CONCLUSÕES: Os resultados mostraram a eficiência destas medidas quando empregadas em conjunto.

INTRODUCTION: In the town of Porteirinha, State of Minas Gerais, 23 human cases of visceral leishmaniasis (VL) in 1998 and 1999 were recorded. METHODS: A study was conducted involving the triad of action recommended for the control of VL. Patients were treated and serologically positive dogs were euthanized quarterly. The pyrethroid insecticide α-cypermethrin was applied in the neighborhoods where human cases were recorded. RESULTS: A reduction in canine seroprevalence and sand flies occurred following the implementation of control measures, reflecting in a reduction in human cases of VL. CONCLUSIONS: The results show the efficiency of such control measures when used in association.

[Sandflies (Diptera: Psychodidae) in an outbreak of cutaneous leishmaniasis in the State of Minas Gerais]. / Flebotomíneos (Diptera: Psychodidae) de um foco de leishmaniose tegumentar no Estado de Minas Gerais.

Between January and December 2000, systematic monthly capture of phlebotomine sandflies was undertaken by means of light traps of CDC type in Brejo do Mutambal, an endemic area for American cutaneous leishmaniasis located in the municipality of Varzelândia, State of Minas Gerais. Nineteen phlebotomine species were captured, totaling 6,756 specimens. The species correlated with ACL transmission were captured in low numbers, as follows: Lutzomyia intermedia (5.1%), L. migonei (0.4%) and L. whitmani (0.1%). Lutzomyia longipalpis was the predominant species captured (34.8%), thus also suggesting a risk of visceral leishmaniasis transmission. The proportion of sandflies captured in areas surrounding homes was 91.7 % while 8.3% were captured inside homes. The interference of climatic factors (temperature, relative air humidity and rainfall) on phlebotomine population dynamics was evaluated.

Flebotomíneos (Diptera: Psychodidae) de um foco de leishmaniose tegumentar no Estado de Minas Gerais / Sandflies (Diptera: Psychodidae) in an outbreak of cutaneous leishmaniasis in the State of Minas Gerais

Na localidade do Brejo do Mutambal, situado no município de Varzelândia (MG), área endêmica para leishmaniose tegumentar, foram realizadas capturas mensais sistemáticas utilizando-se armadilhas luminosas do tipo CDC durante o período de janeiro a dezembro de 2000. Foram capturadas 19 espécies de flebotomíneos, totalizando 6.756 exemplares. Lutzomyia intermedia (5,1 por cento), L. migonei (0,4 por cento) e L. whitmani (0,1 por cento), relacionadas com a transmissão de leishmaniose tegumentar, foram capturadas em número reduzido. Lutzomyia longipalpis foi a espécie predominante (34,8 por cento), sugerindo também um risco de transmissão da leishmaniose visceral. A proporção de insetos capturados no peridomícilio foi de 91,7 por cento enquanto no intradomicílio foi de 8,3 por cento. A interferência de fatores climáticos (temperatura, umidade relativa do ar e pluviosidade) sobre a dinâmica populacional de flebotomíneos foi avaliada.

Between January and December 2000, systematic monthly capture of phlebotomine sandflies was undertaken by means of light traps of CDC type in Brejo do Mutambal, an endemic area for American cutaneous leishmaniasis located in the municipality of Varzelândia, State of Minas Gerais. Nineteen phlebotomine species were captured, totaling 6,756 specimens. The species correlated with ACL transmission were captured in low numbers, as follows: Lutzomyia intermedia (5.1 percent), L. migonei (0.4 percent) and L. whitmani (0.1 percent). Lutzomyia longipalpis was the predominant species captured (34.8 percent), thus also suggesting a risk of visceral leishmaniasis transmission. The proportion of sandflies captured in areas surrounding homes was 91.7 percent while 8.3 percent were captured inside homes. The interference of climatic factors (temperature, relative air humidity and rainfall) on phlebotomine population dynamics was evaluated.

Aspectos da ecologia e do comportamento de flebotomíneos em área endêmica de leishmaniose visceral, Minas Gerais / Aspects of the ecology and behaviour of phlebotomines in endemic area for visceral leishmaniasis in State of Minas Gerais

O comportamento e hábitos alimentares de algumas espécies da flebotomíneos têm sido útil na compreensão da epidemiologia das leishmanioses. No município de Porteirinha (MG), foram realizadas capturas mensais sistematizadas utilizando-se 28 armadilhas luminosas tipo CDC, durante o período de janeiro a dezembro de 2002. Foram capturadas 14 espécies de flebotomíneos, totalizando 1.408 exemplares. De acordo com o ambiente, os resultados obtidos mostraram que o peridomicílio apresentou a maior (53,3 por cento) porcentagem dos espécimens encontrados na região, embora parte (46,7 por cento) da fauna também tenha sido encontrada no intradomicílio. O repasto sanguíneo de 38 fêmeas de Lutzomyia longipalpis, provenientes do campo, foi identificado através da reação de precipitina. Os resultados indicam que Lutzomyia longipalpis foi a espécie predominante (65,1 por cento), mostrando-se oportunista, podendo sugar uma ampla variedade de vertebrados.

