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1.
PLoS Negl Trop Dis ; 16(7): e0010564, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35802748

ABSTRACT

Yellow fever virus (YFV) has a long history of impacting human health in South America. Mayaro virus (MAYV) is an emerging arbovirus of public health concern in the Neotropics and its full impact is yet unknown. Both YFV and MAYV are primarily maintained via a sylvatic transmission cycle but can be opportunistically transmitted to humans by the bites of infected forest dwelling Haemagogus janthinomys Dyar, 1921. To better understand the potential risk of YFV and MAYV transmission to humans, a more detailed understanding of this vector species' distribution is critical. This study compiled a comprehensive database of 177 unique Hg. janthinomys collection sites retrieved from the published literature, digitized museum specimens and publicly accessible mosquito surveillance data. Covariate analysis was performed to optimize a selection of environmental (topographic and bioclimatic) variables associated with predicting habitat suitability, and species distributions modelled across South America using a maximum entropy (MaxEnt) approach. Our results indicate that suitable habitat for Hg. janthinomys can be found across forested regions of South America including the Atlantic forests and interior Amazon.


Subject(s)
Alphavirus , Culicidae , Mercury , Yellow Fever , Animals , Brazil/epidemiology , Ecosystem , Humans , Mosquito Vectors , South America/epidemiology , Yellow Fever/epidemiology , Yellow fever virus
2.
Viruses ; 14(6)2022 06 07.
Article in English | MEDLINE | ID: mdl-35746705

ABSTRACT

Genomic surveillance of SARS-CoV-2 is one of the tools that provide genomic information on circulating variants. Given the recent emergence of the Omicron (B.1.1.529) variant, this tool has provided data about this lineage's genomic and epidemiological characteristics. However, in South America, this variant's arrival and genomic diversity are scarcely known. Therefore, this study determined the genomic diversity and phylogenetic relationships of 21,615 Omicron genomes available in public databases. We found that in South America, BA.1 (n = 15,449, 71%) and BA.1.1 (n = 6257, 29%) are the dominant sublineages, with several mutations that favor transmission and antibody evasion. In addition, these lineages showed cryptic transmission arriving on the continent in late September 2021. This event may have contributed to the dispersal of Omicron sublineages and the acquisition of new mutations. Considering the genomic and epidemiological characteristics of these lineages, especially those with a high number of mutations in their genome, it is important to conduct studies and surveillance on the dynamics of these lineages to identify the mechanisms of mutation acquisition and their impact on public health.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , Genomics , Humans , Phylogeny , SARS-CoV-2/genetics , South America/epidemiology
3.
Glob Health Epidemiol Genom ; 2022: 8551576, 2022.
Article in English | MEDLINE | ID: mdl-35655960

ABSTRACT

Since the zoonotic event from which SARS-CoV-2 started infecting humans late in 2019, the virus has caused more than 5 million deaths and has infected over 500 million people around the world. The pandemic has had a severe impact on social and economic activities, with greater repercussions in low-income countries. South America, with almost 5% of the world's population, has reckoned with almost a fifth of the total people infected and more than 26% (>1/4) of the deceased. Fortunately, the full genome structure and sequence of SARS-CoV-2 have been rapidly obtained and studied thanks to all the scientific efforts and data sharing around the world. Such molecular analysis of SARS-CoV-2 dynamics showed that rates of mutation, similar to other members of the Coronaviridae family, along with natural selection forces, could result in the emergence of new variants; few of them might be of high consequence. However, this is a serious threat to controlling the pandemic and, of course, enduring the process of returning to normalization with the implicit monetary cost of such a contingency. The lack of updated knowledge in South America justifies the need to develop a structured genomic surveillance program of current and emerging SARS-CoV-2 variants. The modeling of the molecular events and microevolution of the virus will contribute to making better decisions on public health management of the pandemic and developing accurate treatments and more efficient vaccines.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , Genomics , Humans , SARS-CoV-2/genetics , South America/epidemiology
5.
Age Ageing ; 51(5)2022 05 01.
Article in English | MEDLINE | ID: mdl-35604089

