Abstract
To determine whether disease outcomes and clades of Leishmania braziliensis genotypes are associated, we studied geographic clustering of clades and most severe disease outcomes for leishmaniasis during 1999-2003 in Corte de Pedra in northeastern Brazil. Highly significant differences were observed in distribution of mucosal leishmaniasis versus disseminated leishmaniasis (DL) (p<0.0001). Concordance was observed between distribution of these disease forms and clades of L. braziliensis genotypes shown to be associated with these disease forms. We also detected spread of DL over this region and an inverse correlation between frequency of recent DL diagnoses and distance to a previous DL case. These findings indicate that leishmaniasis outcomes are distributed differently within transmission foci and show that DL is rapidly spreading in northeastern Brazil.
Highlights
To determine whether disease outcomes and clades of Leishmania braziliensis genotypes are associated, we studied geographic clustering of clades and most severe disease outcomes for leishmaniasis during 1999–2003 in Corte de Pedra in northeastern Brazil
The broader distribution of disseminated leishmaniasis (DL) compared with mucosal leishmaniasis (ML) was surprising because only during the past decade has disseminated disease become more frequently diagnosed in Corte de Pedra
A distinct geographic clustering of disease forms secondary to L. braziliensis infection was found in the study region
Summary
To determine whether disease outcomes and clades of Leishmania braziliensis genotypes are associated, we studied geographic clustering of clades and most severe disease outcomes for leishmaniasis during 1999–2003 in Corte de Pedra in northeastern Brazil. In Ecuador and Peru, the highlands harbor almost exclusively localized cutaneous leishmaniasis (CL) cases caused by several Leishmania spp., whereas mucosal leishmaniasis (ML) is mostly limited to the Amazon rain forest and caused by L. braziliensis [6,7]. Observations such as those in the Peruvian lowlands, where L. braziliensis causes CL throughout the country but ML is almost exclusively found in Amazonian provinces [7], lend support to the hypothesis that strain variability within a species may influence the form and distribution of ATL. To understand whether geographic segregation of ATL outcomes occurs within a more confined geographic space (foci of ATL transmission), we compared how cases of ML and disseminated leishmaniasis (DL) were distributed during 1999–2003 in Corte de Pedra in northestern Brazil, where active transmission of parasites from a complex population of L. braziliensis to humans occurs
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