Biodiversity assessment of Phlebotomine (Diptera: Psychodidae) in an environmental impacted area in Rio de Janeiro State, Brazil

ABSTRACT From October 1994 to September 1996, in the municipality of Mangaratiba, Rio de Janeiro State, phlebotomines were captured on the walls of the houses by means of a manual suction tube and light traps, in the household, the peridomicile and in the forest. As it is an area undergoing a real expansion and an increment in the local tourism, with the purpose of assessing changes in the phlebotomine fauna caused by environmental changes in the region, new captures were made in the same location from October 2015 to September 2016, this time using only light traps. In the two phases of the study, a total of 6,681 phlebotomines were captured. The results indicated that Ny. intermedia and Mg. migonei are fully adapted to this anthropic environment, while Pi. fischeri was more abundant and eclectic, and was probably attracted to exercise hematophagy. Nyssomyia intermedia can be suggested as the main vector of the etiological agent of the American Tegumentary Leishmaniasis in the studied areas. Pintomyia fischeri can also transmit Leishmania braziliensis, both in the environment altered by human action, and in the wild environment. Phlebotomines were captured in greater numbers between 6 and 8 pm in the peridomicile and between 9 and 11 pm in the household. The highest densities of phlebotomines were recorded in December, January and February. Despite almost 20 years between the two studies in the municipality of Mangaratiba, there was no change in the profile of the phlebotomine fauna in general; however, there was a greater density of species of medical importance in areas that suffered environmental impacts.

Perfil epidemiológico da leishmaniose tegumentar americana na Região Amazônica, Brasil, entre 2010 e 2019 / Epidemiological profile of American tegumentary leishmaniasis in the Amazon Region, Brazil, between 2010 and 2019

Objetivo: descrever o perfil epidemiológico dos casos de leishmaniose tegumentar americana (LTA) no município de Altamira, Pará, no período de 2009 a 2019. Métodos: trata-se de um estudo transversal, descritivo, retrospectivo de abordagem quantitativa, utilizando dados secundários de casos confirmados LTA, ocorridos entre os anos de 2010-2019 registrados no Sistema de Informações de Agravos de Notificação (SINAN) e disponibilizados no site do Departamento de Informática do Sistema Único de Saúde (DATASUS). Resultados: foram notificados 1.177 casos de LTA no município de Altamira entre 2010 e 2019, com média de 117,7 casos notificados e incidência média de 107,66 casos para cada 100 mil habitantes. Predomínio do sexo masculino (83,3%), idade entre 20-39 anos (51,8%) e autodeclarado pardo (71,7%). Quanto à forma, a cutânea foi a mais registrada, com 96% dos casos, e em 97% destes evoluíram para a cura. Conclusões: a LTA apresentou alta incidência em Altamira no período analisado, assim se caracterizando como um problema de saúde pública. Acometendo, sobretudo, o sexo masculino, pardos e a faixa etária de 20 a 39 anos, estando, dessa forma, intrinsecamente relacionada às atividades laborais dessa população, além do desequilíbrio ambiental relacionado a desmatamento na zona rural. Sugere-se a existência de transmissão peri e intradomiciliar relacionada ao acometimento de crianças e idosos. A distribuição espacial dos casos não foi homogênea, possuindo maior concentração em áreas centrais do município de altamira. É importante ressaltar que a incidência tem uma forma não linear, que não se deve ao aumento gradual do número de casos, mas ao aumento da população.

Objective: to describe the epidemiological profile of cases of American tegumentary leishmaniasis (ATL) in the municipality of Altamira, Pará, from 2009 to 2019. Methods: this is a cross-sectional, descriptive, retrospective study with a quantitative approach, using secondary data from confirmed cases of LTA, which occurred between the years 2010-2019, registered in the Information System of Notifiable Diseases (SINAN) and available on the website of the Department of Informatics of the Unified Health System (DATASUS). Results: 1,177 cases of ATL were reported in the municipality of Altamira between 2010 and 2019, with an average of 117.7 reported cases and an average incidence of 107.66 cases per 100,000 inhabitants. Male predominance (83.3%), aged between 20-39 years (51.8%) and self-declared brown (71.7%). As for the form, the cutaneous one was the most registered with 96% of the cases, and in 97% they evolved to cure. Conclusions: ATL had a high incidence in Altamira in the analyzed period, thus characterizing it as a public health problem. Affecting, above all, males, browns and the age group from 20 to 39 years. being, therefore, intrinsically related to the work activities of this population, in addition to the environmental imbalance related to deforestation in rural areas. It is suggested the existence of peri- and intra-household transmission related to the involvement of children and the elderly. The spatial distribution of cases was not homogeneous, with a greater concentration in central areas of the municipality of altamira. It is important to emphasize that the incidence has a non-linear form, which is not due to the gradual increase in the number of cases, but to the increase in the population.

