Impacto del aislamiento social por COVID-19 en niños y niñas con trastornos del espectro autista y sus familias en la provincia de Misiones / Impact of social isolation by COVID-19 on children with autism spectrum disorders and their families in the province of Misiones

RESUMEN INTRODUCCIÓN El trastorno del espectro autista (TEA) se caracteriza por alteraciones en la comunicación y patrones restrictivos del comportamiento. El Aislamiento Social, Preventivo y Obligatorio (ASPO) en Argentina generó cambios en las dinámicas familiares de personas con TEA. El objetivo del estudio fue describir el impacto del ASPO en el acompañamiento de niños/as con TEA. MÉTODOS Se creó un instrumento específico de diseño mixto, con implementación de encuestas virtuales a familiares de personas con TEA. RESULTADOS Las 66 encuestas obtenidas revelaron ventajas, tales como la posibilidad de compartir tiempo en familia y conocer las necesidades de las/os hijas/os, el establecimiento de un ambiente con estímulos adecuados y ausencia de distractores, y la enseñanza con ritmos de aprendizaje y contenidos ajustados a las necesidades de niños/as con TEA. También se encontraron dificultades para la socialización: surgimiento de comportamientos no adaptativos (crisis, ansiedad, agresividad), barreras en la comunicación entre docentes y familias, imposibilidad de acceder a terapias y obstáculos para acceder a terapias virtuales. DISCUSIÓN El ASPO incidió en la vida cotidiana de las personas con TEA, de manera similar a lo observado en otras latitudes. A partir de lo experimentado durante el ASPO se proponen estrategias contextualizadas a la situación de pandemia actual y a potenciales escenarios similares.

ABSTRACT INTRODUCTION Autism spectrum disorder (ASD) is characterized by alterations in communication and restrictive behavior patterns. The Social, Preventive and Compulsory Isolation in Argentina changed family dynamics of people with ASD. The objective of this study was to describe the impact of isolation on accompanying children with ASD. METHODS A specific instrument of mixed design was created by conducting virtual surveys to relatives of ASD children. RESULTS The 66 surveys included in the study revealed advantages, such as the possibility of sharing family time and recognizing children's needs, environment with adequate stimuli and without distractors as well as teaching according to learning pace and content adjusted to ASD children. They also found difficulties in socialization: emergence of non-adaptive behaviors (crisis, anxiety, aggressiveness), communication barriers between teachers and families, therapy inaccessibility and obstacles to access to online therapies. DISCUSSION The isolation affected ASD people's daily life, similarly as in other countries. Based on the experiences during the isolation, strategies are proposed within the framework of the current pandemic situation and for potential similar scenarios.

Interacción entre los determinantes medioambientales y socioeconómicos para el riesgo para leishmaniasis cutánea en América Latina / Interaction among environmental and socioeconomic determinants of risk for cutaneous leishmaniasis in Latin America / Interação entre os determinantes ambientais e socioeconômicos para o risco de leishmaniose cutânea na América Latina

RESUMEN Objetivo. Determinar y caracterizar áreas de riesgo potencial de la ocurrencia de leishmaniasis cutánea (LC) en América Latina (AL). Método. Estudio observacional ecológico con unidades de observación definidas por municipios con transmisión de LC entre 2014-2018. Se utilizaron variables medioambientales y socioeconómicas disponibles para al menos 85% de los municipios, combinados en una sola base de datos, a través del software R. Se combinó la metodología de análisis de componentes principales con un análisis de conglomerados jerárquicos para la formación de conglomerados de municipios en función de su similitud. Se estimó el V-test para definir la asociación positiva o negativa de las variables con los conglomerados y separación por divisiones naturales para determinar cuáles contribuyeron más a cada conglomerado. Se incorporaron los casos para atribuir el riesgo de LC para cada conglomerado. Resultados. Se incluyeron en el estudio 4 951 municipios con transmisión de LC (36,5% del total en AL) y se definieron siete conglomerados por su asociación con 18 variables medioambientales y socioeconómicas. El riesgo histórico de LC se asocia de manera positiva y en forma decreciente con los conglomerados Amazónico, Andino y Sabana; y de manera negativa con los conglomerados Boscoso/perenne, Boscoso/cultivo y Boscoso/poblado. El conglomerado Agrícola no reveló ninguna asociación con los casos de LC. Conclusiones. El estudio permitió identificar y caracterizar el riesgo de LC por conglomerados de municipios y conocer el patrón propio epidemiológico de distribución de la transmisión, lo que proporciona a los gestores una mejor información para las intervenciones intersectoriales para el control de la LC.

