Cases Of American Tegumentary Leishmaniasis Research Articles

Spatio-temporal analysis of American Tegumentary Leishmaniasis incidences in the Brazilian state of Amazonas: 2011 to 2022

This study aimed to conduct a spatio-temporal analysis of tegumentary leishmaniasis occurrences in the Amazonas state, Brazil. An ecological study encompassing time series and spatial analysis was performed, exploring the geographic distribution and temporal trends of American Tegumentary Leishmaniasis (ATL) in Amazonas between 2011 and 2022. Secondary data extracted from the Department of Informatics of the Unified Health System (DATASUS) were utilized for this analysis. The study evaluated the relationship between disease cases and environmental/climatic variables (deforestation, temperature, precipitation, and relative humidity). Over the study period, 19,730 cases of tegumentary leishmaniasis were recorded, averaging an incidence of 41.4/100,000 inhabitants across the 62 municipalities of Amazonas state. Disease intensity varied with seasons. Generally, Amazonas state displayed a declining trend in ATL cases. However, certain municipalities, notably Rio Preto da Eva and Presidente Figueiredo, exhibited high incidence rates, while Canutama, Envira, Eirunepé, and Pauini municipalities demand closer attention due to their demonstrated increasing temporal trend of ATL cases. The analysis indicated a correlation between the number of ATL cases reported and relative humidity as well as precipitation. These findings underscore the significance of tegumentary leishmaniasis as a public health issue in the region and emphasize the necessity for public initiatives aimed at preventing this endemic illness.

Clinical Presentation of American Tegumentary Leishmaniasis in a Leishmania (Viannia) braziliensis Endemic Hotspot: A 35-Year History.

American tegumentary leishmaniasis (ATL) is a neglected tropical disease affecting the skin and mucosa. American tegumentary leishmaniasis due to Leishmania (Viannia) braziliensis is endemic in Argentina, where the Department of Oran is a hyperendemic focus. All cases of ATL with laboratory confirmation evaluated at a referral center in Oran city between 1985 and 2019 were analyzed retrospectively. Information from cases included clinical form, lesion size and number, time of evolution, and anatomical location; sex, age, and geographic origin were also studied. The temporal distribution of cases was analyzed. A total of 3,573 cases were included in the analysis. The ratio of males to females was 3:1 and the median age was 33 years old. Eighty-seven percent of cases were from Oran city and its surroundings, highlighting the hyperendemic nature of the area. Regarding clinical forms, 92.5% of cases were cutaneous and 7.5% were mucosal, with a median evolution time until clinical evaluation of 30 days and 7 months, respectively. Single cutaneous lesions were more frequent, localized mainly on the exposed areas in the upper and lower limbs. Secondary events were observed and described in 140 (4%) cases, with a median interval of 3.8 years for the appearance of recurrent mucosal disease in previously cutaneous forms. This is the largest case series of ATL due to L. (V.) braziliensis. The most classic presentation is of adult males with single cutaneous ulcers in exposed body areas, with < 10% of cases with mucosal complications. This comprehensive clinical characterization serves as a basis for future studies of the care and control of this neglected tropical disease.

Are the clinical features of leprosy and American tegumentary leishmaniasis worse in patients with both diseases?

ABSTRACTThis cross-sectional population-based study compared clinical features of leprosy and American tegumentary leishmaniasis (ATL) in patients diagnosed with both diseases (n=414) and in those diagnosed with only leprosy (n=27,790) or only ATL (n=24,357) in Mato Grosso State, which is a hyperendemic area for both diseases in Midwest Brazil. All new cases of leprosy and ATL reported in the area from 2008 to 2017 were included. Patients diagnosed with both diseases were identified by a probabilistic linkage procedure applied to leprosy and ATL databases of the national reporting system. The distribution of the frequency of clinical features between groups was compared by the chi-square test, followed by a multivariate logistic regression. Patients diagnosed with both leprosy and ATL presented higher odds of having nerve damage (OR: 1.34; 95% CI: 1.09–1.66) and leprosy reactions (OR: 1.35; 95% CI: 1.04–1.76) compared to patients diagnosed only with leprosy. Mucocutaneous leishmaniasis (OR: 2.29; 95% CI: 1.74–3.00) was more frequent among patients with both diagnoses when compared to patients who only had ATL. In conclusion, patients diagnosed with both leprosy and ATL present more severe clinical features of such diseases. Our data can be useful for designing health policies aimed at timely and integrated management of leprosy and ATL in co-endemic areas.