Favorable responses to treatment with 5 mg Sbv/kg/day meglumine antimoniate in patients with American tegumentary leishmaniasis acquired in different Brazilian regions

Abstract INTRODUCTION: Favorable responses in American tegumentary leishmaniasis (ATL) patients to treatment with 5 mg Sbv/kg/day meglumine antimoniate (MA) has been reported in Rio de Janeiro, but little is known regarding the therapeutic response to low doses in patients from other locations. METHODS: A retrospective review of medical records was conducted to compare the therapeutic response to 5 mg Sbv/kg/day MA treatment among 36 patients who acquired ATL in Brazilian states other than Rio de Janeiro (OS group) and 72 patients from Rio de Janeiro (RJ group). RESULTS: One course of 5 mg Sbv/kg/day MA cured 72.8% of 81 cutaneous (CL) and 66.6% of 27 mucosal (ML) leishmaniasis-infected patients: 70% in the CL/RJ group, 81% in the CL/OS group, 50% in the ML/RJ group, and 80% in the ML/OS group. After up to two additional treatment courses at the same dose, 88.9% and 85.2% of the CL and ML patients were cured, respectively. Adverse events were observed in 40% of patients in the CL/RJ group, 57% of the CL/OS group, 58% of the ML/RJ group, and 80% of the ML/OS group. No significant differences were observed in the cure rates or adverse effects between the RJ and OS groups. No patients required permanent discontinuation of treatment due to adverse events. CONCLUSIONS: Patients with ATL acquired in both RJ and OS may respond to low-dose MA. While high-dose MA should remain the standard treatment for ATL, low-dose MA might be preferred when toxicity is a primary concern.

Pertinencia intercultural de la atención en salud. El camino a seguir en Leishmaniosis Tegumentaria Americana / Intercultural relevance of health care. The way to follow in American Tegumentary Leishmaniosis

La Leishmaniosis tegumentaria americana (LTA) es considerada un problema de salud pública por su elevada incidencia. Además, es una patología abordada en muchos países a través de programas sanitarios con estructura vertical, sin contacto social y sin considerar la cultura de los grupos poblacionales, a sabiendas que existen diferencias en cuanto a ésta en el tratamiento de la enfermedad. El objetivo es la descripción y análisis de la pertinencia cultural del proceso de atención en salud en el caso de LTA, con base en la revisión bibliográfica de literatura científica sobre esta patología y sobre el papel de la cultura sobre la misma como aporte de ideas y de conocimientos para el debate necesario en el diseño de políticas y programas sanitarios de control de patologías parasitarias.(AU)

American tegumentary Leishmaniasis (LTA) is considered a public health problem because of its high incidence. In addition, it is a pathology addressed in many countries through health programs with vertical structure, without social contact and without considering the culture of the population groups, knowing that there are differences in the treatment of the disease. The objective is the description and analysis of the cultural relevance of the health care process in the case of LTA, based on the bibliographical review of scientific literature on this pathology and on the role of culture in the same as contribution of ideas and of knowledge for the necessary debate in the design of health policies and programs to control parasitic diseases.(AU)

Low dose systemic or intralesional meglumine antimoniate treatment for American tegumentary leishmaniasis results in low lethality, low incidence of relapse, and low late mucosal involvement in a referral centre in Rio de Janeiro, Brazil (2001-2013)

BACKGROUND American tegumentary leishmaniasis (ATL) is a non-lethal parasitic disease that presents with cutaneous (CL) and mucosal (ML) clinical forms. ATL treatment aims at healing the lesions and preventing the development of the late mucosal form. Systemic meglumine antimoniate (MA) therapy with 10-20 mg Sb5+/kg/day is the first choice of treatment. However, alternative therapies using 5 mg Sb5+/kg/day or intralesional (IL) MA are the usual regimens at the National Institute of Infectious Diseases (NIID), Rio de Janeiro, Brazil. OBJECTIVES To evaluate lethality and the incidence of relapse and development of late ML in CL patients treated at NIID from 2001 until 2013. METHODS Data were recovered from records of all ATL patients diagnosed during that period. FINDINGS Out of 777 patients, 753 were treated with MA (96.9%). Of those, 89.1% received alternative therapy of 9.9% IL and 79.2% systemic 5 mg Sb5+/kg/day. Some patients required 1-3 additional courses of treatment, thus making a total of 997 courses; 85.2% of them were subjected to alternative therapies. Lethality was 0.1%, relapse incidence 5.8%, and late ML incidence 0.25%. As a final outcome for the 777 patients, 95.9% were cured, 0.1% died and 4.0% were not able to follow-up. MAIN CONCLUSIONS Alternative MA schedules resulted in low lethality without increase of relapse or late ML incidence.

New human case reports of cutaneous leishmaniasis by Leishmania (Viannia) naiffi in the Amazon region, Brazil / Novos relatos de casos de leishmaniose cutânea por Leishmania (Viannia) naiffi na região amazônica, Brasil

Few cases of human cutaneous leishmaniasis (CL) caused by Leishmania naiffi were described in the medical literature. The aim of this study was to report and analyze new cases of L. naiffi in the period between the years 1992 to 2011. The strains were characterized by isoenzyme analysis. All patients assisted had small lesions; ranging from 1.0x1.0 mm and 13.5x11.5 mm. The lesions observed were widely distributed: 55.5% on the lower limb, 5.5% in the abdominal area, 16.6% on upper limb and 22.2% in upper limb and back. Seventy-two percent of patients had ulcerated lesions. Clinical course of the disease varied from 1 to 10 months. According to gender, most infected individuals were men (83.3%). The patients came from Amazonas (10), Pará (01) and Rondônia (01), north States of Brazil. Five patients were infected in experimental stations of the National Institute of Amazonian Research (INPA). Although the results of this study were similar to other reports in the literature, some of the patients had more of one skin lesion. It is also reported the first case of CL caused by L. naiffi in the State of Rondônia and identified an area of disease transmission in the experimental station of INPA.