ABSTRACT

Latin American countries (LAC), with their culturally and ethnically diverse populations, form a region that is difficult to define and to understand. The region's health systems are deeply fragmented, which poses great challenges to overall equity levels in health. This is also one of the fastest ageing regions in the world, with increasing demands as well for acute and long-term care (LTC). Demographic and epidemiological transitions across the region are heterogeneous. In this context, health systems are in general, largely unprepared to face the challenge of promoting healthy ageing. This unpreparedness has been magnified by the Coronavirus disease-2019 pandemic. Here, we analyse the burden of disease in the older population and identify priorities to improve the care and quality of life for people living in LAC. Besides an adequately prepared workforce, we must remediate disparities and inequities; develop and implement integrated care; achieve patient-centred care and further develop palliative and end-of-life care; simultaneously, we must develop the structure and financing of LTC services and strengthen the role of public health making healthy ageing an essential component.


Subject(s)
COVID-19 , Quality of Life , Aged , COVID-19/epidemiology , Delivery of Health Care , Humans , Long-Term Care , South America/epidemiology
6.
Ann Parasitol ; 67(4): 723-731, 2021.
Article in English | MEDLINE | ID: mdl-35294139

ABSTRACT

The most frequent etiologic agent of diphyllobothriosis in South America and the only one confirmed by molecular data in human cases in Peru is Adenocephalus pacificus (syn. Diphyllobothrium pacificum). This cestode is transmitted by ingestion of the plerocercoids found in marine fish, causing a parasitic zoonosis. The objective of the present study was to identify two cestodes isolated from two specimens of the South American sea lion (Otaria byronia) stranded on the beaches of Huacho and Barranca cities, located on the northern Peruvian coasts, in the department of Lima. Tapeworms were confirmed by morphological characteristics due to the presence of transverse papilla-like tegumental protuberances in proglottids and small sized eggs, as well as by sequencing of the partial cytochrome c oxidase subunit 1 (mtDNA-COI) gene that are congruent with additional available A. pacificus sequences. Even though sea lions in Peru are distributed along the coast and in areas of difficult access, generally located in protected natural areas, the fortuitous finding represented an opportunity to confirm the presence of A. pacificus in South American sea lions. This report of tapeworm A. pacificus could allow future monitoring of the occurrence and geographical distribution of this causative agent in epidemiological studies, since it is one of the main species of zoonotic importance in Peru.


Subject(s)
Cestoda , Diphyllobothrium , Sea Lions , Animals , Cestoda/genetics , Diphyllobothrium/anatomy & histology , Peru/epidemiology , Sea Lions/genetics , South America/epidemiology
7.
Nat Commun ; 13(1): 1195, 2022 03 07.
Article in English | MEDLINE | ID: mdl-35256608

ABSTRACT

Previous ancient DNA research has shown that Mycobacterium pinnipedii, which today causes tuberculosis (TB) primarily in pinnipeds, infected human populations living in the coastal areas of Peru prior to European colonization. Skeletal evidence indicates the presence of TB in several pre-colonial South and North American populations with minimal access to marine resources- a scenario incompatible with TB transmission directly from infected pinnipeds or their tissues. In this study, we investigate the causative agent of TB in ten pre-colonial, non-coastal individuals from South America. We reconstruct M. pinnipedii genomes (10- to 15-fold mean coverage) from three contemporaneous individuals from inland Peru and Colombia, demonstrating the widespread dissemination of M. pinnipedii beyond the coast, either through human-to-human and/or animal-mediated routes. Overall, our study suggests that TB transmission in the pre-colonial era Americas involved a more complex transmission pathway than simple pinniped-to-human transfer.


Subject(s)
Caniformia , Mycobacterium tuberculosis , Mycobacterium , Tuberculosis , Animals , Caniformia/genetics , DNA, Ancient , Humans , Mycobacterium/genetics , Mycobacterium tuberculosis/genetics , South America/epidemiology , Tuberculosis/epidemiology , Tuberculosis/microbiology
8.
Sci Rep ; 12(1): 1748, 2022 02 02.
Article in English | MEDLINE | ID: mdl-35110661