American Tegumentary Leishmaniasis in Montes Claros: an epidemiological study

Introduction: American Tegumentary Leishmaniasis (ATL), or kala azar, is a serious chronic disease caused by Leishmania spp. It is an infectious and non-contagious disease that affects both humans and several species of wild and domestic animals, presenting the clinical forms of cutaneous, mucocutaneous and diffuse cutaneous. ATL is classified as a generalized zoonotic disease that has a global impact. It is caused by protozoa of the genus Leishmania and is considered a serious public health problem. Objective: To describe the epidemiological profile of cases found in Montes Claros-MG. Methodology: An epidemiological assessment was performed based on secondary data from SINAN/MS from January 2010 to December 2015. Results: From 2010 to 2015, 286 cases of ATL were registered, with the majority of cases occurring in children under 19 years of age (31.81%) and patients over 59 years (17.83%) had a lower percentage of disease involvement. The first choice drug used by patients was Glucantime (87.06%). The most affected gender was male (52.44%) and most patients had no comorbidities (76.96%). Conclusion: In Montes Claros, Minas Gerais, ATL presented high cases during the research period. In this sense, this study guides the development of new researches that address and monitor the spread of the disease by monitoring urban areas concomitantly with the capture of animals for the presence of the parasite, thus assisting in public health decision-making in controlling the disease.

A follow-up study (2007-2018) on American Tegumentary Leishmaniasis in the municipality of Caratinga, Minas Gerais State, Brazil: Spatial analyses and sand fly collection.

The municipality of Caratinga is an important endemic area for American Tegumentary Leishmaniasis (ATL) and no epidemiological studies were performed during the past two decades. Here, we analyzed the epidemiological situation and the geographical distribution of ATL cases in the municipality of Caratinga from 2007 to 2018 using geographic information systems (GIS). Also, we evaluated the impact of several demographic parameters in ATL distribution and the sand flies incriminated in its transmission. All demographic information (gender, age, educational level, clinical form, diagnostic criteria and case evolution) used in this study was retrieved from the public health archives and confirmed in the State Health Services databases. All cases were analyzed using GIS software based on ATL distribution. Also, non-systematic sand fly collections and molecular detection of Leishmania were performed in the hotspots. During the period, ATL cases continued and increased especially in the past years (2016-2018). Hotspots included urban Caratinga areas and the districts of Patrocínio de Caratinga and Sapucaia. The species Nyssomyia whitmani, Nyssomyia intermedia, Migonemyia migonei and Evandromyia cortelezzii complex were captured. However, ITS1-PCR did not detect Leishmania DNA in those insects. Based on our analyses, urbanization of ATL in Caratinga has occurred in the past years. Due to the increase in the number of cases and vectors presence, it is recommended that health authorities focus on control measures in the most affected areas (Patrocínio of Caratinga and Sapucaia districts and urban Caratinga).

Retrospective study of american cutaneous leishmaniosis in humans in the city of Manaus, Amazonas (2018-2019)

American Tegumentary Leishmaniasis (ATL) is characterized as a zoonosis caused by protozoa of the genus Leishmania spp., presenting a chronic, non-contagious evolution, and its transmission occurs through the bite of sand fly insects (Diptera: Psychodidae). The process of expansion of cities, agricultural frontiers, and the occupation of peripheral areas contribute to the occurrence of epidemic outbreaks of the disease. This article aimed to study the incidence of human cases of ATL in the city of Manaus, describing qualitatively and quantitatively the occurrence of this disease. From the transfer of data from the Notifiable Diseases Information System - SINAN, made available by the Amazonas Health Surveillance Foundation - FVS/AM, this study describes a total of 789 cases, which occurred between 2018 and 2019, in the capital of Amazonas, which were classified according to age, gender, occupation, clinical signs, as well as the condition of the autochthonous case, the relationship with work, and the evolution of the case. As a result, 789 cases were confirmed, ranging in age from 1 to 90 years, and with a higher prevalence in males. As for the form of the lesion, the cutaneous type was identified in 98.73% of the cases, and 57% of the cases had a clinical cure. The results show ATL as a disease related to the socioeconomic and mainly health conditions in which the patient fits, with a high number of patients in large expanding cities, such as the city of Manaus. Thus, further work is needed to provide clarification on the disease, especially in the state of Amazonas, as it is still a neglected disease and related to the population's living conditions.

