Epidemiology of human visceral leishmaniasis in the urban centers of the lower-middle São Francisco Valley, Brazilian semiarid region

Abstract INTRODUCTION: Visceral leishmaniasis (VL) is a zoonosis caused by parasites of the Leishmania genus. VL is present in countries with tropical climates, being endemic in Brazil,, including the region of the lower-middle São Francisco Valley which includes the urban centers of Petrolina (Pernambuco state) and Juazeiro (Bahia state). METHODS: This retrospective and descriptive epidemiological study analyzed secondary data obtained from the mandatory visceral leishmaniasis notification forms of the Ministry of Health, which were compiled in the Information System for Notifiable Diseases (SINAN) database. We analyzed 181 autochthonous cases reported in the two aforementioned cities between 2010 and 2016. Data collection occurred in June 2017. RESULTS: Of the 181 VL cases in the study area, 40.9% (n=74) occurred in Juazeiro and 59.1% (n=107) occurred in Petrolina. The average numbers of cases per year were 9.5 in Juazeiro and 14 in Petrolina; respectively, the incidence ranges were 2-8.6 cases and 2.8-6.1 cases per 100,000 inhabitants. Fever, weakness, weight loss, and pallor were the most commonly observed clinical manifestations. Coinfection with human immunodeficiency virus (HIV) was observed in 16.8% and 5.4% of cases in Petrolina and Juazeiro, respectively. The lethality rates were 2.8% and 5.4% in Petrolina and Juazeiro, respectively. CONCLUSIONS: Both cities had a high incidence of VL during the studied period. The findings of this study contribute to a better understanding of the behavior of VL during recent years and may help to direct regional disease control measures.

Perfil epidemiológico relacionado aos casos de letalidade por leishmaniose visceral em Alagoas: uma análise entre os anos de 2007 a 2012 / Epidemiological profile related to deaths by Alagoas visceral Leishmaniasis: an analysis between the years 2007-2012

A Leishmaniose visceral é uma doença zoonótica de transmissão vetorial crônica grave, potencialmente fatal para os homens. No Brasil, apresenta grande relevância na saúde coletiva, com elevadas taxas de incidências e de letalidades. O estudo teve como objetivo pesquisar os aspectos epidemiológicos relacionados aos óbitos por Leishmaniose visceral em Alagoas. Utilizou-se o método epidemiológico descritivo e os dados foram obtidos do Sistema de Informação de Agravos de Notificação (SINAN) e do Sistema de Informação de Mortalidade (SIM) do Ministério de Saúde do Estado de Alagoas. O estudo compreendeu um período de seis anos (2007 a 2012). As variáveis estudadas foram: taxa de letalidade, sexo, faixa etária, ocupação, duração da doença, tempo decorrido dos primeiros sintomas, ate a instituição no tratamento, tempo decorrido do início do tratamento até óbito. Foram registrados 23 óbitos de um total de 210 casos confirmados no período, representando uma letalidade de 11%, A letalidade foi ascendente nos últimos três anos (2010-5,55%, 2011-16,21% e 2012- 14,70%). As maiorias dos óbitos foram de pessoas do sexo masculino. (60,86%). Em relação à ocupação, os estudantes obtiveram maior índice de óbitos com 19,9%. O tempo de evolução da doença ate o óbito foi curto para importante parcela dos pacientes. O aumento da letalidade ocorre devido ao baixo nível socioeconômico, presença de complicações e tratamento e diagnostico tardio.(AU)

Visceral Leishmaniasis, also called Kala-azar, tropical splenomegaly and fever dundun, is a zoonotic vector severe, chronic, life-threatening disease for males transmission. In Brazil, are highly relevant in public health, with high rates of incidence and mortality rates. The study aimed to investigate the epidemiological related deaths due to Visceral Leishmaniasis in Alagoas aspects. We used a descriptive epidemiological method and data were obtained from the Information System for Notifiable Diseases (ISND) and the Mortality Information System (MIS) of the Ministry of Health of the State of Alagoas. The study covered a period of six years (2007-2012). The variables studied were: mortality rate, sex, age, occupation, disease duration, time of onset, until the institution in the treatment, time from the start of treatment until death. 23 deaths out of a total of 210 confirmed cases were reported in the period , representing a mortality rate of 11 % , the mortality rate was up over the last three years ( 2010 to 5.55 % , 2011 to 16.21 % and from 2012 to 14.70 % ) . The majority of the deaths were of males. (60.86 %). In terms of occupation, students had higher death rate with 19.9 % . The progression of the disease until death was short for significant portion of patients. The increased lethality occurs due to low socioeconomic status, complications and late diagnosis and treatment.(AU)

Human immunodeficiency virus/Leishmania infantum in the first foci of urban American visceral leishmaniasis: clinical presentation from 1994 to 2010

