Meglumine antimoniate intralesional infiltration for localised cutaneous leishmaniasis: a single arm, open label, phase II clinical trial

BACKGROUND Cutaneous leishmaniasis (CL) is a world-wide health problem which currently lacks effective, affordable and easy to use therapy. Recently, the meglumine antimoniate (MA) intralesional infiltration was included among the acceptable therapies for New World leishmaniasis. While this approach is attractive, there is currently little evidence to support its use in Americas. OBJECTIVES The aim of this study was to provide information about effectiveness and safety of a standardised MA intralesional infiltration technique for the treatment of CL. METHODS It is a single-arm phase II clinical trial conducted at a Brazilian referral centre. CL cases with parasitological confirmation presenting a maximum of three CL-compatible skin lesions were treated with weekly MA intralesional infiltration by using a validated technique, up to a maximum of eight infiltrations. RESULTS A total of 53 patients (62 lesions) were included. Overall, patients received a median of seven infiltrations (IQR25-75% 5-8) over a median treatment period of 43 days (IQR25-75% 28-52 days). The definitive cure rate at D180 was 87% (95% CI:77-96%). The majority of adverse events were local, with mild or moderate intensity. Bacterial secondary infection of the lesion site was observed in 13% of the treated patients, beside two intensity-three adverse events (hypersensitivity reactions).

Seasonality of sand flies (Diptera: Psychodidae) and Leishmania DNA detection in vector species in an area with endemic visceral leishmaniasis

BACKGROUND Leishmaniases are a serious health problem in southeast Brazil, including the city of Belo Horizonte (BH), Minas Gerais state (MG), where there are high rates of incidence and mortality due to visceral leishmaniases. BH is divided into nine sanitary districts (SD) of which one, the Venda Nova SD, was selected for this study because it has high rates of positivity for canine leishmaniasis and high incidence of human leishmaniasis. OBJECTIVES This study aimed to survey the sand fly fauna in Venda Nova SD from August 2011 to July 2013 and perform a descriptive analysis of the vector population. METHODS The sampling was carried out using automatic HP light traps at all covered areas of the Venda Nova SD, in a total of eighteen light traps. Sampled specimens were identified following Galati (2003), and females were submitted to molecular techniques for the detection and identification of Leishmania DNA. A simple environmental description was done for it area and Kernel estimation was used to infer vector density for each study site. FINDINGS A total of 2,427 sand fly specimens belonging to eight species and five genera were collected of which 95.3% were Lutzomyia longipalpis. The seasonal variation curve was delineated by this species. Lu. longipalpis was the most abundant at all collection points and in all months of the study, and exhibited a natural infection rate of 1.01% for Leishmania infantum and 1.77% for Leishmania braziliensis. MAIN CONCLUSIONS The results show the presence and adaptation of Lu. longipalpis to the anthropic environment of BH and reinforces its role as the main vector of L. infantum in the region.

Estudo populacional de flebotomíneos (Diptera: Psychodidae) no Município de Belo Horizonte e no Parque Estadual do Sumidouro – Minas Gerais - Brasil

O município de Belo Horizonte e sua região metropolitana ilustram o mais sério exemplo de expansão da leishmaniose visceral no sudeste do Brasil. O município e o parque Estadual do Sumidouro localizam-se no bioma cerrado, segundo maior bioma terrestre da América do Sul. Os objetivos deste projeto foram:estudar a variação sazonal da fauna flebotomínica no DS Venda Nova (Belo Horizonte) e no PES; descrever os padrões de riqueza e diversidade fauna flebotomínica nas formações vegetais do PES e no DS Venda Nova; determinar a taxa de infecção natural de fêmeas capturadas; estudar a variação morfológica das populações de Lu. longipalpis coletadas nos diferentes ambientes; avaliar os impactos das ações de controle realizadas no DS Venda Nova nas taxas de ocorrência sazonal e densidade das populações de flebotomíneos. Foram realizadas coletadas mensais no período de agosto de 2011 a agosto de 2013. Os insetos foram identificados de acordo com Galati 2003. As fêmeas coletadas não ingurgitadas foram submetidas à extração de DNA e reações de PCR e de PCR-RFLP para a averiguação da infecção natural por espécies de Leishmania. Para comparação das localidades de estudo foi utilizada análise descritiva e índices ecológicos. Para a comparação morfológica trinta casais (quinze proveniente do DS Venda Nova e quinze do PES) da espécie Lu. longipalpis foram medidos, e foram comparados tantos as médias como as variâncias dos caracteres entre os grupos.