Poucos casos de leishmaniose cutânea humana (LC) causada por Leishmania naiffi foram descritos na literatura médica. Assim, o objetivo deste estudo foi relatar e analisar novos casos de infecção por L. naiffi no período compreendido entre os anos de 1992 a 2011. As cepas foram caracterizadas por análise de isoenzimas. Todos os pacientes atendidos apresentavam lesões pequenas; variando entre 1,0x1,0 mm e 13,5x11,5 mm. As lesões observadas foram amplamente distribuídas: 55,5% no membro inferior, 5,5% na área abdominal, 16,6% no membro superior e 22,2% no membro superior e para trás. Setenta e dois por cento dos pacientes tiveram lesões ulceradas. O curso clínico da doença variou de 1 a 10 meses. De acordo com o sexo, a maioria dos indivíduos infectados eram homens (83,3%). Os pacientes vieram de Amazonas (10), Pará (01) e Rondônia (01), estados do norte do Brasil. Cinco pacientes foram infectados em estações experimentais do Instituto Nacional de Pesquisas da Amazônia (INPA). Embora os resultados encontrados neste estudo fossem semelhantes às outras descrições na literatura, alguns dos pacientes apresentavam mais de uma lesão cutânea. Também é relatado o primeiro caso de LC causada por L. naiffi no Estado de Rondônia e identificada uma área de transmissão da doença na estação experimental do INPA.

Sporotrichoid leishmaniasis: a cross-sectional clinical, epidemiological and laboratory study in Rio de Janeiro State, Brazil

ABSTRACT Background Atypical presentations of cutaneous leishmaniasis include sporotrichoid leishmaniasis (SL), which is clinically described as a primary ulcer combined with lymphangitis and nodules and/or ulcerated lesions along its pathway. Aims To assess the differences between patients with sporotrichoid leishmaniasis and typical cutaneous leishmaniasis (CL). Methods From January 2004 to December 2010, 23 cases of SL (4.7%) were detected among 494 CL patients diagnosed at a reference center for the disease in Rio de Janeiro State, Brazil. These 23 cases were compared with the remaining 471 patients presenting CL. Results SL predominated in female patients (60.9%, p = 0.024), with older age (p = 0.032) and with lesions in upper limbs (52.2%, p = 0.028). CL affected more men (64.5%), at younger age, and with a higher number of lesions exclusively in lower limbs (34.8%). Conclusions Differences in clinical and epidemiological presentation were found between SL patients as compared to CL ones, in a region with a known predominance of Leishmania (Viannia) braziliensis. The results are similar to the features of most of the sporotrichosis patients as described in literature, making the differential diagnosis between ATL and sporotrichosis more important in overlapping areas for both diseases, like in Rio de Janeiro State.

Caracterização clínica e laboratorial das manifestações orais de leishmaniose tegumentar americana / Characterization of the oral manifestations in the american tegumentary leishmaniasis based on the clinical and laboratorial findings

A leishmaniose é uma zoonose infecciosa causada por protozoários do gênero Leishmania, que parasitam as células do sistema mononuclear fagocitário. Esta doença pode se manifestar de duas formas: leishmaniose tegumentar e a leishmaniose visceral. A leishmaniose tegumentar pode acometer pele ou mucosas inclusive da cavidade oral. As lesões orais de leishmaniose por não serem ainda bem estudadas são frequentemente confundidas com outras doenças da boca, o que atrasa o diagnóstico e o tratamento específico, aumentando a probabilidade de sequelas. Desta maneira, aumentar o conhecimento da evolução das lesões orais de leishmaniose tegumentar americana (LTA) pode auxiliar no diagnóstico precoce da infecção, melhorando seu prognóstico. Objetivos: Avaliar a frequência da ocorrência de lesões orais de LTA e descrever suas peculiaridades clínicas, laboratoriais, e terapêuticas. Métodos: Foi realizado um estudo transversal descritivo com amostra de conveniência, utilizando dados obtidos de prontuários e de exame clínico das mucosas das vias aéreo-digestivas superiores de 206 pacientes com Leishmaniose Mucosa (LM), atendidos no Laboratório de Vigilância em Leishmanioses-IPEC-Fiocruz entre 1989 e 2013...

Leishmaniasis is an infectious zoonotic disease caused by protozoa of the genus Leishmania, which infects the mononuclear phagocyte system. This disease can be clinical presented as: Tegumentary leishmaniasis (TL) and visceral leishmaniasis. The TL can affect the skin and the mucosa (mucosal leishmaniasis – ML), including oral cavity. The oral lesions of TL are often confused with mouth’s lesions with other ethiologies, and as there are few studies characterizing oral leishmaniasis , the correct diagnosis and treatment can be delayed, increasing the likelihood of sequelae. In this way, the increase of knowledge about this site of TL lesions can help an early diagnosis of the infection and improve the patients prognosis. Objectives : Identify the frequency of occurrence of ATL oral lesions and describe the clinical, laboratorial and therapeutics characteristics. Methods: Was made a cross-sectional descriptive study with a convenience sample, using data obtained from medical records and specific clinical mucosa examination, especially the oral mucosa, of 206 patients with mucosal leishmaniasis (ML), treated at the ambulatory of Otorhinolaryngology, from Laboratório de Vigilância em Leishmanioses-IPEC-Fiocruz between 1989 e 2013...