INTRODUCTION: Human immunodeficiency virus (HIV) coinfection with Leishmania infantum or Leishmania donovani, the agents of visceral leishmaniasis (or kala-azar), has become a fatal public health problem in the tropics where kala-azar is endemic. METHODS: The clinical presentation of patients with HIV and L. infantum coinfection is described using two unique databases that together produce the largest case series of patients with kala-azar infected with HIV in South America. First, a retrospective study paired the list of all patients with kala-azar from 1994 to 2004 with another of all patients with HIV/AIDS from the reference hospital for both diseases in the City of Teresina, State of Piauí, Brazil. Beginning in 2005 through to 2010 this information was prospectively collected at the moment of hospitalization. RESULTS: During the study, 256 admissions related to 224 patients with HIV/L. infantum coinfection were registered and most of them were males between 20-40 years of age. Most of the 224 patients were males between 20-40 years of age. HIV contraction was principally sexual. The most common symptoms and signs were pallor, fever, asthenia and hepatosplenomegaly. 16.8% of the cohort died. The primary risk factors associated to death were kidney or respiratory failure, somnolence, hemorrhagic manifestations and a syndrome of systemic inflammation. The diagnosis of HIV and kala-azar was made simultaneously in 124 patients. CONCLUSIONS: The urban association between HIV and kala-azar coinfection in South America is worrisome due to difficulty in establishing the diagnosis and higher mortality among the coinfected then those with either disease independently. HIV/L. infantum coinfection exhibits some singular characteristics and due to its higher mortality it requires immediate assistance to patients and greater research on appropriate combination therapy. .

Delimitation of kala-azar risk areas in the district of Vaishali in Bihar (India) using a geo-environmental approach

Remote sensing and geographical information technologies were used to discriminate areas of high and low risk for contracting kala-azar or visceral leishmaniasis. Satellite data were digitally processed to generate maps of land cover and spectral indices, such as the normalised difference vegetation index and wetness index. To map estimated vector abundance and indoor climate data, local polynomial interpolations were used based on the weightage values. Attribute layers were prepared based on illiteracy and the unemployed proportion of the population and associated with village boundaries. Pearson's correlation coefficient was used to estimate the relationship between environmental variables and disease incidence across the study area. The cell values for each input raster in the analysis were assigned values from the evaluation scale. Simple weighting/ratings based on the degree of favourable conditions for kala-azar transmission were used for all the variables, leading to geo-environmental risk model. Variables such as, land use/land cover, vegetation conditions, surface dampness, the indoor climate, illiteracy rates and the size of the unemployed population were considered for inclusion in the geo-environmental kala-azar risk model. The risk model was stratified into areas of "risk"and "non-risk"for the disease, based on calculation of risk indices. The described approach constitutes a promising tool for microlevel kala-azar surveillance and aids in directing control efforts.

Urbanization of visceral leishmaniasis (kala-azar) in Fortaleza, Ceará, Brazil / Urbanización de la leishmaniasis visceral (kala-azar) en Fortaleza, Ceará, Brasil

OBJECTIVES: Visceral leishmaniasis (VL) is endemic in Brazil and appears to occur in epidemic form in the state of Ceará. Few epidemiologic studies have been done on VL in this state. The aim of this study is to establish the epidemiologic pattern of VL in Fortaleza City and to show how urbanization has occurred in recent years. METHODS: Data were obtained from the State Health Department of Fortaleza, Ceará, and included all cases of VL registered in Fortaleza from January 2001 to December 2006. RESULTS: There were a marked increase and an elevated incidence of cases of VL in urban areas. Children and young people were the most affected group. CONCLUSION: The epidemic occurrence of VL in the region must convince authorities to adopt more adequate policies of disease control.

OBJETIVOS: La leishmaniasis visceral (LV) es endémica en Brasil y suele ocurrir en forma epidémica en el estado de Ceará. Se han realizado pocos estudios epidemiológicos sobre LV en ese estado. El objetivo de este estudio es establecer el patrón epidemiológico de LV en la ciudad de Fortaleza y mostrar cómo ha ocurrido la urbanización de esta enfermedad en los últimos años. MÉTODOS: Los datos se obtuvieron del Departamento Estatal de Salud de Fortaleza, Ceará, y abarcaron todos los casos de LV registrados en esa ciudad entre enero de 2001 y diciembre de 2006. RESULTADOS: Se observó un marcado incremento y una elevada incidencia de LV en las áreas urbanas. Los niños y jóvenes fueron los grupos más afectados. CONCLUSIÓN: La ocurrencia de epidemias de LV en la región debe convencer a las autoridades para que adopten políticas más apropiadas para el control de esta enfermedad.