Disseminated cutaneous leishmaniasis due to Leishmania (Leishmania) amazonensis in human immunodeficiency virus (HIV)-infected patients: A report of two cases

Rationale: Co-infection of human immunodeficiency virus (HIV) and Leishmania spp. has impact on clinical and therapeutic outcomes of leishmaniases. Most studies do not present the identification of Leishmania species causing American tegumentary leishmaniasis in co-infections. In the Americas, Leishmania (L.) Viannia (V.) braziliensis and L. (V.) guyanensis have been identified.Patient concerns: In this study, two cases of American tegumentary leishmaniasis in patients infected with HIV are described. Patients presented several lesions with rapid dissemination and mucosal involvement.Diagnosis: Disseminated cutaneous leishmaniasis caused by L. amazonensis was identified by molecular test.Interventions: The patients were treated with conventional therapies for HIV infection and American tegumentary leishmaniasis.Outcomes: In co-infection, the clinical manifestations are atypical and the treatment response can be impaired.Lessons: These cases show that HIV infection impacts L. amazonensis infection and point to the relevance of identifying Leishmania species, which can lead to a better patient management.

American Tegumentary Leishmaniasis in an endemic municipality in the North of Minas Gerais State: spatial analysis and socio-environmental factors.

ABSTRACTAmerican Tegumentary Leishmaniasis (ATL) is endemic in the municipality of Montes Claros, Minas Gerais State. The use of geotechnology such as spatial statistics and remote sensing has contributed to a better understanding of the eco-epidemiology of diseases, and consequently a better definition of control strategies. This study aimed to analyze the spatial distribution of probable sites of cases of ATL infection (2007-2011) in the municipality of Montes Claros and to identify related socio-environmental factors. Data on ATL cases notification were obtained from the Municipal Health Department of Montes Claros. The annual incidence of ATL in the municipality was calculated and the probable sites of infection were georeferenced. Crude Rate and the Local Empirical Bayesian Rate were calculated with census sectors considered as the unit of analysis. The Normalized Difference Vegetation Index (NDVI) was calculated from LANDSAT 5 TM images. The spatial association between the crude rate of ATL and the NDVI of the census tracts was evaluated using the Local Bivariate of Moran I. The socio-environmental aspects of household structures were assessed based on a structured questionnaire. The incidence of ATL in the evaluated period ranged from 6.2 to 16.6 cases/100,000 inhabitants. The highest rates of ATL occurrence were found in the census sectors located in the rural area and in the peripheral census sectors in the city. Through the Empirical Bayes Smoothed Rate map, it was found that in the peripheral areas of the city, the rates of ATL occurrence were lower than in the rural area and their values decreased as they approach the city center. Local Bivariate of Moran I showed a positive correlation between NDVI and crude ATL rates, with significant high-high clusters observed in the rural area and in the census sectors in the Western peripheral area of the city that have experienced an urban expansion concomitant to the period investigated. In most homes of people affected by the disease, there were domestic animals and organic matter in the peridomicile. In addition, a high percentage of individuals affected by ATL reported the presence of rodents circulating near their homes. In conclusion, it is possible that the disorderly expansion process in the city of Montes Claros favored the establishment of the ATL periurban and urban transmission cycle. These regions deserve special attention from health surveillance to combat this zoonosis.

