Abstract
0 ver the last 10 years, 153,283 cases of American cutaneous leishmaniasis (ACL) were reported in Brazil. ACL incidence has been estimated to be around 20,000 new cases per year over the last five years,’ characterizing this disease as highly endemic in many parts of the country. Prevention of ACL is based largely on avoiding contact with the vector, a method not always feasible because of the way the disease is transmitted. Contrary to what has been observed in visceral leishmaniasis, the complex epidemiology combined with the problems associated with drug treatment (prolonged treatment time and numerous side effects, in addition to drug resistance) make prophylaxis against ACL a serious health problem in countries affected by the disease. Due to the peridomiciliary habits of the only vector of American visceral leishmaniasis known to date (Lutzomyin hgipalpis) and the fact that the disease is relatively easy to detect in the main reservoir, the domestic dog, effective prophylactic measures such as patient treatment, insecticide spraying, elimination of the reservoirs, and epidemiological surveillance are usually successful in American visceral leisl~maniasis.2,‘? Unfortunately, this is not the case in ACL. Due to the sylvatic nature of both the vectors (many sandfly species have been identified as possible vectors) and reservoirs (most of them, still not identified),4 effective prophylactic measures are rarely effective in this form of leishmaniasis.5 Since most of the infections are acquired inside the forest, measures such as insecticide spraying and elimination of the reservoirs are virtually unfeasible. In addition, the possibility of development of insecticide resistance’ in some sandfly species has also to be taken into consideration, not to mention the severe risks of environmental contamination associated with such procedures. ACL is, thus, an
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