Cytokine profile in Leishmania-positive blood donors.

Serum levels of interleukin 2 (IL-2), interleukin 4 (IL-4), interleukin 6 (IL-6), interleukin 10 (IL-10), interleukin 17 (IL-17), interferon gamma (IFN-γ), tumor necrosis factor α (TNF-α), and interleukin 1ß (IL-1ß), cytokines involved in the immune response, were investigated in 75 Leishmania-positive blood donors living in endemic areas. Based on their status in 2011 and 2015, the subjects were clustered into three groups: positive for at least one diagnostic method in both years, but lacking clinical progression to disease (G1); positive on at least one method in 2011 but negative in 2015 (G2); negative on all methods in both years (G3). Donors were interviewed for sociodemographic data collection and underwent clinical evaluation and laboratory tests. Serum cytokines were quantified using a CBA Flex set (BD Biosciences). Significant differences were found for all the cytokines evaluated, with lower concentrations in consistently Leishmania-negative individuals. The exception was IFN-γ, with similar levels among all donors. No changes consistent with active disease were observed in the laboratory results for Leishmania-positive donors who underwent clinical evaluation, none of whom progressed to disease. This suggests that infection control is associated with serum IL-17 levels. Resolution of Leishmania infection in positive donors may be related to high levels of IL-17 and low levels of IL-10, highlighting the role played by IL-17 in asymptomatic Leishmania-infected individuals.

Presence of anti-Leishmania antibodies in candidates for kidney transplantation.

OBJECTIVES: Visceral leishmaniasis (VL) is a progressive disease that, left untreated, is typically fatal. The purpose of this investigation was to detect Leishmania sp. infection in hemodialysis patients who had received multiple blood transfusions at a private clinic in Campo Grande, Mato Grosso do Sul state, Midwest Brazil. METHODS: Fifty randomly selected volunteers were interviewed for collection of demographic, socioeconomic, and epidemiological data. Indirect immunofluorescence (titers positive when ≥1:40) and rK39 immunochromatographic tests were employed for serological investigation. RESULTS: Males predominated (60%). Age ranged from 20 to 77 years. Most subjects reported being on hemodialysis for at least one year (94%) and 84% were candidates for kidney transplantation, 67% of whom were on the waiting list. Leishmania sp. infection was detected in 32%. Contact with infected dogs was the only variable associated with infection. CONCLUSIONS: Under immunocompromised conditions, VL is opportunistic and potentially fatal. Despite existing risks, screening for VL is not performed in asymptomatic donors and recipients. The detection of anti-Leishmania antibodies in these patients reinforces the need for infection screening before immunosuppressive treatment is initiated to reduce not only the risks of VL development and severity, but also mortality rates in cases of reactivation of latent infection.

Viability of Leishmania in blood donors: A tangible possibility of transfusion transmission.

Asymptomatic individuals apparently able for blood donation, could be infected with Leishmania imposing risks for immunologically vulnerable recipients. Reverse transcribed conventional PCR targeting the 28S ribosomal subunit was conducted, in order to confirm the viability of the parasite in blood donors positive for Leishmania infection.

Leishmania (Viannia) braziliensis type 2 as probable etiological agent of canine cutaneous leishmaniasis in Brazilian Amazon.

Canine cutaneous leishmaniasis (CCL) is a zoonosis of public health interest, and in the Americas, Leishmania (Viannia) braziliensis has been identified as the main etiological agent. The present study sought to investigate Leishmania spp. infection in domestic dogs from a rural area of the Xapuri municipality, Acre state, Brazilian Amazonia. For this purpose, visits were carried out to domiciles where the human cases of American cutaneous leishmaniasis (ACL) occurred, followed by the clinical evaluation of the animals in search of clinical signs suggestive of CCL. Blood samples were collected from 40 dogs, 13 of which had lesions suggestive of CCL, and biopsies of these lesions were performed. The methods used were Neal, Novy, and Nicolle's (NNN) medium cultures and direct parasitological examination. Further, to detect and characterize Leishmania DNA some molecular techniques were performed such as conventional polymerase chain reaction (PCR) and sequencing targeting SSU rDNA and ITS1, restriction fragment length polymorphism (RFLP) and high resolution melting (HRM) analysis targeting hsp70. The investigation revealed that the results obtained from the parasitological methods were negative. In PCR by ITS1 and network topology sequences, six strains from dogs, isolated from the Peruvian Andes, appeared identical to Leishmania (Viannia) braziliensis type 2 (99-100%). By other molecular methods these samples turned out to be positive to Leishmania (Viannia) sp.. The diagnosis of Leishmania in domestic dogs from Acre state showed a high proportion of infected animals, and the occurrence of L. braziliensis type 2 in Brazil for the first time. This new report suggests that L. braziliensis type 2 is both trans- and cis-Andean. However, more studies are needed regarding the clinical and diagnostic aspects of this species of Leishmania.

