Demographic and clinical characterization of human visceral leishmaniasis in the State of Pernambuco, Brazil between 2006 and 2015

Abstract

Introduction: Human visceral leishmaniasis (HVL) primarily occurs in regions that present socioeconomic, health, and environmental vulnerability. In Pernambuco, Brazil, this neglected zoonosis has expanded in magnitude as well as geographically, and efforts to manage HVL have been insufficient to contain its spread. The objective of this study was to describe the epidemiological profile of human illness due to HVL during 2006 to 2015 in Pernambuco State. Methods: This study was conducted using secondary data collected from the Health Information System. Results: During the study period, Pernambuco accounted for 2.4% of HVL cases in Brazil, with 49.6% of these concentrated in the macroregions of São Francisco Valley and Araripe. The percentage of municipalities that reported cases at the beginning of the study period increased from 21.1% (n = 39) to 43.8% (n = 81) by the end of the period. Cases were found predominantly among males, brown-skinned individuals, children aged 1-4 years, and individuals with incomplete 1 st to 4 th grade education. Coinfection with HIV was present in 5.6% of cases. Incidence was 9.7 cases per 100,000 inhabitants, and lethality was 12.3%. Conclusions: HVL has shown worrying expansion and evolution, in addition to high lethality, in Pernambuco. The only study of its kind in the past decade, it was evident from this study that despite efforts to contain this disease, HVL in Pernambuco exhibits patterns similar to those described in previous studies. Based on our results, we suggest reassessing the current prevention and control measures in the state.

Multiple Nodular Lesions in Spleen and Liver in Visceral Leishmaniasis

“…Although VL is seen in both genders, most of our cases were men, similar to the previous studies (15,16,(24)(25)(26). Since men live outdoor more than women, they are exposed to phlebotomine sand flies which is a vector that causes VL transmission (25).…”

“…However, these chronic conditions were not associated with late diagnosis or prognosis (18)(19)(20)(21)(22)(23). In the previous reports, HIV infection was one of the most important risk factors for VL, although none of our patients was HIV-positive (18)(19)(20)24). In our series, four patients received steroid treatment before the diagnosis of VL, and one of them resulted in death.…”

Leishmaniose visceral: distribuição temporal e espacial em Fortaleza, Ceará, 2007-2017

“…A similar situation was detected in Pernambuco, between 2003 and 2015, when 12.9% of that state's cases had incomplete elementary education. 22 Schooling is a proxy variable to the extent that it can suggest that poor socioeconomic conditions and vulnerabilities are more frequent among individuals affected by the disease. Notwithstanding, poor filling in of this variable on the investigation form hinders interpretation.…”

“…23 Greater susceptibility of children may be explained by low immunity, greater exposure to the vector in the area around the household and poor nutritional status, which are common events in endemic regions. 22 While in the first period assessed, 2007-2010, there were more cases and greater vulnerability among children, in the following periods, 2011-2013 and 2014-2017, the 20-39 age group became the most affected by the disease, probably due to the increase in the number of cases of VL-HIV coinfection among individuals of adult age, who are more susceptible to immune system suppression. This characteristic was reported by another epidemiological study conducted in Ceará between 2007 and 2011.…”

Sandflies in an endemic area for Visceral Leishmaniasis in Northeastern Brazil

“…Both of these diseases (i.e. CL and VL) are endemic in several Brazilian states, including those in the northeastern region (SOUSA et al, 2018). In fact, this region is responsible for 44.5% of cases of VL in the country (BRASIL, 2018).…”