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. 2017 Oct 1;111(10):440-447.
doi: 10.1093/trstmh/trx080.

Changing epidemiology of visceral leishmaniasis in northeastern Brazil: a 25-year follow-up of an urban outbreak

Ádila L M Lima  1   2 , Iraci D de Lima  1 , José F V Coutinho  1   2   3 , Úrsula P S T de Sousa  2 , Marcos A G Rodrigues  2 , Mary E Wilson  4 , Richard D Pearson  5 , José W Queiroz  3 , Selma M B Jerônimo  1   3   6   7
Affiliations

Changing epidemiology of visceral leishmaniasis in northeastern Brazil: a 25-year follow-up of an urban outbreak

Ádila L M Lima et al. Trans R Soc Trop Med Hyg. .

Abstract

Background: Visceral leishmaniasis (VL) continues to be a deadly parasitic disease in Brazil but the epidemiology has changed. The objective of this study was to assess the evolution of urban VL in the city of Natal, Brazil, over the past 25 y.

Methods: A retrospective study of human VL was performed, considering reported cases over the past 25 y in Natal. Analyses considered the spatial distribution of VL cases, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) co-infection, Leishmania infantum infection in dogs, density of the insect vector (Lutzomyia longipalpis) and socio-economic factors.

Results: Paralleling migration of the population, VL cases changed from mostly rural to predominantly urban regions. The incidence of human VL was highest during the initial years (1990-1994) of our study. Human VL was positively associated with a high density of L. longipalpis, a high prevalence of canine L. infantum infection and HIV/AIDS co-infection. The average age at diagnosis increased over prior years and males were more frequently affected. The overall fatality rate was 6%. Socio-economic variables indicative of poverty were associated with a greater incidence of VL and clusters of VL.

Conclusion: VL has become endemic in Natal. The disease is associated with poverty and male gender. Surprisingly, there has been an increase in the age at diagnosis.

Keywords: Brazil; Leishmania infantum; Spatial distribution; Urbanization; Visceral leishmaniasis.

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Figures

Figure 1.
Figure 1.
Incidence of VL, fatality rate and VL/HIV co-infection per 100 000 inhabitants in Natal, Brazil between 1990 and 2014.
Figure 2.
Figure 2.
Incidence of VL per 100 000 in Natal, Brazil between 1990 and 2014, plotted according to (A) sex and (B) age group.
Figure 3.
Figure 3.
Spatial distribution of human VL in Natal, Brazil. (A) Human VL cases according to the year of occurrence. (B) Empirical Bayesian estimator on the map of human VL cases per 100 000 inhabitants by neighbourhood.
Figure 4.
Figure 4.
Maps and Moran diagram incidence of VL per 100 000 inhabitants of Natal, Brazil in 4-y periods: (A, B) 2007–2010 and (C, D) 2011–2014.
Figure 5.
Figure 5.
Log-log diagram of the correlation of the incidence of human VL and the weighted proportion of infected dogs, Natal, Brazil, 2007–2014.
Figure 6.
Figure 6.
Human visceral leishmaniasis and vector infestation. (A) Correlation between the incidence of VL and entomological indicators of vector infestation. (B) Relative abundance of L. longipalpis in Natal.
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