Disney Trap Attractiveness for the Cortelezzii Series (Diptera: Psychodidae, Phlebotominae) in a Fishing Tourism Area, Bonito Municipality, Mato Grosso do Sul State, Brazil.

Sand fly fauna is frequently sampled using automatic light or Shannon traps, yet few studies have been devoted to investigating the effectiveness of Disney traps baited with live animals as an attractant. This study sought to identify the phlebotomine fauna attracted to Disney traps having hamsters (Mesocricetus auratus) as bait. A hamster-baited Disney trap was installed in a gallery forest located in Águas do Miranda District, Bonito Municipality, Mato Grosso do Sul state, Brazil, from November 2011 to October 2012. A total of 717 phlebotomines were collected, in which male (251) and female (463) specimens of the Cortelezzii series (Diptera: Psychodidae) predominated (99%). Males were attracted from January to July, whereas the females were predominantly attracted from January to May. No significant correlation was observed between the monthly climatic averages of temperature, rains and humidity, and the numbers of insects collected. Although these findings showed the attractiveness of both sexes of the species of the Cortelezzii series to golden hamsters, further studies are needed to investigate the blood meal preferences of these females to other rodents. As rodents have been reported as reservoirs of Leishmania spp. (Kinetoplastida: Trypanosomatidae), research using live-baited traps can reveal feeding preferences of sand flies and the importance of various rodent species in the zoonotic cycle.

Leishmania infection in blood donors: A new challenge in leishmaniasis transmission?

Transfusion-transmitted leishmaniasis has been a concern in regions endemic for the disease. Whether immediate or delayed, the risks posed by this mode of transmission call for careful assessment. The purpose of this study was to detect Leishmania infection in blood donors living in an endemic area and to investigate progression to the disease in these individuals. Immunofluorescent antibody test, enzyme-linked immunosorbent assay, leishmaniasis rapid test, and the polymerase chain reaction were applied to 430 donors in an initial evaluation. Of those donors with at least one positive test, 50 were reevaluated four years later by the same methods, as were 25 controls who had been negative on the same tests. In the first evaluation, Leishmania infection was detected in 41.4% (95% CI: 36.7-46.1) of donors (n = 430). None of the 75 reevaluated individuals had developed the disease, but retesting revealed positivity in at least one test in 36.0% (95% CI: 25.1-46.9) of donors. Of the 50 initially testing positive, 50% remained so on retesting. Of the 25 initially negative controls, two tested positive in the subsequent evaluation. The severity of the parasitosis and the risk of transfusion transmission warrant investigation of the potential inclusion of methods for Leishmania detection into blood banks for effective screening of infected donors.

Characterization of Leishmania species from Central-West Region of Brazil.

Leishmaniasis represents a complex of diseases with a broad clinical spectrum and epidemiological diversity. Involving a variety of agents, reservoirs, and vectors, cutaneous leishmaniasis (CL) presents different transmission patterns, which makes its control especially difficult. Epidemiological characterization with identification of existing Leishmania species in a particular region is essential for understanding this parasitosis epidemiology. Because similar results may be observed in places with overlapping transmission of visceral and cutaneous leishmaniasis, contributing to knowledge about the epidemiological cycle of cutaneous leishmaniasis is of global interest. This study proposes to identify the different species of Leishmania present in human CL cases in the state of Mato Grosso do Sul, Brazil. Slides of imprint tissue were selected from patients diagnosed with CL from 2009 to 2013 at the Laboratório de Parasitologia Clínica, Universidade Federal de Mato Grosso do Sul. The slides were scraped and extracted genetic material was amplified with PCR addressing the Leishmania spp. kDNA region. The reaction product was subjected to RFLP for the specific identification of Leishmania. Forty-three samples (82.7%) amplified with PCR were considered positive. Of these, it was possible to determine the species in 40 samples (76.9%) through analysis of electrophoresis profiles. Leishmania (Viannia) braziliensis, Leishmania (Leishmania) amazonensis, and Leishmania (Leishmania) infantum were identified as the etiologic agents of CL in Mato Grosso do Sul. The results of this study permit a more detailed understanding of CL epidemiology and the geographical distribution of its agents.

