ABSTRACT
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.
Subject(s)
Leishmaniasis, Visceral/epidemiology , Leishmaniasis, Visceral/mortality , Urban Population , Adolescent , Adult , Aged , Aged, 80 and over , Brazil/epidemiology , Cohort Studies , Female , Humans , Male , Middle Aged , Risk Factors , Young AdultABSTRACT
The occurrence of an outbreak of cutaneous leishmaniasis associated with Leishmania (Leishmania) amazonensis in the municipality of Bela Vista, state of Mato Grosso do Sul, Brazil, and the absence of information on its vectors in this area led the authors to undertake captures of phlebotomine sand flies, using Shannon traps and automatic CDC light traps, in domiciles, forested areas and animal shelters from February 2004-January 2006. A total of 808 specimens belonging to 18 sandfly species have been identified: Bichromomyia flaviscutellata, Brumptomyia avellari, Brumptomyia brumpti, Brumptomyia sp, Evandromyia aldafalcaoae, Evandromyia cortelezzii, Evandromyia evandroi, Evandromyia lenti, Evandromyia teratodes, Evandromyia termitophila, Lutzomyia longipalpis, Nyssomyia whitmani, Pintomyia christenseni, Psathyromyia aragaoi, Psathyromyia campograndensis, Psathyromyia punctigeniculata, Psathyromyia shannoni and Sciopemyia sordellii. The presence of Lu. longipalpis, Ny. whitmani and Bi. flaviscutellata, vectors of Leishmania chagasi, Leishmania braziliensis and L. amazonensis, respectively, has increased.
Subject(s)
Insect Vectors/classification , Psychodidae/classification , Animals , Brazil/epidemiology , Endemic Diseases , Female , Humans , Leishmaniasis, Visceral/epidemiology , Leishmaniasis, Visceral/transmission , Male , Population Density , SeasonsABSTRACT
The occurrence of an outbreak of cutaneous leishmaniasis associated with Leishmania (Leishmania) amazonensis in the municipality of Bela Vista, state of Mato Grosso do Sul, Brazil, and the absence of information on its vectors in this area led the authors to undertake captures of phlebotomine sand flies, using Shannon traps and automatic CDC light traps, in domiciles, forested areas and animal shelters from February 2004-January 2006. A total of 808 specimens belonging to 18 sandfly species have been identified: Bichromomyia flaviscutellata,Brumptomyia avellari, Brumptomyia brumpti, Brumptomyia sp, Evandromyia aldafalcaoae, Evandromyia cortelezzii, Evandromyia evandroi, Evandromyia lenti, Evandromyia teratodes, Evandromyia termitophila, Lutzomyia longipalpis, Nyssomyia whitmani, Pintomyia christenseni, Psathyromyia aragaoi, Psathyromyia campograndensis, Psathyromyia punctigeniculata, Psathyromyia shannoni and Sciopemyia sordellii. The presence of Lu. longipalpis, Ny. whitmani and Bi. flaviscutellata, vectors of Leishmania chagasi, Leishmania braziliensis and L. amazonensis, respectively, has increased.
Subject(s)
Animals , Female , Humans , Male , Insect Vectors/classification , Psychodidae/classification , Brazil/epidemiology , Endemic Diseases , Leishmaniasis, Visceral/epidemiology , Leishmaniasis, Visceral/transmission , Population Density , SeasonsABSTRACT
OBJECTIVES: Because of the large number of cases of visceral leishmaniasis (VL) recorded in Brazil over the last few years, this disease has been showing characteristics different from previously known ones. We report cases of pregnant women treated for VL, describing their course and outcome and the chemotherapeutic medication used according to the clinical signs and symptoms of each patient. STUDY DESIGN: We report five cases of pregnant women treated for VL in a central-western region of Brazil. RESULTS: No case of vertical transmission was observed, even in patients who were treated after delivery. One of the patients with a late diagnosis made after the onset of symptoms died. Thus, the treatment of VL during pregnancy reduces maternal mortality and the rate of vertical transmission of the disease, being safe and effective as long as the disease is diagnosed early. CONCLUSION: At present, amphotericin B and its derivatives appear to be the best therapeutic option for the mother-child binomial.
Subject(s)
Leishmaniasis, Visceral/drug therapy , Pregnancy Complications, Infectious/drug therapy , Pregnancy Outcome , Adult , Amphotericin B/therapeutic use , Animals , Antimony Sodium Gluconate/therapeutic use , Antiprotozoal Agents/therapeutic use , Brazil , Deoxycholic Acid/therapeutic use , Drug Combinations , Female , Fever/parasitology , Hepatomegaly/parasitology , Humans , Leishmaniasis, Visceral/diagnosis , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Splenomegaly/parasitologyABSTRACT
This paper describes the modifications made to the original model of the Disney trap, with a view to easier handling of the same, greater practicability in the collection of sand flies, protection of the animal bait and durability of the trap in the field.
