Leishmaniose tegumentar americana em centro de treinamento militar localizado na Zona da Mata de Pernambuco, Brasil

Major environmental and socioeconomic determinants of cutaneous leishmaniasis in Brazil - a systematic literature review

Cutaneous leishmaniasis (CL) is a zoonotic disease with complex transmission cycle. Some environmental and socioeconomic factors are known to be the major determinants of the transmission process, which are involved in configuring the spatiotemporal patterns and thus can be delimiting. However, the relevance of these socioeconomic and environmental determinants is still not well understood. In this study, we aimed to identify the major environmental and socioeconomic determinants of CL in Brazil by articulating a systematic literature review of studies that are based on this subject. The methodology included a search for studies according to a structured protocol using the scientific platforms, such as Scielo and PubMed. The references of each identified article were who referred to CL determinants were further screened, and so on. We extracted information from 41 articles and the determinants were grouped accordingly. Two measures were evaluated as follows: a) the frequency of citations of the determinants; and b) the proportion of determinants identified as having "significant association in analytical studies" with respect to the total number of determinants analyzed in other analytical studies using the same concept. The analyzed articles covered most of the regions of Brazil and 7 other countries bordering Brazil. We found 43 concepts of determinants. However, the final selection resulted in the identification of 14 major determinants. These results therefore contribute in the identification of major CL determinants and this information can be used to establish strategies for identifying risk prone areas for disease surveillance.

Detection of Leishmania DNA in Sand Flies (Diptera: Psychodidae) From a Cutaneous Leishmaniasis Outbreak Area in Northeastern Brazil

Cutaneous leishmaniasis (CL) by Leishmania braziliensis Vianna (Kinetoplastida: Trypanosomatidae) is a widespread disease in the western hemisphere and Brazil is the country reporting the majority of the human cases each year. Several phlebotomine sand flies have been regarded as putative or proven vectors of L. braziliensis and multiple vectors may be involved in the transmission of this parasite in the same endemic foci. In this study, we tested a subset of female phlebotomine sand flies collected in the frame of a previous study conducted in a military training camp, where outbreaks of CL by L. braziliensis have sporadically been reported. In total, 1,807 female phlebotomine sand flies were tested (individually or in pools) by real-time PCR and a minimum infection rate of 0.9% (95% CI: 0.6-1.5%) was detected. Positive females belonged to the species Psychodopygus complexus (Mangabeira) or Psychodopygus wellcomei Fraiha, Shaw & Lainson (females of these species are morphologically indistinguishable), Trichopygomyia longispina (Mangabeira), and Sciopemyia sordellii (Shannon & Del Ponte) (Diptera: Psychodidae). By restriction enzyme analysis, 13 samples (nine of Ty. longispina, two of Ps. complexus/wellcomei, and two of Sc. sordellii) presented a HaeIII restriction profile identical to L. braziliensis. The results of this study reinforce the notion that multiple vectors may be involved in the transmission of L. braziliensis in a single focus, ultimately making the epidemiological picture more complex than currently recognized.

Phlebotomines in an area endemic for American cutaneous leishmaniasis in northeastern coast of Brazil

Abstract Phlebotomines have worldwide distribution with many species present in Brazil, including the northeastern region, where the fauna is very diverse. The aim of this study was to identify the sandfly fauna in an area endemic for American cutaneous leishmaniasis (ACL) in the state of Pernambuco. Sandflies were caught on three consecutive nights every month from October 2015 to September 2016, from 5 pm to 5 am, using seven light traps of Centers for Disease Control (CDC) type. Females were identified and used for molecular Leishmania detection. A total of 2,174 specimens belonging to ten species were collected: Lutzomyia choti (88.2%; 1,917/2,174) was the most abundant species, followed by Lutzomyia whitmani (8.1%; 176/2,174) and Lutzomyia sordellii (1.5%; 33/2,174). The majority of the specimens were collected in peridomestic areas (64.1%; 1,394/2,174) and during the rainy period. All the samples examined were negative for Leishmania spp. The presence of Lutzomyia whitmani indoors and in peridomestic areas indicates that the inhabitants of this area are exposed to the risk of infection by the parasites responsible for ACL.