ABSTRACT

African horse sickness is a vector-borne, non-contagious and highly infectious disease of equines caused by African horse sickness viruses (AHSv) that mainly affect horses. The occurrence of the disease causes huge economic impacts because of its high fatality rate, trade ban and disease control costs. In the planning of vectors and vector-borne diseases like AHS, the application of Ecological niche models (ENM) used an enormous contribution in precisely delineating the suitable habitats of the vector. We developed an ENM to delineate the global suitability of AHSv based on retrospective outbreak data records from 2005 to 2019. The model was developed in an R software program using the Biomod2 package with an Ensemble modeling technique. Predictive environmental variables like mean diurnal range, mean precipitation of driest month(mm), precipitation seasonality (cv), mean annual maximum temperature (oc), mean annual minimum temperature (oc), mean precipitation of warmest quarter(mm), mean precipitation of coldest quarter (mm), mean annual precipitation (mm), solar radiation (kj /day), elevation/altitude (m), wind speed (m/s) were used to develop the model. From these variables, solar radiation, mean maximum temperature, average annual precipitation, altitude and precipitation seasonality contributed 36.83%, 17.1%, 14.34%, 7.61%, and 6.4%, respectively. The model depicted the sub-Sahara African continent as the most suitable area for the virus. Mainly Senegal, Burkina Faso, Niger, Nigeria, Ethiopia, Sudan, Somalia, South Africa, Zimbabwe, Madagascar and Malawi are African countries identified as highly suitable countries for the virus. Besides, OIE-listed disease-free countries like India, Australia, Brazil, Paraguay and Bolivia have been found suitable for the virus. This model can be used as an epidemiological tool in planning control and surveillance of diseases nationally or internationally.


Subject(s)
African Horse Sickness Virus , African Horse Sickness , Ecosystem , Models, Statistical , Africa/epidemiology , African Horse Sickness/epidemiology , African Horse Sickness/transmission , Animals , Ceratopogonidae/virology , Disease Outbreaks/veterinary , Horses , India/epidemiology , Insect Vectors/virology , Software , South Africa/epidemiology , South America/epidemiology , Temperature , Vector Borne Diseases/epidemiology , Vector Borne Diseases/transmission , Vector Borne Diseases/veterinary
9.
Pediatr Neurol ; 128: 33-44, 2022 03.
Article in English | MEDLINE | ID: mdl-35066369

ABSTRACT

BACKGROUND: Our objective was to characterize the frequency, early impact, and risk factors for neurological manifestations in hospitalized children with acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or multisystem inflammatory syndrome in children (MIS-C). METHODS: Multicenter, cross-sectional study of neurological manifestations in children aged <18 years hospitalized with positive SARS-CoV-2 test or clinical diagnosis of a SARS-CoV-2-related condition between January 2020 and April 2021. Multivariable logistic regression to identify risk factors for neurological manifestations was performed. RESULTS: Of 1493 children, 1278 (86%) were diagnosed with acute SARS-CoV-2 and 215 (14%) with MIS-C. Overall, 44% of the cohort (40% acute SARS-CoV-2 and 66% MIS-C) had at least one neurological manifestation. The most common neurological findings in children with acute SARS-CoV-2 and MIS-C diagnosis were headache (16% and 47%) and acute encephalopathy (15% and 22%), both P < 0.05. Children with neurological manifestations were more likely to require intensive care unit (ICU) care (51% vs 22%), P < 0.001. In multivariable logistic regression, children with neurological manifestations were older (odds ratio [OR] 1.1 and 95% confidence interval [CI] 1.07 to 1.13) and more likely to have MIS-C versus acute SARS-CoV-2 (OR 2.16, 95% CI 1.45 to 3.24), pre-existing neurological and metabolic conditions (OR 3.48, 95% CI 2.37 to 5.15; and OR 1.65, 95% CI 1.04 to 2.66, respectively), and pharyngeal (OR 1.74, 95% CI 1.16 to 2.64) or abdominal pain (OR 1.43, 95% CI 1.03 to 2.00); all P < 0.05. CONCLUSIONS: In this multicenter study, 44% of children hospitalized with SARS-CoV-2-related conditions experienced neurological manifestations, which were associated with ICU admission and pre-existing neurological condition. Posthospital assessment for, and support of, functional impairment and neuroprotective strategies are vitally needed.


