Leishmaniasis in Chaparé, Bolivia

Abstract

et al. Variation of the hepatic C virus 5′ non-coding region: implications for secondary structure, virus detection and typing. J Gen Virol. 1995;76:174976: -61. DOI: 10.109976: /0022-131776: -76-7-1749 Leishmaniasis in Chaparé, BoliviaTo the Editor: In Bolivia, most cases of leishmaniasis are caused by Leishmania (Viannia) braziliensis (1). The parasite is transmitted zoonotically by several sandfl y species and, when transmitted to humans, may cause cutaneous leishmaniasis (CL), and potentially, mucosal leishmaniasis (ML) (2).Data on the prevalence and effects of CL in Bolivia have been scarce, even though anecdotal and offi cial reports indicate a dramatic increase in the number of human CL cases in Bolivia in the past decade (1,3). Also, although CL was originally a sylvatic disease in Bolivia, some evidence indicates that the transmission cycle has adapted to the peridomestic habitat. However, this evidence is largely based on individual case reports. No information is available on parasite species, vectors, and reservoirs in such a peridomestic transmission cycle.A preliminary study to guide future research focus and assist in immediate leishmaniasis prevention and control policy decision making is underway in Isiboro-Secure National Park, Chaparé, Bolivia. Our objectives were to collect data on the prevalence of leishmaniasis in that area and evidence for peridomestic Leishmania transmission.A survey was carried out during April-July 2007 in 2 communities in Isiboro-Secure National Park, San Gabriel (16°40′31′′S and 65°37′38′′W) and San Julian (16°41′59′′S and 65°38′10′′W). These 2 communities were selected because of local knowledge of disease in the community, their moderate degree of urbanization (i.e., ≈50% of the communities' houses are clustered around the main access road), and the accessibility of the sites to the fi eld team. In this area, CL is transmitted from April through October. We surveyed 133 and 52 households in San Gabriel and San Julian, which represented 86% and 80% of the total households of the respective communities; 21 and 13 households, respectively, were visited but did not participate because the owners refused or were not present. Of the 965 persons surveyed, 488 (50.6%) were male and 476 (49.3%) were female; 9 (0.9%) had active CL lesions and 62 (6.4%) had CL scars. One person had ML, and 3 had evidence of past ML; all ML patients were male. Of those with CL lesions, all had 1 lesion only. The mean lesion size was 2.3 cm (range 1.5-3 cm), and the mean lesion duration (to survey date) was 5.6 months (range 1-11 months). The clinical CL lesions were parasitologically confi rmed by microscopy (n = 4) or PCR (n = 8). Parasite culture was performed on patient isolates (n = 6), and L. (V.) braziliensis was identifi ed and characterized as the etiologic agent of these CL cases.Active lesion and scar prevalence were associated with male sex Whether the surveyed population is representative of the total population living in the study area is debatable. However on the basis of curre...

Co-Infection of Leishmania (Viannia) braziliensis and HIV: Report of a Case of Mucosal Leishmaniasis in Cochabamba, Bolivia

“…The patient reported to have gone to work in an area (i.e., Chapare) known to be endemic for LCL and ML. 19 Treatment with amphotericin B did not result in clinical cure of lesions, and it is likely that the poor treatment response was compounded by the severe immunosuppression of the patient.…”

Leishmaniases in Bolivia: Comprehensive Review and Current Status

“…Traditionally, the leishmaniases were considered a sylvatic disease, with data typically showing that both CL and VL in Bolivia are associated with sex, age, living in/close to the forest, or pursuing labor in forested areas. 16,25,33,40,41 Although this still holds true for much of the Bolivian territory, in the past few years, an increasing number of reports emerged of LCL in children and cases contracting the disease in an urban environment rather than in forested areas. 22,25 For better epidemiologic leishmaniases' surveillance in Bolivia, multidisciplinary studies will have to investigate these trends in the future, studying the extent of peridomestic transmission and determining risk factors for infection and disease.…”

“…In Bolivia, CL is mostly caused by L. (Viannia) braziliensis (up to 85% cases), [16][17][18][19][20][21][22][23][24][25] L. (Leishmania) amazonensis, 24,26 and L. (V.) lainsoni 22,[27][28][29] ; recently, some cases have also been found to be caused by L. (V.) guyanensis ( Table 1 ). 22 All parasite isolates that have been characterized to species have primarily been reported in the north, center, and east of the country (i.e., Departments of La Paz, Beni, Pando, Santa Cruz, and Cochabamba) ( Figure 1 ).…”

“…76 Ideally, to be sustainable in the long term and especially if new evidence corroborates recent reports of domestic transmission of Leishmania spp. in Bolivia, 22,25,33 leishmaniasis case management, prevention, and control should be-inasmuch as possible-integrated in the MoH's overall strategy for other vector-borne diseases, including malaria and Chagas disease. Unfortunately, even these programs suffer from poor funding support and implementation.…”

“…22 All parasite isolates that have been characterized to species have primarily been reported in the north, center, and east of the country (i.e., Departments of La Paz, Beni, Pando, Santa Cruz, and Cochabamba) ( Figure 1 ). [16][17][18][19][20][21][22][23][24][25][26][27][28][29] Leishmania (L.) infantum , the causative agent of VL, was isolated from or detected in patients, [31][32][33] dogs, 34,35 and the insect vector Lutzomyia longipalpis 36 in the Yungas region in the Department of La Paz. To our knowledge, VL remains rare in Bolivia and is restricted to this unique focus in the Yungas region in the Beni department, where the first autochthonous case was diagnosed in 1984.…”