Sand fly population dynamics and cutaneous leishmaniasis among soldiers in an Atlantic forest remnant in northeastern Brazil

Outbreaks of cutaneous leishmaniasis are relatively common among soldiers involved in nocturnal activities in tropical forests. We investigated the population dynamics of sand flies in a military training camp located in a remnant of Atlantic rainforest in northeastern Brazil, where outbreaks of cutaneous leishmaniasis have sporadically been described. From July 2012 to July 2014, light traps were monthly placed in 10 collection sites, being nine sites located near the forest edge and one near a sheep and goat stable. Light traps operated from 5:00 pm to 6:00 am, during four consecutive nights. Leishmania infection in sand flies was assessed using a fast real-time PCR assay. Cases of cutaneous leishmaniasis among soldiers were also investigated. In total, 24,606 sand flies belonging to 25 species were identified. Males (n = 12,683) predominated over females (n = 11,923). Sand flies were present during all months, being more numerous in March (n = 1,691) and April 2013 (n = 3,324). Lutzomyia choti (72.9%) was the most abundant species, followed by Lutzomyia longispina (13.8%), Lutzomyia complexa (5.3%), representing together >90% of the sand flies collected. Forty cases of cutaneous leishmaniasis were recorded among soldiers from January 2012 to December 2014. Leishmania isolates were obtained from eight patients and were all characterized as Leishmania braziliensis. Soldiers and anyone overnighting in Atlantic rainforest remnants should adopt preventative measures such as the use of repellents on bare skin or clothes and insecticide-treated tents.

Outbreaks of cutaneous leishmaniasis are relatively common among soldiers involved in nocturnal activities in tropical forests. However, there is limited information on the relationship between sand fly population dynamics and cases of cutaneous leishmaniasis in Atlantic forest remnants. In this study, we investigated the population dynamics of sand flies in a military training camp located in a remnant of Atlantic rainforest in northeastern Brazil, where outbreaks of cutaneous leishmaniasis have sporadically been described. In total, 24,606 sand flies belonging to 25 species were identified. Sand flies were present during all months, being more numerous in March and April 2013. Lutzomyia choti was the most abundant species and three pools of females belonging to this species were found to be positive for Leishmania braziliensis DNA. Our results suggest that the risk of cutaneous leishmaniasis by Leishmania braziliensis in Atlantic rainforest remnants is permanent and thus not dictated by sand fly population peaks. People overnighting in Atlantic rainforest remnants should adopt preventative measures such as the use of repellents on bare skin or clothes and insecticide-treated tents.

Environmental Niche Modelling of Phlebotomine Sand Flies and Cutaneous Leishmaniasis Identifies Lutzomyia intermedia as the Main Vector Species in Southeastern Brazil

Cutaneous leishmaniasis (CL) is caused by a protozoan of the genus Leishmania and is transmitted by sand flies. The state of Espírito Santo (ES), an endemic area in southeast Brazil, has shown a considerably high prevalence in recent decades. Environmental niche modelling (ENM) is a useful tool for predicting potential disease risk. In this study, ENM was applied to sand fly species and CL cases in ES to identify the principal vector and risk areas of the disease. Sand flies were collected in 466 rural localities between 1997 and 2013 using active and passive capture. Insects were identified to the species level, and the localities were georeferenced. Twenty-one bioclimatic variables were selected from WorldClim. Maxent was used to construct models projecting the potential distribution for five Lutzomyia species and CL cases. ENMTools was used to overlap the species and the CL case models. The Kruskal-Wallis test was performed, adopting a 5% significance level. Approximately 250,000 specimens were captured, belonging to 43 species. The area under the curve (AUC) was considered acceptable for all models. The slope was considered relevant to the construction of the models for all the species identified. The overlay test identified Lutzomyia intermedia as the main vector of CL in southeast Brazil. ENM tools enable an analysis of the association among environmental variables, vector distributions and CL cases, which can be used to support epidemiologic and entomological vigilance actions to control the expansion of CL in vulnerable areas.

Sand flies (Diptera, Psychodidae, Phlebotominae), vectors of Leishmania protozoa, at an Atlantic Forest Conservation Unit in the municipality of Nísia Floresta, Rio Grande do Norte state, Brazil

Background

Sand flies are insect vectors of protozoa from the genus Leishmania, causative parasites of visceral and American tegumentary leishmaniases. The present study discusses the bioecological aspects of sand fly species, transmitters of Leishmania protozoa, in different ecotopes of an Atlantic Forest Conservation Unit located in the metropolitan region of Natal, Rio Grande do Norte state, Brazil.

