Abstract
ObjectivesHuman migration and concomitant HIV infections are likely to bring about major changes in the epidemiology of some parasitic infections in Brazil. Human visceral leishmaniasis (HVL) control is particularly fraught with intricacies. It is against a backdrop of decentralized health care that the complex HVL control initiatives are brought to bear. This comprehensive review aims to explore the obstacles facing decentralized HVL control in urban endemic areas in Brazil.MethodA literature search was carried out in December 2015 by means of three databases: MEDLINE, Google Scholar, and Web of Science.ResultsAlthough there have been many strides that have been made in elucidating the eco-epidemiology of Leishmania infantum, which forms the underpinnings of the national control program, transmission risk factors for HVL are still insufficiently elucidated in urban settings. Decentralized HVL epidemiological surveillance and control for animal reservoirs and vectors may compromise sustainability. In addition, it may hamper timely human HVL case management. With the burgeoning of the HIV-HVL co-infection, the potential human transmission may be underestimated.ConclusionHVL is a disease with focal transmission at a critical juncture, which warrants that the bottlenecks facing the control program within contexts of decentralized healthcare systems be taken into account. In addition, HIV-driven HVL epidemics may substantially increase the transmission potential of the human reservoir. Calculating the basic reproductive number to fine-tune interventions will have to take into consideration the specific socio-economic development context.
Highlights
Human visceral leishmaniasis (HVL) is endemic in 70 countries [1]
Results: there have been many strides that have been made in elucidating the eco-epidemiology of Leishmania infantum, which forms the underpinnings of the national control program, transmission risk factors for HVL are still insufficiently elucidated in urban settings
Epidemiology Human visceral leishmaniasis (HVL) is a disease of public health importance caused by protozoans belonging to the genus Leishmania, which is present worldwide, in Brazil, Bangladesh, India, Nepal, and Sudan [25]
Summary
Leishmania infantum chagasi is the main species causing HVL in Brazil. The typical manifestations of HVL include fever, weight loss, hepatosplenomegaly, and pancytopenia resulting from replication of Leishmania amastigotes in macrophages mainly in the liver, spleen, and bone marrow, causing severe and lethal lesions [11]. Typical features such as splenomegaly may be absent in VL-HIV-co-infected patients [12], whereas atypical organ involvement, such as of the lungs or gastrointestinal system and renal failure has been associated with chronic VL in HIV patients [13,14,15]. As HIV viral load increases in patients with HIV-Leishmania co-infection [16], it promotes the clinical progression of HIV and the development of AIDSdefining conditions [17]
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