Subject(s)
COVID-19/complications , Nervous System Diseases/epidemiology , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/epidemiology , Acute Disease , Adolescent , Brain Diseases/epidemiology , Brain Diseases/etiology , COVID-19/epidemiology , Child , Child, Preschool , Cross-Sectional Studies , Female , Headache/epidemiology , Headache/etiology , Humans , Infant , Intensive Care Units, Pediatric/statistics & numerical data , Logistic Models , Male , Nervous System Diseases/etiology , Prevalence , Risk Factors , South America/epidemiology , United States/epidemiology
11.
Acta Parasitol ; 67(2): 577-581, 2022 Jun.
Article in English | MEDLINE | ID: mdl-35000114

ABSTRACT

PURPOSE: Livestock is regarded as a source of parasites to wildlife populations, but no assessment of the nature and magnitude of parasite transmission from livestock to South American canids is available. METHODS: Here we systematically reviewed articles that evaluate protozoa, helminths and arthropods in wild canids living in areas with and without the presence of livestock. RESULTS: There is an unbalanced study effort which precludes proper testing of the assumption that livestock increase the incidence and prevalence of parasites in wild canids. Most of the parasites reported are shared with domestic carnivores. CONCLUSION: Available information strongly suggests that the role played by livestock and their associated dogs on wild canid parasitism should be re-evaluated.


Subject(s)
Canidae , Parasites , Animals , Animals, Wild/parasitology , Livestock , South America/epidemiology
13.
Viruses ; 13(12)2021 12 11.
Article in English | MEDLINE | ID: mdl-34960753

ABSTRACT

The rabies virus (RABV) is characterized by a history dominated by host shifts within and among bats and carnivores. One of the main outcomes of long-term RABV maintenance in dogs was the establishment of variants in a wide variety of mesocarnivores. In this study, we present the most comprehensive phylogenetic and phylogeographic analysis, contributing to a better understanding of the origins, diversification, and the role of different host species in the evolution and diffusion of a dog-related variant endemic of South America. A total of 237 complete Nucleoprotein gene sequences were studied, corresponding to wild and domestic species, performing selection analyses, ancestral states reconstructions, and recombination analyses. This variant originated in Brazil and disseminated through Argentina and Paraguay, where a previously unknown lineage was found. A single host shift was identified in the phylogeny, from dog to the crab-eating fox (Cerdocyon thous) in the Northeast of Brazil. Although this process occurred in a background of purifying selection, there is evidence of adaptive evolution -or selection of sub-consensus sequences- in internal branches after the host shift. The interaction of domestic and wild cycles persisted after host switching, as revealed by spillover and putative recombination events.


Subject(s)
Rabies virus/genetics , Rabies virus/isolation & purification , Rabies/veterinary , Animals , Animals, Domestic/virology , Animals, Wild/virology , Dog Diseases/epidemiology , Dog Diseases/virology , Dogs , Evolution, Molecular , Foxes/virology , Nucleoproteins/genetics , Phylogeny , Rabies/epidemiology , Rabies/virology , Rabies virus/classification , Recombination, Genetic , South America/epidemiology
14.
Trends Parasitol ; 38(3): 195-204, 2022 03.
Article in English | MEDLINE | ID: mdl-34952798

ABSTRACT

Fasciola hepatica is a worldwide emerging and re-emerging parasite heavily affecting several regions in South America. Some lymnaeid snail species of American origin are among the major hosts of F. hepatica worldwide. Recent paleoparasitological findings detected its DNA in a 2300-year-old sample in Patagonia, countering the common hypothesis of the recent arrival of F. hepatica in the Americas during European colonization. Thus, the theory of an initial introduction in the 1500s can no longer be sustained. This article discusses how it was possible for F. hepatica to reach and spread in the Americas in relation to the availability and compatibility of hosts through natural and incidental introductions. Our study will serve to better understand the ongoing Neotropical scenario of fasciolosis.