Methods

Two monthly captures were made in 1 year, using CDC light traps, in two anthropized and two preserved environments.

Results

A total of 2936 sand flies belonging to the following ten species were captured: Evandromyia walkeri, Evandromyia evandroi, Psychodopygus wellcomei, Sciopemyia sordellii, Psathyromyia brasiliensis, Lutzomyia longipalpis, Evandromyia lenti, Psathyromyia shannoni, Nyssomyia whitmani and Nyssomyia intermedia. The most common species was E. walkeri (77.6 %), followed by E. evandroi (17.5 %). Forest was the site with the greatest abundance (32.4 %), followed by bamboo grove (26.3 %).

Conclusions

Sand flies were generally more abundant in the rainy season and L. longipalpis, a vector species of Leishmania infantum, was adapted to anthropized environments. It was confirmed that P. wellcomei, a vector of Leishmania braziliensis in Amazônia, is a species associated with more preserved environments, and occurs only in the rainy season.

Outbreak of Cutaneous Leishmaniasis in Peruvian Military Personnel Undertaking Training Activities in the Amazon Basin, 2010

Military personnel deployed to the Amazon Basin are at high risk for cutaneous leishmaniasis (CL). We responded to an outbreak among Peruvian Army personnel returning from short-term training in the Amazon, conducting active case detection, lesion sample collection, and risk factor assessment. The attack rate was 25% (76/303); the incubation period was 2-36 weeks (median = 8). Most cases had one lesion (66%), primarily ulcerative (49%), and in the legs (57%). Real-time polymerase chain reaction (PCR) identified Leishmania (Viannia) braziliensis (59/61 = 97%) and L. (V.) guyanensis (2/61 = 3%). Being male (risk ratio [RR] = 4.01; P = 0.034), not wearing long-sleeve clothes (RR = 1.71; P = 0.005), and sleeping in open rooms (RR = 1.80; P = 0.009) were associated with CL. Sodium stibogluconate therapy had a 41% cure rate, less than previously reported in Peru (~70%; P < 0.001). After emphasizing pre-deployment education and other basic prevention measures, trainees in the following year had lower incidence (1/278 = 0.4%; P < 0.001). Basic prevention can reduce CL risk in deployed militaries.

Ecological interactions among phlebotomines (Diptera: Psychodidae) in an agroforestry environment of northeast Brazil

Phlebotomine vectors transmit parasites and can cause visceral leishmaniasis (VL) or cutaneous leishmaniasis (TL). Phlebotomine females are hematophagous but need to ingest carbohydrates, possibly promoting the development of protozoan parasites in their digestive tract. The present study evaluated the species composition and abundance across several habitats in a metropolitan landscape, as well as associations among phlebotomines, plants, and local climatic parameters. Three consecutive monthly collections were carried out in an Atlantic Forest fragment, using CDC light traps in peridomestic areas and cashew, coconut, and mango tree. plantations. Eight species of phlebotomine were captured: Evandromyia evandroi, Lutzomyia longipalpis, Psathyromyia shannoni, Sciopemyia sordellii, Evandromyia walkeri, Psychodopygus wellcomei, Nyssomyia whitmani, and Nyssomyia intermedia, primarily from the forest environment. L. longipalpis was confirmed as a species adapted to anthropic environments, while P. wellcomei was shown to be predominately forest-dwelling. Phlebotomines exhibited diversified food consumption patterns in relation to carbohydrate sources. They fed on both native and exotic species of arboreal and shrubby vegetables and gramineous plants.

Phlebotomine sandflies (Diptera: Psychodidae) of the Atlantic forest in Recife, Pernambuco state, Brazil: the species coming to human bait, and their seasonal and monthly variations over a 2-year period

In a study of the phlebotomine sandflies (Diptera: Psychodidae) in a forest reserve in Recife, Pernambuco state, north-eastern Brazil, the sandflies landing on human bait between 1.00 and 1.42 h after sunset were collected weekly for 2 years. Although 10,287 sandflies of 10 Lutzomyia species were collected, almost all (96.5%) of the sandflies caught were Lu. umbratilis. This species and several others caught are potential vectors of some of the Leishmania parasites that cause human disease. The recorded landing rate for Lu. umbratilis peaked, at the high level of 333.3 flies/person-hour, during the collections made in May 2003.The relative rarity in the collections of males of some of the species caught probably indicates that these species do not lek on their bloodmeal sources. It is likely that the sizes of the local populations of species that are not very anthrophilic, such as Lu. flaviscutellata, are much larger than indicated by the collections made on human bait.