Subject(s)
Insect Control/instrumentation , Insect Vectors/classification , Psychodidae/classification , Animals , Female , Insect Control/methods , Male , Population DensityABSTRACT
This paper describes the modifications made to the original model of the Disney trap, with a view to easier handling of the same, greater practicability in the collection of sand flies, protection of the animal bait and durability of the trap in the field.
Subject(s)
Animals , Female , Male , Insect Control/instrumentation , Insect Vectors/classification , Psychodidae/classification , Insect Control/methods , Population DensityABSTRACT
Investigation was undertaken on the behaviour of the phlebotomine fauna in caves, forests, and anthropic environments of the Serra da Bodoquena, between January 1998 and January 2000. This paper reports on the phlebotomines captured in forested areas with automatic light traps (ALT), Shannon traps (ST), aspiration (AN), at natural resting sites and by human attractiveness (HA) during 24 h. The diversity and abundance of the species were investigated with ALT installed at 16 points (ground level) and 6 in the canopy. Natural infection by flagellates was investigated in females captured with ST AN, and HA. The sandfly fauna was represented by 23 species. Twenty-two of these were captured with ALT 15 of them on the western side, and 20 on the eastern. Lutzomyia longipalpis and Nyssomyia whitmani were the most abundant on the former and this species together with Lutzomyia almerioi on the latter side. On the eastern side the ecotopes located close to caves rendered a significantly greater number (P < or = 0.01) of specimens than did more distant sites. On this side Lu. almerioi contributed with 56% of the total number of specimens. Lu. almerioi females were predominantly attracted by humans (96.4%) and by ST (93.2%) and three of the 2173 dissected (0.138%) presented natural infection by flagellates. The attraction of Lu. almerioi to humans occurred during all seasons, predominantly in the summer, and in nocturnal and diurnal periods. Thus it is bothersome to inhabitants of and visitors to the Bodoquena ridge and a potential vector of flagellates.
Subject(s)
Insect Vectors/physiology , Psychodidae/physiology , Animals , Brazil , Female , Humans , Insect Vectors/classification , Leishmaniasis/transmission , Male , Population Density , Psychodidae/classification , Seasons , TreesABSTRACT
Investigation was undertaken on the behaviour of the phlebotomine fauna in caves, forests, and anthropic environments of the Serra da Bodoquena, between January 1998 and January 2000. This paper reports on the phlebotomines captured in forested areas with automatic light traps (ALT), Shannon traps (ST), aspiration (AN), at natural resting sites and by human attractiveness (HA) during 24 h. The diversity and abundance of the species were investigated with ALT installed at 16 points (ground level) and 6 in the canopy. Natural infection by flagellates was investigated in females captured with ST, AN, and HA. The sand fly fauna was represented by 23 species. Twenty-two of these were captured with ALT, 15 of them on the western side, and 20 on the eastern. Lutzomyia longipalpis and Nyssomyia whitmani were the most abundant on the former and this species together with Lutzomyia almerioi on the latter side. On the eastern side the ecotopes located close to caves rendered a significantly greater number (P < 0.01) of specimens than did more distant sites. On this side Lu. almerioi contributed with 56 percent of the total number of specimens. Lu. almerioi females were predominantly attracted by humans (96.4 percent) and by ST (93.2 percent) and three of the 2173 dissected (0.138 percent) presented natural infection by flagellates. The attraction of Lu. almerioi to humans occurred during all seasons, predominantly in the summer, and in nocturnal and diurnal periods. Thus it is bothersome to inhabitants of and visitors to the Bodoquena ridge and a potential vector of flagellates.
Subject(s)
Humans , Animals , Male , Female , Insect Vectors/physiology , Psychodidae/physiology , Brazil , Insect Vectors/classification , Leishmaniasis/transmission , Population Density , Psychodidae/classification , Seasons , TreesABSTRACT
The present paper deals with the phlebotomine species captured during the period from January 1998 to June 2000 in 12 caves located in the Serra da Bodoquena, situated in the south central region of Mato Grosso do Sul State, Brazil. Three of the caves are situated further north (in Bodoquena county), seven in the central area (Bonito county) and two in the south (Jardim county). These last two caves and three of those in Bonito are located at the west side of the ridge. Eighteen species of phlebotomines were captured within the caves: Brumptomyia avellari (Costa Lima, 1932), Brumptomyia brumpti (Larrousse, 1920), Brumptomyia cunhai (Mangabeira, 1942), Brumptomyia galindoi (Fairchild & Hertig, 1947), Evandromyia corumbaensis (Galati, Nunes, Oshiro & Rego, 1989), Lutzomyia almerioi Galati & Nunes, 1999, Lutzomyia longipalpis (Lutz & Neiva, 1912), Martinsmyia oliveirai (Martins, Falcão & Silva, 1970), Micropygomyia acanthopharynx (Martins, Falcão & Silva, 1962), Micropygomyia peresi (Mangabeira, 1942), Micropygomyia quinquefer (Dyar, 1929), Nyssomyia whitmani (Antunes & Coutinho, 1939), Psathyromyia campograndensis (Oliveira, Andrade-Filho, Falcão & Brazil, 2001), Psathyromyia punctigeniculata (Floch & Abonnenc, 1944), Psathyromyia shannoni (Dyar, 1929), Pintomyia kuscheli (Le Pont, Martinez, Torrez-Espejo & Dujardin, 1998), Sciopemyia sordellii (Shannon & Del Ponte, 1927) and Sciopemyia sp. A total of 29,599 phlebotomine sandflies was obtained. Lutzomyia almerioi was absolutely predominant (91.5 per cent) over the other species on both sides of the Bodoquena ridge, with the exception of the southern caves in which it was absent. It presents summer predominance, with nocturnal and diurnal activities. The species breeds in the caves and was captured during daytime both in the dark area and in the mouth of the caves. Martinsmyia oliveirai, the second most frequent sandfly, also presents a summer peak and only predominated over the other species in one cave, in which there were human residues.
