The following review of visceral leishmaniasis in Brazil is abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1-2] Primary references are available on request.
Time and Place:
- Visceral leishmaniasis was first described in Brazil in 1934 and first reported from Rio de Janeiro state in 1977.
- Brazil accounts for over 90% of cases in the New World.
- 90% of cases are reported from the north (mouth of Amazon) and eastern region.
- 44,289 cases were reported during 1980 to 2000 – 89.9% of these from the northeast
- 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 first reported in 1981, from Teresina (Piaui State).
- A large focus extends from Roraima into Venezuela and Guyana.
Annual rates have remained fairly constant since 1995, and are strikingly similar to those reported in India – see graph [3] : 95 to 278 fatal cases per year were reported during this period – see graph.
Incidence by district and state:
- Aracatuba (Sao Paulo) reported 43 cases (4 fatal) in 2002.
- Bahia reported 12,413 cases during 1985 to 1999. 7% of municipalities were endemic in 1985; 18% in 1990; 30% in 1996.
- Belo Horizonte reported only one case prior to 1994; 35 during an epidemic in 1994.
- Brasilia, Federal District reported 21 autochthonous cases during 2005 to 2009.
- Ceara: Fortaleza registered 1,379 cases during 2001 to 2006.
- Ipanema, Minas Gerais reported six cases during September 2009 to February 2010.
- Mato Grosso reported 123 cases of canine infection in 2007; 301 (and 6 cases of human infection) in 2008.
- 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. 10 577 cases were reported in Campo Grande in 2001.
- Natal reported 316 cases Natal during 1989 to 1993.
- Pernambuco reported 1,310 cases during 1990 to 1999; 427 during 2000 to 2001.
- Piaui and Maranhao reported 1,400 cases in 1994 (over 50% of Brazilian cases).
- Rio de Janeiro reported 87 cases during 1977 to 2006.
- Roraima reported 82 cases among Indians during 1989 to 1993.
- Teresina reported almost 1,000 cases during 1981 to 1985; 1,200 during 1993 to 1996.
- Tres Lagoas, Mato Grosso do Sul State reported 149 cases during 2000 to 2003.
Prevalence surveys:
0.3% of solid organ transplant recipients (2001 to 2006)
1% of renal transplant recipients in Fortaleza, Ceara State (2008 publication)
Seroprevalence surveys:
4.5% of inhabitants of 15 villages (L. infantum, Paco do Lumiar County, 2007 publication)
4.8% to 20% of asymptomatic inhabitants of northeastern Sao Paulo (2007 publication)
20.6% of persons in rural Rio Grande do Norte (2008 publication)
24.6% of asymptomatic persons in Natal (2011 publication)
47% in Pancas, Espirito Santo (2003 to 2004)
18.9% of persons in Raposa, Maranhao State (2011 publication)
12.6% of persons in Barcarena, PA (2003)
24.4% of persons in an endemic region of Para State (2008 publication)
22.3% of hemodialysis patients in Natal (2009 publication)
The rate of infection among children ages 1 to 11 years in rural Ceara is 4.6% per year (1987 to 1989).
- 61.7% of children age – Acquisition through blood transfusion has been reported. Nine percent of volunteer blood donors and 37% of multiply-transfused hemodialysis patients from Natal (Rio Grande do Norte) are seropositive (1994 to 1996).
HIV-AIDS and visceral leishmaniasis:
25 cases of HIV-Leishmania coinfection were reported to November 1995; 100 to June 2003.
- An additional 15 cases were reported in a 2009 publication.
- The estimated rate of visceral leishmaniasis among HIV-positive patients treated at a tertiary medical center in Brasilia was 16% (2009 publication) 31
- HIV-positive patients with visceral leishmaniasis were found to have a mean age of 37.3 years, vs. 12.5 years among HIV-negative leishmaniasis patients. Co-infected patients were more likely to be male (88% vs. 65%, Rio Grande do Norte, 1990 to 2009).