Treatment of American tegumentary leishmaniasis in special populations: a summary of evidence

We aimed to assess and synthesize the information available in the literature regarding the treatment of American tegumentary leishmaniasis in special populations. We searched MEDLINE (via PubMed), EMBASE, LILACS, SciELO, Scopus, Cochrane Library and mRCT databases to identify clinical trials and observational studies that assessed the pharmacological treatment of the following groups of patients: pregnant women, nursing mothers, children, the elderly, individuals with chronic diseases and individuals with suppressed immune systems. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The available evidence suggests that the treatments of choice for each population or disease entity are as follows: nursing mothers and children (meglumine antimoniate or pentamidine), patients with renal disease (amphotericin B or miltefosine), patients with heart disease (amphotericin B, miltefosine or pentamidine), immunosuppressed patients (liposomal amphotericin), the elderly (meglumine antimoniate), pregnant women (amphotericin B) and patients with liver disease (no evidence available). The quality of evidence is low or very low for all groups. Accurate controlled studies are required to fill in the gaps in evidence for treatment in special populations. Post-marketing surveillance programs could also collect relevant information to guide treatment decision-making.

APPLICABILITY OF kDNA-PCR FOR ROUTINE DIAGNOSIS OF AMERICAN TEGUMENTARY LEISHMANIASIS IN A TERTIARY REFERENCE HOSPITAL / Aplicacao do kDNA-PCR para diagnostico de rotina de leishmaniose tegumentar americana em um hospital de referencia

SUMMARY This study evaluated the applicability of kDNA-PCR as a prospective routine diagnosis method for American tegumentary leishmaniasis (ATL) in patients from the Instituto de Infectologia Emílio Ribas (IIER), a reference center for infectious diseases in São Paulo - SP, Brazil. The kDNA-PCR method detected Leishmania DNA in 87.5% (112/128) of the clinically suspected ATL patients, while the traditional methods demonstrated the following percentages of positivity: 62.8% (49/78) for the Montenegro skin test, 61.8% (47/76) for direct investigation, and 19.3% (22/114) for in vitro culture. The molecular method was able to confirm the disease in samples considered negative or inconclusive by traditional laboratory methods, contributing to the final clinical diagnosis and therapy of ATL in this hospital. Thus, we strongly recommend the inclusion of kDNA-PCR amplification as an alternative diagnostic method for ATL, suggesting a new algorithm routine to be followed to help the diagnosis and treatment of ATL in IIER. .

RESUMO Este estudo avaliou a aplicabilidade do kDNA-PCR como método de rotina para diagnóstico de leishmaniose tegumentar americana (ATL) no Instituto de Infectologia Emílio Ribas (IIER), São Paulo, SP, Brasil. O método kDNA-PCR detectou DNA de Leishmania em 87,5% (112/128) dos pacientes com suspeita de ter leishmaniose e, os métodos tradicionais apresentaram as seguintes porcentagens de positividade: 62,8% (49/78) para o teste de Montenegro, 61,8% (47/76) para a pesquisa direta e 19,3% (22/114) para cultura in vitro. O método molecular confirmou a doença em amostras negativas ou inconclusivas pelos métodos laboratoriais tradicionais e, mostrou-se capaz de auxiliar na identificação de infecções causadas pela espécie Leishmania (V.) braziliensis. Além disso, a revisão dos prontuários médicos confirmou a importância do método PCR-RFLP no diagnóstico final de ATL, prognóstico e escolha do tratamento. Assim, recomendamos a inclusão do PCR como método diagnóstico de ATL na rotina hospitalar, e sugerimos um fluxograma para solicitação de exames laboratoriais. .

Phlebotomine saddflies in rural locations in the state of parana, southern Brazil / Flebotomineos em localidades rurais do Estado do Parana, Sul do Brasil

SUMMARY This study reports the fauna and frequency of sandflies in domestic animal shelters, residences and other ecotopes in rural areas of the municipality of Bandeirantes, Paraná State. Sandflies were collected twice in eight rural villages by using Falcon traps from 8pm to 6am in 2008. In these localities 4,790 sandflies were collected, which were represented by ten sandfly species, prevailing of Nyssomyia neivai and Nyssomyia whitmani species. It was observed that animal shelters are the domestic ecotopes where there is the greatest frequency of these insects. The localities where the collections were made had the environmental characteristics that allow the persistence of transmission of parasites from the American tegumentary leishmaniasis. Although the fauna and the behavior of sandflies species are similar in different localities, the method of controlling these insects should be adjusted to the environmental characteristics of each one of the most diverse endemic areas of American tegumentary leishmaniasis in the municipalities of Paraná State. .

RESUMO Relatam-se, neste trabalho, a fauna e frequência de flebotomíneos em abrigos de animais domésticos, residências e outros ecótopos em áreas rurais do município de Bandeirantes, Estado do Paraná. Os flebotomíneos foram coletados em oito bairros rurais, com armadilhas de Falcão, duas vezes em cada bairro, das 20 às 6 horas, em 2008. No conjunto dos bairros coletaram-se 4.790 flebotomíneos, representados por dez espécies, com predomínio de Nyssomyia neivai e Nyssomyia whitmani. Os abrigos dos animais domésticos são os ecótopos onde há maior frequência desses insetos. As localidades onde as coletas foram realizadas têm características ambientais que permitem a persistência da transmissão de parasitos da leishmaniose tegumentar americana. Apesar da fauna e do comportamento das espécies de flebotomíneos serem semelhantes nas diversas localidades, o método de controle desses insetos deve ser ajustado às características ambientais de cada uma das mais diversas áreas endêmicas de leishmaniose tegumentar americana, nos municípios do Paraná. .

