American cutaneous leishmaniasis on the northern coast of São Paulo state, Brazil, 1993 to 2005.

Introdução. O Litoral Norte Paulista, até a década de 1980, era hipoendêmico para transmissão de leishmaniose tegumentar americana (LTA). A partir da década de 1990, esta parasitose adquiriu caráter epidêmico em todos os municípios: Caraguatatuba, Ilhabela, São Sebastião e Ubatuba. Objetivo. Realizar análise descritiva da ocorrência dos casos de LTA autóctone no Litoral Norte Paulista, entre 1993 e 2005 e registrar as espécies de flebotomíneos na área de transmissão. Métodos. Foram analisados dados secundários obtidos das fichas de casos de LTA autóctones, notificados ao serviço de vigilância epidemiológica da Secretaria Estadual de Saúde, segundo distribuição espacial, temporal, atributos pessoais e dados das fichas de captura entomológica da Superintendência de Controle de Endemias. Resultados. A LTA apresentou distribuição espacial heterogênea, com casos isolados e agrupados. Houve sincronismo na manifestação do agravo, com ciclicidade, em intervalo de seis a oito anos. Todas as faixas etárias e sexo foram acometidos, sem evidência de risco com ocupação específica. A fauna flebotomínea foi composta por dezesseis espécies, com predomínio de Ny. intermedia (>80,4%), no peri e intra domicílio. Conclusões. A LTA apresenta estreita relação com a floresta e a transmissão ocorre no peri e no intradomicílio, tanto no ambiente periurbano como no interior da mata. Neste caso, a transmissão estaria mais relacionada com os focos enzoóticos.Introduction. The northern coast of the State of São Paulo was, up to the decade of the 1980´s, hypoendemic for the transmission of American cutaneous leishmaniasis (ACL). However, as from the decade of the 1990´s this disease acquired epidemic characteristic in all the municipalities: Caraguatatuba, Ilhabela, São Sebastião and Ubatuba. Objective. To undertake a descriptive study of the occurrences of the autochthonous cases of ACL in the four municipalities of the northern coast of the state of São Paulo, between 1993 and 2005, and to record the phlebotomine species in the area of transmission. Methods. Secondary data of spatial and temporal distribution and personal characteristics were analyzed from the records of autochthonous ACL cases notified to the epidemiological surveillance service of the State Health Secretariat. Information on phlebotomines were obtained from data of entomological captures undertaken by the Superintendência de Controle de Endemias. Results. The ACL presented heterogeneous spatial distribution with both isolated and clustered cases. There was synchronicity in the occurrence of the disease in all the municipalities, with cyclicality at intervals of from six to eight years. All age groups and both sexes were affected, without any particular profession. The phebotomine fauna consisted of sixteen species, with Ny. intermedia predominating (>80.4%) both in the peri and intra domicíle. Conclusions. ACL presented a close relation with the forest and its transmission occurs in the peri and intra-domicile, in the periurban environment and within the forest. In this latter case the transmission is more closely related to the enzootic foci

Schistosomiasis Mansoni in Bananal (State of São Paulo, Brazil). I. efficiency of diagnostic and treatment procedures

Bananal is an important focus of Schistosoma mansoni in the State of São Paulo. Accordingly, programmed active search for human cases, annual coproscopic surveys and treatment of infected cases were started in 1998, aiming at producing a sharp prevalence rate drop by the year 2000. S. mansoni eggs were searched for in two Kato-Katz slides per patient. Cases were followed up according to the routine of the local Family Health Program. In 1998, 130 samples out of 3,860 showed S. mansoni eggs; in 1999, 105 out of 3,550, and in 2000, 64 out of 3,528. Prevalence rates were 3.4%, 2.9%, and 1.8%, and average egg-counts 59, 64, and 79 eggs per gram of feces respectively. Prevalence rates decreased steadily after treatment, but persistently positive cases showed no significant decrease in parasite burdens. Egg count variation depended on sex and age bracket. Persistent residual cases admittedly preclude the eradication of this infection by only searching for and treating carriers. In addition, resistance to therapy and low sensitivity of fecal examinations, can not be ignored. Moderate to heavy worm burdens, frequently associated with hepatomegaly elsewhere, produced no serious cases in Bananal