- Asymptomatic leishmaniasis was identified in 10.8% of HIV-positive patients (ELISA, Minas Gerais, 1999 to 2001)
Reservoirs:
- 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.
- Leishmania chagasi infection has been documented in a bush dog (Speothos venaticus) in Mato Grosso State (2007 publication)
- The first case in the Americas of natural infection in a cat (Felis catus) was reported from Sao Paulo State.
An infected cat was subsequently identified in Belo Horizonte City.
5.8% of cats in Andradina Municipality, Sao Paulo State were found to be infected (2010 publication)
21.85% of cats in an endemic area of Sao Paulo State were found to be infected (2012 publication)
23.0% of cats in Aracatuba, Sao Paulo State were found to be seropositive (CAG-ELISA, 2011 publication)
49.1% of cats with dermatological problems were found to be infected by Leishmania chagasi (Aracatuba, 2008 to 2009)
- An opossum (Didelphis albiventris) from Jacobina, Bahia State, was found naturally infected with Leishmania donovani . Natural infection has also been demonstrated in Didelphis aurita in the region of Rio de Janeiro and in 20.4% of Didelphis albiventris in Mato Grosso do Sul.
- Infection has been identified in wild canids in Belo Horizonte: bush dog (Speothos venaticus), hoary zorro (Lycalopex vetulus), crab-eating fox (Cerdocyon thous) 46 and maned wolf (Chrysocyon brachyurus).
- Infection has also been identified in wild and captive felids (jaguars and pumas).
- There is evidence for infection by Leishmania (Leishmania) amazonensis and Leishmania (Leishmania) infantum chagasi in Brazilian bats.
- There is no evidence for infection of capybaras (Hydrochoerus hydrochaeris) in Sao Paulo (2009 publication)
- Evidence for natural infection has been found in a variety of captive primates in Belo Horizonte: a black-fronted titi (Callicebus nigrifrons), a howler monkey (Alouatta guariba), golden-bellied capuchins (Cebus xanthosternos), a golden-headed lion tamarin (Leontopithecus crysomelas), a black-headed owl monkey (Aotus nigriceps), Rio Tapajos sakis (Pithecia irrorata) and emperor tamarins (Saguinus imperator).
- 23% of fleas and 50% of ticks from dogs infected by Leishmania chagasi were found to carry the parasite (2011 publication)
Canine infection rates:
- 21.4% of stray dogs and 26.2% of in domestic dogs in Fortaleza, Ceara State (2008 publication)
- 36% in Jacobina (1993 publication)
- 47.8% in Raposa, Maranhao State (2011 publication)
- 42.5% in Anastacio, Mato Grosso do Sul (2004 publication)
- 11.2% in Cuiaba/Mato Grosso (2011 publication)
- 2% to 5% in Belo Horizonte; 5% in Montes Claros, Minas Gerais (2002 and 2007)
- 24.7% in Belo Horizonte, Minas Gerais (2011 publication)
- 7.8% in Belo Horizonte, Minas Gerais (2010 publication)
- 23.47% in northern Minas Gerais (positive by at least one test, 2008 to 2009)
- 77.0% to 77.5% of asymptomatic and 87.5% to 95.0% of symptomatic dogs in Minas Gerais (conjunctival PCR, 2012 publication)
- 46% in the Krenak indigenous community, Minas Gerais (2007)
- 23.3% in Para State (2010 publication)
- 78% in Piaui (2011 publication)
- 4.2% of domiciled dogs in Paracatu (2010 publication)
- 0.0027% (a single dog) in Parana State (2010 publication)
- 6% to 20% in various areas of Parana (2007 publication)
- 40.3% in Pernambuco (2006 publication)
- 16% in Garanhuns, Pernambuco (2010 publication)
- 4.7% (L. infantum) in Sao Paulo (2007 publication)
- 1% of sick dogs in Sao Paulo State (2007 publication)
- 0% in rural Botucatu, Sao Paulo State (2011 publication)
- 3.79% in Sao Paulo (1999 publication)
- 64.7% of euthanized dogs in Ilha Solteira, Sao Paulo (2009 publication)
- 57% in Pancas, Espirito Santo (2003 to 2004)
- 58.5% in the rural northeast (2010 publication)
- 18% in Lago Norte, Federal District (2008)
- 4.6% in Rio de Janeiro in 1984; 1.6% in 2008.