Cutaneous leishmaniasis in northeastern Brazil: a critical appraisal of studies conducted in State of Pernambuco

American cutaneous leishmaniasis (ACL) is a complex disease with clinical and epidemiological features that may vary from region to region. In fact, at least seven different Leishmania species, including Leishmania (Viannia) braziliensis, Leishmania (Viannia) guyanensis, Leishmania (Viannia) lainsoni, Leishmania (Viannia) naiffi, Leishmania (Viannia) shawi, Leishmania (Viannia) lindenbergi, and Leishmania (Leishmania) amazonensis, have been implicated in the etiology of ACL in Brazil, and numerous phlebotomine sandfly species of the genus Lutzomyia have been regarded as putative or proven vectors. Because ACL is a focal disease, understanding the disease dynamics at the local level is essential for the implementation of more effective control measures. The present paper is a narrative review about the ACL epidemiology in Pernambuco, northeastern Brazil. Furthermore, the need for more effective diagnosis, treatment, control and prevention strategies for the affected populations is highlighted. This paper will provide researchers with a critical appraisal of ACL in Pernambuco. Hopefully, it will also be helpful for public health authorities to improve current control strategies against ACL at the state and country levels.

Phlebotomine sandflies (Diptera: Psychodidae) in São Vicente Férrer, a sympatric area to cutaneous and visceral leishmaniasis in the state of Pernambuco, Brazil

INTRODUCTION: In the last decades, a considerable geographic expansion of the leishmaniases in all regions of Brazil has been observed. The present study was carried out to identify the composition of the phlebotomine sandfly fauna and verify the seasonal variation of the main species after environmental changes occurred in São Vicente Férrer Municipality, State of Pernambuco, Brazil. METHODS: Captures were carried out during four consecutive nights of each month using Centers for Disease Control and Prevention light traps from September 2009 to September 2010. The correlation between the number of phlebotomine sandflies captured and climatic factors (temperature and rainfall) was evaluated. RESULTS: A total of 13,872 specimens belonging to 20 species were captured, of which, 6,247 (45%) were females, and 7,625 (55%) were males. Lutzomyia migonei was the most abundant species with 9,964 (71.8%) specimens, being predominant in the intradomicile and peridomicile areas with 108 (86.4%) and 9,746 (97%), respectively. In the forest remnants, Lutzomyia complexa 2,395 (65%) and Lutzomyia sordellii 770 (20.8%) predominated. The correlation analysis between the total number of sandflies captured and climatic factors did not show a significant influence on population density. CONCLUSIONS: The high abundance of Lutzomyia migonei and Lutzomyia complexa indicates the possibility of new cases of cutaneous leishmaniasis (CL).

Phlebotomine sand flies (Diptera: Psychodidae: Phlebotominae) in the State of Pernambuco

INTRODUCTION: Phlebotomine sand flies are small insects of great medical relevance. This article presents an updated list of the phlebotomine sand flies occurring in the State of Pernambuco, Brazil. METHODS: A review of literature published since the 1940s up to May 2010 was conducted and voucher material deposited in reference collections were studied. RESULTS: A total of 37 phlebotomine species have previously been reported as occurring in Pernambuco, but the record of six species needs confirmation. CONCLUSIONS: This work provides an updated list of phlebotomine sand flies of Pernambuco, with some notes on their taxonomy, ecology, distribution and epidemiological relevance.

Novo surto de leishmaniose tegumentar americana em área de treinamento militar na Zona da Mata norte do Estado de Pernambuco

Relata-se novo surto de LTA em militares com 71 casos confirmados pelos critérios clínico, epidemiológico e laboratorial. Obteve-se o isolamento de sete amostras, identificadas como Leishmania (Viannia) braziliensis. A ocorrência de surtos nesta região confirma o caráter endêmico, cuja magnitude parece estar relacionada a não adoção de medidas de proteção individual.