Leishmaniose tegumentar americana: perfil epidemiológico dos casos notificados no Brasil entre os anos de 2009 a 2018 e considerações sobre os aspectos e manifestações de importância odontológica

A Leishmaniose tegumentar americana (LTA) é uma doença infecto-parasitária de ampla distribuição mundial que pode acometer tecidos cutâneos e mucosos, tais como as mucosas nasal e oral, apresentando manifestações de interesse odontológico. Uma vez que constitui um problema de saúde pública, objetivou-se avaliar o perfil epidemiológico dos casos de LTA notificados no Brasil, fazendo-se ainda algumas considerações acerca de suas manifestações de interesse odontológico. Assim, esta pesquisa trata-se de um estudo ecológico retrospectivo, descritivo com abordagem quantitativa sobre o número de casos de LTA notificados no Brasil entre os anos de 2009 a 2018. Os dados mostram que foram notificados nesse período um total de 209.129 casos. A maioria acomete indivíduos do gênero masculino, na faixa etária dos 20 aos 39 anos, de raça/etnia parda, baixo grau de escolaridade e que habitam em zonas rurais, sendo a maioria notificado na região Norte. Os casos são majoritariamente novos, forma cutânea, autóctones, diagnosticados através de parâmetros clínico-laboratoriais e de evolução para a cura. Os resultados deste estudo permitem estimar que embora a propagação nacional dos casos de LTA tenha apresentado algumas transformações em seu perfil epidemiológico, observa-se ainda uma alta prevalência, afetando principalmente homens de baixa renda/escolaridade. Além disso, o acometimento da forma mucosa através de lesões ulceradas e destrutivas nas regiões nasal e oral ressaltam a importância do Cirurgião-Dentista (CD) no diagnóstico e manejo dessas lesões.

Leishmaniases of the New World from a historical and global perspective, from the 1930s to the 1960s

The first autochthonous cases of cutaneous and mucocutaneous leishmaniasis in the Americas were described in 1909, but visceral leishmaniasis only erupted as a public health problem in the region in 1934. Today Brazil is the country with the most cases of American tegumentary leishmaniasis, and alongside India has the highest incidence of visceral leishmaniasis. Knowledge production and efforts to control these diseases have mobilized health professionals, government agencies and institutions, international agencies, and rural and urban populations. My research addresses the exchange and cooperation networks they established, and uncertainties and controversial aspects when notable changes were made in the approach to the New World leishmaniases.

Search for Leishmania spp. in sandflies (Diptera: Psychodidae) from the municipality of Iúna, Espírito Santo

This study evaluated the local fauna of phlebotomine vectors for American Tegumentary Leishmaniasis (ATL) in the rural region of Iúna, state of Espírito Santo, Brazil. Diptera catches encompassed five rural locations where ATL cases had previously been reported. The selection criteria for the installation of the traps were properties with a previous history of human clinical cases of ATL and the presence of dogs without clinical signs of the disease, but seropositive to Leishmania (Viannia) braziliensis by the indirect ELISA technique. The collections were carried out with the aid of "CDC" type light traps (Centers for Diseases Controls) installed at 6:00 p.m. and collected at 06:00 a.m., totaling 336 operating hours. Among fourteen collection points, ten showed positive for the presence of sandflies, and a total of 1148 specimens were all processed and identified. The 60 females from positive collection point was submitted to a polymerase chain reaction (PCR) technique to evaluate the presence of the genus Leishmania spp. in the digestive tubes of Diptera. Three females were positive for nucleic acids of Leishmania (Viannia) braziliensis. Among the 1148 phlebotomines, the species Migonemyia migonei was the one that presented the most abundant being responsible for 71.7% of the specimens, followed by Nyssomyia intermedia 21.5%, adding the other species captured 6.8%. Considering the vector capacity of Mg. migonei and Ny. intermedia, as well as their anthropophilic habits already described in the literature, we can suggest that these species may be acting as transmitters of ATL in the region.

Incidence of American Tegumentary Leishmaniosis in the Municipality of Rondoland - MT in the Period 2010 to 2018