Subject(s)
Fasciola hepatica , Fascioliasis , Americas/epidemiology , Animals , Fasciola hepatica/genetics , Fascioliasis/epidemiology , Fascioliasis/parasitology , Snails/parasitology , South America/epidemiology
15.
Pathog Glob Health ; 116(4): 236-243, 2022 06.
Article in English | MEDLINE | ID: mdl-34928187

ABSTRACT

Vaccine hesitancy is considered one of the greatest threats to the ongoing coronavirus disease 2019 (COVID-19) vaccination programs. Lack of trust in vaccine benefits, along with concerns about side effects of the newly developed COVID-19 vaccine, might significantly contribute to COVID-19 vaccine hesitancy. The objective of this study was to determine the level of vaccine hesitancy among communities in particular their belief in vaccination benefits and perceived risks of new vaccines. An online cross-sectional study was conducted in 10 countries in Asia, Africa, and South America from February to May 2021. Seven items from the WHO SAGE Vaccine Hesitancy Scale were used to measure a construct of belief in vaccination benefit, and one item measured perceived riskiness of new vaccines. A logistic regression was used to determine which sociodemographic factors were associated with both vaccine hesitancy constructs. A total of 1,832 respondents were included in the final analysis of which 36.2% (range 5.6-52.2%) and 77.6% (range 38.3-91.2%) of them were classified as vaccine hesitant in terms of beliefs in vaccination benefits and concerns about new vaccines, respectively. Respondents from Pakistan had the highest vaccine hesitancy while those from Chile had the lowest. Being females, Muslim, having a non-healthcare-related job and not receiving a flu vaccination during the past 12 months were associated with poor beliefs of vaccination benefits. Those who were living in rural areas, Muslim, and those who did not received a flu vaccination during the past 12 months had relatively higher beliefs that new vaccines are riskier. High prevalence of vaccine hesitancy in some countries during the COVID-19 pandemic might hamper COVID-19 vaccination programs worldwide. Programs should be developed to promote vaccination in those sociodemographic groups with relatively high vaccine hesitancy.


Subject(s)
COVID-19 , Influenza Vaccines , Africa , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Cross-Sectional Studies , Female , Humans , Male , Pakistan , Pandemics , SARS-CoV-2 , South America/epidemiology , Vaccination , Vaccination Hesitancy
16.
Am J Trop Med Hyg ; 106(1): 33-37, 2021 11 29.
Article in English | MEDLINE | ID: mdl-34844214

ABSTRACT

Tropical alluvial gold and gem miners are often an especially at-risk population for malaria infection. Geographical areas of mining-associated malaria epidemics in the recent past include Southeast Asia (Cambodia, Thailand, and Myanmar); the Amazon basin (Brazil, French Guyana, Suriname, Columbia, and Peru); and tropical Africa. Mobile populations of young adult men engaged in the hard labor of mining may experience severe malaria especially if they lack preexisting immunity and are irregularly consuming antimalarial drugs. Particular problems occur because much of this informal mining activity is illegal and done in isolated areas without access to health services and with evidence of emerging antimalarial drug resistance. Concentrating vulnerable populations in an ecologically disturbed landscape is often conducive to epidemics, which can then spread as these highly mobile workers return to their homes. Mining-associated malaria endangers malaria elimination efforts and miners need to be addressed as a group of particular concern.


Subject(s)
Malaria/epidemiology , Miners , Africa/epidemiology , Antimalarials/therapeutic use , Asia, Southeastern/epidemiology , Epidemics , Humans , Male , Mining , South America/epidemiology , Vulnerable Populations , Young Adult
17.
Ann Hematol ; 101(2): 341-348, 2022 Feb.
Article in English | MEDLINE | ID: mdl-34713310

ABSTRACT

Chronic lymphocytic leukemia (CLL) is the most common mature B-cell neoplasm in the West. IGHV4-34 is one of the most frequently used genes in CLL patients, which usually display an indolent outcome. In this study, we explored the mutational profile of CLL patients expressing IGHV4-34 within different stereotypes and their association with prognostic factors and clinical outcome. A multi-institutional cohort of unselected 1444 CLL patients was analyzed by RT-PCR and bidirectional sequencing. Cytogenetics and molecular cytogenetics analyses were also performed. We identified 144 (10%) IGHV4-34 expressing cases, 119 mutated (M), 44 of them with stereotyped B-cell receptors. Subset #4 was the most frequent (56.8% of cases) followed by subsets #16 (13.6%), #29 (6.8%), and #201 (2.3%), with different distribution among countries. Analysis of somatic hypermutation profile showed significant differences among stereotyped subsets for G28>D/E, P45>S, E55>Q, and S64>I changes (p < 0.01) and high frequency of disruption of the glycosylation motif in the VH CDR2 region. All stereotyped IGHV4-34 cases showed normal karyotypes. Deletion 13q14 as a sole alteration was present in 42.8% of stereotyped cases with a different distribution among subsets. A shorter time to first treatment was found in non-stereotyped vs. stereotyped M-IGHV4-34 patients (p = 0.034). Our results add new information supporting the importance of recurrent amino acid changes at particular positions, contributing to refine the molecular characterization of South American CLL patients.