[Aspects of the ecology and behaviour of phlebotomines in endemic area for visceral leishmaniasis in State of Minas Gerais]. / Aspectos da ecologia e do comportamento de flebotomíneos em área endêmica de leishmaniose visceral, Minas Gerais.

Studies on the behavioral and feeding habits of some species of phlebotominae sand flies have contributed to the comprehension of the epidemiology of leishmaniasis. In the present work, systematic captures were performed monthly in the municipality of Porteirinha (MG) using 28 light traps (CDC) from January to December 2002. Fourteen different species of phlebotomine were captured in a total of 1,408 specimens. The highest percentage of individuals (53.3%) was collected in the peridomicile against 46.7% in the intradomicile. Lutzomyia longipalpis was the predominant species in that region. The blood feeding of 38 females of this species from the field was analyzed by precipitin reaction. The results indicated that Lutzomyia longipalpis is an opportunist (65.1%) species that feeds on a wide variety of vertebrates in nature.

Phlebotomine sand flies in Porteirinha, an area of American visceral leishmaniasis transmission in the State of Minas Gerais, Brazil.

A study of the phlebotomine sand fly fauna was carried out in an endemic area of American visceral leishmaniasis (AVL) in the municipality of Porteirinha, in the Brazilian state of Minas Gerais. Captures were performed with CDC light traps in 7 districts, 5 days per month, during 2 consecutive years (January 2000 to December 2001). A total of 3240 sand flies were captured and identified. Sixteen species were found, among which 15 belonged to the genus Lutzomyia and one to the genus Brumptomyia. Lutzomyia longipalpis, a proven vector of AVL, was the predominant species (71.85%) throughout the time period. The interference of climatic factors (temperature, humidity, and rainfall) over the populational dynamics of the sand flies was determined. Statistical analysis of the data showed a significant correlation among the number of phlebotomine sand flies collected, rainfall, and humidity, whereas the effect of temperature was negligible, in that particular region. The amount of collected phlebotomine, the number of human cases, and the prevalence of canine AVL in the districts of Porteirinha are discussed.

Phlebotomine sand flies in Porteirinha, an area of American visceral leishmaniasis transmission in the State of Minas Gerais, Brazil

A study of the phlebotomine sand fly fauna was carried out in an endemic area of American visceral leishmaniasis (AVL) in the municipality of Porteirinha, in the Brazilian state of Minas Gerais. Captures were performed with CDC light traps in 7 districts, 5 days per month, during 2 consecutive years (January 2000 to December 2001). A total of 3240 sand flies were captured and identified. Sixteen species were found, among which 15 belonged to the genus Lutzomyia and one to the genus Brumptomyia. Lutzomyia longipalpis, a proven vector of AVL, was the predominant species (71.85 percent) throughout the time period. The interference of climatic factors (temperature, humidity, and rainfall) over the populational dynamics of the sand flies was determined. Statistical analysis of the data showed a significant correlation among the number of phlebotomine sand flies collected, rainfall, and humidity, whereas the effect of temperature was negligible, in that particular region. The amount of collected phlebotomine, the number of human cases, and the prevalence of canine AVL in the districts of Porteirinha are discussed.

Efficacy of azithromycin in the treatment of cutaneous leishmaniasis.

The present open pilot study was conducted to assess the efficacy of azithromycin for the treatment of patients with cutaneous leishmaniasis in Ara ua and Varzelândia, MG. Twenty-four patients with less of six months of disease evolution were treated after clinical examination, Montenegro test and a biopsy. The treatment schemes consisted of oral doses of 500 mg per day for 3, 5 and 10 days and of 1000 mg for two days. A clinical control was performed monthly and treatment cycles were repeated when necessary until full reepithelialization of the lesions. On the occasion of the final evaluation, 20 patients had completed the study and 17 of them (85%) were cured. The time to obtain a cure was 60 days ifor 6 (30%) patients, 90 days for 7 (35%), and 120 for 4 (20%). The three patients with treatment failure received a pentavalent antimonial for 20 days. No adverse reactions to the medication were observed and a 14 month follow-up did not show recurrence in any patient. These results suggest that azithromycin can be a good therapeutic option for the treatment of cutaneous leishmaniasis caused by Leishmania Viannia brasiliensis.

Efficacy of azithromycin in the treatment of cutaneous leishmaniasis

The present open pilot study was conducted to assess the efficacy of azithromycin for the treatment of patients with cutaneous leishmaniasis in Araçuaí and Varzelândia, MG. Twenty-four patients with less of six months of disease evolution were treated after clinical examination, Montenegro test and a biopsy. The treatment schemes consisted of oral doses of 500 mg per day for 3, 5 and 10 days and of 1000 mg for two days. A clinical control was performed monthly and treatment cycles were repeated when necessary until full reepithelialization of the lesions. On the occasion of the final evaluation, 20 patients had completed the study and 17 of them (85 percent) were cured. The time to obtain a cure was 60 days ifor 6 (30 percent) patients, 90 days for 7 (35 percent), and 120 for 4 (20 percent). The three patients with treatment failure received a pentavalent antimonial for 20 days. No adverse reactions to the medication were observed and a 14 month follow-up did not show recurrence in any patient. These results suggest that azithromycin can be a good therapeutic option for the treatment of cutaneous leishmaniasis caused by Leishmania Viannia brasiliensis