American tegumentary leishmaniasis (ACL) is an infectious, non-contagious disease that causes ulcers on the skin and mucous membranes. The disease is caused by protozoa of the genus Leishmania. The objective of the research was to verify the incidence of American cutaneous leishmaniasis in the municipality of Rondolândia - MT from 2010 to 2018. The methodology and of the transversal, documental, descriptive and quantitative type, the information will be obtained from the analysis of epidemiological data provided by health surveillance of the municipality of Rondolândia - MT, who were attended at the Hueverton basic health unit Bruno da Silva Rabelo, who will be separated through a questionnaire carried out by the researchers themselves containing 4 basic questions based on the SINAN compulsory notification form. It was verified that 40 cases of American tegumentary leishmaniasis were reported in the municipality of Rondolândia-MT between 2010 and 2018, 90.0% being male and 10.0% female in the age group with the highest incidence 18 to 59 years of age to 85.0% of the reports and 45.0% of the patients were brown, 95.0% of the patients presented skin lesions and were classified as new cases. The patients' diagnoses were confirmed by 85.0% laboratory, 90.0% of the patients were treated with pentavalent antimonial and 90.0% of the patients were from the rural area of the municipality of Rondolândia-MT. It is concluded that the incidence of cases of American tegumentary Leishmaniasis in the municipality of Rondolândia-MT has been increasing over the years, that is, approximately 1 case per 100 inhabitants, thus, the annual average of these cases corresponding to 5 cases of the annual disease. An urgent action is required by the health surveillance department of the municipality to carry out disease control, since if it continues without prevention in the municipality, this annual index may suffer a great increase over the years.

Prevalence and Association of Leishmania RNA Virus-1 (LRV-1) in Severe and Non-Severe Phenotypes of American Tegumentary Leishmaniasis from Peru

Background: American tegumentary leishmaniasis (ATL) comprises a discrete set of clinical presentations of leishmaniasis endemic to Latin America and particularly Peru. Leishmania RNA virus-1 (LRV-1) is a double stranded RNA virus identified in 20-25% of the Leishmania Viannia complex, and is believed to be a predictive biomarker of severe ATL. Our objective was to determine the baseline prevalence of LRV-1 and associations with clinical phenotypes of ATL in patients from Peru. Methods & Materials: Banked clinical isolates of Leishmania Viannia spp. from patients residing in or traveling to Peru between 2012 and 2016 were species identified, by PCR, RFLP analysis, and Sanger sequencing, and screened for LRV-1 by real-time PCR. Patient isolates were stratified according to clinical phenotype: localized cutaneous leishmaniasis (LCL) was defined as “non-severe” ATL, whereas “severe ATL” was defined as mucosal or mucocutaneous leishmaniasis (ML/MCL); erythematous, purulent, or painful ulcers and/or lymphatic involvement (inflammatory ulcers); or multifocal/disseminated ulcers (≥4 in ≥2 anatomic sites). Proportions of LRV-1-positivity were calculated and compared across phenotypes. Results: Of 81 patients enrolled, 45(56%) and 36(44%) of ATL cases had the severe and non-severe phenotypes, respectively. Seventeen (38%) of 45 severe ATL cases and 13(36%) of 36 non-severe ATL cases were positive for LRV-1, respectively (p = 1.00). The severe phenotype was over-represented among older patients (median age 42 years vs. 30.5 years in non-severe ATL, p = 0.01), while LRV-1 was over-represented among younger patients (median age 28 years vs. 39 years in LRV-1 negative, p = 0.02). No difference in disease severity by sex (p = 0.12) or causative species (p = 0.057) was identified. Similarly, no difference in LRV-1 status was observed by sex (p = 1.00) or causative species (p = 0.45). LRV-1 copy number was greater in those with ML/MCL compared to those with all forms of CL (p = 0.04). Conclusion: A direct association between LRV-1 status and clinical phenotype was not demonstrated, however LRV-1 copy number was higher in patients with ML/MCL. Our findings suggest age as a contributing factor to disease severity. Given the likelihood of relapse in patients with severe ATL and associated risk of treatment failure, further elucidation of LRV-1's possible contribution to disease severity in ATL warrants further exploration.