Tratamento intralesional da leishmaniose cutânea com antimoniato de meglumina no instituto de pesquisa clínica Evandro Chagas, Fiocruz, Rio de Janeiro (2002 a julho 2011) / Intralesional treatment of cutaneous leishmaniasis with meglumine antimoniate at the institute of clinical research Evandro Chagas, Fiocruz, Rio de Janeiro (2002 to July 2011)

A leishmaniose tegumentar americana é uma doença que acomete a pele e as mucosas das vias aero digestivas superiores. Os antimoniais pentavalentes vêm sendo empregados há muitas décadas como fármacos de primeira linha para o seu tratamento. Pacientes com poucas lesões cutâneas, com impossibilidade de receber medicação parenteral regular ou com sinais de toxicidade importante ao antimonial por via sistêmica, podem ser submetidosao tratamento intralesional com antimoniato de meglumina. Objetivos:descrever a eficácia e a segurança do antimoniato de meglumina administrado por via intralesional, para o tratamento da leishmaniose cutânea. Método: Foi realizado um estudo descritivo, retrospectivo, tipo série de casos, de pacientes atendidos no Laboratório de Vigilância em Leishmanioses do Instituto de Pesquisa Clínica Evandro Chagas – FIOCRUZ, de 2002 até julho de 2011, que tivessem sido tratados para leishmaniose cutânea com aplicação intralesional de antimoniato de meglumina, após tratamento sistêmico com o mesmo fármaco...

American tegumentary leishmaniasis is a disease that affects the skin and mucous membranes of the upper aerodigestive tract. Pentavalent antimonial compounds have been used for decades as a first-line drugs for its treatment.Patients with few skin lesions, with inability to receive parenteral medication regularly or with signs of significant toxicity to antimony systemically, may be subjected to treatment with intralesional meglumine antimoniate. Objectives: Todescribe the efficacy and safety of meglumine antimoniate administered intralesionally, for the treatment of cutaneous leishmaniasis. Methods: We conducted a descriptive, retrospective case series of patients treated at the Leishmaniasis Surveillance Laboratory, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, from 2002 until July2011, which had been treated for cutaneous leishmaniasis with intralesional meglumine antimoniate after systemic treatment with the same drug...

Ensaio clínico fase III para leishmaniose tegumentar americana forma cutânea. Equivalência entre esquemas de alta e baixa dose de antimoniato de meglumina / Phase III clinical trial for american cutaneous leishmaniasis. Equivalence between high and low dose schemes of meglumine antimoniate

Neste estudo comparamos esquemas de alta e baixa dose de antimoniato demeglumina (AM) para o tratamento da forma cutânea de leishmaniose tegumentar americana, em pacientes oriundos do estado do Rio de Janeiro. OBJETIVO:Comparar a eficácia representada pela cura imediata (epitelização em 120 dias),tardia (cicatrização em 360 dias) e definitiva (ausência de reativação ou lesão mucosa em 720 dias) e toxicidade (clínica, laboratorial e eletrocardiográfica) com duas diferentes doses de tratamento com AM para leishmaniose cutânea (LC) e comparar os critérios de cura clínica aqui adotados com aqueles estabelecidos pelo Ministério da Saúde. MÉTODO: Ensaio clínico de não inferioridade, controlado,randomizado, cego e de fase III, com 60 pacientes com LC alocados em dois grupos de tratamento: (A) 20mg Sb5+/kg/dia por 20 dias e (B) 5mg Sb5+/kg/dia por 30 dias administrados por via intramuscular. RESULTADOS: Pacientes dos grupos A e B apresentaram, respectivamente: Cura imediata 90,0% e 86,7%, com tempo médio de epitelização de 58,7 e 54,9 dias; cura tardia por intenção de tratar 76,7% e73,3%; e cura tardia por análise de protocolo 84,6% e 75,9%. Dos 53 pacientes que apresentaram epitelização em até 120 dias, 44 (83,4%)evoluíram para cura tardia...

In this study, we compare schemes of high and low dose of meglumine antimoniate(MA) for the treatment of cutaneous form of American tegumentary leishmaniasis in patients from Rio de Janeiro. OBJECTIVE: To compare the efficacy represented by immediate healing ( epithelialization in 120 days) , late healing (scarring within 360days ) and final healing (no reactivation or mucosal lesion in 720 days) and clinical ,laboratory and electrocardiographic toxicity with two different schemes of treatment with MA for cutaneous leishmaniasis (CL ) and compare the clinical cure criteria adopted here with those established by the Ministry of Health. METHOD :Randomized, controlled, blind, phase III clinical trial, of non-inferiority with 60patients presenting CL divided into two treatment groups: (A) 20 mg Sb5+ / kg / day for 20 days and (B) 5 mg Sb5+ / kg / day for 30 days administered intramuscularly.RESULTS : Patients in groups A and B presented, respectively : immediate healingof 86.7 % and 90.0 % , with a mean time of epithelialization of 58.7 and 54.9 days;late healing by intention to treat of 76.7 % and 73.3%; and late healing by protocol analysis of 84.6 % and 75.9 % .From 53 patients who presented epithelialization within 120 days , 44 (83.4 %) had late healing...

