Associated factors, incidence, and management of gestational and congenital syphilis in a Brazilian state capital: a cross-sectional study

ABSTRACT Maternal and child health remains an enduring global challenge, having occupied a prominent position on international agendas since the dawn of the 21st century. During pregnancy, syphilis emerges as the second most prevalent cause of stillbirth on a global scale, potentially leading to a range of adverse outcomes. This study aimed to describe the clinical and epidemiological profile of cases of gestational and congenital syphilis and the hospital care provided for newborns in Campo Grande municipality, Mato Grosso do Sul State, Brazil, from 2013 to 2018. This is a cross-sectional study based on data from Brazilian Notifiable Diseases Surveillance System (SINAN) and hospital medical records. Chi-square or Fisher's exact test and logistic regression analysis were used to assess the associations and relationships between the child's clinical outcome at birth and the mother's clinical-obstetric and epidemiological characteristics. Cumulative detection rate of gestational syphilis was 174.3 cases per 1,000 live births and cumulative incidence of congenital syphilis was 47.7 cases per 1,000 live births. Alcoholism, prenatal care, number of prenatal visits, maternal treatment regimen, and timing of maternal diagnosis were associated with child's clinical outcome at birth and considered in the regression model. Prenatal visits showed a protective effect against the signs and symptoms of congenital syphilis (odds ratio = 0.37; 95% confidence interval = 0.17−0.77). Medical assistance was considered inadequate in 62.3% of cases. Prenatal consultations should be encouraged among pregnant women. There is a need for better education of health personnel on the treatment and diagnosis of syphilis.

Syphilis notifications among pregnant women in Campo Grande, state of Mato Grosso do Sul, Brazil, 2011 to 2017

Abstract INTRODUCTION Syphilis is a sexually transmitted infection caused by Treponema pallidum. Considering the high rates of syphilis in pregnancy and congenital syphilis reported in Brazil in the past, and their serious consequences, this study described the epidemiological and clinical profile of pregnant women with a confirmed diagnosis of syphilis in Campo Grande, in the state of Mato Grosso do Sul, Brazil, from 2011 to 2017. METHODS: This is a descriptive study, based on syphilis notifications among pregnant women reported to the Sistema de Informação de Agravos de Notificação (National System of Disease Notification of Brazil). RESULTS: Over the study period, 2,056 confirmed cases of syphilis in pregnancy were reported, resulting in a crude cumulative incidence of 144.76 cases per 1,000 live-born babies. The incidence increased from 9.97 cases per 1,000 live-born babies in 2011 to 36.10 cases per 1,000 live-born babies in 2017. It was more prevalent in women who were young, of mixed race, with low educational attainment. Over one third of women were diagnosed in the first trimester of pregnancy; therefore, they were at risk of reinfection if they or their sexual partners were inadequately treated. Furthermore, syphilis was not well classified according to its clinical stage, which led to inappropriate treatments. CONCLUSIONS: Despite efforts to reduce the incidence of syphilis, syphilis during pregnancy remains a public health problem, reflecting possible inadequacies in antenatal care, especially in vulnerable populations. It is important to include sexual partners in syphilis treatment during pregnancy to prevent reinfection.

Leishmania amazonensis DNA in wild females ofLutzomyia cruzi (Diptera: Psychodidae) in the state of Mato Grosso do Sul, Brazil

Studies on natural infection by Leishmania spp of sandflies collected in endemic and nonendemic areas can provide important information on the distribution and intensity of the transmission of these parasites. This study sought to investigate the natural infection by Leishmaniain wild female sandflies. The specimens were caught in the city of Corumbá, state of Mato Grosso do Sul (Brazil) between October 2012-March 2014, and dissected to investigate flagellates and/or submitted to molecular analysis to detect Leishmania DNA. A total of 1,164 females (77.56% of which were Lutzomyia cruzi) representing 11 species were investigated using molecular analysis; 126 specimens of Lu. cruziwere dissected and also submitted to molecular analysis. The infection rate based on the presence of Leishmania DNA considering all the sandfly species analysed was 0.69%; only Leishmania (Leishmania) amazonensis was identified in Lu. cruzi by the molecular analysis. The dissections were negative for flagellates. This is the first record of the presence of L. (L.) amazonensis DNA in Lu. cruzi, and the first record of this parasite in this area. These findings point to the need for further investigation into the possible role of this sandfly as vector of this parasite.