American tegumentary leishmaniasis: a multivariate analysis of the spatial circuits for production of cases in Minas Gerais State, Brazil, 2007 to 2011

The aim of this study was to explain the association between social-environmental factors and major land uses and the occurrence of cases of American tegumentary leishmaniasis (ATL) in the spatial circuits of production in Minas Gerais State, Brazil. This was an analytical-type ecological study based on secondary data on ATL divided by three-year period from 2007 to 2011, in which the analytical units were municipalities belonging to the spatial circuits. Two distinct stages were performed. The first was the elaboration of thematic maps with identification of the circuits. In the second, a new indicator, ATL cases by population density, was associated with social-environmental indicators and major land uses, submitted to multivariate principal components analysis (PCA). During the periods studied, three circuits were identified, distributed in the major regions of Northern Minas Gerais, Rio Doce Valley, and Greater Metropolitan Belo Horizonte. There was a strong association between ATL by population density and temporary crops, natural pasture, natural forest, unusable lands, and rural population, and a weak association with planted pasture. The association of cases with the major land uses variable in different agricultural profiles shows the occupational nature of ATL, associated mainly with rural workers. The association of the disease with environmental variables and deficient basic sanitation also proved relevant in the transmission profile in spatial circuits of production in Minas Gerais.

American tegumentary leishmaniasis: epidemiological and molecular characterization of prevalent Leishmania species in the State of Tocantins, Brazil, 2011-2015.

ABSTRACTDetermination of the epidemiological profile of the American tegumentary leishmaniasis (ATL) and identification of Leishmania species that are prevalent in the State of Tocantins were carried out through a retrospective and descriptive study based on data reported in SINAN, in the period from 2011 to 2015. Molecular techniques such as PCR-RFLP and PCR-G6PD to amplify Leishmania DNA were performed on stored on Giemsa-stained slides from lesion scarifications of ATL patients who were amastigote-positive by the direct microscopic examination. There were 1,434 ATL cases in Tocantins reported in this period. The highest incidence was reported in men aged over 60 years, rural residents, the most affected ethnic group was mixed ethnicity (mixed black and white) and the ones with lower education. The predominant clinical form was cutaneous, being diagnosed mainly by laboratory methods. Pentavalent antimonial was effective in resolving cases. The predominant species found in 271 analyzed samples from 32 municipalities located in 8 different health regions of Tocantins was Leishmania (Viannia) braziliensis. Identifying the epidemiological profile and characterizing the Leishmania spp species on regional level is essential to establish control and prevention behaviors, minimizing the number of cases and treatment resistance, recurrence and evolution to mucosal forms.

Leptomonas seymouri and Crithidia fasciculata exoantigens can discriminate human cases of visceral leishmaniasis from American tegumentary leishmaniasis ones.

ABSTRACT Exoantigens (exo) from Leptomonas seymouri and Crithidia fasciculata were used in an enzyme linked immunosorbent assay (ELISA), showing 100% reactivity with sera from visceral leishmaniasis (VL) cases, and no reactivity with American tegumentary leishmaniasis (ATL) ones. Our results have indicated that these exoantigens can be applied in the discrimination of VL and ATL cases.

Clinical, laboratory, and therapeutic characteristics of American tegumentary leishmaniasis in the 15 th State Health Division, Northwest Paraná State, Southern Brazil.

American tegumentary leishmaniasis (ATL) is an endemic disease in many regions of Brazil; however, only few reports on the actual epidemiological conditions are available. Here, we aimed to assess the clinical, epidemiological, and laboratory characteristics of ATL patients and their treatment in the 15th Regional Health Division of Paraná State, Maringá, Brazil. This epidemiological study included patients diagnosed with ATL from January 2010 to September 2014, from the 15th Regional Health Division database. A total of 220 cases aged 3-84 years (85% male and 60.9% with up to 8 years of schooling) were included. The cases were classified as having the cutaneous form (n=183; 83.2%), mucosal form (n=26; 11.8%), mucocutaneous form (n=11; 5%), and relapses (n=21; 9.6%). Diagnosis was made via laboratory test results in 197 (89.5%) patients, and 172 (78.2%) completed the treatment within the study period. With regard to patients with the cutaneous form, 134 (95%) were cured, 131 (97.8%) were treated with Glucantime(r), and 47 (36.7%) received dosage of >15 and <20mg Sb5+/kg/day. Among the cases with mucosal involvement, 87.1% were cured and most were treated with <20mg Sb5+/kg/day. Thus, the cure rate was 93.6%. During the study period in the 15th Regional Health Division of Paraná State, ATL cases had a good response to treatment with a low rate of relapse or treatment failure, although a high percentage of mucosal or mucocutaneous form cases was also noted.

STATUS OF THE AMERICAN TEGUMENTARY LEISHMANIASIS IN THE STATE OF RIO DE JANEIRO , BRAZIL, FROM 2004 TO 2013.

