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Human Visceral Leishmaniosis: Epidemiological Analysis of the Brazilian Territory.

Brasileiro MR*

Bachelor of Biological Sciences and Master of Animal Science Universidade do Oeste Paulista, UNOESTE, Brazil

Corresponding Author:
Brasileiro MR
Bachelor of Biological Sciences and Master of Animal Science
Universidade do Oeste Paulista, UNOESTE, Brazil
Tel: 18998138768
E-mail: [email protected]

Accepted Date: July 29, 2017

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Abstract

Visceral leishmaniasis is a chronic disease of visceral manifestation caused by a protozoan of the Leishmania genus belonging to the Trypanosomatidae Family. The causative agent of Visceral Leishmaniasis in Brazil is Leishmania chagasi, a mandatory intracellular parasite parasite. The current study aimed at a quantitative retrospective approach on human visceral leishmaniasis in Brazil, according to data from a Ministry of Health platform, SINAN, reporting on the number of cases in the Brazilian states in January 2003 To December 2013. In the period established, Brazil had 36,658 cases, an average of 3,675 cases per year. The most endemic region is the Northeast, with 21,049 (47.14%) of the total confirmed cases in the Brazilian territory, followed by the Southeast (21.58%), North (20.35%) and Central West and South with 10, 81% and 0.12% respectively.

Keywords

Leishmaniasis, American visceral leishmaniasis, Leishmania chagasi, Calazar

Introduction

Visceral leishmaniasis is a chronic disease of visceral manifestation caused by a protozoan of the genus Leishmania [1]. The genus belongs to the family Trypanosomatidae, and the causative agent of Visceral Leishmaniasis (LV) in Brazil has been described as Leishmania infantum [2]. They later described the causative agent of visceral leishmaniasis in the America as Leishmania chagasi, noting that Leishmania infantum is a different species of Leishmania chagasi [3,4]. LV is popularly known as Calazar being one of the most deadly diseases in the world.

It is estimated that 200 to 400 thousand new cases of LV per year and that 6 countries including Brazil account for 90% of these new cases. The number of confirmed cases in Brazil each year is increasing, which is a concern for public health, an opinion of the Ministry of Health 5 reports the increase in LVH lethality from 3.4% in 1994 to 5.5% In 2008, an increase of 61.8% in this period.

In Brazil, approximately 90% of the reported cases of Human visceral leishmaniasis (LVH) in the 1990s occurred in the Northeast region. Over the years, the disease spread to other regions. In 2010, the Northeast had 48% of the national cases [5].

Leishmania chagasi

Protozoan parasite obligatory intracellular that needs to complete its life cycle in two types of hosts. One of the hosts is an invertebrate belonging to the Family Psychodidae, Subfamily Phlebotominae, being in Brazil of the genus Lutzomyia longipalpis known popularly as a straw or birigui mosquito, this one presents in its digestive tube the flagellate form of the protozoan 6 known as Promastigota, and the second host is a mammalian vertebrate, being the human and domestic dog (Canis lupus familiaris) [6].

Wild hosts

In the state of Mato Grosso do Sul, wild animals naturally infected with Leishmania chagasi were found: opossums (Didelphis albiventris), foxes (Cerdocyon thous) and foxes (Lycalopex vetulus) [7].

Vector transmission

In Brazil the main transmitter is Lutzomyia longipalpis popularly known as straw mosquito or birigui [8]. It is a hematophagous diphtheria that when feeding the prey, in the case the susceptible mammalian vertebrate host regurgitates along with the saliva the protozoa in the promastigote form. Once inoculated into the animal, this protozoa may invade mainly the macrophages, thus hiding itself from the other cells of defense. When the macrophage phagocytes the flagellated forms, they are not destroyed, transforming later to the amastigote form, non-flagellated forms. These forms can reproduce inside the cells by binary division, increasing more and more the amastigote forms of the protozoan, until breaking the macrophage wall falling into the bloodstream and infecting new cells [9]. There are no confirmed cases of direct transmission in humans, that is, from person to person. The protozoan needs to complete the 2 life cycles, respectively in the invertebrate and mammalian vertebrate, in order to be transmitted by the vector to the human.

Diagnosis

The disease is characterized mainly by irregular fever, weight loss and enlargement of the liver and spleen. The diagnosis of LVH is confirmed in the laboratory, through clinical and laboratory analyzes, consisting of parasitological tests for identification of the protozoan and immunological tests.

Vaccination and treatment

According to the Brazilian Society of Tropical Medicine, the vaccine for Leishmaniasis in humans is still something futuristic and that the vaccine against Canine LV is in a way much more efficient for the control of the disease [10]. As for the treatment, two main drugs are used in Brazil: a pentavalent antimonial and Amphotericin B. The Ministry of Health 5 recommends N-methyl Glucamine Antimonate as the initial drug for the treatment of LVH [11].

Methodology

This is a retrospective descriptive research aimed at collecting epidemiological data regarding LVH in the period from January 2003 to December 2013. Values collected from the online database of the Ministry of Health/SVS - Notification - SINAN, aiming at the schematic presentation of the number of confirmed cases in the period stipulated in the federative units of Brazil. The results were filtered by specific year of infection occurrence and Federative Unit (UF), later worked on Excel 2010 spreadsheets.