Subject(s)
Animals , Diptera , Ecology , PsychodidaeABSTRACT
Desenvolveram-se estudos sobre flebotomíneos em área de leishmaniose tegumentar, fazenda Boa Sorte, Município de Corguinho, Mato Grosso do Sul, Brasil, com vistas a incriminar vetor dessa parasitose. No início dos estudos, encontravam-se bem preservados vários tipos da cobertura vegetal primitiva, com predomínio de cerrado e cerradäo, denominado localmente de "Croa". Decorridos quatro meses, parte significativa da "Croa" e do cerrado foi queimada para transformaçäo em áreas de pastagens. Durante julho/1991 a junho/93, realizaram-se coletas semanais das 18:00 às 6:00 horas, com armadilha CDC (Center on Disease Control), em floresta-galeria, floresta de encostas, cerrado, "Croa", peridomicílio (chiqueiro e poleiro) e no interior de uma tulha, coletas mensais com armadilha de Shannon das 18:00 às 24:00 horas em floresta-galeria e "Croa". De junho/91 a setembro de 1992, capturas mensais com isca humana, por 24 horas, em floresta-galeria. Investigou-se infecçäo natural por flagelados em flebotomíneos coletados com armadilha de Shannon e isca humana. As coletas com CDC resultaram 24 espécies de Lutzomyia e duas de Brumptomyia. A "Croa" foi o ambiente que mais contribuiu com espécimes e que apresentou a maior diversidade, juntamente com a floresta de encostas. Nas coletas com CDC, L. whitmani revelou-se a mais abundante, índice de abundância padronizado = 0,991; porém, esteve muito pouco representada no interior do anexo domiciliar; apresentou prevalência de 96,0 por cento nas armadilhas de Shannon e isca humana, respectivamente com 3,265 e 516 espécimes. Sua maior frequência deu-se em épocas frias e secas. Dotada de atividade quase que exclusivamente noturna, exibiu pico de ocorrência das 18:00 às 19:00 horas. A taxa de infecçäo natural por flagelados, em 680 fêmeas de flebotomíneos dissecadas, foi de 0,15 por cento e, entre 613 fêmeas de L. whitmani, de 0,16 por cento. Com base em seu comportamento L. whitmani foi incriminada como provável vetora da leishmaniose tegumentar na área. A segunda espécie mais abundante, L. lenti, näo demonstra antropofilia. Apresenta-se também a fauna flebotomínica por ambientes
Subject(s)
Animals , Psychodidae/classification , Disease Vectors , Leishmaniasis, Mucocutaneous/transmission , Ecosystem , Insect Vectors/classificationABSTRACT
Com o objetivo de se conhecer a prevalência da infecçao por leishmaniose tegumentar americana, e caracterizaçao da populaçao atingida, em área de transmissao recente, na localidade de Boa Sorte, município de Corguinho, MS, procedeu-se ao estudo, no período de março/9l a março/94, da populaçao residente, compreendendo 150 habitantes. Destes, 12 apresentavam lesoes suspeitas de leishmaniose tegumentar. Em 8 deles foi possível a confirmaçao por meio de exames parasitológicos. Apenas um paciente apresentou a forma mucosa, os demais manifestaram as formas cutâneas, sendo: ulcerada (3), úlcero-verrucosa (1), úlcero vegetante (1), placa-infiltrada (1) e lesao nodular com exuberante adenopatia regional (1). Os pacientes responderam bem ao tratamento com antimoniato de N-metilglucamina (glucantime), 10 a 2Omg Sbv/kg/dia durante 20 dias, com cicatrizaçao das lesoes e raros efeitos colaterais. O parasito isolado de todos os pacientes foi identificado como Leishmania (Viannia) braziliensis, através de anticorpos monoclonais. O teste de Montenegro aplicado em 150 moradores revelou 32 reagentes. Destes, 6 eram portadores da doença, 21 mostraram seqüelas sugestivas da parasitose e 5 nao apresentaram sinais da infecçao. A faixa etária atingida pela parasitose compreendia de 22 a 78 anos com predomínio de homens (75 por cento). A transmissao até o momento revelou-se de caráter extradomiciliar.
