Visceral leishmaniasis in a Brazilian endemic area: an overview of occurrence, HIV coinfection and lethality

The Brazilian municipality of Rondonópolis, Mato Grosso State, represents an important visceral leishmaniasis (VL) endemic area. This study described epidemiological and clinical aspects of the occurrence, VL/HIV coinfection and lethality related to VL in Rondonópolis. Data from autochthonous cases reported between 2011 and 2016 were obtained from official information systems. During this period, 81 autochthonous cases were reported, with decreasing incidence through 2016. Contrastingly, the lethality rate was 8.6% overall, but varied widely, reaching a peak (20%) in 2016. Almost 10% of patients had VL/HIVcoinfection. The occurrence of VL prevailed among men (56.8%), brown-skinned (49.4%), urban residents (92.6%), aged 0-4 years (33.3%). Housewives or retired (29.6%) were the most affected occupational groups. Lower age was the main difference among the total VL cases and those who were coinfected or died. Clinically, fever, weakness and splenomegaly were more frequent among all VL cases and VL/HIV coinfected individuals. Bacterial infections (p=0.001) and bleeding (

Basic knowledge about visceral leishmaniasis before and after educational intervention among primary health care professionals in Midwestern Brazil

Health education and training of primary health care (PHC) professionals are highly recommended to reduce the occurrence and lethality of visceral leishmaniasis (VL). This study assessed the impact of an educational intervention on the basic knowledge about visceral leishmaniasis (VL) among PHC professionals from the Brazilian municipality of Rondonopolis, an important endemic area for VL. Responses provided by physicians, nurses, nursing technicians and community health agents from 12 PHC facilities were recorded through the application of self-completed and semi-structured questionnaires before (n=92) and after (n=64) an in-person health training course covering various aspects of VL. Closed- and open-ended responses were compared by the chi-square test and analyses of word clouds, respectively. The proportion of professionals aware of the correct etiological agent (p<0.001) and transmission route (p<0.001) of VL increased post-intervention. In addition, they increased their ability to recognize fever (p<0.001), weakness (p<0.001), weight loss (p<0.001), pallor (p<0.001) and abdominal distention (p=0.013) as clinical manifestations of human VL, and weakness (p<0.001), alopecia (p<0.001) and weight loss (p=0.019) as signs of canine VL. Analyses of word clouds suggested that the participants became more aware of the role of dogs in VL transmission and the role of environmental management in the prevention of VL. In conclusion, the intervention positively impacted the baseline knowledge concerning VL among the professionals. This can support the planning of educational activities for the PHC team regarding early case detection, prevention and control of VL in endemic areas

Composto orgânico e biofertilizante supermagro na formação de cafeeiros

To evaluate fertilization with organic compost associated to supermagro biofertilizer leaf application on growth and development of coffee (Coffea arabica L. cultivar Topázio MG-1190), a greenhouse study carried out at the Federal University of Lavras, from March 15 to October 4 of 2003. A randomized complete block design in factorial arrangement (5 x 5 + 3 adictional factors) was used with four replications, using one plant per plot. First factor used was organic compound rate/pot (110, 330, 550, 770 and 990 g). The second factor was supermagro applied monthly to leaf at 0%, 3%, 6%, 12% and 24% concentration. Additional treatments were organic fertilizer, organic + mineral and mineral fertilizer soil application. Characteristics evaluated were plant stalk node number, leaf area (cm2), leaf number, leaf dry weight, aerial part plant dry weight, total plant dry weight. Significant interaction occurred with numbers of lateral branch, leaf, leaf dry weight, aerial part dry matter and total plant dry weight. The best plant development was from 702 to 770g rating of the compost/pot plus supermagro application from 14.6% to 16.2% rating.Com o objetivo de avaliar a adubação constituída de composto orgânico associado à aplicação foliar do biofertilizante "supermagro" no desenvolvimento e crescimento de cafeeiros da cultivar Topázio MG-1190 (Coffea arabica L.), foi instalado um experimento em casa-de-vegetação na Universidade Federal de Lavras, no período de 15 de março a 4 de outubro de 2003. O delineamento experimental foi em blocos casualizados, com quatro repetições, e os tratamentos dispostos em esquema fatorial 5 x 5 + 3, sendo a parcela constituída por um vaso com uma planta. Os tratamentos constaram de composto orgânico nas doses de 110, 330, 550, 770 e 990 g vaso-1, associados ao biofertilizante pulverizado a 0%, 3%, 6%, 12% e 24%. Os tratamentos adicionais consistiram de adubação orgânica, orgânica mais mineral e apenas mineral, fornecidos ao substrato. Avaliaram-se o número de nós do ramo ortotrópico, número de ramos plagiotrópicos, número de nós dos ramos plagiotrópicos, área foliar, número de folhas e massa seca das folhas, da parte aérea e total. O melhor desenvolvimento do cafeeiro foi promovido pelo composto entre 702 a 770 g vaso-1, associado ao biofertilizante nas concentrações de 14,6% a 16,2%

