Spatial epidemiologic trends of cutaneous leishmaniasis in Rio de Janeiro State, Southeast Brazil, 2001-2020

Abstract

Cutaneous leishmaniasis (CL) has substantial epidemiological and clinical differences depending on host characteristics, Leishmania species and geographic areas. CL in Rio de Janeiro State was evaluated. Mandatory notifications of confirmed cases from 2001-2020 were analyzed considering sociodemographic and clinical variables, temporal trends, the Cutaneous Leishmaniasis Composite Indicator (CLCI) for each affected city in relation to the total of affected cities in the state, and each triennium from the beginning to the end of the time series (2001-2003, 2002-2004 until 2018-2020, sequentially). The number of cases decreased over time. High average incidence rates occurred in contiguous cities from the Southernmost to the Northernmost regions of Rio de Janeiro State, following areas where the Atlantic Forest persists. The CLCI showed temporal variations in the intensity of the risk of CL in the affected cities. Rio de Janeiro city was the only one with intense or very intense risk of CL throughout the studied period. The disease predominantly affected people residing in urban areas and in the middle age groups (20-59 years). CL also predominated in males, regardless of age. The mucosal clinical form was also significantly associated with men, with an 80% chance of them being more affected than women. Regarding diagnostic tests, the Leishmanin Skin Test showed higher positivity than the direct parasitological exam and the histopathological exam. No differences regarding cure between sexes were found. This study may guide control actions in areas where they are most needed in Rio de Janeiro State.

Figure 1. Cities of Rio de Janeiro State numbered from the left to the right, according to Table 1.

Figure 2. Average of the annual incidence rates per 100,000 inhabitants of cutaneous leishmaniasis in the cities of Rio de Janeiro State, 2001–2020.

Figure 3. Cutaneous Leishmaniasis Composite Indicator (CLCI) for triennia (indicated at the left of the top of each map) from 2001 to 2020 in the cities of Rio de Janeiro State. Colors indicate different risk levels in the affected cities for each triennium. White means unaffected cities in the respective triennia.

Figure 4. Gender according to age range of the confirmed cases of cutaneous leishmaniasis in the Information System for Notifiable Diseases (SINAN), 2001–2020. Cases of ATL in Rio de Janeiro State, data provided by the Health Department of Rio de Janeiro State; y = years.