As ações de controle da LV no DS Venda Nova realizadas nos período de janeiro de 2011 a dezembro de 2013 foram analisadas descritivamente e relacionadas à curva sazonal de Lu. longipalpis. A riqueza, a diversidade e a equitabilidade da fauna de flebotomíneos foram marcadamente diferentes entre o DS Venda Nova e o PES. Na área urbana foram coletados 2.247 espécimes pertencentes a cinco gêneros e oito espécies, a curva de acumulação de espécies atingiu a saturação na 19º amostragem. No DS Venda Nova a curva de variação sazonal foi delineada principalmente por Lu. longipalpis e 95,3% dos espécimes pertenciam a esta espécie.

Lu. longipalpis apresentou taxas de infecção natural de 1,01% para Leishmaniainfantum e 1,77% para Leishmaniabraziliensis. No PES foram coletados 4.675 espécimes pertencentes a cinco gêneros e 25 espécies e a curva de acumulação atingiu a saturação na 16º amostragem. No PES não houve uma única espécie que apresentasse padrão tão pronunciado de dominância. Lu. longipalpis correspondeu a 5,35% dos espécimes. Diversas espécies com envolvimento (suspeito ou comprovado) nos ciclos de LTA foram registradas. Uma fêmea do complexo cortellezzi apresentou detecção positiva para Le. braziliensis. A comparação morfométrica e de composição de feromônios indicou grande similaridade entre as duas populações de Lu. longipalpis avaliadas. A análise realizada para correlação das ações de controle com a variação sazonal de Lu. longipalpis indicam a necessidade de estudos pormenorizados para inferências mais robustas. Os resultados evidenciam a dominância da espécie Lu. longipalpis no ambiente urbano, e indicam que as mudanças antrópicas no cerrado podem alterar a composição das populações de flebotomineos e os ciclos de transmissão de patógenos aos humanos.

Biogeographical aspects of the occurrence of Nyssomyia neivai and Nyssomyia intermedia (Diptera: Psychodidae) in a sympatric area of the Brazilian savannah

Nyssomyia intermedia and Nyssomyia neivai constitute a species complex associated with Leishmania transmission. The aim of this study was to analyse the ecological profiles of the Ny. intermedia and Ny. neivai populations in a sympatric area in the Brazilian savannah along the banks of the Velhas River. Captures were performed from July 2003-June 2005 in two distinct environments: a gallery forest with various degrees of anthropogenic modification and animal shelters. A total of 20,508 Ny. neivai (86%) and Ny. intermedia (14%) sandflies were collected. The difference between the proportions of the sandflies that were collected (Ny. neivai/Ny. intermedia) per bank was significant. The right bank presented a greater number of sandflies (65%) and more preserved vegetation. The abundance of Ny. neivai was higher than that of Ny. intermedia on both banks. The results demonstrate that anthropic activities can affect the sandfly populations in this area, thereby leading to a reduction in species abundance. Nevertheless, the environments with higher levels of antropogenic modification displayed sandfly population numbers that favour the Leishmania transmission cycle.