ABSTRACT Objective. Determine and characterize areas at potential risk for the occurrence of cutaneous leishmaniasis (CL) in Latin America. Method. Ecological observational study with observation units defined by municipalities with CL transmission during 2014-2018. Environmental and socioeconomic variables available for at least 85% of municipalities were combined in a single database, using R software. Principal component analysis was combined with hierarchical cluster analysis for the formation of clusters of municipalities according to their similarity. The V-test was used to define positive or negative association of variables with clusters and separation by natural divisions to determine which contributed more to each cluster. Cases were included to attribute CL risk for each cluster. Results. The study included 4 951 municipalities with CL transmission (36.5% of municipalities in Latin America); seven clusters were defined by their association with 18 environmental and socioeconomic variables. Historical risk of CL is associated positively and in descending order with the Amazonian, Andean, and Savanna clusters; and negatively with the Forest/perennial, Forest/cultivated, and Forest/populated clusters. The Agricultural cluster showed no association with CL cases. Conclusions. The study made it possible to identify and characterize CL risk by clusters of municipalities and to understand the characteristic epidemiological distribution patterns of transmission, providing program managers with better information for intersectoral interventions to control CL.

RESUMO Objetivo. Determinar e caracterizar as áreas de risco de ocorrência de leishmaniose cutânea na América Latina. Método. Estudo observacional ecológico com unidades de observação definidas por municípios com transmissão de leishmaniose cutânea entre 2014 e 2018. Foram usadas as variáveis ambientais e socioeconômicas disponíveis em 85% ou mais dos municípios, reunidas em uma única base de dados com o uso do software R. A metodologia de análise de componentes principais foi combinada a uma análise de conglomerados com agrupamento hierárquico para formar conglomerados de municípios por semelhança. O teste V foi usado para estabelecer a associação (positiva ou negativa) das variáveis com os conglomerados e uma separação por divisões naturais foi usada para determinar as variáveis que mais contribuíram em cada conglomerado. Os casos foram incluídos para avaliar o risco de leishmaniose cutânea em cada conglomerado. Resultados. A amostra do estudo compreendeu 4.951 municípios com transmissão de leishmaniose cutânea (36,5% do total na América Latina). Foram definidos sete conglomerados por apresentarem associação com 18 variáveis ambientais e socioeconômicas. Foi observada associação positiva e decrescente do risco histórico de leishmaniose cutânea com os conglomerados Amazônico, Andino e Savana e negativa com os conglomerados Mata/perene, Mata/cultivo e Mata/povoado. O conglomerado Agrícola não demonstrou associação com casos de leishmaniose cutânea. Conclusões. Este estudo permitiu identificar e caracterizar o risco de leishmaniose cutânea por conglomerados de municípios e conhecer o padrão epidemiológico de distribuição da transmissão da doença, oferecendo às autoridades dados melhores para subsidiar as intervenções intersetoriais para o controle da leishmaniose cutânea.

Lutzomyia longipalpis (Diptera: Psychodidae) Argentina-Bolivia border: new report and genetic diversity

American visceral leishmaniasis (AVL) has two main scenarios of transmission as follows: scattered cases in rural areas and urban outbreaks. Urban AVL is in active dispersion from the northeastern border of Argentina-Paraguay-Brazil to the South. The presence of Lutzomyia longipalpis was initially reported in urban environments in the northwestern border of the country. The presence of Lu. longipalpis, environmental variables associated with its distribution, and its genetic diversity were assessed in Salvador Mazza, Argentina, on the border with Bolivia. The genetic analysis showed high haplotype diversity, low nucleotide diversity, and low nucleotide polymorphism index. We discuss the hypothesis of an expanding urban population with introgressive hybridisation of older haplogroups found in their path in natural forest or rural environments, acquiring a new adaptability to urban environments, and the possibility of changes in vector capacity.

Respuesta doméstica a las recomendaciones sanitarias de intervención sobre ambiente y perros en una localidad con transmisión de leishmaniasis visceral (Pto. Iguazú, Argentina, 2014­2016) / Domestic response to intervention based on health recommendations on the environment and dogs in a locality with transmission of visceral leishmaniosis (Pto. Iguazú, Argentina, 2014-2016)

Introducción: La leishmaniasis visceral (LV) es una enfermedad parasitaria emergente en Argentina. En Puerto Iguazú, frontera con Brasil y Paraguay, en 2010 se registró presencia del vector y casos caninos; y en 2014-2015 dos casos humanos. Objetivo: Este artículo tiene como objetivo analizar los cambios en el nivel micro escala después de dar a conocer a los convivientes el diagnóstico de LV canina (LVC), informándoles estrategias de manejo ambiental para reducir el contacto con el vector. Método: Es una investigación descriptiva, que indagó en dos momentos (2014 y 2016) una muestra no probabilística distribuida en base al criterio de mejor escenario para la presencia del vector (n = 55) en la que se seleccionaron, luego de un primer rastrillaje entomológico y de diagnóstico veterinario, puntos de muestreo con presencia de vectores y al menos un perro con LVC (n = 6/55). Resultados: Un único hogar implementó las modificaciones sugeridas. Esos cambios no resultaron suficientes para controlar la transmisión. La hipótesis es que las medidas de control requieren intervención a meso escala (el vecindario y no el domicilio), atendiendo al radio real de dispersión de vectores. Conclusiones: El riesgo de infección humana por LV se relaciona con el modo de vida, incluyendo las relaciones interespecie. Las relaciones humano-perro combinan especismo y poshumanismo, acotando la efectividad de la "tenencia responsable" como modelo de vínculo saludable.