The effect of age on the frequency of adverse reactions caused by antimony in the treatment of American tegumentary leishmaniasis in Governador Valadares, State of Minas Gerais, Brazil / Efeito da idade na frequência das reações adversas provocadas pelo antimônio no tratamento de pacientes com leishmaniose tegumentar americana, em Governador Valadares, Estado de Minas Gerais, Brasil

INTRODUCTION: Governador Valadares is an endemic area of American tegumentary leishmaniasis (ATL). The detection rate was 15.36 per 100,000 habitants from 2001 to 2006 (Miranda, 2008). This study aimed to analyze the effects of age on the frequency of adverse reactions caused by antimony in the treatment of ATL in the City of Governador Valadares, State of Minas Gerais, Brazil, during 2009. METHODS: Data were collected from the forms of the Information System for Notifiable Diseases, and from charts, questionnaires, and home visits to patients. RESULTS: The study included 40 patients, 26 (65%) of whom were males. Individuals over the age of 50 had a 66% higher rate of adverse effects than subjects who were 50 years old or less (CI 95%, 1.14-2.41). The average age of individuals who reported some type of adverse effect was 44.11 years (SD = 20.14), while the average age of the group that did not report any adverse effect was of 25.46 years (SD = 18.37; p < 0.01). Clinical healing was 67.5%, and 10% of patients discontinued the treatment. CONCLUSIONS: In the treatment of ATL, the age of patients should be considered, because most adverse reactions occur in individuals over 50 years of age. For this reason, the drug should be used with restriction in these cases.

INTRODUÇÃO: Governador Valadares constitui uma área endêmica de leshmaniose tegumentar americana (LTA) e o coeficiente de detecção foi de 15,36/100.000 habitantes no período de 2001 a 2006 (Miranda, 2008). Este estudo teve como objetivo analisar o efeito da idade na frequência das reações adversas provocadas pelo antimônio no tratamento de pacientes com LTA, em Governador Valadares, Estado de Minas Gerais, Brasil, no período de janeiro a dezembro de 2009. MÉTODOS: Para coleta de dados foram utilizados: ficha de notificação do Sistema de Informação de Agravos de Notificação (SINAN), prontuários, questionário e visitas domiciliares aos pacientes. RESULTADOS: Participaram do estudo 40 pacientes, sendo 26 (65%) do sexo masculino. Os indivíduos acima de 50 anos de idade tiveram prevalência 66% maior de reações adversas que as pessoas com idade de 50 ou menos (IC 95% -1,14-2,41). A média de idade dos indivíduos que relataram algum tipo de reação adversa foi de 44,11 anos (DP=20,14), enquanto no grupo que não relatou reação adversa, a média de idade foi de 25,46 anos (DP=18,37) e p < 0,01. A cura clínica foi de 67,5% e 10% dos pacientes abandonaram o tratamento. CONCLUSÕES: No tratamento da LTA, a idade do paciente deve ser considerada; pois ocorrem mais reações adversas em indivíduos acima de 50 anos de idade, que nesses casos o medicamento deve ser utilizado com restrição.

Magnitude e tendência da Leishmaniose Tegumentar Americana no Estado de São Paulo, Brasil, 1975 a 2008 / Magnitude and trend of American Tegumentary Leishmaniasis in the State of São Paulo, Brazil, 1975 to 2008

O objetivo deste estudo foi analisar a magnitude e tendência da Leishmaniose Tegumentar Americana (LTA) no Estado de São Paulo entre 1975 e 2008. Foi conduzido um estudo ecológico que categorizou os municípios segundo a magnitude da transmissão. No período de 1975 a 1985, 45 municípios foram responsáveis pelo registro de 1.281 casos de LTA, passando a 258 municípios e 4.093 casos entre 1986 e 1995, e a 385 municípios e 7.604 casos entre 1996 a 2008. O vetor Lutzomyia intermedia s.l. foi coletado na maioria das pesquisas entomológicas. Na classificação dos municípios segundo a magnitude pode-se verificar que 67,5% possuíam "pequena magnitude", 19,2% "média magnitude" e 13,3% "grande magnitude". As maiores incidências de LTA permanecem restritas a algumas áreas carentes e próximas à Mata Atlântica. Houve aumento no número de municípios com pequena ocorrência de casos e ampliação da área de risco.

The aim of this study was to analyze the magnitude and trend of American Tegumentary Leishmaniasis (ATL) in the State of São Paulo from 1975 to 2008. An ecological study that classified municipalities according to the magnitude of transmission was performed. From 1975 to 1985, 1,281 cases of ATL were registered in 45 municipalities, rising to 258 municipalities and 4,093 cases from 1986 to 1995; and reaching 385 municipalities and 7,604 cases from 1996 to 2008. Lutzomyia intermedia s.l. was collected in most of the entomological surveys. In the classification of municipalities according to magnitude, 67.5% were observed to have a "small magnitude," 19.2% "moderate magnitude" and 13.3% "high magnitude." The highest incidences of ATL have been restricted to underserved areas close to the Atlantic fo-rest. There was an increase in the number of municipalities with small occurrence of cases and expansion in the area of risk.

