Spatial analysis of leishmaniasis in Brazil: a systematized review

Tegumentary leishmaniasis in Brazil: priority municipalities and spatiotemporal relative risks from 2001 to 2020

Understanding the distribution of tegumentary leishmaniasis (TL) in different periods enables the adequate conduction of actions at the public health level. The present study analyzes the spatiotemporal evolution of TL incidence rates in the municipalities of Brazil and identifies priority areas from 2001 to 2020. Notifications of new cases were analyzed employing space-time scan statistics and Local Indicators of Spatial Association. As TL incidence rates presented a downward trend in most Brazilian municipalities, spatiotemporal clusters of high relative risks (RR) were more frequent in the first decade of the series. There was a concentration of those clusters in the North and Northeast regions, mainly in the Legal Amazon area. More recent high-RR areas were identified in municipalities of different regions. The number of priority municipalities showed a stable trend in Brazil. There was a great concentration of such municipalities in the states of Acre, Mato Grosso, Rondônia, Pará, and Amapá, as well as large areas in Roraima, Amazonas, Maranhão, and Tocantins, and smaller areas in the states of Goiás, Ceará, Bahia, Minas Gerais, São Paulo, and Paraná. The present study contributes to the understanding of the historical evolution of TL in Brazil and subsidizes actions to combat the disease.

One Health Approach to Toxoplasmosis: Owner and Dog Seropositivity as Spatial Indicators of Risk Areas for Acquired, Gestational and Congenital Transmission

BACKGROUND

Toxoplasmosis has been of public health concern due to direct associations with socioeconomic vulnerability and inadequate living conditions.

METHODS

Accordingly, the present study aimed to assess antibodies against T. gondii, historical reported toxoplasmosis cases and associated socio-environmental risk factors in Pinhais, a full urban area of Curitiba, currently the eighth biggest metropolitan area of Brazil. Anti-Toxoplasma gondii antibodies were assessed by an indirect immunofluorescence reaction (RIFI). Owner and dog samples were also tested by IFAT to anti-Leishmania spp. and anti-Trypanosoma cruzi antibodies.

RESULTS

Overall, 20/135 (14.8%) persons and 13/133 (9.8%) dogs from 25 different households were considered seropositive to T. gondii. All samples were seronegative to Leishmania spp. and Trypanosoma cruzi.

CONCLUSIONS

Although no significant covariates were found in the regression model, statistically associated risk factors in the bivariate analysis included no public water use (p = 0.016) and drinking raw milk (p = 0.041) for owners, and obesity (p = 0.028) and tick infestation (p = 0.03) for dogs. In addition, a spatial cluster of T. gondii seropositivity for both owners and their dogs overlapped the location of historic reported cases of human acquired, gestational and congenital toxoplasmosis. Finally, the results herein showed tick infestation as an indicator of socio-environmental risk for T. gondii exposure in the household environment, and dogs may be used as sentinels for human toxoplasmosis cases.

Anti-Leishmania amazonensis Activity, Cytotoxic Features, and Chemical Profile of Allium sativum (Garlic) Essential Oil

Human tegumentary leishmaniasis (HTL) is a serious tropical disease caused by Leishmania amazonensis. Developing new leishmanicidal agents can help overcome current treatment challenges, such as drug resistance and toxicity. Essential oils are a source of lipophilic substances with diverse therapeutic properties. This study aimed to determine the anti-L. amazonensis activity, cytotoxicity, and chemical profile of Allium sativum essential oil (ASEO). The effect of ASEO on parasite and mammalian cells viability was evaluated using resazurin and MTT assays, respectively. The oil's effect against intracellular amastigotes was also determined. Transmission electron microscopy was used to assess the ultrastructural changes induced by ASEO. In addition, the chemical constituents of ASEO were identified by gas chromatography-mass spectrometry (GC-MS). The cytotoxic potential was evaluated in vitro and in silico. The oil displayed IC₅₀ of 1.76, 3.46, and 3.77 µg/mL against promastigotes, axenic, and intracellular amastigotes, respectively. Photomicrographs of treated parasites showed plasma membrane disruption, increased lipid bodies, and autophagic-like structures. ASEO chemical profiling revealed 1,2,4,6-tetrathiepane (24.84%) and diallyl disulfide (16.75%) as major components. Computational pharmacokinetics and toxicological analysis of ASEO's major components demonstrated good oral bioavailability and better toxicological endpoints than the reference drugs. Altogether, the results suggest that ASEO could be an alternative drug candidate against HTL.

