Active surveillance of American tegumentary leishmaniasis in endemic areas in rural Bolivia

Abstract

Introduction: American tegumentary leishmaniasis (ATL), including mucocutaneous leishmaniasis (MCL) and localized cutaneous leishmaniasis (LCL), is endemic in Bolivia. We describe the results of active surveillance of ATL from 2001 to 2006 and assess demographic data related to ATL epidemiology in the Yungas valleys. Methods: Community-based active ATL surveillance was performed by the institutions SERVIR, CÁRITAS, and the Health Services Department of La Paz, whose files were reviewed retrospectively. A cross-sectional survey was carried out to assess demographic data in two communities. Results: Two thousand nine hundred nine cases of ATL were detected from 2001 to 2006: 2,488 (85.5%) corresponded to LCL and 421 (14.5%) to MCL. A reduction in the proportion of mucosal cases was observed between 2001 and 2006. The proportion of MCL cases increased with age and was higher among males (15.5% versus 12.1%, p=0.018). The rate of positivity via direct observation of the parasite in dermal scrapings and in parasite cultivation was significantly higher for LCL than for MCL (p<0.001 and p=0.009, respectively). The rate of reactivity in the leishmanin skin test was higher in the group with mucosal lesions (p=0.012). The cross-sectional survey showed that 40% of the families had emigrated from the Altiplano. Conclusions: It is necessary to undertake continuous case detection of ATL in the area, where the disease presents a high rate of mucosal cases. Increasing incidence seems to be associated with immigration and continuous deforestation to expand the crop-growing areas. Keywords: American tegumentary leishmaniasis. Surveillance. Bolivia. Treatment. Diagnosis. RESUMO Introdução:A leishmaniose tegumentar americana (LTA), incluindo a leishmaniose mucocutânea (LMC) e a leishmaniose cutânea (LC), é endêmica em várias regiões da Bolívia. Descreve-se um sistema de vigilância da LTA conduzido entre 2001 e 2006 e avaliando-se dados demográficos relacionados à epidemiologia da doença. Métodos: O sistema de busca ativa foi realizado conjuntamente pelas instituições SERVIR e CÁRITAS e pelo Servicio de Salud de La Paz (SEDES), cujos arquivos foram revisados, retrospectivamente. Um estudo transversal foi realizado em duas comunidades para aquisição de dados sócio-demográficos. Resultados: Dois mil novecentos e nove casos de LTA, sendo 2.488 (85,5%) de LC e 421 (14,5%) de LMC foram diagnosticados de 2001 a 2006. Foi observada redução na proporção de casos mucosos ao longo do período. A proporção de LMC aumentou proporcionalmente à idade dos pacientes, sendo mais frequente entre pessoas do sexo masculino (15,5% versus 12,1%, p = 0,018). A taxa de detecção do parasita nos raspados cutâneos e no cultivo foram significativamente maiores em pacientes com LC do que em pessoas com LMC (p < 0,001 e p = 0,009 respectivamente). A reatividade à reação de Montenegro foi mais frequente em pessoas com LMC (p = 0.012). O estudo transversal mostrou que 40% das famílias nas comunidades estudadas emigraram do Altiplano. Conclusões: Faz-se nec...

Mucosal Leishmaniasis: An Underestimated Presentation of a Neglected Disease

“…From 1982 to 2003, among 100 cases of Leishmania infection observed among Brazilian HIV-1 infected patients, 68% had mucosal involvement [9]. In Bolivia, which is known to have the highest incidence of ATL (33 cases/100,000 inhabitants) [10], according to data from the MHNPLC (Ministry of Health National Program of Leishmaniasis Control), from 1983 to 2006, 4619 cases of ML have been described [11]. …”

“…Nowadays, leishmaniasis is largely moving towards domestic habitats, as a direct consequence of the spreading of Leishmania vectors to urbanized areas, especially outskirts [10, 11]. The increasing number of long-distance travels and the spreading of vectors towards currently not endemic areas are likely to cause a marked rise in the incidence of leishmaniasis also in Europe [31, 32].…”

Enhanced photodynamic leishmanicidal activity of hydrophobic zinc phthalocyanine within archaeolipids containing liposomes

“…MCL represents a considerable health care problem in Latin America. 5 Nowadays, leishmaniasis is largely moving towards domestic habitats, 6,7 resulting in a marked MCL-incidence rise in Europe. 8,9 Although there are no standardized protocols for the treatment of MCL, 10 the World Health Organization recommends the use of intravenous pentavalent antimony and its derived molecules: sodium stibogluconate and meglumine antimoniate.…”

The potential economic value of a cutaneous leishmaniasis vaccine in seven endemic countries in the Americas

“…These are likely conservative estimates, as infection risk in certain regions within an endemic country may be higher than the risk in the country overall. In fact, although the estimated overall CL risk in Bolivia is around 0.03%, some regions have reported risks as high as 1%[28]; therefore, vaccinating in these regions may even result in cost savings.…”

“…CL infection risk was varied from 0.005-5%, as reported in endemic and epidemic settings in the countries of interest [28-31]. Sensitivity analyses were conducted for cost per vaccine dose (range: $0.5-10), vaccine efficacy (range: 50-90%), compliance with subsequent doses in the vaccine regimen (range: 50-100%), vaccine protection duration (range: 5-20 years), and the likelihood of revaccination after protection from prior vaccination has expired (range: 50-100%).…”