Introduction: Visceral leishmaniasis (VL) is an emerging parasitic disease in Argentina. In Puerto Iguazú, border with Brazil and Paraguay, vector and canine cases were registered in 2010; and in 2014 and 2015 there were two human cases. Objective: The objective of this article is to analyze changes at the micro-scale level after informing the cohabitants of the diagnosis of canine LV (LVC), letting them know the environmental management strategies to reduce contact with the vector. Method: It is a descriptive researh, which investigated in two moments (2014 and 2016) a non-probabilistic sample distributed based on the criterion of the best scenario for the presence of the vector (n = 55). Sampling points with the presence of vectors and at least one dog with LVC (n = 6/55) were selected, after a first entomological and veterinary diagnosis raking. Results: A single household implemented the suggested modifications. The changes were not enough to control the transmission. The hypothesis is that the control measures require intervention at a meso-scale (the neighborhood instead of the home), taking into account the real radius of vector dispersion. Conclusions: The risk of human infection due to VL is related to the way of life, including interspecies relationships. The human-dog relationships combine speciesism and post-humanism, which limits the effectiveness of "responsible ownership" as model of a healthy bond.

Addressing the recent dispersion of urban visceral leishmaniasis in the border of Argentina, Brazil, Paraguay + Uruguay + Bolivia ­ Project IDRC

The territory located in the border of Argentina, Brazil and Paraguay is endemic for tegumentary leishmaniasis (TL). However, Lutzomyia longipalpis first report in the area was in 2010-Argentina, in 2012-Brazil, and no records in the Paraguayan border despite of reports of human visceral leishmaniasis (VL) cases. Therefore, we developed a research from 2014 to 2017 to study VL in the three-country border at locality level; Uruguay-2015, and Bolivia-2016 joined latter due to the alerts of VL in the Argentinean borders. The space-time distributions of vectors, infected dogs and environmental variables were recorded and associated at three progressive scales, while anthropological surveys were performed. Three scenarios were characterized based on canine VL prevalence, vector presence-abundance and the spatial distribution consistency between them: settled VL, incipient VL, and steady TL with imported canine VL. The vector abundance was clustered in 'hot spots' persistent in time that could act as 'source populations'. The clustering distribution was associated with environmental variables at the different scales studied. Therefore, the vector distribution (proxy of human-dog exposure) could be modeled in recent southern scenarios to focus the surveillance and interventions on predicted 'hot spots', in order to increase the effectiveness and efficiency of program activities. (AU)

O território localizado na fronteira da Argentina, Brasil e Paraguai é endêmico para leishmaniose tegumentar (LT). Entretanto, o primeiro relato de Lutzomyia longipalpis na área foi em 2010-Argentina, em 2012-Brasil, sem registros na fronteira em Paraguai apesar dos casos de leishmaniose visceral humana (LV). Portanto, desenvolvemos uma pesquisa de 2014 a 2017 para estudar a LV na tríplice fronteira em nível de localidades; Uruguai-2015 e Bolívia-2016 aderiram mais tarde devido aos alertas de LV nas fronteiras argentinas. As distribuições espaço-temporais de vetores, cães infectados e as variáveis ambientais foram registradas e associadas em três escalas progressivas, enquanto se realizou o inquérito antropológico. Três cenários foram caracterizados com base na prevalência de LV canina, na abundância-presença de vetores, e a coerência da distribuição espacial entre eles: LV instalada, LV incipiente e LT estável com LV canina importada. A abundância de vetores foi agrupada em "pontos quentes" persistentes no tempo que poderiam atuar como "populações fonte". A distribuição de agrupamento foi associada a variáveis ambientais nas diferentes escalas. Portanto, a distribuição vetorial (proxy da exposição humana a cães) poderia ser modelada em cenários recentes do sul para focar a vigilância e as intervenções nos "pontos quentes" previstos, a fim de aumentar a eficácia e a eficiência das atividades do programa. (AU)

Addressing the recent dispersion of urban visceral leishmaniasis in the border of Argentina, Brazil, Paraguay + Uruguay + Bolivia – Project IDRC / Abordando a recente dispersão da leishmaniose visceral urbana nas fronteiras da Argentina, Brasil e Paraguai + Uruguai + Bolívia - Projeto IDRC

