American cutaneuos leishmaniasis in Ilhéus - BA: Characterization of human cases and risk factors associated / Leishmaniose tegumentar americana no município de Ilhéus- BA: Caracterização de casos humanos e fatores de risco associados




In Brazil, the American Cutaneous Leishmaniasis (ACL) is highly endemic, and has been a serious public health problem. The country currently confronts the spreading and urbanization, in big and middle-sized cities, of the ACL, which is primally zoonotic and related to forest environments. The present work valued the epidemiologic aspects of ACL in Ilhéus, and the possible risk factors associated to its appearance in the urban area of this city, with previous case reports notified as autochthones of this area. A revision of all investigation cards of ACL cases in Ilhéus, registered by the SVE/SMS/Ilhéus from January 2000 to December 2006 was performed, analyzing the follows information about the referred cases: age, sex, clinical forms, diagnostic date and illness evolution. A study on phlebotomine sand fly occurrence in the urban area of Ilhéus was carried out from March to August 2006, using CDC light traps. The canine infection was investigated through indirect fluorescent antibody test (IFAT) and BIOGENE enzyme- linked immunosorbent antibody test (ELISA) for calazar canine. Additionally, with the purpose of identifying risk factors for cutaneous leishmaniasis transmission in the urban area of Ilhéus, a matched case-control study was carried out involving the human population. The information about the human cases, sand fly fauna and dogs was analyzed with frequency tables. The human cases were also analyzed, with correlation studies between the probable infection date and climate data. The possible risk factors were determinated with X MacNemar calculation, Odds Ration (OR) and 95% Confidence Intervals (CI). Analysis of investigation records showed that ACL affects mainly adult subjects, with cutaneous lesions as the principal clinical form. The seasonality analysis showed the probable infection period to be quarter September-November (Spring). No statistically significant correlation was observed (p<0.05) between case number and climate data (rain fall, humidity and temperature). On the other hands, periods with high rainfall and humidity showed a smaller number of cases. Lu. Cortelezzii was the one species collected in urban area. Three seropositive dogs were identified by the immunofluorescence assay. The case-control study showed that the age group 13 to 44 years (p= 0.0061; OR=0.13; 95% CI= 0.076-0.22), living close to woodlands, was associated with decreased risk; the habit of going to the rural area of Ilhéus showed to be a risk factor to ACL (p= 0.003; OR= 5.5; 95%; CI= 1.75- 17.29). With these results, we can conclude that ACL in Ilhéus is not urban, since no typical vector species were found, and the human cases were associated to the habit of going to the rural area. Additionally, the case profiles, adult males, showed that the subjects exposed demonstrate non- compatible characteristics with a wider-ranging exposure, as should be expected to happen if the illness transmission cycle took place in Ilhéus urban area. We also note the importance of maintaining a strict registry of human cases, with maximum rigidity, to guarantee specific diagnostic for ACL, making possible epidemiological analysis more rustworthy.


leishmaniose tegumentar americana urban areas Área urbana risk factors epidemiologia animal american cutaneuos leishmaniasis fatores de risco

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