Influence of anthropic changes and environmental characteristics on the occurrence of Tegumentary Leishmaniasis in Montes Claros, Minas Gerais, Brazil, between 2012 and 2019

This is an ecological study that investigated the influence of environmental, socioeconomic characteristics and changes in land use and cover on the occurrence of Tegumentary Leishmaniasis (TL) in the city of Montes Claros. The relationships between the number of cases of TL, which occurred between 2012 and 2019, in each census sector and the standardized covariates (Number of properties, altitude, Brazilian Deprivation Index, Normalized Difference Vegetation Index (NDVI), proportion of sector (PS) deforested, PS that underwent other anthropic alterations and unaltered PS) were evaluated with ecological Bayesian Models. Four multivariate models were constructed, with similar quality of adjustments, but Model 1 was the most parsimonious. Model 1 revealed that for each one-unit increase of standard deviation (SD) in the log of the number of properties, at the altitude and root of the deforested PS, corresponds to an increase of 44%, 34% and 24.5% in the number of cases of TL, respectively. The variable NDVI, included in models 3 and 4, was positively associated with the increase in the number of TL cases, being that for each one-unit increase in the NDVI was verified an increase of 21.3% and 20.2% respectively in the models. This study showed that the spatial distribution of TL cases in the city of Montes Claros occurs in a heterogeneous way and our findings support the hypothesis that socio-environmental characteristics and deforestation influence the occurrence of this disease in the studied area. Thus, these factors must be considered for the development of disease control strategies.

Ecology and natural infection of phlebotomine sand flies in different ecotopes and environments in the municipality of Pains, Minas Gerais, Brazil

Phlebotomines (Diptera: Psychodidae) are vectors of protozoa of the genus Leishmania and distributed throughout Brazil, formerly restricted to rural areas, have expanded including to periurban and urban regions, been recorded in different habitats. This study aimed to understand the dynamics of sand flies in different ecotopes in the municipality of Pains. Sand flies were captured during thirty samplings using HP light traps installed in seven different ecotopes for two consecutive nights, once a month, from August 2018 to July 2019. A total of 1,352 sand flies were captured, representing 24 species belong to ten genera. Evandromyia edwardsi was the most abundant species, followed by Evandromyia lenti and Micropygomyia quinquefer. Leishmania DNA was detected in seven female sand flies in four ecotopes, for an infection rate of 0.9%. Sand flies were collected in all seven ecotopes, although forest (23.04%), cave (20.88%) and pasture (17.75%) had higher abundance and richness. Similarity was found among ecotopes, indicating that they are all important for the maintenance of the sand fly community. Spatial analysis indicated high densities of sand flies in areas with natural characteristics. All ecotopes in the municipality were evidenced to have an adequate and harmonious epidemiological profile for the transmission and expansion of leishmaniasis throughout the territory. Because of the increasing environmental changes and deforestation in the municipality, the risk of generating ecological imbalance and increased cases of leishmaniasis is imminent, which highlights the importance of developing preventive and control strategies.

Environmental and socioeconomic risk factors for visceral and cutaneous leishmaniasis in São Paulo, Brazil

Leishmaniasis is a vector-borne disease caused by the protozoan Leishmania spp. mainly affecting individuals of low socioeconomic status. In tropical regions the transmission risk to humans depends not only on environmental factors, such as vegetation cover and climate, but also on the socioeconomic characteristics of human populations. However, the relative contribution of these factors to disease risk and incidence is not well understood. Yet this information is critical for the development of epidemiological surveillance schemes and control practices. Leishmaniasis cases have increased in São Paulo state, Brazil over recent years but the underlying risk factors for transmission remain understudied. Here, we use generalized linear mixed models to quantify the association between occurrence and incidence (number of cases) of cutaneous (CL) and visceral (VL) leishmaniasis from 1998 to 2015, and landscape (native vegetation cover), climate (seasonal and interannual variation in precipitation and temperature) and socioeconomic factors (population, number of cattle heads, Human Development Index - HDI, Gini inequality index and income per capita) across the 645 municipalities of São Paulo state, Brazil. For CL, probability of occurrence was greater in municipalities with high native vegetation cover and economic inequality and in years with greater average winter precipitation. For VL, probability of occurrence was greater in years with high minimum spring precipitation and maximum annual temperatures, and in municipalities with larger HDI values and a greater number of cattle heads. The number of VL cases increased during years with high mean fall precipitation and, for both CL and VL the number of cases was greater in years of high annual mean temperature. Understanding how these risk factors influence spatial and temporal variation in the risk and incidence of leishmaniasis can contribute to the development of effective public health policies and interventions.