Expression of TLR2 and TLR4 in lesions of patients with tegumentary american leishmaniasis / Expressão de TLR2 e TLR4 em lesões de pacientes com leishmaniose tegumentar americana

OBJECTIVES: The aim of this study was to describe the pattern of expression of Toll-like receptor 2 (TLR2) and Toll-like receptor 4 (TLR4) in skin biopsies of patients with American tegumentary leishmaniasis (ATL) caused by Leishmania braziliensis. METHODS: This prospective study evaluated 12 patients with ATL caused by Leishmania braziliensis confirmed by polymerase chain reaction. Immunohistochemistry was performed to determine the expression of TLR2 and TLR4. The number of NK cells, dendritic cells and macrophages in the tissue were calculated. The cytokine expression was determined using the anti-TNF-α, anti-IFN-Γ, anti-IL-1 and anti-IL-6. Double immunostaining reactions were used to determine the cell expressing TLR2 and TLR4. RESULTS: The numbers of cells expressing TLR2 and TLR4 were 145.48 ± 82.46 cell/mm² and 3.26 ± 4.11 cell/mm² respectively (p < 0.05). There was no correlation of TLR2 and TLR4 with the amount of cytokines and the number of NK cells, dendritic cells or macrophages. The double immunostaining revealed that TLR2 was expressed by macrophages. CONCLUSION: In human cutaneous leishmaniasis caused by Leishmania braziliensis, TLR2 is the most common TLR expressed during active disease, mainly by macrophages although without correlation with the amount of cytokines and number of cells.

OBJETIVOS: O objetivo deste estudo foi descrever o padrão de expressão dos receptores toll-like 2 e 4 (TLR2 e TLR4) em biópsias de pele de pacientes com leishmaniose tegumentar americana (LTA). MÉTODOS: Este estudo prospectivo avaliou 12 pacientes com LTA causada por Leishmania braziliensis confirmada por reação em cadeia da polimerase. Imunohistoquímica foi realizada para determinar a expressão de TLR2 e TLR4. O número de células NK, células dendríticas e macrófagos foi calculado no tecido. A expressão de citocinas foi determinada usando anti-TNF-α, anti-IFN-Γ, anti-IL-1 e anti-IL-6. Dupla marcação foi usada para determinar a célula responsável pela expressão de TLR2 e TLR4. RESULTADOS: O número de células expressando TLR2 e TLR4 foi 145.48±82.46 cell/mm² e 3.26 ± 4.11 cell/mm² respectivamente (p < 0.05). Não houve correlação entre a quantidade de expressão de TLR2 e TLR4 com a quantidade de citocinas e o número de células NK, macrófagos e células dendríticas. A dupla marcação revelou que o TLR2 é expresso por macrófagos. CONCLUSÃO: Na LTA causada por Leishmania braziliensis, TLR2 é o TLR mais comum na doença ativa, principalmente por macrófagos sem correlação com a quantidade de citocinas e outras células.

Active surveillance of American tegumentary leishmaniasis in endemic areas in rural Bolivia / Vigilância ativa da leishmaniose tegumentar americana em áreas endêmicas na Bolívia

INTRODUCTION: American tegumentary leishmaniasis (ATL), including mucocutaneous leishmaniasis (MCL) and localized cutaneous leishmaniasis (LCL), is endemic in Bolivia. We describe the results of active surveillance of ATL from 2001 to 2006 and assess demographic data related to ATL epidemiology in the Yungas valleys. METHODS: Community-based active ATL surveillance was performed by the institutions SERVIR, CÁRITAS, and the Health Services Department of La Paz, whose files were reviewed retrospectively. A cross-sectional survey was carried out to assess demographic data in two communities. RESULTS: Two thousand nine hundred nine cases of ATL were detected from 2001 to 2006: 2,488 (85.5 percent) corresponded to LCL and 421 (14.5 percent) to MCL. A reduction in the proportion of mucosal cases was observed between 2001 and 2006. The proportion of MCL cases increased with age and was higher among males (15.5 percent versus 12.1 percent, p=0.018). The rate of positivity via direct observation of the parasite in dermal scrapings and in parasite cultivation was significantly higher for LCL than for MCL (p<0.001 and p=0.009, respectively). The rate of reactivity in the leishmanin skin test was higher in the group with mucosal lesions (p=0.012). The cross-sectional survey showed that 40 percent of the families had emigrated from the Altiplano. CONCLUSIONS: It is necessary to undertake continuous case detection of ATL in the area, where the disease presents a high rate of mucosal cases. Increasing incidence seems to be associated with immigration and continuous deforestation to expand the crop-growing areas.

INTRODUÇÃO: A leishmaniose tegumentar americana (LTA), incluindo a leishmaniose mucocutânea (LMC) e a leishmaniose cutânea (LC), é endêmica em várias regiões da Bolívia. Descreve-se um sistema de vigilância da LTA conduzido entre 2001 e 2006 e avaliando-se dados demográficos relacionados à epidemiologia da doença. MÉTODOS: O sistema de busca ativa foi realizado conjuntamente pelas instituições SERVIR e CÁRITAS e pelo Servicio de Salud de La Paz (SEDES), cujos arquivos foram revisados, retrospectivamente. Um estudo transversal foi realizado em duas comunidades para aquisição de dados sócio-demográficos. RESULTADOS: Dois mil novecentos e nove casos de LTA, sendo 2.488 (85,5 por cento) de LC e 421 (14,5 por cento) de LMC foram diagnosticados de 2001 a 2006. Foi observada redução na proporção de casos mucosos ao longo do período. A proporção de LMC aumentou proporcionalmente à idade dos pacientes, sendo mais frequente entre pessoas do sexo masculino (15,5 por cento versus 12,1 por cento, p = 0,018). A taxa de detecção do parasita nos raspados cutâneos e no cultivo foram significativamente maiores em pacientes com LC do que em pessoas com LMC (p < 0,001 e p = 0,009 respectivamente). A reatividade à reação de Montenegro foi mais frequente em pessoas com LMC (p = 0.012). O estudo transversal mostrou que 40 por cento das famílias nas comunidades estudadas emigraram do Altiplano. CONCLUSÕES: Faz-se necessária uma contínua busca ativa de casos de LTA na região, onde a doença é hiperendêmica. As elevadas taxas de incidência parecem estar relacionadas à imigração e ao desflorestamento para expansão das áreas cultivadas.

