Expansão geográfica da leishmaniose visceral no Estado de Pernambuco

Abstract

No Brasil, a leishmaniose visceral (LV) apresenta uma ampla distribuição geográfica, além de alta letalidade, quando não instituído o tratamento adequado em tempo hábil. Associado ao seu espectro de morbidade, esta zoonose é causada por um protozoário de ciclo biológico complexo, o que a torna uma enfermidade de grande magnitude e de baixa vulnerabilidade às atuais medidas de controle. A escassez de recursos e a atual falta de infra-estrutura dos serviços de saúde, especialmente no que concerne ao diagnóstico da infecção ABSTRACTThis study aimed to demonstrate the geographical expansion of visceral leishmaniasis in Pernambuco State, Brazil. With data on the number of visceral leishmaniasis cases notified from 1990 to 2001, maps showing the biannual evolution of the geographical distribution of the disease per municipality were elaborated. A map of the cumulative geographical distribution of the cases registered during the whole period was also constructed. From 1990 to 2001, 1,737 cases of visceral leishmaniasis were notified in Pernambuco. In 1990, 15.2% (n = 28) of the municipalities notified cases of the disease. In contrast, this percentage increased to 78.3% (n = 144), over an eleven-year period. The map of cumulative geographical distribution during the whole period shows a notable concentration of cases in Agreste and Sertão. A notable geographical expansion of visceral leishmaniasis in Pernambuco also occurred, probably reflecting the low impact of the current control measures and, possibly, an improvement in the notification system. Key-words: Visceral leishmaniasis. Distribution. Urbanization. Epidemiology.por Leishmania chagasi (Kinetoplastida: Trypanosomatidae), na população canina e humana, tornam as atuais medidas de controle pouco factíveis. Esse quadro vem se constituindo como um paradigma, favorecendo a perpetuação do ciclo vicioso entre pobreza e doença em muitos estados brasileiros, nos quais a LV permanece como mais uma doença negligenciada. Em resposta a este cenário desfavorável, têm sido empreendidos vários esforços na tentativa de definir uma nova abordagem mais efetiva para o controle da doença no Brasil 6 .

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

“…In Pernambuco, AVL is now present in almost all regions of the State, although most cases are from the Sertão (backlands) 5,6 . In 1999 and 2000, twelve human cases of AVL were reported in São Vicente Férrer, a municipality (county) located in the northern Zona da Mata region near the Agreste region.…”

Prevalence of zoonotic visceral leishmaniasis in dogs in an endemic area of Brazil

“…In Brazil, ZVL has been reported in different regions with different rates of prevalence. Indeed, the northeast region of Brazil is traditionally endemic for ZVL, accounting for about 40% of the annual cases that occur throughout the country (3) . In this area, the humans, animal reservoir, and vector share the same ecological niche, which contributes to the persistence of the disease.…”

“…Over the preceding years, several human cases have been diagnosed in this area, specifi cally more than 100 cases between 2001 and 2010 (6) . Indeed, approximately 40% of the annual cases of ZVL occur in the northeast region of Brazil (3) . In this area, humans, dogs, and vector share the same ecological niche, which contributes to the persistence of the infection in a given population.…”

Control of phlebotomine (Diptera: Psychodidae) leishmaniasis vectors

“…Thus, the wild endemic pattern has been replaced by the spread of the disease associated with environmental modifi cations, disordered human occupation and substandard living conditions. The disease is spreading in both rural and urban areas, exceeding old defi ned geographic limits and becoming a serious public health problem (Dantas-Torres & Brandão-Filho 2006). On one hand, the vector adapts easily to the peridomestic conditions of impoverished areas, exploiting the accumulation of organic matter produced by domestic animals and poor sanitary conditions.…”