Visceral Leishmaniasis In Urban Areas Research Articles

Dynamics of Leishmania spp. infection in dogs from an unaffected region in transition to a visceral leishmaniasis transmission area, Rio Grande do Sul, Brazil.

In Brazil, visceral leishmaniasis (VL) has been expanding and urbanizing, mainly in non-endemic areas such as the State of Rio Grande do Sul. Considering that infected dogs are the main reservoirs of VL in urban areas, the present study aimed to evaluate the propagation of canine visceral leishmaniasis (CVL) infection from an unaffected region in transition to a VL transmission area. For this, 1159 and 1087 samples of canine serum from 2015 and 2021, respectively, were analyzed, using the indirect immunofluorescence test. In addition, necropsy reports between 2007 and 2021 were evaluated. The results showed a prevalence of anti-Leishmania spp. antibodies of 7.5% in the samples from 2015, while in 2021 samples, it was 23.5%, with an incidence of 0.4 cases per 100 dogs. It is noteworthy that in 2007, there was no record of CVL as the cause of death in the pathological reports, and in 2021, 41 diagnoses were made with the protozoan being a determinant of the death of the animal. These values indicate an increasing trend in the prevalence and incidence coefficients of CVL. The results of this study allowed us to verify the spread of the disease from an unaffected region to a transmission area of the agent, as well as provide subsidies for health authorities to implement improvements in the CVL control program in the municipality, to mitigate the emergence of human cases of the disease.

Leishmaniasis in non-human primates: Clinical and pathological manifestations and potential as reservoirs.

Although the domestic dog is the most important reservoir of visceral leishmaniasis in urban areas, there have been an increasing number of reports of naturally occurring leishmaniasis in non-human primates. Reported cases affecting neotropical and Old World non-human primates as well as their potential role as reservoirs were reviewed.

Autochthonous Canine Visceral Leishmaniasis in Urban Area of Porto Alegre, RS, Brazil

Background: Leishmaniasis is a chronic infectious disease caused by intracellular protozoan Leishmania that affects canine and human. The visceral leishmaniasis (VL) is caused by the Leishmania donovani complex, in which canines are the main reservoir for human VL. In Southern Brazil, case reports of this disease have increased, especially when canines are infected in endemic areas in the country. Canines usually present a systemic disease, characterized by cutaneous lesions, weight loss, generalized lymphadenopathy, hepatomegaly and splenomegaly. This report aims to describe the clinicalpathological features of a case of autochthonous VL in a canine of an urban area of Porto Alegre.Case: A male, mixed breed, dog , 7 year-old, resident at the East Side of Porto Alegre, living together with two other canines, presented at clinical examination progressive weight loss, associated with hyporexia and hyperthermia, evolving to lateral recumbency, paralisys, and death. At necropsy, the dog was cachectic with diffusely pale mucosae. Gross findings included liver enlarged, with multifocal firm brownish areas, spleen enlarged, showing multifocal firm round dark-red areas, and kidneys diffusely pale with evidentiated tranversal striations on cortical zone. At microscopic examination, there was on the spleen diffuse inflammatory infiltrate of macrophages with large cytoplasm containing multiple amastigotes. The liver, exhibited atrophy of hepatocytes and moderate multifocal inflammatory infiltrate in sinusoids of macrophages containing multiple amastigotes. These features were also observed moderately on lymph nodes and lamina propria of large intestine. Immunohistochemistry examination showed marked positive staining for Leishmania spp. in amastigotes located whitin the cytoplasm of macrophages of spleen, liver, lymph nodes and large intestine.Discussion: Canine leishmaniasis is a disease that affects both internal organs and skin. However, the condition is called VL mostly because it is associated with the same species that cause the visceral form in humans. In this case the canine presented liver, spleen and lymph node lesions; however no skin lesion was observed during the clinical examination. A serological evaluation of canids in East Side of Porto Alegre performed in 2005 showed that 3.5% of these dogs were positive for Leishmania; yet neither of these animals presented clinical signs. This demonstrates that the agent was already present, however only 3-10% of the canines infected develop clinical disease. In non-endemic areas VL is related to the migration of canids from endemic areas, where VL is common. However the canine here described was born, raised, and was living in Porto Alegre. Lutzomyia longipalpis is the main vector of VL and despite its wide distribution it was identified only in 2009 in Rio Grande do Sul State. Autochthonous cases of VL were reported in canines and humans in this state, confirming the hypothesis that the vector was widely distributed and it is now present in Porto Alegre, keeping the epidemiological cycle of that disease active. Canine VL occurs prior in humans, since canines are the main domestic reservoirs and are critical for the maintenance of this disease cycle. This is the first autochthonous VL in a canine of an urban area of Porto Alegre; therefore authorities should be alert, and new control measures must be taken to avoid the canine leishmaniasis outbreak due to its potential for zoonotic transmission.Keywords: leishmaniasis, canine, protozoan, immunohistochemistry.

