Clinical and epidemiological profiles of patients with American cutaneous leishmaniasis from the states of Pernambuco and Amazonas, Brazil

Abstract

Introduction: Brazil has a high number of cases of American cutaneous leishmaniasis (ACL) in the north and northeast regions. Therefore, continuous surveillance of environmental and socioeconomic factors in endemic areas is needed to develop strategic control measures. This study aimed to describe the clinical and epidemiological profiles of patients with ACL. Methods: All patients were from the states of Amazonas and Pernambuco, and examinations were carried out between 2015 and 2018. All patients had a clinical and epidemiological history compatible with ACL after positive diagnostic tests. Information obtained from medical records included gender, employment activity, level of education, age, and number and sites of lesions. Results: A total of 213 patients were included, of whom 30.98% were female and 69.02% were male. The main employment activity was agriculture (27.56%). The most common level of education was elementary (62.42%). The average age was approximately 39 years. The majority of the patients presented only with one lesion (54.87%), and legs/feet were the most commonly affected area (48.25%), followed by the arms/hands (44.75%). Conclusions: These data demonstrated that irrespective of the patients' places of origin, interventions need to be focused on men of economically productive age, in view of the high risk of exposure to the vector in this group. Education activities need to be directed to farmers about the importance of protection against ACL vectors during work. Such information must also be directed to employers as a way of implementing and maintaining appropriate working conditions and stepping up vector control.

Occurrence of Leishmania infection in the immediate geographic region of Ji-Paraná, Rondônia State, Brazil

“…The highest proportion of infections occurred as single lesions, and the parts of the body most affected were the arms, legs, head, and feet, which corroborate the findings of other studies 12,13,14 . These parts of the body are the most affected because they remain exposed to vectors for many hours of the day when individuals work in forest environments (primarily in the occupations of logging and hunting) 7,11,12 .…”

“…This profile could be explained by the fact that people aged 30-50 years are the most economically active, and that rural residents generally live and work near forests or forest fragments, which greatly increases their exposure to sand fly bites. This pattern has been observed in Rondônia and other states in the Brazilian Amazon 9,10,11,12,13,14 .…”

“…We observed two cases of L. guyanensis in two municipalities; its prevalence in Rondônia is low relative to that in L. braziliensis 2,3 . Leishmania guyanensis is widely distributed in the Amazon Basin, and its distribution is certainly related to the presence and abundance of Nyssomyia umbratilis (Ward & Fraiha) populations 11,12,13 . In Amazonas, L. guyanensis is the primary agent of ACL, and N. umbratilis, its main vector, is present in high abundance 13 .…”

“…Leishmania guyanensis is widely distributed in the Amazon Basin, and its distribution is certainly related to the presence and abundance of Nyssomyia umbratilis (Ward & Fraiha) populations 11,12,13 . In Amazonas, L. guyanensis is the primary agent of ACL, and N. umbratilis, its main vector, is present in high abundance 13 . Studies indicate that N. umbratilis is present in low abundance in Rondônia 9,10 .…”

“…In Rondônia, the presence of cases in urban areas could be attributable to cultural practices such as farm visits, camping, and fishing during holidays. People who practice these leisure activities generally remain in close proximity to forest environments for many hours; therefore, their risk may have increased exposure to sand fly bites and possible infection by Leishmania species 13 .…”