Visceral leishmaniasis in Brazil: revisiting paradigms of epidemiology and control

Abstract

SUMMARYIn the last 20 years, despite the known underestimation of cases, Brazil registered a marked increase in the incidence of visceral leishmaniasis. The main goal of this review is to reflect on some aspects of this zoonosis in Brazil and also to encourage the discussion in order to find more viable, effective and affordable strategies to be implemented by the Brazilian Leishmaniasis Control Program. The current situation of visceral leishmaniasis in Brazil might be seen as a paradox: the most important aspects of the disease are known, but so far the control of this disease has not yet been achieved. The current control strategies have not been able to prevent the geographical expansion, and even a rise in the incidence and lethality of visceral leishmaniasis. There is a need not only for a better definition of priority areas, but also for the implementation of a fieldwork monitoring system to the disease surveillance that could permit a further evaluation of the control program in areas where visceral leishmaniasis is endemic.

Severe visceral leishmaniasis in children: the relationship between cytokine patterns and clinical features

“…In addition to its persistence, a progressive spreading of the disease to new areas has been observed, and the associated lethality has increased in various regions of the country [1][2][3] . In 1994, the incidence of lethality was 3.4%; in 2003, the lethality reached 8.5%; and in 2009, the lethality was 5.8% 3,4 .…”

Canine antibody response to Lutzomyia longipalpis saliva in endemic area of visceral leishmaniasis.

“…Leishmania (Leishmania) chagasi] that is mainly transmitted by the sand fly Lutzomyia longipalpis. Dogs (Canis familiaris) are considered the main domestic reservoir for VL transmission and have been the target of control actions, because they form part of the transmission cycle of L. infantum (1) . Previous studies concerning the potential transmission of VL from infected dogs are controversial.…”

Inquérito soroepidemiológico de leishmaniose canina em áreas endêmicas de Cuiabá, Estado de Mato Grosso

“…Esse hospedeiro apresenta variações no quadro clínico da doença, passando de animais aparentemente sadios a oligossintomáticos podendo chegar a estágios graves da doença com intenso parasitismo cutâneo. Assim, o cão representa uma fonte de infecção para o vetor, precedendo a maioria dos casos no homem 5 e promovendo a dispersão da doença para áreas não-endêmicas 3 15 .…”