Prediction of high-risk areas for visceral leishmaniasis using socioeconomic indicators and remote sensing data.

Spatial heterogeneity in the incidence of visceral leishmaniasis (VL) is an important aspect to be considered in planning control actions for the disease. The objective of this study was to predict areas at high risk for visceral leishmaniasis (VL) based on socioeconomic indicators and remote sensing data. We applied classification and regression trees to develop and validate prediction models. Performance of the models was assessed by means of sensitivity, specificity and area under the ROC curve. The model developed was able to discriminate 15 subsets of census tracts (CT) with different probabilities of containing CT with high risk of VL occurrence. The model presented, respectively, in the validation and learning samples, sensitivity of 79% and 52%, specificity of 75% and 66%, and area under the ROC curve of 83% and 66%. Considering the complex network of factors involved in the occurrence of VL in urban areas, the results of this study showed that the development of a predictive model for VL might be feasible and useful for guiding interventions against the disease, but it is still a challenge as demonstrated by the unsatisfactory predictive performance of the model developed.

Molecular and serological detection of Leishmania spp. in captive wild animals from Ilha Solteira, SP, Brazil

Leishmaniasis is a zoonotic disease that affects 12 million people worldwide. Several mammalian species can serve as a reservoir for this disease. Dogs are the main reservoir for visceral leishmaniasis in urban areas, which has become a serious public health concern in Brazil. The aim of this study was to evaluate the presence of Leishmania spp. in captive wild animals from Ilha Solteira, São Paulo, Brazil. Blood and various tissues samples were collected from animals of five different species: Speothos venaticus, Chrysocyon brachyurus, Cerdocyon thous, Pseudalopex vetulus, and Procyon cancrivorus. Antibodies against Leishmania spp. were detected in three wild canids by indirect fluorescent antibody test (IFAT) and enzyme-linked immunosorbent assay (ELISA). PCR analyses of blood and bone marrow from all animals were negative, but Leishmania DNA was found in the tissues and skin of seropositive animals. Positive PCR samples were also positive for Leishmania donovani complex. Analysis of sequenced PCR products showed similarities with different regions of Leishmania (Leishmania) infantum and Leishmania (Leishmania) chagasi kinetoplastids. Measures to control visceral leishmaniasis in wild animals kept in Brazilian zoos should be established, as no disease control programs are currently available.

Urbanization of visceral leishmaniasis (kala-azar) in Fortaleza, Ceará, Brazil

Visceral leishmaniasis (VL) is endemic in Brazil and appears to occur in epidemic form in the state of Ceará. Few epidemiologic studies have been done on VL in this state. The aim of this study is to establish the epidemiologic pattern of VL in Fortaleza City and to show how urbanization has occurred in recent years. Data were obtained from the State Health Department of Fortaleza, Ceará, and included all cases of VL registered in Fortaleza from January 2001 to December 2006. There were a marked increase and an elevated incidence of cases of VL in urban areas. Children and young people were the most affected group. The epidemic occurrence of VL in the region must convince authorities to adopt more adequate policies of disease control.

