Increase of visceral leishmaniasis in Brazil
Quoted in ProMED:
Visceral leishmaniasis was 1st described in Brazil in 1934 and 1st reported from Rio de Janeiro state in 1977.
90 percent of cases are reported from the north (mouth of the Amazon) and eastern regions. The disease is endemic to Alagoas, Bahia, Ceara, Espirito Santo, Goias, Maranhao, Mato Grosso do Sul, Minas Gerais, Para, Paraiba, Pernambuco, Piaui, Rio Grande do Norte, Roraima and Sergipe. Urban transmission was 1st reported in 1981, from Teresina (Piaui State). A large focus extends from Roraima into Venezuela and Guyana.
The reported incidence has increased from 164 cases (35 fatal) in 1980 to 3220 (223 fatal) in 2005; see graph . A total of 44 289 cases were reported during 1980 to 2000, 39 823 of these from the northeast. Brazil accounts for over 90 percent of cases in the New World.
Incidence by district and state:Aracatuba (Sao Paulo) reported 43 cases (4 fatal) in 2002.
Bahia reported 12 413 cases during 1985 to 1999. Seven percent of municipalities were endemic in 1985; 18 percent in 1990; 30 percent in 1996.
Belo Horizonte reported only one case prior to 1994; 35 during an epidemic in 1994.
Mato Grosso do Sul reported 114 cases (9 fatal) in 2001; 25 (6 fatal) during January to April 2002; 149 (12 fatal) during 2000 to 2003.
Natal reported 316 cases during 1989 to 1993.
Pernambuco reported 1310 cases during 1990 to 1999, 427 during 2000 to 2001.
Piaui and Maranhao reported 1400 cases in 1994 (over 50 percent of Brazilian cases).
Roraima reported 82 cases among Indians during 1989 to 1993. 10.3 percent of dogs in the region are infested.
Teresina reported almost 1000 cases during 1981 to 1985.
Tres Lagoas, Mato Grosso do Sul State reported 149 cases during 2000 to 2003.
Seroprevalence surveys:
4.5 percent of inhabitants of 15 villages were seropositive to _L. infantum chagasi_ (Paco do Lumiar County, 2007 publication)
4.7 percent of dogs (_L. infantum_) (Sao Paulo, 2007 publication)
One percent of sick dogs (Sao Paulo State, 2007 publication)
The rate of infection among children ages 1-11 years in rural Ceara is 4.6 percent per year (1987 to 1989).
61.7 percent of children age <15 years in Sao Jose de Ribamar, Maranhao are skin-test positive.
Acquisition through blood transfusion has been reported. Nine percent of volunteer blood donors and 37 percent of multiply-transfused hemodialysis patients from Natal (Rio Grande do Norte) are seropositive (1994 to 1996).
25 cases of HIV-Leishmania coinfection were reported to November 1995; 100 to June 2003.
The etiologic agent is _Leishmania chagasi_ (_L. infantum_), and the local vector is _Lutzomyia longipalpis_. _Lu. forattinii_ has also been implicated in Mato Grosso do Sul; and _Lu. whitmani_ in Parana state. _Lutzomyia longipalpis_ (95 percent) was the most common vector identified in Mato Grosso do Sul state; trypanosomoids were detected in 10.39 percent. _Brumptomyia avellari_, _Evandromyia cortelezzii_, _Evandromyia lenti_ and _Nyssomyia whitmani_ were also found (2003). 1.1 percent of female sandflies (all _Lu. longipalpis_) carry _Leishmania_ species (Teresina, Piaui, 2004 to 2005). _Lutzomyia complexa_ is the most common sandfly species in Sao Vicente Ferrer, followed by _L. migonei_ (northern Zona da Mata, Pernambuco State, 2002 to 2003). _Viannamya furcata_ has also been implicated.
Dogs are key reservoirs in this country in addition to foxes (_Cerdocyon thous_) in northeastern Brazil. The role of additional fox species (_Dusicyon vetulus_) in the north and of opossums (_Didelphis albiventris_ and _D. marsupialis_) is unclear. Two to 5 percent of dogs in Belo Horizonte are infected; 5 percent in Montes Claros, Minas Gerais (2002 and 2007); 36 percent in Jacobina; 3.79 percent in Sao Paulo; 40.3 percent in Pernambuco; 6 percent to 20 percent in various areas of Parana. _Leishmania chagasi_ infection has been documented in a bush dog (Mato Grosso State, 2007 publication). The 1st case in the Americas of natural infection in a cat (_Felis catus_) was reported from Sao Paulo State.