- 2.9% in Rio de Janeiro (2011 publication)
- 27.9% in Monte Negro, Rondonia (2010 publication)
- 40% in Salvador (spleen PRC, 2011 publication)
Vectors:
The etiologic agent of visceral leishmaniasis 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; and Lu. corelezzi in Santa Luzia, Minas Gerais state
- Lutzomyia longipalpis (95%) was the most common vector identified in Mato Grosso do Sul State; trypanosomoids were detected in 10.39%. Brumptomyia avellari, Evandromyia cortelezzii, Evandromyia lenti and Nyssomyia whitmani were also found. (2003)
- Lutzomyia longipalpis was identified in a coastal area of Rio de Janeiro (2008 to 2009)
- 1.1% 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 Lu. migonei. (northern Zona da Mata, Pernambuco State, 2002 to 2003)
- 1.5% of Lu. cruzi and 0.7% of Lu. forattinii sandflies were infected with L. chagasi (L. infantum). (Corumba, Mato Grosso do Sul, 2006) Lu. almerioi has also been identified as a vector in the area.
- 1.6% of Lutzomyia longipalpis in Raposa, Maranhao State were found to be infected (2011 publication)
- Vectors in Maranhao include L. longipalpis, L. evandroi, L. lenti, L. termitophila, L. flaviscutellata, L. migonei, L. infraspinosa, L. sordellii, L. wellcomei, L. antunesi, and L. trinidadensis.
- Vectors identified in Espirito Santo do Pinhal include Nyssomyia whitmani and Pintomyia pessoai in the rural area, Lutzomyia longipalpis and Ny. whitmani in the periurban area and Lu. longipalpis in the urban area.
- 3.9% of Lu. longipalpis in Janauba, Minas Gerais were found to carry Leishmania infantum chagasi (2011 publication)
- Lutzomyia cruzi has been identified as a vector in Jaciara, Mato Grosso.
- Migonemyia migonei has been implicated as a vector in Pernambuco.
- 1.9% of phlebotomine sandflies (99.15% Lu. longipalpis) carry Leishmania chagasi. (Mato Grosso do Sul, 2005 to 2006)
- Viannamya furcata, Lutzomyia neivai and Lutzomyia sallesi have also been implicated.
- Leishmania infantum has been identified in ticks Rhipicephalus sanguineus in Italy and Brazil (2010 publication)
- Leishmania infantum was found in 19% of Lutzomyia longipalpis, 3.8% of Nyssomyia whitmani, 33.3% of Evandromyia termitophila and Nyssomyia intermedia (southeastern Brazil, 2006 to 2007)
Notable outbreaks:
1964 (publication year) – An outbreak of visceral leishmaniasis was reported in Bahia.
1980 to 1986 – An outbreak was reported in Piaui.
1981 to 1985 – An outbreak (1,000 cases) was reported in Terasina.
1986 (publication year) – An outbreak was reported in Santarem, Para State.
1993 to 1996 – An outbreak (1,200 cases) was reported in Terasina.
1994 (publication year) – An outbreak (316 cases) was reported in Natal.
2008 – An outbreak (17 cases, 6 fatal) was reported in Rondonopolis, Mato Grosso.
References:
1. Berger SA. Infectious Diseases of Brazil, 2012. 553 pages, 118 graphs, 4191 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-brazil/
2. Berger SA. Visceral Leishmaniasis: Global Status, 2012. 88 pages, 73 graphs, 832 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/visceral-leishmaniasis-global-status/
3. Gideon Graph Tool, see tutorial at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps
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