Visceral leishmaniasis in large Brazilian cities: challenges for control

The objectives of this article were to discuss the rapid spread of visceral leishmaniasis in urban areas of Brazil and to raise practical questions and perspectives related to control of the disease. Among the proposed methods, the elimination of seropositive dogs is the most controversial and least accepted by society. Its impact on incidence rates varies among studies (positive in some and relatively unimportant in others). Treatment of infected dogs, although widespread in veterinary practice, is based on studies with weak scientific evidence. Insecticide spraying of areas is more acceptable to the population, but is costly and operationally difficult. Intra and inter-urban factors have scarcely been studied and may affect control of the disease. Finally, the article discusses the use of deltamethrin-impregnated dog collars and vaccines, with high expectations for impact on disease transmission, although no product currently available on the market has been fully evaluated, so that further studies are required.

Forum: geographic spread and urbanization of visceral leishmaniasis in Brazil. Introduction

The geographic spread and urbanization of visceral leishmaniasis in Brazil has been described since the early 1980s. However, the putative factors associated with this process, its full characterization, and the implications for disease control still challenge researchers and Public Health professionals. Although the available data show that the disease occurs mainly in urban areas, current knowledge is insufficient to claim specificity in urban transmission as compared to rural niches. Transmission scenarios in urban settings appear to be highly heterogeneous, each showing some degree of similarity to the rural epidemiological pattern. The understanding of a relatively recent and complex problem like the introduction, spread, and maintenance of visceral leishmaniasis in urban areas requires new analytical approaches that consider the network of relevant variables and more elaborate methods capable of capturing the dynamics of the environmental and demographic transformations taking place in transmission areas.

Household structure and urban services: neglected targets in the control of visceral leishmaniasis

Visceral leishmaniasis (VL) caused by Leishmania chagasi is a growing public-health problem in many parts of the New World. Although several studies have focused on the consequences of environmental damage, human migration and land occupation on the incidence of VL, the effects on the disease of the substandard living conditions that often result from the process of urbanization have not been investigated in detail. The present study was based in the Brazilian city of Teresina, where, since 1980, there have been two large outbreaks of VL (one in 1981-1985 and the other in 1993-1996), each involving at least 1000 newly reported cases. The role of household structure and the provision of urban services in the city, as predictors of the occurrence of VL, was studied in a case-control investigation. After controlling for age, crowding, and the background incidence of VL in the area where the subjects lived, the risk of acquiring the disease was found to be significantly higher for those who lived in houses with an inadequate sewage system and those who had no regular rubbish collection. Improving household structure and providing basic urban services might be effective strategies for controlling the spread of VL in urban areas.

The burden of Leishmania chagasi infection during an urban outbreak of visceral leishmaniasis in Brazil

First noted in the city of Teresina in 1981, the last decades have witnessed a remarkable increase in urban transmission of American visceral leishmaniasis (VL) in many Brazilian cities. Teresina, the site of this study, has faced two large outbreaks of VL. The first occurred from 1981–1985 when almost 1000 new cases were reported. The second started in the 1990s, and between 1993 and 1996 more than 1200 new cases were detected. This report describes the prevalence of infection with Leishmania chagasi in Teresina at the end of the second outbreak and gives estimates of the number of people who became infected during the epidemic. Between June 1995 and May 1996, 200 households were chosen at random from a list of addresses covering about 93% of Teresina's urban households. In each household, one person over the age of 1 year was screened for Leishmania antibodies and skin-tested. Nearly 50% of persons had a positive leishmanin reaction, but only 13.9% had detectable antibodies to L. chagasi. While prevalence estimates based on the leishmanin skin-test increased with age ( P<0.001), those based on serological tests showed a lesser, and non significant, variation with age ( P=0.31). Using a geometric growth equation, and assuming that the annual distribution of clinical cases may serve as an approximation to what would have been the distribution of infections by year, we estimated that over 320 000 persons were infected during the epidemic. Little is known about the epidemiology of VL in urban areas, where social networks, population density, and relationships of housing with the natural environment are more varied and complex than in the rural scene. In those areas, control interventions have failed to eliminate transmission of the parasite and prevent new epidemics. Further epidemiological studies of VL in urban areas might be needed to inform control actions.