The territory located in the border of Argentina, Brazil and Paraguay is endemic for tegumentary leishmaniasis (TL). However, Lutzomyia longipalpis first report in the area was in 2010-Argentina, in 2012-Brazil, and no records in the Paraguayan border despite of reports of human visceral leishmaniasis (VL) cases. Therefore, we developed a research from 2014 to 2017 to study VL in the three-country border at locality level; Uruguay-2015, and Bolivia-2016 joined latter due to the alerts of VL in the Argentinean borders. The space-time distributions of vectors, infected dogs and environmental variables were recorded and associated at three progressive scales, while anthropological surveys were performed. Three scenarios were characterized based on canine VL prevalence, vector presence-abundance and the spatial distribution consistency between them: settled VL, incipient VL, and steady TL with imported canine VL. The vector abundance was clustered in ‘hot spots’ persistent in time that could act as ‘source populations’. The clustering distribution was associated with environmental variables at the different scales studied. Therefore, the vector distribution (proxy of human-dog exposure) could be modeled in recent southern scenarios to focus the surveillance and interventions on predicted ‘hot spots’, in order to increase the effectiveness and efficiency of program activities.

O território localizado na fronteira da Argentina, Brasil e Paraguai é endêmico para leishmaniose tegumentar (LT). Entretanto, o primeiro relato de Lutzomyia longipalpis na área foi em 2010-Argentina, em 2012-Brasil, sem registros na fronteira em Paraguai apesar dos casos de leishmaniose visceral humana (LV). Portanto, desenvolvemos uma pesquisa de 2014 a 2017 para estudar a LV na tríplice fronteira em nível de localidades; Uruguai-2015 e Bolívia-2016 aderiram mais tarde devido aos alertas de LV nas fronteiras argentinas. As distribuições espaço-temporais de vetores, cães infectados e as variáveis ambientais foram registradas e associadas em três escalas progressivas, enquanto se realizou o inquérito antropológico. Três cenários foram caracterizados com base na prevalência de LV canina, na abundância-presença de vetores, e a coerência da distribuição espacial entre eles: LV instalada, LV incipiente e LT estável com LV canina importada. A abundância de vetores foi agrupada em “pontos quentes” persistentes no tempo que poderiam atuar como “populações fonte”. A distribuição de agrupamento foi associada a variáveis ambientais nas diferentes escalas. Portanto, a distribuição vetorial (proxy da exposição humana a cães) poderia ser modelada em cenários recentes do sul para focar a vigilância e as intervenções nos “pontos quentes” previstos, a fim de aumentar a eficácia e a eficiência das atividades do programa.

Environmental suitability for Lutzomyia longipalpis in a subtropical city with a recently established visceral leishmaniasis transmission cycle, Argentina

BACKGROUND Visceral leishmaniasis (VL) is an endemic disease in northeastern Argentina including the Corrientes province, where the presence of the vector and canine cases of VL were recently confirmed in December 2008. OBJECTIVES The objective of this study was to assess the modelling of micro- and macro-habitat variables to evaluate the urban environmental suitability for the spatial distribution of Lutzomyia longipalpis presence and abundance in an urban scenario. METHODS Sampling of 45 sites distributed throughout Corrientes city (Argentina) was carried out using REDILA-BL minilight traps in December 2013. The sampled specimens were identified according to methods described by Galati (2003). The analysis of variables derived from the processing of satellite images (macro-habitat variables) and from the entomological sampling and surveys (micro-habitat variables) was performed using the statistical software R. Three generalised linear models were constructed composed of micro- and macro-habitat variables to explain the spatial distribution of the abundance of Lu. longipalpis and one composed of micro-habitat variables to explain the occurrence of the vector. FINDINGS A total of 609 phlebotominae belonging to five species were collected, of which 56% were Lu. longipalpis. In addition, the presence of Nyssomyia neivai and Migonemya migonei, which are vectors of tegumentary leishmaniasis, were also documented and represented 34.81% and 6.74% of the collections, respectively. The explanatory variable normalised difference vegetation index (NDVI) described the abundance distribution, whereas the presence of farmyard animals was important for explaining both the abundance and the occurrence of the vector. MAIN CONCLUSIONS The results contribute to the identification of variables that can be used to establish priority areas for entomological surveillance and provide an efficient transfer tool for the control and prevention of vector-borne diseases.