Enteroparasites in Riverside Settlements in the Pantanal Wetlands Ecosystem.

BACKGROUND: Intestinal parasites are a major source of health problems in developing countries, where socioeconomic, cultural, and environmental conditions contribute in maintaining the biological cycles of various parasites and facilitating their spread. The objective of this study, conducted in Corumbá, Mato Grosso do Sul state, Brazil, was to investigate the occurrence of intestinal parasites in riverside communities in the South Pantanal wetlands and conduct educational interventions focused on health and environmental preservation. METHOD: In total, 196 stool samples were tested for parasites using the merthiolate-iodine-formaldehyde concentration (MIFC) technique and spontaneous sedimentation and educational activities were carried out. RESULTS: Enteroparasite prevalence was 72% (65.6-78.2%; 95% CI). Of the 141 positive cases, monoparasitism was found in 34.7%, biparasitism in 23%, and polyparasitism in 14.3%. Entamoeba coli was the most frequent protozoan (70.2%). Among helminths, hookworms were the most prevalent. Enteroparasitosis prevalence did not differ for sex or place of abode but proved higher in individuals older than 10 years. CONCLUSION: The high positivity rate for enteroparasites found for the communities stems from lack of sanitation and poor personal and environmental hygiene habits, indicating that effective health policies and educational interventions are needed to reduce the current risk levels.

Serological and molecular inquiry of Chagas disease in an Afro-descendant settlement in Mato Grosso do Sul State, Brazil.

Furnas do Dionísio is a Brazilian Afro-descendant settlement in the city of Jaraguari, 21.4 miles from Campo Grande, Mato Grosso do Sul, Brazil. Approximately 96 families live in this quilombola (Maroon) settlement, also known in Brazil as a remnant community of descendants of African slaves. Recent studies found 20% of households were infested by triatomines, 18% of insects captured in the community were infected by Trypanosoma cruzi, and 22.7% of dogs presented T. cruzi antibodies. The low prevalence of Chagas disease observed in humans in Mato Grosso do Sul State is attributed to its arrival via colonist migration and subsequent transplacental transmission. In order to gain a better understanding of the T. cruzi cycle in residents of the study community, serological and molecular tests were carried out to diagnose Chagas disease. In the present study, 175 residents between 2 and 80 years old were included. A total of 175 participants were interviewed and 170 provided blood samples, which were tested for T. cruzi antibodies with serological tests. Molecular diagnosis was performed in 167 participants by PCR (KDNA) and NPCR (satellite DNA) tests. One of the 170 samples tested positive for all serological tests performed. The overall frequency of Chagas disease in the community was low (0.6%). Interview responses revealed that 66.3% knew of triatomine insects and 65.7% reported having had no contact with them. Physical improvements to residences, together with vector surveillance and control by the State and municipal governments and local ecological conservation contribute to the low frequency of the Chagas disease in this quilombola community.

Leishmania amazonensis isolated from human visceral leishmaniasis: histopathological analysis and parasitological burden in different inbred mice.

Leishmania amazonensis is a major etiological agent of human cutaneous leishmaniasis in the Americas; nevertheless there are some reports of this species causing visceral disease in dogs and men. In the present work we have studied a Leishmania strain isolated from a human case of visceral leishmaniasis. We have infected different mouse strains and analyzed the development of the disease, studying the parasite's ability to visceralize and whether this ability is influenced by host genetics. Female BALB/c, C57BL/6, C57BL/10, CBA, DBA/2, and C3H/He mice were subcutaneously infected with 104 L. amazonensis amastigotes. BALB/c, C57BL/6 and C57BL/10 mice were found to be very susceptible to infection, showing lesions that developed to necrosis and ulceration. CBA mice developed a late but severe lesion. DBA/2 mice developed only discrete lesions, while C3H/He mice did not develop any lesions. All mouse strains except C3H/He showed some degree of visceralization, presenting parasites in the spleen, while BALB/c, C57BL/6 and CBA presented parasites also in the liver. Moreover, most of the strains presented high parasite load at the infection site, whereas DBA and C3H/He mice showed low or no parasite load 90 days after infection, respectively. Histopathology corroborates the results, showing that susceptible mice presented an inflammatory reaction with parasites in the skin, lymph nodes and spleen, while strains that are more resistant presented low parasitism and discrete inflammatory reaction. Results indicate that this isolate is extremely virulent, can easily visceralize and that the pathogenesis of leishmaniasis is, at least in part, related to the genetic background of the host.