Phlebotomine sand flies (Diptera, Psychodidae) in an American tegumentary leishmaniasis transmission area in northern Espírito Santo State, Brazil

American tegumentary leishmaniasis is endemic to the Espírito Santo State, Brazil, where it is widely distributed. The composition of the phlebotomine sand fly fauna in an American tegumentary leishmaniasis focus was determined by monthly sampling, using Shannon light traps in an Atlantic Forest reserve and adjacent habitat that had been modified by human activity. Seasonal fluctuations in numbers of the most abundant species were also monitored from June 2004 to May 2006. Of the 6,176 specimens collected, 47.4% were captured in the forest and 52.6% in the disturbed habitat. Although Lutzomyia davisi (60.8%) predominated in specimens from the forest, those captured near human dwellings consisted almost entirely of Lu. choti (72%) and Lu. intermedia (24.3%). All three species occurred throughout the year. Based on our findings, Lu. intermedia probably acts as the principal domestic Leishmania vector in the study area.

The leishmaniases--survival and expansion in a changing world. A mini-review

The number of cases of visceral and cutaneous leishmaniasis is increasing globally at an alarming rate irrespective of the region and the leishmaniases are amongst the top emergent diseases in spite of control measures. In the present review attention is drawn to some of the reasons for this. The leishmaniases have expanded beyond their natural ecotopes due to the ecological chaos caused by man and this in turn affects the levels of his exposure to the vectors. Examples of how different phenomana (such as war, civilian migration, immuno-suppression caused by medication and viral infections, globalization of work and leisure and transmission outside endemic areas) contribute to the spread and increase of the disease are discussed.

Phlebotomine sandfly species from an American visceral leishmaniasis area in the Northern Rainforest region of Pernambuco State, Brazil

The aim of this study was to identify the fauna of phlebotomine sandflies in an area with incidence of American visceral leishmaniasis (AVL) in São Vicente Férrer, a municipality (county) located in the northern Zona da Mata in Pernambuco State, Brazil. Sandfly captures were conducted monthly for four nights/month from December 2002 to November 2003, by means of manual captures (with a Shannon trap) and by CDC light traps. A total of 23,156 specimens of phlebotomines sandflies were collected in a remnant of the Atlantic rainforest, houses, and animal shelters. Lutzomyia complexa was the most prevalent species, with a frequency of 62.5% (14,445/23,156), followed by Lutzomyia migonei, with 33.2% (7,677/23,156). No Lutzomyia longipalpis (the main vector of Leishmania chagasi in Brazil and the Americas) was found in the target area. Some specimens were dissected, but no Leishmania parasites were found.

Dinâmica espaço-temporal de flebotomíneos (Diptera, Psychodidae) do município de Santa Quitéria, área de cerrado do Estado do Maranhão, Brasil

A flutuação sazonal, a freqüência horária e a ocorrência dos flebotomíneos nos ambientes intradomiciliar, peridomiciliar e extradomiciliar (cerrado), no município de Santa Quitéria, Estado do Maranhão foram estudados. Os espécimes foram capturados entre 18 e 6 horas, de maio de 1999 a abril de 2000, com armadilhas luminosas tipo CDC. Foram coletados 4.880 espécimes de 11 espécies. A riqueza e abundância foram maiores no peridomicílio (11 espécies; 50,1% dos espécimes), seguido pelo intradomicílio (9 espécies, 34%) e cerrado (7 espécies, 15,8%). Duas espécies foram encontradas na estação chuvosa, uma na estiagem e oito em ambas estações. Na estiagem foram registradas elevadas freqüências de Lutzomyia longipalpis Lutz & Neiva, 1912 (88,4%), L. evandroi Costa Lima & Antunes, 1936 (83,6%), L. lenti Mangabeira, 1938 (86%) e L. shannoni Dyar, 1929 (100%), enquanto as freqüências de L. quinquefer Dyar, 1929 (100%) e L. whitmani Antunes & Coutinho, 1939 (75%) foram maiores no período chuvoso. Os flebotomíneos foram encontrados a noite inteira, mas os horários de maior freqüência variaram de acordo com a espécie, observando-se picos no crepúsculo vespertino e primeiras horas da noite: L. quinquefer (18 h - 19 h); L. goiana Martins, Falcão & Silva, 1962 (18 h - 21 h); L. whitmani (19 h - 21 h) e L. longipalpis (20 h - 21 h) e ao longo da noite e no crepúsculo matutino: L. evandroi (21 h - 23 h e 3 h - 5 h), L. longipalpis (1 h - 3 h), L. lenti (22 h - 23 h e 4 h - 5 h). A ocorrência dos flebotomíneos nos diferentes ambientes, horários e estações vem sendo acompanhada por notificações de vários casos de leishmanioses cutânea e visceral.