Factores de riesgo, representaciones y prácticas asociadas con la leishmaniasis visceral humana en un foco urbano emergente en Posadas, Argentina / Risk factors, representations and practices associated with emerging urban human visceral leishmaniasis in Posadas, Argentina

Introducción. La leishmaniasis visceral es una enfermedad desatendida de alta letalidad que amerita que se profundice en los estudios locales para diseñar estrategias efectivas de control. En América, su transmisión ya se ha evidenciado en las zonas urbanas, en donde el reservorio principal es el perro doméstico. Las condiciones socioeconómicas, así como las representaciones y las prácticas de los grupos domésticos podrían desempeñar un papel crucial y poco conocido en su transmisión. Objetivo. Analizar las representaciones y las prácticas de prevención y afrontamiento de la leishmaniasis visceral humana y canina, así como los factores socioeconómicos de riesgo. Materiales y métodos. Se hizo un estudio transversal de casos y controles. Se definió´caso´ como un grupo doméstico en el que, al menos, un integrante tuviera antecedentes de leishmaniasis visceral humana y hubiera sido notificado por el Ministerio de Salud Pública. El´control´ se definió como un grupo doméstico sin integrantes con antecedentes de la enfermedad. A partir de la información primaria, se caracterizó demográfica y socialmente a la población, se estableció la calidad de las viviendas, se hizo una clasificación de los conocimientos y las actitudes en torno a la enfermedad, y se describieron las prácticas asociadas al riesgo y la presencia de leishmaniasis visceral canina. Resultados. La mala calidad de la vivienda (p=0,001), las personas del grupo doméstico que permanecían fuera de esta después de las 18 horas (razón de momios, OR ( odds ratio) =4,5; IC 95% 1,69-12,18), la reproducción sin control de la raza canina (OR=15,7; IC 95% 3,91-63,2) y la presencia de leishmaniasis visceral canina en el domicilio (OR=120,3; IC 95% 18,51-728,3), se asociaron positivamente o incrementaron el riesgo de contraer leishmaniasis visceral humana. Conclusión. Se observó que la pobreza estructural constituía un factor social determinante del riesgo, y que aumentaba la probabilidad de contacto entre humanos y vectores por la mala calidad de la vivienda y el hacinamiento. El factor de riesgo más importante para la leishmaniasis visceral humana fue la tenencia en el domicilio de perros con la enfermedad.

Introduction: Visceral leishmaniasis is an often overlooked disease with high lethality rates about which there is need of additional local studies to inform the design of effective control strategies. The urbanization of its transmission has already been verified in America, with domestic dogs being the primary reservoirs and vectors of the disease. Socio-economic conditions, demographics and practices of domestic groups typically present in urban settings may play a specific role in the transmission of the infection, which is still poorly understood. Objective: To analyze the sociodemographic characteristics, risk factors and overall practices concerning prevention and coping strategies of visceral leishmaniasis, in both human beings and canines. Materials and methods: This study utilized a cross-sectional case-control design. Cases were defined as a domestic group where the Public Health Ministry had at least one record of a member with human visceral leishmaniasis. Control cases were defined as a domestic group without a clinical record of the disease. The populations were characterized demographically and socially using primary information sources. Measures of household quality and a ranking of knowledge and attitudes towards visceral leishmaniasis were constructed, and practices associated with the presence, and the risk for canine visceral leishmaniasis were described. Results: Low household quality (p=0.001), a member of the domestic group out of the household after 6:00 pm (OR=4.4; 95% CI: 1.69-12.18), the uncontrolled racial breeding of dogs (OR=15.7; 95% CI: 3.91-63.2), and the presence of infected dogs infected in the household (OR=120.3; 95% CI: 18.51-728.3) were variables positively associated with the risk of infection. Conclusion: We observed certain social risk factors, primarily low household quality and overcrowding, associated with structural poverty that could increase human-vector contact probability. The most important risk factor for human visceral leishmaniasis was the possession of infected dogs in the household.

Conocimiento, percepción y actitud sobre la enfermedad de chagas en un centro de referencia urbano / Knowledge, attitude and perception of Chagas disease in an urban center of reference

La tendencia para las próximas décadas de la enfermedad de Chagas (ECh) es la dispersión hacia los centros urbanos. El objetivo de este trabajo fue explorar, a partir de una encuesta semiestrucuturada, conocimientos, actitudes y percepción de la ECh en 153 adultos que asistieron al Instituto Nacional de Parasitología entre marzo a octubre de 2004 para confirmación de su diagnóstico. Se identificó en el 66% de la población un conocimiento básico relacionado al vector y las afecciones cardíacas. El 62% consideró a la ECh grave y una vez conocido el diagnóstico el 80% buscó asesoramiento. El 84% no se consideró incapacitado, pero al tratar de ingresar a trabajos formales encontraron dificultades para su inserción. Cuando se les propuso sugerir propuestas de mejoramiento el 56% destacó la importancia sobre nuevos tratamientos, información y la visibilidad de la ECh. Este trabajo revela un conocimiento limitado, una percepción de gravedad de la ECh y por lo tanto una buena disposición para desarrollar acciones de apoyo, educativas, y de prevención en esta población.