Isolation and molecular characterization of Leishmania infantum in urine from patients with visceral leishmaniasis in Brazil.

Leishmania infantum is a protozoan that causes visceral leishmaniasis, a potentially deadly neglected tropical disease. The gold standard for diagnosis has traditionally been detection of amastigotes in bone marrow or spleen aspirates, but this is an invasive procedure that carries the risk of serious complications. Newer PCR techniques are opening new avenues and tissues for testing. Therefore, we tested if amastigotes and DNA from L. infantum could be detected in patient urine. We detected L. infantum DNA in six out of 30 urine samples from patients with visceral leishmaniasis and the promastigotes were isolated in culture from the urine of one patient. These results suggest the feasibility of using urine samples to diagnose visceral leishmaniasis, especially in acute cases or renal infection, providing a valuable tool for doctors and clinicians to use for screening and diagnosis of leishmaniasis in patients.

Canine visceral leishmaniosis in an area of fishing tourism, Bonito Municipality, Mato Grosso do Sul, Central-West Brazil / Leishmaniose visceral canina em área de turismo pesqueiro, município de Bonito, Mato Grosso do Sul, Centro-Oeste do Brasil

ABSTRACT: The study aimed to investigate Leishmania infection in a population of dogs (92 animals) in a fishing area of Bonito Municipality, and evaluate comparatively the serological methods used, immunoenzymatic assay (ELISA), indirect immunofluorescence antibody test (IFAT), and rapid Dual Path-Platform test (DPP®). Blood and aspirate of bone marrow samples were used and parasitological investigation was also performed, such as parasite isolation in Neal, Novy, Nicolle (NNN) medium culture, Woo technique, Giemsa stained smears and specific identification by polymerase chain reaction (PCR). IFAT revealed 56/92 seropositive, the ELISA 8/92 and the DPP®41/92. Regarding the agreement between the serological tests by the Kappa index, there was a slight agreement between ELISA/IFAT and ELISA/DPP®, and fair agreement in IFAT/DPP®. The NNN culture was positive in three out of 21 dogs, and identified by PCR as Leishmania infantum chagasi. No samples were positive by the Woo technique. Our results showed low agreements between the serological tests recommended by the Brazilian Ministry of Heath, and it is necessary to associate other diagnostic techniques, such as parasitological tests and PCR, to increase the sensitivity for canine visceral leishmaniosis diagnosis, mainly regarding asymptomatic dogs in endemic areas.

RESUMO: O estudo teve como objetivo verificar a infecção por Leishmania em uma população de cães (n=92 animais) de uma área de turismo de pesca no município de Bonito e avaliar comparativamente os métodos sorológicos utilizados, ensaio imunoenzimático (ELISA), reação de imunofluorescência indireta (RIFI) e teste rápido de plataforma dupla (DPP®). Testes parasitológicos também foram realizados, como o isolamento do parasita em meio de cultura Neal, Novy, Nicolle, técnica de Woo, esfregaços em lâminas coradas com Giemsa e identificação específica pela reação em cadeia da polimerase (PCR). A RIFI revelou sorologia positiva de 56/92, ELISA 8/92 e DPP®41/92. Quanto à concordância entre os testes sorológicos pelo índice Kappa, houve um ligeiro acordo entre ELISA/RIFI e ELISA/DPP®, e uma concordância razoável entre RIFI/DPP®. A cultura NNN foi positiva em três cães, e identificada por PCR como Leishmania infantum chagasi. Nenhuma amostra foi positiva pela técnica de Woo. Nossos resultados mostraram baixas concordâncias entre os testes sorológicos recomendados pelo Ministério da Saúde, sendo necessário associar a outras técnicas de diagnóstico, como testes parasitológicos e PCR, para aumentar a sensibilidade ao diagnóstico de leishmaniose visceral canina, principalmente, com relação aos cães assintomáticos em áreas endêmicas.

Intestinal parasitism among waste pickers in Mato Grosso do Sul, Midwest Brazil.

