ABSTRACT
BACKGROUND Costa Rica has a history of neglecting prevention, control and research of leishmaniasis, including limited understanding on Leishmania species causing human disease across the country and a complete lack of knowledge on the Leishmania RNA virus, described as a factor linked to the worsening and metastasis of leishmanial lesions. OBJECTIVES The aim of this work was to describe a case of cutaneous leishmaniasis by Leishmania (Viannia) guyanensis, bearing infection with Leishmaniavirus 1 (LRV1) in Costa Rica, raising the suspicion of imported parasites in the region. METHODS The Leishmania strain was previously identified by routine hsp70 polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in Costa Rica and subsequently characterised by isoenzyme electrophoresis and Sanger sequencing in Brazil. Screening for LRV1 was conducted with a dual RT-PCR approach and sequencing of the fragment obtained. FINDINGS Since 2016 Costa Rica performs Leishmania isolation and typing as part of its epidemiological surveillance activities. Amongst 113 strains typed until 2019, only one was characterised as a L. (V.) guyanensis, corresponding to the first confirmed report of this species in the country. Interestingly, the same strain tested positive for LRV1. Sequencing of the viral orf1 and 2, clustered this sample with other LRV1 genotypes of South American origin, from the Northeast of Brazil and French Guiana. MAIN CONCLUSION The unique characteristics of this finding raised the suspicion that it was not an autochthonous strain. Notwithstanding its presumed origin, this report points to the occurrence of said endosymbiont in Central American Leishmania strains. The possibility of its local dispersion represents one more challenge faced by regional health authorities in preventing and controlling leishmaniasis.
ABSTRACT
Resumen El objetivo de esta investigación fue describir el estado actual de la leishmaniosis en Costa Rica, profundizar en las diferentes manifestaciones clínicas y en las especies identificadas a la fecha causantes de la enfermedad, para recomendar tratamientos de acuerdo con estas, así como describir su comportamiento epidemiológico con el propósito de recomendar estrategias de prevención y control en los grupos identificados. Como fuentes de información se utilizaron la base de datos del Registro Colectivo del Ministerio de Salud de Costa Rica, de 2011 a 2016 y las estimaciones de población del Instituto Nacional de Estadísticas y Censos. La incidencia promedio de leishmaniosis en el trienio 2005-07 fue de 35,5 casos por 100 000 y pasó a 30,5 en el trienio 2014-16. Los grupos más afectados fueron los menores de 15 años con: 44,42 casos por cien mil. En San Ramón, Guatuso, Turrialba y Talamanca las tasas de incidencia superan la tasa de incidencia promedio.
Abstract The purpose of the present research was to describe the different species of Leishmania sp. in Costa Rica so as to recommend specific treatment; also, we wish to describe the epidemiological behavior of the different species in order to suggest prevention and control strategies. Our sources were Collective Registry Data of the Ministry of Health estimates (2011 to 2016) and population data from the National Institute of Statistics and the Census. The average incidence rate from 2005 through 2007 was 35.5 cases per 100,000; the rate went down to 30.5 during the years 2011 through 2016. The most affected age group were those younger than 15 years with a rate of 44.42 per 100,000. Since 2005, the areas in which incidence rates are higher than the average national incidence rate are: San Ramón, Guatuso, Turrialba and Talamanca. Management must be carried out according to: the identified species of the parasite and also according to the experience of experts in Costa Rica. Prevention must be directed to the identified risk groups.