Results

The collection of retrospective epidemiological data is important for the epidemiology of the disease to be mapped, reporting the regions that present confirmed cases and the most endemic states, allowing later work on these data.

As shown in Table 1, the Central-West Region had the state of Mato Grosso do Sul with the highest 37 number of cases, 2,644 (67.2%). In the Northeast, the state with the highest number of cases was Ceará with 5,190 cases, representing 24.7% of the total number of confirmed cases in the region. In the North, the states of Tocantins with a total of 3,838 cases and Pará with a total of 3,471 cases, representing respectively 51.4% and 46.5% of the total cases in the region. In the Southeast Region the state with the highest number of cases was Minas Gerais with a total of 5,270 (66.6%) followed by the State of São Paulo with 2,552 (32.2%). Southern Brazil is the region least affected by the disease, the state with the highest number of cases was Paraná with 28 (62.2%).

Region/Federative unit (UF) 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Total/UF x̄/UF Total/Region/x̄/UF
Midwest Distrito Federal 0 73 98 80 57 61 59 37 40 38 45 588 53 3963(10.81%) (360/year)
Goiás 30 27 22 30 19 28 23 33 29 28 32 301 27
Mato Grosso Do Sul 194 238 240 241 234 252 195 213 273 320 244 2644 240
Mato Grosso 10 19 21 21 31 55 68 55 55 60 35 430 39
Northeast Alagoas 52 59 58 48 32 25 31 34 37 37 25 438 40 21049 (47.14%) (1913/year)
Bahia 374 465 516 376 233 197 349 394 378 314 322 3918 356
Ceará 241 313 410 371 550 556 677 541 611 439 481 5190 472
Maranhão 735 435 395 371 301 404 370 354 381 239 519 4504 409
Paraíba 37 30 32 37 25 41 21 33 42 41 37 376 34
Pernambuco 75 95 98 104 76 85 83 67 85 71 73 912 83
Piauí 446 549 495 367 363 452 267 248 313 317 398 446 383
Rio Grande Do Norte 75 61 53 75 71 93 96 84 121 101 80 910 83
Sergipe 18 37 45 50 75 40 45 90 78 58 50 586 53
North Rondônia 0 2 0 0 3 0 0 0 1 2 2 10 1 7461 (20.35) (678/year)
Roraima 11 17 12 5 2 2 6 16 14 10 20 115 10
Tocantins 277 183 192 248 424 488 464 372 519 374 297 3838 349
Acre 0 0 0 0 0 0 0 0 0 0 0 0 0
Amapá 0   0 0 1 1 0 0 0 0 0 2 0.2
Pará 193 370 484 501 370 366 0 312 365 258 252 3471 316
Amazonas 2 4 5 2 1 4 3 1 1 2 0 25 2
Southeast Espírito Santo 4 3 4 2 0 3 8 2 11 2 4 43 4 7909 (21.58%) (719/year)
Minas Gerais 369 620 479 437 423 526 579 580 506 412 339 5270 479
Rio De Janeiro 2 3 4 10 3 0 6 2 0 5 9 44 4
São Paulo 197 168 184 281 264 307 231 226 234 257 203 2552 232
South Paraná 1 3 3 2 3 3 1 5 2 5 0 28 3 45 (0.12%) (4/year)
Rio Grande Do Sul 1 0 0 1 0 0 0 2 2 0 3 9 1
Santa Catarina 0 2 0 0 1 0 0 0 2 2 1 8 1
Total of cases/year 3344 3776 3850 3660 3562 3989 3582 3701 4100 3392 3471 40427 36658 (100%) (3675/year)

Table 1: Confirmed cases of Human Visceral Leishmaniosis in Brazil (2003-2013).

Brazil presented a total of 36,658 cases and the most endemic region is the Northeast, with 21,049 (47.14%) of the total number of confirmed cases in Brazil, Figure 1 shows the concentration of confirmed cases in each Federative Unit with a schematization Of the climatic map of Brazil from Köppen-Geiger.

immune-system-climatic-map

Figure 1: Cocentration of cases of LV per frderative unit in a climatic map of Brazil (2003-2013).

Discussion

Brazil is among the most endemic countries on the planet in relation to LVH. The fact that this disease is an anthropozoonosis justifies its difficult control since, among the population we have a culture installed for many generations, in which the creation of dogs in the home environment. It is often regarded as an animal guardian of the house or even a family member. The point to think about is the 3 aspects necessary for the installation of LV; Firstly, the presence of man and the dog is emphasized, but what leads to the occurrence of cases is precisely the presence of the peridomiciliary environment.

Some regions of Brazil have shown an increase in the number of LVH cases, which shows an advance of the disease in the country, a clearer way of seeing this is in the tabulation of epidemiological data confirmed in the country, to complement this study and to prove the increase in Disease in the country, a survey carried out by the Ministry of Health 11 found in 19 years of notification (1984-2002) a total of 48,455 cases of LVH confirmed in Brazil.

Conclusion

The epidemiological situation of Brazil in relation to the number of cases analyzed in the period 2003-2013 is superior to the data demonstrated in the epidemiological survey carried out by the Ministry of Health of 1984-2002.

Control and awareness measures are necessary, mainly for the knowledge and combat of the vector, a measure homologated to combat dengue. For the reduction or population control of these vectors provides the reduction of new cases.

References