The purpose of this study was to estimate the prevalence of intestinal parasites in both cooperative-affiliated and independent waste pickers operating at the municipal sanitary landfill in Campo Grande, Mato Grosso do Sul, Brazil, and associate these findings with hemoglobin, eosinophils, vitamin A and C levels and interleukin 5 and 10 (IL-5 and IL-10) production. Biological samples were collected, in addition to clinical, epidemiological, and sociodemographic data. Stool analyzes were based on sedimentation by centrifugation and on spontaneous sedimentation. High-performance liquid chromatography was used to determine vitamin A and C levels. ELISA was employed to quantify interleukins. Intestinal parasites were found in 29 of the 66 subjects assessed (43.9%). Endolimax nana (22.7%), Entamoeba coli (21.1%), Giardia lamblia (6.1%), Entamoeba histolytica/E. dispar (4.5%), and Ascaris lumbricoides (4.5%) were the most prevalent species. Pathogenic parasites were detected in 11 individuals (16.7%). Hypovitaminoses A and C were detected in 19.6% (13/66) and 98.4% (65/66) of subjects, respectively. IL-5 and IL-10 production was observed in 21 (31.8%) and 32 (48.4%) subjects, respectively. Infection with pathogenic intestinal parasites was not a cause of vitamin A and C deficiency or IL-5 and IL-10 production among these workers.

Prevalence of intestinal parasites among inmates in Midwest Brazil.

BACKGROUND: Intestinal parasitic infections constitute a public health issue in developing countries, with prevalence rates as high as 90%, a figure set to escalate as the socioeconomic status of affected populations deteriorates. Investigating the occurrence of these infections among inmates is critical, since this group is more vulnerable to the spread of a number of infectious illnesses. METHODS: This cross-sectional, analytical, quantitative study was conducted in July 2015 at prison facilities located in Midwest Brazil to estimate the prevalence of parasitic infection among inmates. For detection of parasites, 510 stool samples were examined by ether centrifugation and spontaneous sedimentation. RESULTS: Eight parasitic species were detected, with an overall prevalence of 20.2% (103/510). Giardia lamblia and Entamoeba histolytica/dispar were the most frequent pathogenic parasites. Endolimax nana was the predominant non-pathogenic species. Nearly half of the subjects (53/103; 51.4%) were positive for mixed infection. Logistic regression revealed that inmates held in closed conditions were more likely to contract parasitic infections than those held in a semi-open regime (OR = 1.97; 95% CI = 1.19-3.25; p = 0.0085). A higher prevalence of parasitic infections was observed among individuals who had received no prophylactic antiparasitic treatment in previous years (OR = 10.2; 95% CI = 5.86-17.66; p < 0.001). The other factors investigated had no direct association with the presence of intestinal parasites. CONCLUSION: Infections caused by directly transmissible parasites were detected. Without adequate treatment and prophylactic guidance, inmates tend to remain indefinitely infected with intestinal parasites, whether while serving time in prison or after release.

Leishmania (V.) braziliensis infecting bats from Pantanal wetland, Brazil: First records for Platyrrhinus lineatus and Artibeus planirostris.

In the New World genus Leishmania parasites are etiological agents of neglected zoonoses known as leishmaniasis. Its epidemiology is very complex due to the participation of several species of sand fly vectors and mammalian hosts, and man is an accidental host. Control is very difficult because of the different epidemiological patterns of transmission observed. Studies about Leishmania spp. infection in bats are so scarce, which represents a large gap in knowledge about the role of these animals in the transmission cycle of these pathogens, especially when considering that Chiroptera is one of the most abundant and diverse orders among mammals. Leishmaniasis in Mato Grosso do Sul, Brazil are remarkably frequent, probably due to the abundance of its regional mastofauna. The recent record of L. braziliensis in bats from this state indicates the need to clarify the role of these mammals in the transmission cycle. In this study we evaluated the presence of Leishmania parasites in the skin of different species of bats, using PCR directed to Leishmania spp. kDNA for screening followed by PCR/RFLP analysis of the hsp70 gene for the identification of parasite species. Leishmania species identification was confirmed by PCR directed to the G6PD gene of L. braziliensis, followed by sequencing of the PCR product. Samples from 47 bats were processed, of which in three specimens (6.38%) was detected the presence of Leishmania sp. kDNA. PCR/RFLP and sequencing identified the species involved in the infection as L. braziliensis in all of them. This is the first report of Leishmania braziliensis in bats from Pantanal ecosystem and the first record of this species in Platyrrhinus lineatus and Artibeus planirostris, bats with a wide distribution in South America. These results reinforce the need to deepen the knowledge about the possibility of bats act as reservoirs of Leishmania spp. especially considering their ability of dispersion and occupation of anthropic environments.

Sandflies in an urban area of transmission of visceral leishmaniasis in midwest Brazil.