Sandfly fauna in a military training area endemic for American tegumentary leishmaniasis in the Atlantic Rain Forest region of Pernambuco, Brazil

The aim of this study was to characterize the sandfly fauna in a military training area situated in the "Zona da Mata" region of Pernambuco State, Brazil, where human cases of American tegumentary leishmaniasis (ATL) had been observed, caused by Leishmania (Viannia) braziliensis. The occurrence of 16 sandfly species in the Marshall Newton Cavalcanti Military Training Camp (CIMNC) indicates an important diversity of sandfly species in this study area. Lutzomyia complexa was the most common species (51.36%) followed by L. choti (43.54%). All the captures were made in areas where training activities were conducted and where clinical cases had been detected in individuals performing training, following this period. The data relating the sandfly behavior to previous data in the same area provides strong evidence for the occurrence of an enzootic cycle of the parasite, and outbreaks followed the period of training activities in the remaining Atlantic Rain Forest and secondary forest areas.

[American tegumentary leishmaniasis caused by Leishmania (Viannia) braziliensis in military training area of Zona da Mata in Pernambuco]

The aim of work was to study the epidemiology of American tegumentary leishmaniasis in a military training unit situated in Zona da Mata region of Pernambuco State. Between 2002 and 2003 twenty-three cases were notified by clinical exam, detection and/or isolation of parasite and Montenegro skin test. Seven stocks of Leishmania (Viannia) braziliensis were obtained from patients, identified by a panel of specific monoclonal antibodies and isoenzymatic electrophoresis profiles. An epidemiologic survey on prevalence of infection was carried out by Montenegro skin test in the population that underwent training activities during the same period, out of which 25.3% were identified as positive. These results in association with previous data from this area, shows the maintenance of a primary transmission cycle and the occurrence of periodical outbreaks after training activities in local areas of remnant Atlantic rain forest.

[Phlebotomine sandflies in fragments of rain forest in Recife, Pernambuco State]

An investigation was conducted into the distribution of sandfly fauna in 4 fragments of Atlantic forest in the Metropolitan Area of Recife. It consisted of the capture adult insects using CDC light traps. A total of 1,173 specimens were distributed in 11 species of Lutzomyia: Lutzomyia evandroi, Lutzomyia choti, Lutzomyia walkeri, Lutzomyia umbratilis, Lutzomyia brasiliensis, Lutzomyia sordellii, Lutzomyia claustrei, Lutzomyia wellcomei, Lutzomyia fluviatilis, Lutzomyia furcata e Lutzomyia aragaoi.

Aspectos clínicos e diagnósticos da leishmaniose tegumentar americana em militares simultaneamente expostos à infecção na Amazônia

Os treinamentos militares na selva amazônica constituem importantes fatores na incidência de leishmaniose tegumentar americana na região. Este trabalho descreve 48 casos de leishmaniose tegumentar americana em pacientes militares nos quais a doença se manifestou após operação de treinamento na Amazônia. O período de incubação médio foi de 27,6 dias. Houve predomínio de lesões nos membros superiores, face e pescoço. A maioria dos indivíduos apresentou duas lesões, sendo as úlceras as manifestações mais freqüentes. O diagnóstico foi realizado pelo exame de escarificação das lesões, sendo confirmado pela demonstração do parasito em 43 (89,6%) casos.

First report of Lutzomyia (Nyssomyia) umbratilis Ward & Frahia, 1977 outside of Amazonian Region, in Recife, State of Pernambuco, Brazil (Diptera: Psychodidae: Phlebotominae)

Lutzomyia umbratilis, a known vector of Leishmania guyanensis in the north of Amazon basin, has been exclusively found in the Amazonian region. Here we report for the first time the occurrence of this species in northeastern Brazil. The epidemiological importance of the occurrence of this species in the Atlantic Forest is commented.