Lutzomyia longipalpis urbanisation and control

Since the description of Lutzomyia longipalpis by Lutz and Neiva more than 100 years ago, much has been written in the scientific literature about this phlebotomine species. Soares and Turco (2003) and Lainson and Rangel (2005) have written extensive reviews focused on vector-host-parasite interactions and American visceral leishmaniasis ecology. However, during the last two decades, the success of Lu. longipalpis in colonising urban environments and its simultaneous geographical spreading have led to new theoretical and operational questions. Therefore, this review updates the general information about this species and notes the more challenging topics regarding the new scenario of urbanisation-spreading and its control in America. Here, we summarise the literature on these issues and the remaining unsolved questions, which pose recommendations for operational research.

Incipient colonisation of Lutzomyia longipalpis in the city of Resistencia, province of Chaco, Argentina (2010-2012)

Lutzomyia longipalpis was recorded for the first time in Argentina in 2004, in the province of Formosa. In the following years, the vector spread to the south and west in the country and was recorded in the province of Chaco in 2010. From November 2010-May 2012, captures of Phlebotominae were made in the city of Resistencia and its surroundings, to monitor the spread and possible colonisation of Lu. longipalpis in the province of Chaco. In this monitoring, Lu. longipalpis was absent in urban sampling sites and its presence was restricted to Barrio de los Pescadores. This suggests that the incipient colonisation observed in 2010 was not followed by continuous installation of vector populations and expansion of their spatial distribution as in other urban centres of Argentina.

Cost-effectiveness of prevention strategies for American tegumentary leishmaniasis in Argentina / Custo-efetividade de estratégias de prevenção contra a leishmaniose tegumentar americana na Argentina / Coste-efectividad de estrategias de prevención contra la leishmaniasis tegumentaria americana en Argentina

The aim of this study was to estimate the cost-effectiveness of reducing tegumentary leishmaniasis transmission using insecticide-impregnated clothing and curtains, and implementing training programs for early diagnosis. A societal perspective was adopted, with outcomes assessed in terms of costs per disability adjusted life years (DALY). Simulation was structured as a Markov model and costs were expressed in American dollars (US$). The incremental cost-effectiveness ratio of each strategy was calculated. One-way and multivariate sensitivity analyses were performed. The incremental cost-effectiveness ratio for early diagnosis strategy was estimated at US$ 156.46 per DALY averted, while that of prevention of transmission with insecticide-impregnated curtains and clothing was US$ 13,155.52 per DALY averted. Both strategies were more sensitive to the natural incidence of leishmaniasis, to the effectiveness of mucocutaneous leishmaniasis treatment and to the cost of each strategy. Prevention of vectorial transmission and early diagnosis have proved to be cost-effective measures.

O objetivo deste estudo foi estimar o custo-efetividade para reduzir a transmissão da leishmaniose tegumentar americana, utilizando roupas e cortinas impregnadas com inseticidas e implementando programas de treinamento para o diagnóstico precoce. Adotou-se uma perspectiva social, usando os anos de vida ajustados por incapacidade (AVAI). Estruturou-se uma simulação com o modelo de Markov. Os custos foram expressos em US$. A taxa de custo-efetividade incremental foi calculada para cada estratégia. Foi desenvolvida análise de sensibilidade, uni e multivariada. A taxa de custo- efetividade incremental para o diagnóstico precoce foi estimada em US$ 156,46 por AVAI evitado, enquanto a taxa para prevenção com roupas e cortinas impregnadas foi de US$ 13.155,53 por AVAI evitado. Ambas as estratégias foram mais sensíveis à incidência natural de leishmaniose, à efetividade do tratamento contra a leishmaniose mucocutânea e ao custo de cada estratégia. A prevenção da transmissão vetorial e o diagnóstico precoce provaram ser medidas custo-efetivos.

El objetivo de este estudio fue estimar el coste-efectividad de reducir la transmisión de la leishmaniasis tegumentaria americana utilizando ropas y cortinas impregnadas con insecticidas, e implementando programas de entrenamiento para el diagnostico temprano. Se adoptó una perspectiva social, utilizando los años de vida ajustados por discapacidad (AVAD). Se estructuró una simulación con un modelo de Markov. Los costes fueron expresados en dólares americanos (US$). La razón de coste-efectividad incremental fue calculada para cada estrategia. Se desarrollaron análisis de sensibilidad de una vía y multivariados. La razón de coste-efectividad incremental para el diagnóstico temprano fue estimada en US$ 156,46 por AVAD evitado, mientras que la razón de coste-efectividad incremental para la prevención con ropa y cortinas impregnadas fue de US$ 13.155,52 por AVAD evitado. Ambas estrategias fueron más sensibles a la incidencia natural de leishmaniasis, a la efectividad del tratamiento contra leishmaniasis mucosa y al coste de cada estrategia. La prevención de la transmisión vectorial y el diagnóstico temprano han probado ser medidas coste-efectivas.