The phlebotomine fauna of Campo Grande city, capital of Mato Grosso do Sul state in Brazil, an endemic area for visceral leishmaniasis, has been thoroughly investigated, but all the insect collections were undertaken with automatic light traps. The present study sought to investigate the fauna in this city using Shannon and Disney traps, having human beings and hamsters, respectively, as bait. Both types of traps were installed in forest fragment and peridomiciliary areas in the period from 2007 to 2009. The phlebotomine females were analyzed by PCR for Leishmania identification. Lutzomyia longipalpis was the only species collected in the peridomiciles and rendered a total of 574 specimens with a 5.2:1 male:female ratio. A total of eight species were attracted to the two traps (one of each type) installed in the forest fragment, including: Bichromomyia flaviscutellata, Evandromyia bourrouli, Evandromyia lenti, Lutzomyia longipalpis, Nyssomyia whitmani, Pintomyia christenseni, Psathyromyia bigeniculata, and Sciopemyia sordellii. A total of 143 specimens were collected, Bi. flaviscutellata accounting for 81% and Lu. longipalpis for 1.4% of them. In one female of Lu. longipalpis collected in a Disney trap installed in a peridomicile, Leishmania (Leishmania) infantum DNA was found, thus strengthening the hypothesis that the transmission of leishmaniasis is in fact occurring in the anthropic environment.

Leishmania infantum Genetic Diversity and Lutzomyia longipalpis Mitochondrial Haplotypes in Brazil.

Leishmania infantum is the etiological agent of visceral leishmaniasis (VL) in the Americas with domestic dogs being its major reservoir hosts. The main VL vector is the sandfly Lutzomyia longipalpis, while other Lutzomyia species may play a role in disease transmission. Although the genetic structure of L. infantum populations has been widely evaluated, only a few studies have addressed this subject coupled to the genetic structure of the respective sandfly vectors. In this study, we analyzed the population structure of L. infantum in three major VL endemic areas in Brazil and associated it with Lutzomyia longipalpis geographic structure.

Antissaliva Antibodies of Lutzomyia Longipalpis in area of Visceral Leishmaniasis.

The aim of the present study was to assess the presence of antissaliva antibodies of Lutzomyia longipalpis in human hosts living in area of visceral leishmaniasis, located in the Center-West region of Brazil. The presence of antissaliva antibodies of L. longipalpis exhibited a strong correlation with the protection and development of antibodies against Leishmania sp. Of the 492 children studied, elevated antissaliva antibodies of L. longipalpis were detected in 38.4% of the participants. There was a higher percentage of positivity (64.7%) among children who exhibited anti-Leishmania sp. antibodies and among those who were positive in the delayed hypersensitivity test (34.8%).

Leishmania infantum AS A CAUSATIVE AGENT OF CUTANEOUS LEISHMANIASIS IN THE STATE OF MATO GROSSO DO SUL, BRAZIL.

Cutaneous leishmaniasis is caused by different species of the Leishmania genus. Leishmania(Leishmania) infantum, causing cutaneous leishmaniasis, has been described in patients living in areas where visceral leishmaniasis is endemic. In this study, it was possible to characterize this species in seven slides from cutaneous tissue imprints from patients with cutaneous leishmaniasis in the State of Mato Grosso do Sul, Brazil.

Risk Factors for Death from Visceral Leishmaniasis in an Urban Area of Brazil.

BACKGROUND: Over the last three decades, the epidemiological profile of visceral leishmaniasis (VL) has changed with epidemics occurring in large urban centers of Brazil, an increase in HIV/AIDS co-infection, and a significant increase in mortality. The objective of this study was to identify the risk factors associated with death among adult patients with VL from an urban endemic area of Brazil. METHODOLOGY: A prospective cohort study included 134 adult patients with VL admitted to the University Hospital of the Federal University of Mato Grosso do Sul between August 2011 and August 2013. PRINCIPAL FINDINGS: Patients ranged from 18 to 93 years old, with a mean age of 43.6 (±15.7%). Of these patients, 36.6% were co-infected with HIV/AIDS, and the mortality rate was 21.6%. In a multivariate analysis, the risk factors associated with death were secondary bacterial infection (42.86, 5.05-363.85), relapse (12.17, 2.06-71.99), edema (7.74, 1.33-45.05) and HIV/AIDS co-infection (7.33, 1.22-43.98). CONCLUSIONS/SIGNIFICANCE: VL has a high mortality rate in adults from endemic urban areas, especially when coinciding with high rates of HIV/AIDS co-infection.