The molecular detection of different Leishmania species within sand flies from a cutaneous and visceral leishmaniasis sympatric area in Southeastern Brazil

Over the last 20 years, there has been an increase in the number of leishmaniasis cases in Brazil. Belo Horizonte (BH) is one of the most highly populated Brazilian cities that is affected by visceral leishmaniasis (VL). The health services in BH are coordinated by a central nucleus that is subdivided into nine sanitary districts. Historically, the highest level of human VL cases was found in the northeast sanitary district (NSD). The objective of our study was to detect Leishmania infection in the phlebotomine sand flies collected in the NSD by dissection and molecular approaches. Following the occurrence of human VL cases in 2005, entomological captures were performed from July 2006-June 2007. Out of the 245 sand flies dissected, only three Lutzomyia longipalpis spp contained flagellates. The female sand flies were grouped into 120 pools according to date, collection site and species, with approximately 10 individual sand flies in each pool. Subsquently, the DNA was extracted and Leishmania spp and other parasites were detected and identified by polymerase chain reaction (PCR) and PCR-restriction fragment length polymorfism. Leishmania infantum was present in at least 19 percent of the Lu. longipalpis collected, in 3.8 percent of the Nyssomiya whitmani collected, in 33.3 percent of the Evandromiya termitophila collected and in 14.3 percent of the Nyssomiya intermedia collected. When the females of the cortelezzii complex were compared with each other, 3.2 percent of the females were infected with Leishmania braziliensis, whereas 3.2 percent of the females were infected with trypanosomatids.

Sandflies (Diptera: Psychodidae: Phlebotominae) collected on the banks of the Velhas River in the state of Minas Gerais, Brazil

Leishmaniases are endemic to several Brazilian states, including Minas Gerais. As many cases of these diseases are diagnosed in Minas Gerais every year, this paper aimed to determine the diversity of the species of sandflies vector of leishmaniases, in Lassance and Corinto on the banks of the Velhas River. Over two years, 21,014 specimens of sandflies, belonging to 19 species were captured with light traps. Of these specimens, Nyssomyia neivai (Pinto 1926) (84.18 percent), Nyssomyia intermedia (Lutz & Neiva 1912) (13.41 percent), Evandromyia lenti(Mangabeira 1938) (0.99 percent) and Evandromyia sallesi (Galvão & Coutinho 1939) (0.48 percent) were the most represented. The former two species could be involved in the epidemiological chain of leishmaniasis in this region. No significant difference was found between the species compositions on the two river banks.

Estudo dos flebotomíneos (Diptera: Psychodidae) em área de leishmaniose tegumentar americana nos municípios de Alto Caparaó e Caparaó, Estado de Minas Gerais / Study of the sand flies in American cutaneous leishmaniasis area, in the municipality of Alto Caparaó and Caparaó, Minas Gerais State

No período de novembro de 2000 a novembro de 2001, foi realizado o estudo dos flebotomíneos nos municípios de Alto Caparaó e Caparaó, com o objetivo de determinar a sua variacão sazonal, comparar os pontos de estudo quanto à ocorrência destes insetos e determinar os ambientes de prevalência destes. Foram realizadas coletas mensais, com armadilhas luminosas de Falcão em nove pontos, sendo quatro armadilhas por ponto, nos seguintes ambientes: abrigo de animais, mata, cafezal e parede externa das casas. Lutzomyia intermedia (Lutz & Neiva, 1912) foi a espécie predominante, e o abrigo de animais o ambiente com maior ocorrência de flebotomíneos. Encontrou-se diferenca significativa na composicão de espécies de flebotomíneos nos pontos estudados. Lutzomyia intermedia é a espécie suspeita de transmitir a Leishmania na região.

Bilateral anomaly in the style of Micropygomyia schreiberi (Martins, Falcão & Silva) (Diptera, Psychodidae)

Este trabalho relata o encontro de um flebotomíneo com anomalia bilateral no dististilo. Esta anomalia é rara neste grupo de insetos e pode causar confusão na identificação específica e levar à descrição de novas espécies, aumentando a lista de sinonímia do grupo. O espécime foi medido e comparado com o holótipo e quatro parátipos de Micropygomyia schreiberi (Martins, Falcão & Silva, 1975) e concluímos que, de fato, se trata desta espécie.