Capacidade vetorial de Lutzomyia (Lutzomyia) cruzi (Diptera: Psychodidae) para Leishmania (Leishmania) infantum / Vectorial capacity of Lutzomyia (Lutzomyia) cruzi (Diptera: Psychodidae) for Leishmania (Leishmania) infantum

Em algumas regiões, como nos municípios de Corumbá e Ladário, no Estado de Mato Grosso do Sul, existem evidências ecológicas e epidemiológicas de que Lutzomyia (Lutzomyia) cruzi (Mangabeira, 1938) seja a principal responsável pela transmissão do protozoário Leishmania (Leishmania) infantum Nicolle, 1908 (ou subespécie de L. (L.) infantum chagasi Cunha & Chagas, 1937 segundo alguns autores), agente etiológico da leishmaniose visceral (LV). A ausência de Lutzomyia (Lutzomyia) longipalpis (Lutz & Neiva, 1912), principal vetor do parasito, reforçam esta hipótese. Este estudo teve por objetivo avaliar os parâmetros e estimar a capacidade vetorial de Lu. cruzi para L. (L.) infantum e Leishmania (Leishmania) amazonensis Lainson & Shaw, 1972. Para este último, apenas foram avaliados os parâmetros, sem a estimativa numérica da capacidade vetorial. A avaliação da capacidade vetorial foi realizada a partir de experimentos laboratoriais (infecção experimental) e de campo (atratividade aos flebotomíneos). Por intermédio da infecção experimental de Lu. cruzi pelo parasito, foi possível estimar a expectativa de sobrevida diária de fêmeas infectadas (estimativa vertical e laboratorial), avaliar o período de incubação extrínseco do parasita e obter duração do ciclo gonotrófico. Para a avaliação da competência vetorial do inseto, foram realizadas tentativas de transmissão experimental e natural de Leishmania, a partir de fêmeas provenientes de colônia cujos indivíduos foram alimentados durante o xenodiagnóstico e de fêmeas selvagens capturadas em campo, respectivamente. A distribuição sazonal de Lu. cruzi foi avaliada por meio da instalação semanal de armadilhas luminosas no peridomicílio de cinco residências na área urbana do Município de Corumbá. Variáveis meteorológicas obtidas junto ao Centro de Monitoramento do Tempo, do Clima e dos Recursos Hídricos de Mato Grosso do Sul, índices radiométricos calculado a partir de imagens de resolução espacial (GeoEye) e o percentual de cobertural vegetal foram utilizados neste estudo. Os resultados obtidos permitiram estimar a capacidade vetorial de Lu. cruzi para L. (L.) infantum, que foi de 0,24, ou seja, espera-se que a população de fêmeas da área produzam 0,24 novas infecções viii por dia de exposição de uma infecção. A competência vetorial de Lu. cruzi para L. (L.) infantum e L. (L.) amazonensis, via picada, foi demonstrada por meio de transmissão natural e experimental dos parasitos, respectivamente. Também foi identificada a infecção natural de Lu. cruzi por L. (L.) amazonensis. Com relação à distribuição mensal, embora não tenha sido observada a presença de associação entre essas espécies e as variáveis ambientais de vegetação e clima, foi possível observar picos elevados populacionais na estação chuvosa e picos menores na estação seca. O padrão da distribuição sazonal das espécies de flebotomíneos demonstrado neste estudo foi determinado basicamente pelos espécimes de Lu. cruzi capturados, uma vez que eles representam 93,94 por cento . A variação mensal demonstrou que a espécie Lu. cruzi tem grande plasticidade, tendo sido observada em todos os meses de coleta.