Epidemiological and diagnostic aspects of feline leishmaniasis with emphasis on Brazil: a narrative review

The leishmaniases are a group of diseases caused by the protozoan parasite belonging to the genus Leishmania. In the New World, although dogs are considered the main parasite reservoir, in the last two decades, several studies have confirmed the role of cats (Felis catus) in the epidemiology of the disease and feline leishmaniasis (FeL) is now considered to be an emerging disease. The present review summarizes the current knowledge about FeL, focusing on important immunopathological aspects, epidemiology, and diagnostic methods applied for felines in Brazil. Cats are infected with the same species of Leishmania found in dogs (i.e., Leishmania infantum). Like dogs, skin lesions are the most common in cats with clinical FeL, mainly affecting the cephalic region and less frequently the legs which may be accompanied by generalized signs or visceral involvement. Information on the immune response of cats to Leishmania infection is scarce; however, efficient infection control is seen in most cases. For diagnosis, generally, the same methods as those in dogs are used, mainly serological tools. But there is a lack of studies focusing the performance of these methods for diagnosing FeL. The estimated overall prevalence of FeL in Brazil is 8%, with L. infantum being the most prevalent species. However, infections with Leishmania braziliensis and Leishmania amazonensis have also been reported. In conclusion, although there has been an increase in the publication related to FeL in Brazil in recent years, there is a lack of research relating immune response and diagnosis of these animals. Cats have been shown to be competent hosts for Leishmania parasites, and their role in the epidemiology of the disease cannot be underestimated, especially in areas of Brazil where the disease is historically endemic.

Human visceral leishmaniasis in Central-Western Brazil: Spatial patterns and its correlation with socioeconomic aspects, environmental indices and canine infection

In this ecological study, we investigated spatial patterns of human visceral leishmaniasis (VL) incidence, its correlation with socioeconomic aspects, environmental indices (obtained through remote sensing) and canine VL during 2011-2016 in the municipality of Rondonópolis, a relevant endemic area for VL in Central-Western Brazil. Human VL cases were georeferenced and point patterns were analyzed by univariate Ripley's K function and Kernel density estimation (KDE). Poisson-based scan statistics were used to investigate spatial and spatiotemporal clusters of human VL incidence at the neighborhood level. Socioeconomic and environmental characteristics were compared between neighborhoods within and outside spatial human VL clusters. Also, we assessed the correlation between smoothed human VL incidence and canine VL seropositivity rates within and between neighborhoods. Human VL cases were clustered up to 2000 m; four hotspots were identified by KDE in peripheral areas. Spatial and spatiotemporal low-risk clusters for human VL were identified in central and southern areas. Neighborhoods within spatial low-risk cluster presented higher mean income, literacy rate, sanitary sewage service coverage and lower altitude, compared to the rest of the municipality. A positive correlation was found between the occurrence of human and canine VL. On the northern outskirts, high human VL incidence was spatially correlated with high canine VL seropositivity in surrounding neighborhoods. In conclusion, human VL demonstrated a heterogeneous, aggregated and peripheral spatial pattern. This distribution was correlated with intra-urban socioeconomic differences and canine VL seropositivity at the neighborhood level.

A follow-up study (2007-2018) on American Tegumentary Leishmaniasis in the municipality of Caratinga, Minas Gerais State, Brazil: Spatial analyses and sand fly collection

Background

The municipality of Caratinga is an important endemic area for American Tegumentary Leishmaniasis (ATL) and no epidemiological studies were performed during the past two decades. Here, we analyzed the epidemiological situation and the geographical distribution of ATL cases in the municipality of Caratinga from 2007 to 2018 using geographic information systems (GIS). Also, we evaluated the impact of several demographic parameters in ATL distribution and the sand flies incriminated in its transmission.

Methods

All demographic information (gender, age, educational level, clinical form, diagnostic criteria and case evolution) used in this study was retrieved from the public health archives and confirmed in the State Health Services databases. All cases were analyzed using GIS software based on ATL distribution. Also, non-systematic sand fly collections and molecular detection of Leishmania were performed in the hotspots.

Results and conclusions

During the period, ATL cases continued and increased especially in the past years (2016–2018). Hotspots included urban Caratinga areas and the districts of Patrocínio de Caratinga and Sapucaia. The species Nyssomyia whitmani, Nyssomyia intermedia, Migonemyia migonei and Evandromyia cortelezzii complex were captured. However, ITS1-PCR did not detect Leishmania DNA in those insects. Based on our analyses, urbanization of ATL in Caratinga has occurred in the past years. Due to the increase in the number of cases and vectors presence, it is recommended that health authorities focus on control measures in the most affected areas (Patrocínio of Caratinga and Sapucaia districts and urban Caratinga).