Phlebotomine sandflies (Diptera: Psychodidae) in Governador Valadares, a transmission area for American tegumentary leishmaniasis in State of Minas Gerais, Brazil / Flebotomíneos (Diptera: Psychodidae) em Governador Valadares, área de transmissão de leishmaniose tegumentar americana no Estado de Minas Gerais, Brasil

INTRODUCTION: A study on the phlebotomine sandfly fauna was carried out in an endemic area for American tegumentary leishmaniasis in the municipality of Governador Valadares, in the State of Minas Gerais, Brazil. METHODS: Captures were undertaken using HP light traps in four districts, on three nights per month, for one year (from January to December 2008). Correlations between climatic factors (temperature, relative air humidity and rainfall) and the numbers of sandflies collected was observed. RESULTS: 5,413 phlebotomine specimens were caught and were identified as belonging to 12 species. Of these specimens, 2,851 (52 percent) were females and 2,562 (48 percent) were males. CONCLUSIONS: Lutzomyia intermedia predominated (29.9 percent of the species caught), thus suggesting that they were responsible for transmission of American tegumentary leishmaniasis, together with L. whitmani, which was also found in the area (4.3 percent). The presence of L. longipalpis (11.9 percent), the main vector for visceral leishmaniasis in Brazil, is an important finding, which makes rigorous entomological surveillance of the area necessary.

INTRODUÇÃO: Um estudo da fauna de flebotomíneos foi realizado em uma área endêmica para leishmaniose tegumentar americana no município de Governador Valadares, no Estado de Minas Gerais, Brasil. MÉTODOS: Capturas foram feitas com armadilhas luminosas HP em quatro bairros, três noites por mês, durante o período de janeiro a dezembro de 2008. A correlação entre fatores climáticos (temperatura, umidade relativa do ar e pluviosidade) e o número de flebotomíneos coletados foi avaliada. RESULTADOS: Foram capturados 5.413 espécimes de flebotomíneos, distribuídos em 12 espécies, sendo 2.851 (52 por cento) fêmeas e 2.562 (48 por cento) machos. CONCLUSÕES: Lutzomyia intermedia foi predominante com 29,9 por cento das espécies capturadas, sugerindo ser a responsável pela transmissão de LTA, juntamente com L. whitmani, que também foi encontrada na região (4,3 por cento). A presença de L. longipalpis (11,9 por cento), principal vetor de LV no Brasil, é um dado relevante tornando-se necessário uma rigorosa vigilância entomológica na região.

Immunophenotypic characterization of patients with American cutaneous leishmaniasis prior to and after treatment in Pernambuco, Brazil

Leishmania infections induce a specific activation of host immunological response, particularly characterized by T cell expansion. Studies indicate the importance of the balance between CD4+ and CD8+ T cells, in which the first ones would have their number reduced during the healing process. Meanwhile, CD25+ T cells have been associated with the suppression of the immune response. Since the immune response has an essential role in both healing and progression of diseases, this study aimed to identify the percentage of CD3+, CD4+, CD8+, CD16+ and CD25+ T cells in the peripheral blood of patients afflicted with American cutaneous leishmaniasis (ACL) - before and after treatment - and healthy controls. Peripheral blood was collected and transferred to cytometry tubes containing monoclonal antibodies specific for cell surface markers CD3, CD4, CD8, CD16 e CD25. The immunophenotypic and morphometric parameters of cells were determined by flow cytometry and the results demonstrated a significant increase in the number of T CD8+ cells after treatment, suggesting a cytotoxic T cell response. An increase in CD25+ T cells in patients with active ACL and after treatment was also observed, suggesting the participation of these cells in the modulation of the exacerbated effector response.

Epidemiological profile of leishmaniasis at a reference service in the state of Alagoas, Brazil, from january 2000 to september 2008

Leishmaniasis is a parasitic disease found in the continents of Europe, Asia, Africa and the Americas. In Brazil, the disease is an important public health problem, occurring in most states, but mainly in the Northeast region of the country, with the state of Alagoas having a significant number of confirmed cases. The present study establishes and discusses the epidemiological profile of cases of leishmaniases treated at the Reference Center of Alagoas, Hospital Escola Hélvio de Farias Auto, between January 2000 and October 2008. During thisperiod, records of 2,104 patients notified to the hospital Epidemiological Surveillance Center were reviewed. The epidemiology of leishmaniasis, both visceral and tegumentary, has shown a profile that has changed over throughout the years, with a decrease in the number of notified cases. Disease occurrence was associated with lower social economic classes, and affected mainly rural workers in general, housewives and students.