Spatial and temporal changes in Lutzomyia longipalpis abundance, a Leishmania infantum vector in an urban area in northeastern Argentina

This study aimed to analyse changes in the spatial distribution of Lutzomyia longipalpis in Posadas, an urban area located in northeastern Argentina. Data were obtained during the summer of 2007 and 2009 through two entomological surveys of peridomiciles distributed around the city. The abundance distribution pattern for 2009 was computed and compared with the previous pattern obtained in 2007, when the first human visceral leishmaniasis cases were reported in the city. Vector abundance was also examined in relation to micro and macrohabitat characteristics. In 2007 and 2009, Lu. longipalpis was distributed among 41.5% and 31% of the households in the study area, respectively. In both years, the abundance rates at most of the trapping sites were below 30 Lu. longipalpis per trap per night; however, for areas exhibiting 30-60 Lu. longipalpis and more than 60 Lu. longipalpis, the areas increased in both size and number from 2007-2009. Lu. longipalpis was more abundant in areas with a higher tree and bush cover (a macrohabitat characteristic) and in peridomiciles with accumulated unused material (a microhabitat characteristic). These results will help to prioritise and focus control efforts by defining which peridomiciles display a potentially high abundance of Lu. longipalpis. .

Spatial distribttion of phlebotominae in puertoiguazu-misiones, Argentina-Brazzil-Paraguay border aeaa / Distribuicao espacial de Phlebotominae em Puerto Iguazu, Misiones, area de fronteira da Argentina-Brasil-Paraguai

SUMMARY The first Argentinian autochthonous human case of visceral leishmaniasis (VL) was confirmed in Posadas (Misiones) in 2006. Since then, the disease has increased its incidence and geographical distribution. In the 2006-2012 period, 107 human cases were detected (11 deaths). The presence of Lutzomyia longipalpis was detected in peridomiciles in Puerto Iguazú urban area in 2010; some of these findings were associated with households where cases of canine VL had already been reported. The objective of this study was to ascertain the abundance and spatial distribution of Lu. longipalpis in Puerto Iguazú City, on the Argentina-Brazil-Paraguay border. Lu. longipalpis proved to be exclusively urban and was found in 31% of the households sampled (n = 53), 67% of which belonged to areas of low abundance, 20% to areas of moderate abundance and 13% to areas of high abundance. Nyssomyia whitmani was the only species found both in urban and peri-urban environments, and Migonemyia migonei was registered only on the outskirts of the city. Due to the fact that Puerto Iguazú is considered to be at moderate risk at the moment, it is necessary to intensify human and canine case controls, as well as take integrated prevention and control measures regarding the environment, vectors and reservoirs on the Argentina-Brazil-Paraguay border area. .

RESUMO O primeiro caso humano autóctone de leishmaniose visceral (LV) na Argentina ocorreu na cidade de Posadas (Misiones) em 2006, desde então, tem ocorrido um aumento na incidência e distribuição geográfica da doença. No período entre 2006 e 2012 foram detectados 107 casos humanos com 11 mortes. Em 2010 se constatou a presença de Lutzomyia longipalpis no município de Puerto Iguazú, localizado na fronteira entre Argentina-Brasil-Paraguai. O presente estudo teve como objetivo investigar a abundância e distribuição de Lu. longipalpis no município de Puerto Iguazú. Lu. longipalpis foi encontrada exclusivamente na área urbana, em 31% das amostras coletadas dos domicílios de referência (n = 53), 67% das quais pertenciam às áreas de baixa abundância, 20% às de moderada e 13% às de alta abundância da espécie. Nyssomyia whitmani foi coletado em ambientes urbanos e periurbanos e Migonemyia migonei, somente nas periferias da cidade. Na atualidade, a cidade de Puerto Iguazú é considerada como de risco moderado; por isso, é necessário intensificar o controle tanto de casos humanos como de caninos e levar em conta as medidas de prevenção e controle do ambiente, dos vetores e dos reservatórios na zona de fronteira Argentina-Brasil-Paraguai. .

Leishmaniasis visceral: senderos que confluyen, se bifurcan / Visceral leishmaniasis: paths that converge and divide

La leishmaniasis visceral urbana es una zoonosis emergente en Argentina. En América es producida por Leishmania infantum, con el perro como reservorio principal e insectos flebotomíneos como vectores. En este artículo se presenta el conocimiento acumulado a partir de su emergencia y dispersión en el país, por los referentes del Programa Nacional de Leishmaniasis, en el diagnóstico clínico y de laboratorio, tratamiento, biología de vectores, manejo de reservorio, y el conflicto generado con las acciones recomendadas en relación con los perros infectados. La detección temprana y el tratamiento precoz, con estrategias descentralizadas y horizontales, contribuirán a disminuir la morbimortalidad asociada a la leishmaniasis visceral. El control de su transmisión y dispersión requiere de un manejo ambiental integral y la tenencia responsable de perros. Se discuten los intereses y discursos en conflicto generados por la leishmaniasis visceral en el marco de la relación humano-perro, proponiendo la búsqueda de un discurso consensuado de riesgo.

