American visceral leishmaniasis in a state of northeastern Brazil: clinical, epidemiological and laboratory aspects.

J R S Ferreira,M G S Cavalcanti,T J Matos-Rocha,K M Silva,L C Alves,G C Ferreira-Júnior,D C S Gomes,F A Brayner,M S G De Almeida

doi:10.1590/1519-6984.238383

Abstract

In Brazil, American visceral leishmaniasis (AVL) has become a public health concern due to its high incidence and lethality. This study aimed to analyze the clinical, epidemiological, and laboratory aspects of AVL in a state of Brazil. This descriptive, cross-sectional, retrospective, and quantitative study of notified cases of AVL was carried out in Alagoas between 2008 and 2017 from data obtained from DATASUS/SINAN. Sociodemographic, clinical, and laboratory variables were analyzed. A descriptive analysis was performed using absolute values and valid percentages, using tables and/or graphs. Data processing was performed using Stata 12.0®. Results with P <0.05 were considered statistically significant. During the study period, 352 cases of AVL were reported, of which 6.82% died and 38.92% had met a cure criterion. Male patients were predominant (66.76%). Of the total infected patients, 16.76% had attended only the 1st to the 4th grades, with those most affected aged 1 to 4 years (28.69%). Laboratory diagnostic criteria were most commonly used to confirm the notified cases (76.42%), whereas 51.70% and 8.52% of the cases had positive parasitological and immunofluorescence diagnoses, respectively. Finally, the study showed a higher prevalence of the disease in children, men and in rural residents. Although with low lethality, the expressive frequency of AVL in the State of Alagoas was still verified, since there was an increase in the number of cases during the years of the study.

Highlights

American visceral leishmaniasis (AVL) is a chronic and severe zoonosis, popularly known as Kala-azar in Asia and calazar in Northeast Brazil that is caused by an intracellular protozoan of the genus Leishmania, belonging to the Leishmania donovani complex
Regarding the calculation of lethality, the numbers of deaths were used in the numerator and denominator of the estimated population of the State for each year of the study multiplied by 100,000, which is the epidemiological indicator of AVL defined by the National Council of Health Secretaries (CONASS) (Brasil, 2016a)
In Brazil, AVL is a parasitic infection that traditionally affects males due to their increased exposure to the invertebrate host related to their occupational activities outdoors (Barbosa, 2016; Gusmão et al, 2014)

Summary

Introduction

American visceral leishmaniasis (AVL) is a chronic and severe zoonosis, popularly known as Kala-azar in Asia and calazar in Northeast Brazil that is caused by an intracellular protozoan of the genus Leishmania, belonging to the Leishmania donovani complex. In the WHO Southeast Asia region, the Kala-azar elimination program is progressing satisfactorily, with countries like Bangladesh that reported more than 9.000 cases in 2006 reporting 255 and 192 new cases in 2016 and 2017, respectively (WHO, 2018). From 2010 to 2014, 18.274 cases were confirmed and 1.195 deaths due to AVL were reported in Brazil, corresponding to an average lethality coefficient of 6.5% (Brasil, 2019). AVL is an endemic disease initially associated with rural areas. Environmental changes including progressive and disordered urbanization, the deforestation of native forests, population growth, intense migration, and the creation of new neighborhoods, have contributed to the increased disease distribution beyond the endemic areas and the start of an urban cycle (Lobo et al, 2013; Assis et al, 2015)

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