In some regions such as in the municipalities of Corumbá and Ladário in Mato Grosso do Sul state, there are ecological and epidemiological evidence that Lutzomyia (Lutzomyia) cruzi (Mangabeira, 1938) is the vector of Leishmania (Leishmania) infantum Nicolle, 1908 (or subspecies of L. (L.) infantum chagasi Cunha & Chagas, 1937 according to some authors), the etiologic agent of visceral leishmaniasis (VL). The absence of Lutzomyia (Lutzomyia) longipalpis (Lutz & Neiva, 1912), the main vector of the parasite, supports this hypothesis. This study aimed to evaluate the parameters and estimate the vectorial capacity of Lu. cruzi for L. (L.) infantum and Leishmania (Leishmania) amazonensis Lainson & Shaw, 1972. For the latter, only parameters was evaluated without numerical estimation of the vectorial capacity. The evaluation of the vectorial capacity was carried out from laboratory experiments (experimental infection) and field (attractiveness to sandflies). Through experimental infection by the parasite, it was possible to estimate the expected daily survival of infected females (vertical and laboratory estimate), evaluate the extrinsic incubation period of the parasite and get the length of gonotrophic cycle. To evaluate the insect vector competence, attempts have been made of experimental and natural transmission of Leishmania from females from colony whose subjects were fed for xenodiagnosis and wild females captured in the field, respectively. Monthly and seasonal distribution of Lu. cruzi was evaluated by weekly installation of light traps in the peridomicile of five residences in the urban area of the Municipality of Corumbá. Meteorological variables obtained from the Weather Monitoring Center, Climate and Water of Mato Grosso do Sul Resources, radiometric indices calculated from spatial resolution images (GeoEye) and the percentage of plant cobertural were used in this study. Results allowed estimating the vectorial capacity of Lu. cruzi for L. (L.) infantum, which was 0.24, i.e., it is expected that the female population in the region produce 0.24 new infections per day of exposure to an infection. Vector competence of Lu. cruzi for L. (L.) infantum and L. (L.) amazonensis by biting, was demonstrated by natural and experimental transmission of both parasites, respectively. Natural infection of Lu. cruzi by L. (L.) amazonensis was identified. Regarding the monthly x distribution, there was no significant association between of sandflies and the environmental and climate variables. It was observed high peaks population in the rainy season and lower peaks in the dry season. The pattern of seasonal distribution of species of sand flies demonstrated in this study was determined primarily by Lu. cruzi specimens, since this species represent 93.94 per cent of the total captured. The monthly change showed that Lu. cruzi species has great plasticity and has been observed in all months of collection.

Biotic factors and occurrence of Lutzomyia longipalpis in endemic area of visceral leishmaniasis, Mato Grosso do Sul, Brazil

The relationships between environmental exposure to risk agents and health conditions have been studied with the aid of remote sensing imagery, a tool particularly useful in the study of vegetation cover. This study aims to evaluate the influence of environmental variables on the spatial distribution of the abundance of Lutzomyia longipalpis and the reported canine and human visceral leishmaniasis (VL) cases at an urban area of Campo Grande, state of Mato Grosso do Sul. The sandfly captures were performed in 13 residences that were selected by raffle considering four residences or collection station for buffer. These buffers were generated from the central house with about 50, 100 and 200 m from it in an endemic area of VL. The abundance of sandflies and human and canine cases were georreferenced using the GIS software PCI Geomatica. The normalized difference vegetation index (NDVI) and percentage of land covered by vegetation were the environmental variables extracted from a remote sensing IKONOS-2 image. The average NDVI was considered as the complexity of habitat and the standard deviation as the heterogeneity of habitat. One thousand three hundred sixty-seven specimens were collected during the catch. We found a significant positive linear correlation between the abundance of sandflies and the percentage of vegetation cover and average NDVI. However, there was no significant association between habitat heterogeneity and the abundance of these flies.