SUMMARY The aim of the present study was to analyze the status of the American Tegumentary Leishmaniasis (ATL) in the state of Rio de Janeiro, from 2004 to 2013, through its spatiotemporal distribution. We also described variables considered relevant to the epidemiology of the disease, such as the clinical form, gender, ethnic group, age group, and progression of disease. This is a descriptive study, which used notified secondary data from the Brazilian Information System of Notifiable Diseases (SINAN), Ministry of Health, Brazil, regarding confirmed diagnoses. To help the calculation of coefficients of detection and mortality, we used population data from the Brazilian Institute of Geography and Statistics (IBGE). We analyzed 1,470 cases of ATL with the predominance of the cutaneous clinical form (1,292/87.89%). The data has also revealed seven deaths, a predominance of males (922/62.72%), and a higher incidence of ATL in the white ethnic group (731/49.72%). We observed a high incidence of ATL in the group of 20 - 39 years old (477/32.44%). We concluded that there was a decrease in the number of ATL cases in the state of Rio de Janeiro, based on a coefficient of detection of 1.44/100.000 inhabitants in 2004 decreasing to 0.20/100.000 inhabitants in 2013. The localities with the highest occurrences of ATL were the metropolitan region (843 cases) and the municipality of Rio de Janeiro (740 cases). In 2005, the highest incidence of the disease was observed (351 cases) in the study. Among the variables selected to describe the epidemiology of the disease, the following categories: cutaneous clinical form, male patients, white ethnic group, and the age group of 20 - 39 years old were more affected than the others.

EVOLUTION OF AMERICAN TEGUMENTARY LEISHMANIASIS CASES REPORTED IN PARANÁ STATE, BRAZIL.

SUMMARY Leishmaniases are infectious diseases caused by protozoa of the genus Leishmania. They are widely distributed worldwide and endemic in 88 countries in four continents. The present study analyzed the reported cases of American Tegumentary Leishmaniasis (ATL) in Paraná State (Brazil) from January 2007 to December 2013. The data were grouped according to Regional Health (RH) districts and macroregions, which allowed visualization of the reality in each region in the state. A total of 2,879 ATL cases were reported and distributed among the 22 RH districts, with an average detection rate of 3.9 cases per 100,000 inhabitants. The northwestern region accounted for 50.1% of the total cases, and the northern region accounted for 26.0-76.1% of the reported cases. The 6th RH district did not report any cases. The 7th, 9th, and 18th RH districts had a higher cure rate (> 80%), and lower cure rates were found in the 1st, 4th, and 12th RH districts. Reported unfavorable outcomes included treatment abandonment and death. Overall cure rates are based on the entire country, and unfavorable outcomes require greater attention of managers and health professionals to meet the goals of the Brazilian Ministry of Health.

The isolation and molecular characterization of Leishmania spp. from patients with American tegumentary leishmaniasis in northwest Argentina

American tegumentary leishmaniasis (ATL) is a group of zoonotic diseases caused by kinetoplastid flagellates of the genus Leishmania. A total of 66 patients diagnosed as positive ATL cases from northwest Argentina were included in this study. Leishmania stocks were isolated in vitro and analyzed over promastigote cultures sown on FTA through nested PCR and sequence of cytochrome b (cyt b). The molecular analysis resulted in the incrimination of L. (Viannia) braziliensis as the predominant species in the studied area, identifying two genotypes of L. (V.) braziliensis, 24 cases of Ab-1 cyt b and 41 cases of Ab-2 cyt b. One L. (V.) guyanensis strain was obtained from a traveler from the Brazilian Amazon. The prevalence of different genotypes was in agreement with previous studies, suggesting the necessity for new systems to study the genetic diversity in more detail. Most of the cases typified in this study were registered in the area of Zenta Valley (Orán, Hipólito Yrigoyen, and Pichanal cities), pointing a link between genotype and geographical origin of the sample. Sex and age distribution of the patients indicate that the transmission was predominantly associated with rural areas or rural activities, although the results might not exclude the possibility of peri-urban transmission. This work represents, so far, the largest isolation and molecular characterization of ATL cases in Argentina.