Decentralized control of human visceral leishmaniasis in endemic urban areas of Brazil: a literature review

Abstract

ObjectivesHuman migration and concomitant HIV infections are likely to bring about major changes in the epidemiology of some parasitic infections in Brazil. Human visceral leishmaniasis (HVL) control is particularly fraught with intricacies. It is against a backdrop of decentralized health care that the complex HVL control initiatives are brought to bear. This comprehensive review aims to explore the obstacles facing decentralized HVL control in urban endemic areas in Brazil.MethodA literature search was carried out in December 2015 by means of three databases: MEDLINE, Google Scholar, and Web of Science.ResultsAlthough there have been many strides that have been made in elucidating the eco-epidemiology of Leishmania infantum, which forms the underpinnings of the national control program, transmission risk factors for HVL are still insufficiently elucidated in urban settings. Decentralized HVL epidemiological surveillance and control for animal reservoirs and vectors may compromise sustainability. In addition, it may hamper timely human HVL case management. With the burgeoning of the HIV-HVL co-infection, the potential human transmission may be underestimated.ConclusionHVL is a disease with focal transmission at a critical juncture, which warrants that the bottlenecks facing the control program within contexts of decentralized healthcare systems be taken into account. In addition, HIV-driven HVL epidemics may substantially increase the transmission potential of the human reservoir. Calculating the basic reproductive number to fine-tune interventions will have to take into consideration the specific socio-economic development context.

Epidemiological, clinical and laboratory aspects of human visceral leishmaniasis (HVL) associated with human immunodeficiency virus (HIV) coinfection: a systematic review

“…There have been changes in the epidemiological profile of VL and evidence that both the parasite and the vector have the ability to adapt in different environments (Diro et al , 2014 b ; Castelo Branco et al , 2016). This evidences that there are many obstacles in the control of VL (Menon et al , 2016) and, consequently, HLV/HIV coinfection.…”

An Epidemic Model of Zoonotic Visceral Leishmaniasis with Time Delay

“…Evidence has shown that when a susceptible human, sand-fly or reservoir is infected, there is an incubation period during which the infectious agent develops. The incubation periods for humans, sandflies and reservoir range from 2 to 6 months, 8 to 6 days, and 3 to 7 years, respectively [6,17,18]. Furthermore, to capture the effect of the incubation period on the transmission dynamics of ZVL it is important to incorporate delay caused by the incubation period in the ZVL model.…”

Estudo dos efeitos da proteína LaLRR17 de >i<Leishmania (L.) amazonensis >/i<na infecção do macrófago e identificação de seus possíveis ligantes.>i<

“…Na forma clínica mais grave de leishmaniose, a LV, mais de 95% dos casos é fatal se não for tratada, sendo caracterizada por picos febris irregulares, perda de peso, hepatoesplenomegalia e anemia (TORRES-GUERRERO et al, 2017 chagasi (MENON et al, 2016).…”