Subject(s)
Leukemia, Lymphocytic, Chronic, B-Cell/genetics , Aged , Cohort Studies , Female , Gene Rearrangement , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology , Male , Middle Aged , Mutation , Receptors, Antigen, B-Cell/genetics , Somatic Hypermutation, Immunoglobulin , South America/epidemiology
19.
Curr Hematol Malig Rep ; 16(5): 440-447, 2021 10.
Article in English | MEDLINE | ID: mdl-34655027

ABSTRACT

PURPOSE OF REVIEW: Chronic myeloid leukemia (CML) management in developing countries has improved in the last years, but the availability of therapeutic resources, monitoring, reimbursement, and financial issues may be a challenge and interfere with the best practices and results of CML treatment. This review points out the main challenges in CML management in South America. RECENT FINDINGS: In this review, we describe the access to tyrosine kinase inhibitors and monitoring in different countries of South America. We also address the ongoing discontinuation trials, the progress, and limitations of hematopoietic stem cell transplantation in the last years. There are still many challenges for achieving the best outcomes for CML patients in South America. The continuous efforts to provide continuous education, access to tyrosine kinase inhibitors, and monitoring, providing reference centers for CML management and hematopoietic stem cell transplantation may improve patients' outcomes.


Subject(s)
Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Antineoplastic Agents/therapeutic use , Disease Management , Hematopoietic Stem Cell Transplantation , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology , Protein Kinase Inhibitors/therapeutic use , South America/epidemiology
20.
PLoS Negl Trop Dis ; 15(10): e0009863, 2021 10.
Article in English | MEDLINE | ID: mdl-34644288

ABSTRACT

BACKGROUND: Cutaneous leishmaniasis (CL) is frequent in travellers and can involve oro-nasal mucosae. Clinical presentation impacts therapeutic management. METHODOLOGY: Demographic and clinical data from 459 travellers infected in 47 different countries were collected by members of the European LeishMan consortium. The infecting Leishmania species was identified in 198 patients. PRINCIPAL FINDINGS: Compared to Old World CL, New World CL was more frequently ulcerative (75% vs 47%), larger (3 vs 2cm), less frequently facial (17% vs 38%) and less frequently associated with mucosal involvement (2.7% vs 5.3%). Patients with mucosal lesions were older (58 vs 30 years) and more frequently immunocompromised (37% vs 3.5%) compared to patients with only skin lesions. Young adults infected in Latin America with L. braziliensis or L. guyanensis complex typically had an ulcer of the lower limbs with mucosal involvement in 5.8% of cases. Typically, infections with L. major and L. tropica acquired in Africa or the Middle East were not associated with mucosal lesions, while infections with L. infantum, acquired in Southern Europe resulted in slowly evolving facial lesions with mucosal involvement in 22% of cases. Local or systemic treatments were used in patients with different clinical presentations but resulted in similarly high cure rates (89% vs 86%). CONCLUSION/SIGNIFICANCE: CL acquired in L. infantum-endemic European and Mediterranean areas displays unexpected high rates of mucosal involvement comparable to those of CL acquired in Latin America, especially in immunocompromised patients. When used as per recommendations, local therapy is associated with high cure rates.


Subject(s)
Leishmaniasis, Cutaneous/parasitology , Adolescent , Adult , Africa/epidemiology , Aged , Antiprotozoal Agents , Child , Europe/epidemiology , Female , Humans , Leishmania/classification , Leishmania/drug effects , Leishmania/genetics , Leishmania/isolation & purification , Leishmaniasis, Cutaneous/drug therapy , Leishmaniasis, Cutaneous/epidemiology , Male , Middle Aged , Middle East/epidemiology , South America/epidemiology , Travel , Young Adult
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