Temporal patterns, spatial risks, and characteristics of tegumentary leishmaniasis in Brazil in the first twenty years of the 21st Century

Abstract

Background Tegumentary leishmaniasis (TL) is a significant public health issue in Brazil. The present ecological study describes the clinical and epidemiological characteristics of TL cases reported in the country, and analyzes the spatial and temporal patterns of the incidences and risks of occurrence across the five geopolitical regions and 27 federative units. Methodology/Principal findings Data regarding new cases of TL notified between 2001 and 2020 were obtained from the Information System for Notifiable Diseases of the Brazilian Ministry of Health. Joinpoint and spatial and temporal generalized additive models were used to establish trends in the evolution of TL during the target period. The incidence rate for the entire period was 226.41 cases/100,000 inhabitants. All regions of Brazil showed trends of decreasing incidence rates, albeit with fluctuations at specific times, with the exception of the Southeast where rates have increased since 2014, most particularly in Minas Gerais state. The disease was concentrated predominantly in the North region, with Acre state leading the incidence rank in the whole country, followed by Mato Grosso (Midwest), Maranhão and Bahia (Northeast) states. The spatial distribution of the risk of TL occurrence in relation to the annual averages was relatively stable throughout the period. The cutaneous form of TL was predominant and cases most frequently occurred in rural areas and among men of working age. The ages of individuals contracting TL tended to increase during the time series. Finally, the proportion of confirmations by laboratory tests was lower in the Northeast. Conclusion/Significance TL shows a declining trend in Brazil, but its widespread occurrence and the presence of areas with increasing incidence rates demonstrate the persistent relevance of this disease and the need for constant monitoring. Our findings reinforce the importance of temporal and spatial tools in epidemiologic surveillance routines and are valuable for targeting preventive and control actions.

Oral Leishmaniasis in HIV-Positive and HIV-Negative Patients: A Comparative Analysis with Two New Case Reports

“…Tegumentary leishmaniasis is characterized by a diversity of etiological agents, reservoirs, and vectors, with different transmission patterns and limited knowledge of various aspects, making it di cult to control [2,5]. Brazil is the primary country endemic for visceral leishmaniasis in the Americas, and in Tocantins, a northern state within the Legal Amazon, both visceral and tegumentary leishmaniasis are endemic and are frequently diagnosed [2,21]. This report presents two cases of oral leishmaniasis in Tocantins: one in an HIV-positive patient and one in an HIV-negative patient.…”

“…Diagnosing oral leishmaniasis poses signi cant challenges because of its atypical presentation and overlap with other conditions such as infectious diseases (including bacterial and deep fungal infections), granulomatous diseases (including sarcoidosis and Wegener's granulomatosis), foreign bodies, and squamous cell carcinoma [4,6]. The diagnosis involves clinical examination combined with other diagnostic methods [21]. Parasitological diagnosis includes direct microscopic examination of smears or cultures of skin lesions to con rm the presence of Leishmania parasites.…”

“…Immunological tests include the Montenegro skin test, serological tests, and antigen detection tests. Molecular diagnosis using PCR detects Leishmania DNA in the tissue samples [21].…”

Improved Treatment Outcome Following the Use of a Wound Dressings in Cutaneous Leishmaniasis Lesions

“…Leishmaniasis is a neglected tropical disease caused by Leishmania parasites, with a major public health burden affecting 90 countries with an estimated one million new cases occurring each year [1]. In Brazil, Leishmania braziliensis is the main etiological agent of Cutaneous Leishmaniasis (CL), and between 2001 and 2020, more than 400,000 cases have been reported [2]. CL is the most common clinical form observed in individuals infected by L. braziliensis, but 3% of CL patients develop mucosal leishmaniasis concomitantly or years after the primary skin ulcer [3].…”