Hyperendemicity, heterogeneity and spatial overlap of leprosy and cutaneous leishmaniasis in the southern Amazon region of Brazil

Neglected tropical diseases characterized by skin lesions are highly endemic in the state of Mato Grosso, Brazil. We analyzed the spatial distribution of leprosy and Cutaneous Leishmaniasis (CL) and identified the degree of overlap in their distribution. All new cases of leprosy and CL reported between 2008 and 2017 through the national reporting system were included in the study. Scan statistics together with univariate Global and Local Moran's I were employed to identify clusters and spatial autocorrelation for each disease, with the spatial correlation between leprosy and CL measured by bivariate Global and Local Moran's I. Finally, we evaluated the demographic characteristics of the patients. The number of leprosy (N = 28,204) and CL (N = 24,771) cases in Mato Grosso and the highly smoothed detection coefficients indicated hyperendemicity and spatial distribution heterogeneity. Scan statistics demonstrated overlap of high-risk clusters for leprosy (RR = 2.0; P <0.001) and CL (RR = 4.0; P <0.001) in the North and Northeast mesoregions. Global Moran's I revealed a spatial autocorrelation for leprosy (0.228; P = 0.001) and CL (0.311; P = 0.001) and a correlation between them (0.164; P = 0.001). Both diseases were found to be concentrated in urban areas among men aged 31-60 years, of brown-skinned ethnicity and with a low educational level. Our findings indicate a need for developing integrated and spatially as well as socio-demographically targeted public health policies

Infecção por Giardia duodenalis entre crianças em idade escolar no sul do Mato Grosso

Background and Objectives: Giardiasis represents a health public problem that may damage the physical and mental development, particularly of children. Therefore, the importance of performing the parasitological evaluation of this population and its determinants is highlighted. Thus, this study aimed to evaluate the prevalence and factors associated with Giardia duodenalis infection in children enrolled between the 1st and 3rd grades of primary education in two educational units in the south of Mato Grosso. Methods: After the consent of parents and children, the socioepidemiological questionnaire and the universal collector containing a preservative solution for the single fecal sample collection were handed out, which were analyzed by the spontaneous sedimentation technique. Results: Sixty participants with mean age of 7.05 years and male predominance (53.3%) were included. The overall prevalence of enteroparasites was 36.7%, of which 54.5% was infected by G. duodenalis. A significant association was found between the occurrence of this infection and the fact that the child belonged to the family that declared not having financial income (p = 0.04). Conclusion: G. duodenalis infection in school-age children persists and is associated with the absence of family financial income. These findings highlight the need to improve this population’s living conditions, health education practices, and drug treatment access.Justificación y Objetivos: La giardiasis representa un problema de salud pública con posibilidad de ocasionar agravios en el desarrollo físico y mental, particularmente en niños. Así se pone en relieve la importancia en efectuar la evaluación parasitológica de ese público y sus determinantes. De este modo, esta investigación tuvo como objetivo evaluar la prevalencia y los factores asociados a la infección por Giardia duodenalis en niños matriculados entre el 1º y el 3º año de la enseñanza básica en dos unidades de enseñanza en un distrito en el sur de Mato Grosso (Brasil). Métodos: Después del consentimiento de los padres y de los niños, se les entregó el cuestionario socioepidemiológico y el colector universal conteniendo solución conservante para extraer una única muestra fecal, que fue analizada por el técnica de sedimentación espontánea. Resultados: Se incluyeron 60 participantes con media de edad de 7,05 años y predominancia del sexo masculino (53,3%). La prevalencia global de enteroparasitas fue del 36,7%, de los cuales el 54,5% estaban infectados por G. duodenalis. Se encontró una asociación significativa entre la ocurrencia de esta infección y el hecho del niño pertenecer a la familia que declaró no tener ingresos financieros (p = 0,04). Conclusión: La infección por G. duodenalis en niños en edad escolar persiste y estuvo esencialmente asociada a la ausencia de renta financiera familiar. Estos resultados evidencian la necesidad de mejorar las condiciones de vida, de contar con acciones de educación en salud y tratamiento medicamentoso para esa población.Justificativa e Objetivos: A giardíase representa um problema de saúde pública com possibilidade de ocasionar agravos no desenvolvimento físico e mental, particularmente em crianças. Assim, destaca-se a relevância em efetuar a avaliação parasitológica desse público e seus determinantes. Desse modo, essa pesquisa teve como objetivo avaliar a prevalência e fatores associados à infecção por Giardia duodenalis em crianças matriculadas entre o 1º e 3º ano do ensino fundamental em duas unidades de ensino de um município no sul de Mato Grosso. Métodos: Após o consentimento dos pais e crianças, foram entregues o questionário socioepidemiológico e o coletor universal, contendo solução conservante para a coleta única de amostra fecal, que foi analisada pela técnica de sedimentação espontânea. Resultados: Foram incluídos 60 participantes com média de idade de 7,05 anos e predominância do sexo masculino (53,3%). A prevalência global de enteroparasitas foi de 36,7%, dos quais 54,5% estavam infectados por G. duodenalis. Foi encontrada associação significativa entre a ocorrência dessa infecção e o fato de a criança pertencer à família que declarou não possuir renda financeira (p=0,04). Conclusão: A infecção por G. duodenalis em crianças em idade escolar persiste e está associada à ausência de renda financeira familiar. Tais achados evidenciam a necessidade de melhoria das condições de vida, ações de educação em saúde e tratamento medicamentoso dessa população

