Socioenvironmental aspects of the Purus Region - Brazilian Amazon: Why relate them to the occurrence of American Tegumentary Leishmaniasis?

Abstract

This study aims to analyze factors related to the occurrence of American Tegumentary Leishmaniasis in the Purus Region, based on the reporting of cases between 2001 and 2013, correlating them with livelihoods and subsistence farming in the region, and analyzing them in regards to sex, age, clinical form, occupation, diagnostic methods and seasonality. The analysis parameter which was used included all cases of American Tegumentary Leishmaniasis in each sub-region by municipality. The Purus Region, between the states of Amazonas and Acre, consists of three sub-regions: Upper, Middle, and Lower Purus. We observed that socio-environmental impacts influenced the livelihoods of the human population and that the interaction with extractive activities, especially latex and Brazil nut collecting, where the labor regime implies a long stay in the jungle, leads to socio-environmental conditions that are favorable to the contraction of American Tegumentary Leishmaniasis. During the referred period, there were 13,971 cases of American Tegumentary Leishmaniasis distributed among the sub-regions: High (12611 cases = 90.27%), Middle (1225 cases = 8.77%) and Lower (135 cases = 0.96%). Among the 22 municipalities that were studied, Rio Branco stands out with 31.6% of cases, followed by Xapuri with 12.6% and Sena Madureira with 12.5%. In the results, we highlight the high percentage (20.8%) of mucous forms; the age group from 11 to 50 (70.2%), however, 20.2% were in the age group of 1 month to 10 years of age; cases in males were 69.8%, and, in the reports examined, 43.7%. cited their occupation as extractivism. A statistically significant negative association was demonstrated between cutaneous leishmaniasis and rainfall between Purus municipalities. However, in regards to the association of cutaneous leishmaniasis for both, temperature and Municipal Human Development Index—MHDI, no significant associations were found in Purus. We concluded that American Tegumentary Leishmaniasis occurring in the Purus Region is related to two distinct aspects: the development of enterprises that extend the agricultural frontier, and a change in lifestyle, namely the extraction of wood as an occupation, which has, as a consequence, an environmental impact and creates difficulties in accessing treatment.

American Tegumentary Leishmaniasis in an endemic municipality in the North of Minas Gerais State: spatial analysis and socio-environmental factors

“…In the studied municipality, the highest number of ATL cases occurred among adult male individuals of working age. This profile has also been observed in other studies 22 , 23 , 26 , 27 , and some researchers attribute the vulnerability of this group to the occupational exposure in activities developed in rural areas 28 . However, in this study, significant differences were observed in relation to the occupational activity performed by individuals affected by ATL who lived in rural and urban areas.…”

Interacción entre los determinantes medioambientales y socioeconómicos para el riesgo para leishmaniasis cutánea en América Latina

“…Sin embargo, estos resultados no implican riesgo bajo de transmisión, ya que involucra municipios con importantes registros de LC como Teolândia, en el área cacaotera de Bahía (Brasil), regiones de influencia amazónica con actividades extractivas, y la expansión de la frontera agrícola como en Rio Branco (Brasil) y Tambopata, Madre de Dios (Perú) o Choluteca en Honduras donde se presenta LC atípica debida a L. infantum . Este conglomerado involucra también áreas con transmisión intermedia endémica o con brotes limitados, donde el riesgo peridoméstico se relaciona con la proximidad a cursos de agua, cría de animales y parches de vegetación como bambú y bananas, como en Sapucaia (Brasil) ( 38 , 39 ).…”

Treatment of tegumentary leishmaniasis in two hemodialysis patients with end-stage renal disease using two series of pentamidine

“…In one of the cases described in this report, despite the cumulative potential of pentamidine 5 , it was necessary to repeat the treatment, and complete healing of the lesions occurred only after administering the second series of treatment. This result, which is associated with the lack of data on MIC levels for patients with leishmaniasis and the large percentage of recurrences 1 recorded in the treatment of ATL, indicates a gap in the knowledge thereby raising the question whether the therapeutic failures are inevitable or just need an adjustment of the dose to meet the pharmacokinetic characteristics of individual patient.…”

“…American tegumentary leishmaniasis (ATL) is a zoonotic disease that is transmitted through sandflies (Diptera: Psychodidae) and caused by several species of Leishmania parasite (Kinetoplastida: Trypanosomatidae). It is considered as a neglected infectious disease occurring in tropical regions, and its epidemiology is complex with intra- and inter-specific variations in transmission cycles, clinical manifestations, and variable responses to therapy 1 .…”