An Emerging Peri-Urban Pattern of Infection with Leishmania chagasi, the Protozoan Causing Visceral Leishmaniasis in Northeast Brazil

• Published in: Scandinavian journal of infectious diseases Vol. 36; no. 6-7; pp. 443 - 449
• Main Authors: Jeronimo, Selma M. B., Duggal, Priya, Braz, Regina F. S., Cheng, Chun, Monteiro, Gloria R.G, Nascimento, Eliana T., Martins, Daniella R. A., Karplus, Theresa M., Ximenes, Maria F. F. M., Oliveira, Carlos C. G., Pinheiro, Vanessa G., Pereira, Wogelsanger, Peralta, Jose M., Sousa, Jacira M. A., Medeiros, Iara M., Pearson, Richard D., Burns, Trudy L., Pugh, Elizabeth W., Wilson, Mary E.
• Format: Journal Article
• Language: English
• Published: Basingstoke Informa UK Ltd 01.07.2004; Taylor & Francis
• Subjects: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Animals; Antibodies, Protozoan - blood; Biological and medical sciences; Brazil - epidemiology; Child; Child, Preschool; Communicable Diseases, Emerging - epidemiology; Communicable Diseases, Emerging - parasitology; Communicable Diseases, Emerging - physiopathology; Female; Human protozoal diseases; Humans; Hypersensitivity, Delayed; Infant; Infant, Newborn; Infectious diseases; Leishmania - immunology; Leishmania chagasi; Leishmaniasis, Visceral - epidemiology; Leishmaniasis, Visceral - parasitology; Leishmaniasis, Visceral - physiopathology; Leshmaniasis; Male; Medical sciences; Middle Aged; Parasitic diseases; Protozoal diseases; Sex Distribution; Urban Population; South America; Brazil; America; Infection; Kinetoplastida; Protozoa; Protozoal disease; Leishmania chagasi; Urban environment; Microbiology; Kala azar; Leishmaniasis; Parasitosis
• ISSN: 0036-5548; 1651-1980
• DOI: 10.1080/00365540410020451

Peri-urban visceral leishmaniasis (VL) caused by Leishmania chagasi is emerging in a new epidemiologic pattern in Brazilian cities. We studied peri-urban VL in endemic neighborhoods surrounding Natal, Brazil, identified through hospitalized individuals with VL. Clinical and environmental information obtained for 1106 members of 216 families living in endemic neighborhoods enabled us to identify 4 groups: VL: individuals with current or prior symptomatic visceral leishmaniasis (n=135); DTH+: individuals with positive delayed-type hypersensitivity response with no history of VL (n=390); Ab+: individuals with negative DTH response and seropositive (n=21); DTH−: individuals with negative DTH and seronegative (n=560). The mean±SD age of VL was 9.3±12.3 y. The gender distribution was nearly equal below age 5, but skewed toward males at higher ages. Acutely infected VL subjects had significantly lower hematocrits, neutrophils, and eosinophils than other categories. AB+ subjects also had lower eosinophil counts than others, a possible immune marker of early infection. VL was not associated with ownership of dogs or other animals, raising the question whether the reservoir differs in peri-urban settings. This new pattern of L. chagasi infection enables us to identify epidemiological and host factors underlying this emerging infectious disease.