Are the clinical features of leprosy and American tegumentary leishmaniasis worse in patients with both diseases?

This cross-sectional population-based study compared clinical features of leprosy and American tegumentary leishmaniasis (ATL) in patients diagnosed with both diseases (n=414) and in those diagnosed with only leprosy (n=27,790) or only ATL (n=24,357) in Mato Grosso State, which is a hyperendemic area for both diseases in Midwest Brazil. All new cases of leprosy and ATL reported in the area from 2008 to 2017 were included. Patients diagnosed with both diseases were identified by a probabilistic linkage procedure applied to leprosy and ATL databases of the national reporting system. The distribution of the frequency of clinical features between groups was compared by the chi-square test, followed by a multivariate logistic regression. Patients diagnosed with both leprosy and ATL presented higher odds of having nerve damage (OR: 1.34; 95% CI: 1.09–1.66) and leprosy reactions (OR: 1.35; 95% CI: 1.04–1.76) compared to patients diagnosed only with leprosy. Mucocutaneous leishmaniasis (OR: 2.29; 95% CI: 1.74–3.00) was more frequent among patients with both diagnoses when compared to patients who only had ATL. In conclusion, patients diagnosed with both leprosy and ATL present more severe clinical features of such diseases. Our data can be useful for designing health policies aimed at timely and integrated management of leprosy and ATL in co-endemic areas

Integrated control of neglected tropical diseases in Brazil: document review of a national campaign in light of WHO recommendations

Objective. To describe the results of a national campaign aimed at the integrated control of neglected tropical diseases in Brazil in light of the World Health Organization (WHO) official documentation related to the integration of strategies for the prevention, control, and elimination or eradication of neglected tropical diseases. Methods. A document review that included official WHO documents published between 2007 and 2020 and campaign results extracted from the official technical report produced by the Brazilian Ministry of Health. Results. The integrated control of neglected tropical diseases was gradually incorporated in the WHO documentation over time. Preventive chemotherapy through mass drug administration, intensified case management, and integrated vector management were extensively recommended as strategies for integrated control. The Brazilian campaign was carried out in four iterations between 2013 and 2017. Children aged 5 to 14 years enrolled in municipal public schools nationwide were targeted. In summary, a total of 1 074 and 73 522 new cases of leprosy and trachoma, respectively, were detected. Nearly 18 million doses of preventive chemotherapy for soil-transmitted helminthiasis were administered. More than 700 cases of schistosomiasis were diagnosed and treated. Conclusions. The integrated strategies implemented in Brazil throughout the campaign generated results aligned with the WHO recommendations for the control of neglected tropical diseases, especially those regarding mass drug administration, active case detection, and intensified case management. Therefore, the continuity of the campaign with adequate evaluation tools must be encouraged as a constant public health policy in the Brazilian government agenda