Leishmaniasis is an important health problem in Latin American countries and worldwide. In some places, notification is limited and underreported hindering correct assessment of existing data. In Brazil, ATL is mainly caused by Leishmania (Viannia) braziliensis. It is transmitted by sand fly vectors Nyssomyia whitmani and Nyssomyia intermedia. ATL comprises different clinical manifestations including cutaneous leishmaniasis, muco-cutaneous leishmaniasis and atypical leishmaniasis. The objective is to present the spatial distribution of cases of ATL notified by the Public Health System of Caratinga between the period of 2007 and 2018. This city is one of the most important endemic areas in the State of Minas Gerais and compose the panel of knowledge on epidemiological aspects of cutaneous leishmaniasis caused by L. braziliensis. This information will be important for developing strategies for ATL control in the affected areas. There is strong evidence that supports ATL urbanization in the city of Caratinga and increase of cases in two rural districts (Sapucaia and Patrocínio de Caratinga).

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

American Tegumentary Leishmaniasis (ATL) is endemic in the municipality of Montes Claros, Minas Gerais State. The use of geotechnology such as spatial statistics and remote sensing has contributed to a better understanding of the eco-epidemiology of diseases, and consequently a better definition of control strategies. This study aimed to analyze the spatial distribution of probable sites of cases of ATL infection (2007-2011) in the municipality of Montes Claros and to identify related socio-environmental factors. Data on ATL cases notification were obtained from the Municipal Health Department of Montes Claros. The annual incidence of ATL in the municipality was calculated and the probable sites of infection were georeferenced. Crude Rate and the Local Empirical Bayesian Rate were calculated with census sectors considered as the unit of analysis. The Normalized Difference Vegetation Index (NDVI) was calculated from LANDSAT 5 TM images. The spatial association between the crude rate of ATL and the NDVI of the census tracts was evaluated using the Local Bivariate of Moran I. The socio-environmental aspects of household structures were assessed based on a structured questionnaire. The incidence of ATL in the evaluated period ranged from 6.2 to 16.6 cases/100,000 inhabitants. The highest rates of ATL occurrence were found in the census sectors located in the rural area and in the peripheral census sectors in the city. Through the Empirical Bayes Smoothed Rate map, it was found that in the peripheral areas of the city, the rates of ATL occurrence were lower than in the rural area and their values decreased as they approach the city center. Local Bivariate of Moran I showed a positive correlation between NDVI and crude ATL rates, with significant high-high clusters observed in the rural area and in the census sectors in the Western peripheral area of the city that have experienced an urban expansion concomitant to the period investigated. In most homes of people affected by the disease, there were domestic animals and organic matter in the peridomicile. In addition, a high percentage of individuals affected by ATL reported the presence of rodents circulating near their homes. In conclusion, it is possible that the disorderly expansion process in the city of Montes Claros favored the establishment of the ATL periurban and urban transmission cycle. These regions deserve special attention from health surveillance to combat this zoonosis.

American cutaneous leishmaniasis associated with degradation of native forest, regardless of economic, social and infrastructure vulnerability

American cutaneous leishmaniasis (ACL) is a notifiable dermatozoonosis with relevant morbidity. The present study aimed to evaluate the epidemiological aspects of cases of ACL reported in Northern Paraná (2007-2016), as well as to georeference and analyse the influence of economic, social and environmental variables. Data from ACL notification forms were obtained and the patients' houses were georeferenced. Descriptive statistics, calculations of disease incidence and proportion of vegetation cover by municipality, spatial analysis, multiple linear regression and vulnerability analysis by census sector (CS) were performed. One thousand four hundred fifty-one cases of ACL were reported in the 89 municipalities of four regional health (RH). The average incidence of cases per 10,000 inhabitants was as follows: 11.58, 8.79, 4.92 and 4.03 in 18thRH, 15thRH, 16thRH and 17thRH. Peaks of incident cases were observed in 2008, 2012 and 2015. There was a statistically significant difference between the HR when comparing the proportions of the variables gender, age, education level, area of residence, clinical form, diagnostic criteria, response to treatment and drug used in case of failure. It was observed that the lower the proportion of remaining Atlantic Forest, the greater the incidence of ACL in the municipality. With regard to clusters analysis, treatment abandonment clusters were observed in the 15thRH and mucous form clusters were observed in the 15thRH, 16thRH and 17thRH. The vulnerability analysis by CS allowed us to observe a statistically significant difference in all vulnerability indicators: economic and social in 15thRH and 17thRH; home infrastructure in 15thRH and 18thRH, urban infrastructure in 15thRH and 18thRH and compound vulnerability index in 15thRH and 18thRH. However, the most vulnerable areas did not always have the highest number of cases. The data presented demonstrate that preventive and health education measures must be mainly directed to areas of greater degradation of native forest; regardless of the vulnerability situation.