Urban visceral leishmaniasis is an emerging zoonosis in Argentina. In the Americas the disease is produced by Leishmania infantum, with dogs as the primary reservoir and phlebotomine sandflies as the vectors. This article presents the experience acquired by professionals from the National Leishmaniasis Program in Argentina as visceral leishmaniasis has emerged and spread, especially in clinical and laboratory diagnosis, disease treatment, vector biology, reservoir management, and conflicts regarding recommendations for infected dogs. Early detection and treatment, along with decentralized and horizontal strategies, will contribute to the decrease in morbidity and mortality associated with visceral leishmaniasis. Control over the transmission and spread of the disease requires integral environmental management and responsible dog ownership. The interests and discourses put into conflict by visceral leishmaniasis are discussed in the framework of the human-dog relationship, and the search for a consensus-based risk discourse is proposed.

Lutzomyia longipalpis abundance in the city of Posadas, northeastern Argentina: variations at different spatial scales

The distribution of Lutzomyia longipalpis is heterogeneous with a pattern of high abundance areas (HAAs) embedded in a matrix of low abundance areas (LAAs). The objective of this study was to describe the variability in the abundance of Lu. longipalpis at two different spatial levels and to analyse the relationship between the abundance and multiple environmental variables. Of the environmental variables analysed in each household, the condition that best explained the differences in vector abundance between HAA-LAA was the variable "land_grass", with greater average values in the peridomestic environments within the LAA, and the variables "#sp tree", "#pots" and "dist_water" that were higher in the HAA. Of the environmental variables analysed in the patches, the variable "unpaved_streets" was higher in the LAAs and the variable "prop_inf_dogs" was higher in the HAAs. An understanding of the main environmental variables that influence the vector distribution could contribute to the development of strategies for the prevention and control of visceral leishmaniasis (VL). This is the first work in which environmental variables are analysed at the micro-scale in urban areas at the southern edge of the current range of Lu. longipalpis. Our results represent a significant contribution to the understanding of the abundance of the vector in the peridomestic habitats of the region.

Identification of the natural breeding sites of sandflies (Diptera: Psychodidae: Phlebotominae), potential vectors of leishmaniasis, in the province of Chaco, Argentina

The aim of this work was to identify the natural breeding sites of sandflies in the province of Chaco, Argentina, for the first time. Preliminary studies were conducted in two different phytogeographic regions: dry Chaco (Parque Provincial Pampa del Indio), in January 2010, and humid Chaco (Resistencia, Margarita Belén and Colonia Benítez), from May-September 2010. A total of 127 samples were collected (Pampa del Indio: 15, Resistencia: 37, Margarita Belén: 36, Colonia Benítez: 39). A female of Migonemyia migonei was found in Pampa del Indio at the base of a bromeliad in the summer (January) and a pupal exuvium of a phlebotomine fly was found in Resistencia, in a place where dogs rested, in the winter (July). These findings highlighted these two sites as potential breeding sites. Because the existence of potential natural breeding sites for sandflies has been demonstrated in both forest and periurban areas, expanding the search efforts and characterising these sites will enable the development of specific study designs to gain insight into the spatial distribution of the risks posed by these vectors. The resulting information will serve as a basis for proposing and evaluating vector control measures.

Hourly activity of Lutzomyia neivai in the endemic zone of cutaneous leishmaniasis in Tucumán, Argentina: preliminary results

In the present work, the hourly activity of Lutzomyia neivai was studied in the southern part of the province of Tucumán, Argentina, in an area of transmission of cutaneous leishmaniasis during two months of higher activity. In addition, the variables that influenced the abundance of Lu. neivai were evaluated. A total of 1,146 individuals belonging to Lu. neivai (97 percent) and Lutzomyia migonei (3 percent) were captured. The hourly activity of Lu. neivai was mainly nocturnal, with a bimodal pattern in both months. In January, the variable that most influenced the abundance of Lu. neivai was the temperature, whereas in April, that variable was humidity. These results may contribute to the design of anti-vectorial control measures at a micro-focal scale.

Lutzomyia longipalpis in Uruguay: the first report and the potential of visceral leishmaniasis transmission

Phlebotomine captures were performed in February 2010 in Salto (Salto department) and Bella Unión-Cuarein (Artigas department), Uruguay. Bella Unión is located across the Paraná River from Monte Caseros, Argentina, where a focus of canine visceral leishmaniasis (VL) was reported in 2009. No VL cases have ever been recorded in Uruguay and the last reported capture of Phlebotominae was in 1932 (Lutzomyia cortelezzii and Lutzomyia gaminarai). Light traps were placed in peridomestic environments, and Lutzomyia longipalpis, the main vector of visceral leishmaniasis, was found in Salto and Bella Unión. This is a first report of an area of potential VL transmission in Uruguay. Active and coordinated surveillance is required immediately the Uruguay-Argentina-Brazil border area.